See the Spoken Language Disorders Evidence Map for summaries of the available research on this topic.
The scope of this Practice Portal page is limited to spoken language disorders (listening and speaking) in preschool and school-age children (3–21 years old) who use verbal modes of communication. It can be understood best in relation to the companion Practice Portal on Written Language Disorders.
A spoken language disorder (SLD), also known as an oral language disorder, represents a significant impairment in the acquisition and use of language across modalities due to deficits in comprehension and/or production across any of the five language domains (i.e., phonology, morphology, syntax, semantics, pragmatics). Language disorders may persist across the lifespan, and symptoms may change over time.
When SLD is a primary disability—not accompanied by an intellectual disability, global developmental delay, hearing or other sensory impairment, motor dysfunction, or other mental disorder or medical condition—it is considered a specific language impairment (SLI).
An SLD may also occur in the presence of other conditions, such as
Each of these affected populations may exhibit unique characteristics and behaviors, but all share common characteristics of language problems (Rice & Warren, 2004).
The relationship between spoken and written language is well established (e.g., Hulme & Snowling, 2013). Children with spoken language problems frequently have difficulty learning to read and write. Additionally, children with reading and writing problems often have difficulty with spoken language, particularly as it relates to higher-order spoken language skills, such as expository discourse (Scott & Windsor, 2000). See language in brief and the Practice Portal page on Written Language Disorders.
Some children with language disorders may have social communication difficulty, because language processing, along with social interaction, social cognition, and pragmatics, comprise social communication. See social communication disorder.
Learning disabilities (LD) and language disorders are also closely linked, although the exact relationship between the two is not fully agreed upon. Language disorders are typically diagnosed before learning disabilities and frequently impact a child's academic performance. At that point, the child is often identified as having a learning disability, even though a language disorder often underpins the academic struggles, especially those associated with learning to read and write.
"Incidence" of spoken language disorders refers to the number of new cases identified in a specified time period. No reliable data on the incidence of spoken language disorders in children were located.
"Prevalence" of spoken language disorders refers to the number of people who are living with a spoken language disorder in a given time period. The variability in prevalence estimates below is attributed to differences in how language impairment is defined, the nature of the population studied, and variations in the methodological procedures used (Law, Boyle, Harris, Harkness, & Nye, 2000; Pinborough-Zimmerman et al., 2007).
In children 7 years old and younger in the United Kingdom the median prevalence of receptive language delay/disorder ranged from 2.63%-3.59%, expressive language delay/disorder ranged from 2.81%-16%, and combined receptive and expressive language delay/disorder ranged from 2.02%-3.01% (Law et al., 2000).
The prevalence of language impairment in Canadian kindergarten children was 8.04% overall, 8.37% for girls, and 8.17% for boys (Beitchman, Nair, Clegg, & Patel, 1986).
Among Canadian children 7 to 14 years old with psychiatric disorders, 40% were found to have a language impairment (Cohen, Barwick, Horodezky, Vallance, & Im, 1998). In the Northeastern region of the United States, about 40%-50% of children and adolescent speakers of Spanish and English who were referred for psychiatric services were found to have a language delay or impairment following testing in both languages (Toppelberg, Medrano, Morgens, & Nieto-Castañon, 2002).
The prevalence of SLI for kindergartners in the upper Midwestern region of the United States was 7.4% overall, 6% for girls, and 8% for boys (Tomblin et al., 1997). Prevalence of SLI in racial/ethnic groups was highest in Native Americans, with African Americans being the next highest, followed by Hispanics, and then Whites. No students of Asian descent presented with SLI (Tomblin et al., 1997); however, other research does indicate that SLI is present in children of Asian descent (Gray, 2003; Lahey & Edwards, 1999).
Signs and symptoms of spoken language disorders (SLD) vary across individuals, depending on the language domain(s) affected, severity and level of disruption to communication, age of the individual, and stage of linguistic development. Furthermore, signs and symptoms of SLD may become apparent through evaluation of metacognitive/metalinguistic ability; when later-developing language domains, such as reading and writing (i.e., literacy), are developing; when children encounter the unique disciplinary language associated with certain academic subjects (e.g., humanities classes vs. science classes); or through observation of emotional/behavioral difficulty.
Below are common signs and symptoms among monolingual English-speaking children with spoken language difficulties. These signs and symptoms are grouped by domain and in descending order from basic to higher-order skills. Although these domains are listed separately, it is important to note that skills are not discrete, and there is a synergistic relationship across domains. Skills within form (phonology, syntax, and morphology), function (semantics), and use (pragmatics) interact to form a dynamic integrative whole (Berko Gleason, 2005).
Metalinguistic and metacognitive skills (awareness of language and of one's own thinking and behavior), while not listed below, are critical for the development of advanced language skills. Metalinguistic awareness impacts both spoken language and written language abilities to varying degrees. Phonological awareness is one type of metalinguistic skill, which has been shown to be highly correlated with later reading and writing skills (Al Otaiba, Puranik, Zilkowski, & Curran, 2009).
Phonological deficits include
Morphology and syntax deficits include
Deficits in semantics include
Deficits in pragmatics include
See social communication disorder for more information about pragmatics.
Children with language disorders may experience social/emotional problems and/or exhibit behaviors secondary to language impairment. These difficulties may impact self-perception and awareness, academic performance, peer relationships, and social interactions. Furthermore, the impact of language disorders can result in misperceptions and misattributions of the child's behavior (Cohen, Davine, Horodesky, Lipsett, & Isaacson, 1993).
Children with spoken language disorders may
A spoken language disorder may be a primary disability (SLI) or may exist in conjunction with other disorders and disabilities (e.g., ASD, ADHD, etc.). When a language disorders occurs in conjunction with other disorders and disabilities, the causes are typically defined in terms of these specific conditions. Links to disorder- and condition-specific Practice Portal pages will be included as those pages are developed.
In the case of SLI, the causes are difficult to determine; however, a number of factors have been proposed, including cognitive processing deficits (e.g., Miller, Kail, Leonard, & Tomblin, 2001; Ellis Weismer & Evans, 2002; Leonard et al., 2007), biological differences (e.g., Ellis Weismer, Plante, Jones, & Tomblin, 2005; Galaburda, 1989; Hugdahl et al., 2004), and genetic variations (e.g., Rice, 2012, 2013). These factors may not be independent of one another. For example, a genetic variation might lead to a difference in brain morphology or function that leads to a difference in cognitive processing (Reed, 2012).
Speech-language pathologists (SLPs) play a critical role in the screening, assessment, diagnosis, and treatment of preschool and school-age children with spoken language disorders (SLD). The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), prevention and advocacy, and education, administration, and research. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016).
Appropriate roles for SLPs include:
As indicated in the Code of Ethics, SLPs who serve this population should be specifically educated and appropriately trained to do so.
See the Assessment section of the Spoken Language Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
Screening of spoken language skills is conducted if a language disorder is suspected. Screening does not result in a diagnosis, but rather indicates the potential need for further assessment.
Screening typically includes
Screening may result in recommendations for
Individuals suspected of having a language impairment based on screening results are referred for a comprehensive, linguistically appropriate assessment by a speech-language pathologist and other professionals as needed. Assessment of language skills should be culturally relevant and functional and involve the collaborative efforts of families/caregivers, classroom teachers, SLPs, special educators, and other professionals as needed. See assessment and evaluation of speech-language disorders in schools.
Assessment typically includes the following, with consideration made for the age and linguistic development of the child:
A literacy assessment (reading and writing) is included in the comprehensive assessment for language disorders because of the well-established connection between spoken and written language. Components of a literacy assessment will vary, depending on the child's age and stage of language development, and can include pre-literacy, early literacy, and advanced literacy skills. See the assessment section of the Written Language Disorders Practice Portal page.
A speech sound assessment may also be included, given that speech sound errors can be a result of a phonological disorder, an articulation disorder, or a combined phonological/articulation disorder. See speech sound disorders: articulation and phonology.
It may also be appropriate to assess the potential benefit of implementing augmentative and alternative communication (AAC) strategies, pending the nature and severity of deficits and the child's developmental history. See ASHA's Practice Portal page on Augmentative and Alternative Communication.
The following procedures and data sources may be utilized in the comprehensive assessment for spoken language disorders (SLD):
Standardized Assessment—an empirically developed evaluation tool with established reliability and validity. Standardized language assessments can be used to identify the broad characteristics of language functioning, but should not be used solely to make the diagnosis of SLD. Given the nuanced and subtle nature of strengths and deficits that many children demonstrate, standardized assessments alone are not sufficient to capture the variety of language details that constitute an individual's profile.
At this time, there are very few standardized assessments for individuals who speak a language other than English or who speak a dialect of English. It is essential to consider the language spoken and/or dialect used by the child before selecting a standardized assessment. Translation of a standardized assessment invalidates the results. Standard scores may not be reported when the assessment has been translated. See cultural responsiveness and bilingual service delivery.
Language Sampling—techniques to elicit spontaneous language in various communication contexts (e.g., free play, conversation/dialogue, narration, expository speech) and derive measures (e.g., Mean Length of Utterance [MLU], Type-Token Ratio [TTR], Developmental Sentence Scoring [DSS], clausal density, use of subordinate clauses) to complement data obtained from standardized language assessments.
Dynamic Assessment—a language assessment method in which an individual is tested, skills are addressed, and then the individual is re-tested to determine treatment outcome (i.e., test-teach and re-test). Dynamic assessment can help distinguish between a language difference and a language disorder and can be used in conjunction with standardized assessment and language sampling.
Systematic Observation/Contextual Analysis—observation in the classroom and in various other contexts to describe communication and identify specific problem areas. Descriptions of language functioning across a variety of settings and tasks are used to identify contextual variables that play a part in the student's communication abilities and to complement findings from other assessment procedures.
Ethnographic Interviewing—a technique for obtaining information from the student and the student's family/caregiver and teachers that avoids the use of leading questions and "why" questions and uses open-ended questions, restatement, and summarizing for clarification. The ethnographic technique is used to obtain information from the perspective of the student and other individuals in the student's environment and to validate other assessment findings.
Parent/Teacher/Child Report Measures—checklists and/or questionnaires completed by the family member(s)/caregiver, teacher, and/or student. These report measures enable the clinician to obtain a comprehensive profile of language skills by comparing findings from multiple sources (e.g., family vs. teacher vs. self-report). For individuals who speak a language other than English in the home, the clinician needs to gather detailed information about use of the primary language and English.
Curriculum-Based Assessment—a technique that uses probes, protocols, and direct assessment to determine the language demands of the curriculum and assess the student's ability to handle those demands.
Assessment may result in
Not all children with early language delay (late talkers) have significant language problems when they reach school age (Paul, 1989, 1996; Rescorla, 2002), making it difficult to diagnose a language disorder before the age of about 3 years (Leonard, 1998). However, given the risk that language disorders pose for students, children need to be assessed for language difficulties early and monitored periodically at critical educational stages (e.g., in preschool; then in kindergarten, second grade, and third grade; early middle school; and high school) to track language development and identify any problems that might arise.
It is especially important to monitor and assess young children on a regular basis, if multiple risk factors are evident (e.g., family history of language problems, chronic otitis media, cognitive delay, social communication difficulties, and environmental risks; Paradise et al., 2000; Paul, 1996, 2007).
Children with SLD demonstrate differing patterns of strengths and weaknesses across listening, speaking, reading, and writing; those patterns of strengths and weaknesses may vary over time. In some cases, the language skills of children with SLD become seemingly similar to those of children without SLD.
However, as the complexity of the language demands increase, difficulty may resurface in one or more language domains. This phenomenon is referred to as illusory recovery (Scarborough & Dobrich, 1990). Although children may acquire new vocabulary or improve their use of grammatical forms following language intervention, they may not actually catch up to their peers. In fact, their rate of language growth may slow or level off when they reach early adolescence, resulting in language levels below those expected for their age groups (Rice, 2013).
For this reason, it is important that practitioners use valid and reliable standardized assessments with normative data, in addition to other data sources (e.g., informal measures, benchmarking, progress reports, etc.), when evaluating the language skills of children with SLD over time.
A communication difference/dialect is a variation of a symbol system—used by a group of individuals—that reflects and is determined by shared regional, social, or cultural/ethnic factors. This variation should not be considered a disorder of speech or language.
In addition, children who demonstrate typical patterns of dual language learning, are learning English as a second language, or speak a non-standard dialect of English should not be considered as having a spoken language disorder, based only on those differences (ASHA, 1993).
Clinicians face unique challenges when identifying SLD in children who speak a dialect of English, are bilingual, or are learning English as a second language. Distinguishing difference from disorder requires familiarity with the rules of the spoken dialect, awareness of typical dual language acquisition from birth, and understanding of the sequential process of second language acquisition. For children who speak a non-standard dialect of English, special consideration is given to the influence of the rules of that dialect on assessment measures, which are typically based on standard American English. Results are not valid, if the norming sample of an assessment is not representative of the child being assessed.
Some linguistic characteristics of dual language learning (simultaneous bilingualism) and second language (L2) acquisition (sequential bilingualism) may be the same as those of monolingual children with language impairment.
There is little research/information regarding bilingualism and the broader scope of spoken language disorders, as defined in this Portal page. However, a number of studies have identified potential areas of overlap between second language learners and monolingual children with SLI—one type of spoken language disorder:
Bilingualism is not a cause of language impairment. Typical processes of bilingualism, such as code-mixing, will be seen in bilingual children who have SLI (Gutiérrez-Clellen, Simon-Cereijido, & Leone, 2009). Language dominance may vary across the different domains of language—for example, dominance in L1 in receptive language and dominance in L2 expressively. This also may shift over time relative to environmental linguistic demands. See cultural responsiveness, bilingual service delivery, and phonemic inventories across languages for assistance in distinguishing difference from disorder.
Given the overlap in linguistic characteristics of children during typical bilingual language acquisition and those of monolingual children with language impairment and the reliance on standard measures that are based on rules of standard American English for diagnosis, there is a disproportionate number of linguistically diverse children (e.g., those who speak English as a second language or a dialect of English) who have been (and likely continue to be) identified with speech-language impairment in the school setting. Non-normed (criterion) measures, ethnographic interviewing, and dynamic assessment procedures are fundamental to differentiating a difference from a disorder. Children who have been identified with a difference and not a disorder are not eligible for publicly funded speech-language pathology services.
In the schools, children and adolescents with SLD should be eligible for speech-language services, due to the pervasive nature of language impairment, regardless of cognitive abilities or performance on standardized testing. As mandated by the Individuals with Disabilities Education Improvement Act (IDEA, 2004), categorically applying a priori criteria (e.g., discrepancies between cognitive abilities and communication functioning, chronological age, or diagnosis) in making decisions on eligibility for services is not consistent with the law and IDEA regulations. Also see National Joint Committee for the Communication Needs of Persons With Severe Disabilities (2002) for information related to a priori criteria.
For more information about eligibility for services in the schools, see eligibility and dismissal in schools, IDEA Part B Issue Brief: Individualized Education Programs and Eligibility for Services, and 2011 IDEA Part C Final Regulations.
The practice of cognitive referencing, or denying individuals with disabilities access to communication services and supports because their language skills are determined to be commensurate with their cognitive skills, purports that a language delay warrants intervention only when language skill development lags behind cognitive skill development.
Concerns regarding the use of cognitive referencing include
The Common Core State Standards (CCSS) are internationally benchmarked learning standards being implemented in most states across the country. The standards constitute a framework of knowledge and skills thought necessary to prepare students to enter college and the work force.
Students who have language disorders may require specialized instruction and support to access the CCSS, because language skills are addressed across subject areas and the English Language Arts standards focus on the use of language for communication and academic success. See common core state standards: a resource for SLPs for information and guidance on integrating the CCSS into intervention for students with language disorders.
See the Treatment section of the Spoken Language Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/patient perspective.
Spoken language disorders (SLD) are heterogeneous in nature, and the severity of the disorder can vary considerably. Each individual with language difficulties has a unique profile, based on their current level of language functioning, as well as functioning in areas related to language, including hearing, cognitive level, and speech production skills. In addition to having a unique profile of strengths and needs, individuals bring different backgrounds to the treatment setting. For bilingual individuals, it is important that the clinician consider the language or languages used during intervention. See bilingual service delivery.
The goal of language intervention is to stimulate overall language development and to teach language skills in an integrated fashion and in context, so as to enhance everyday communication and ensure access to academic content. Goals are frequently selected with consideration for developmental appropriateness and the potential for improving the effectiveness of communication and academic and social success.
Roth and Worthington (2015) summarize steps in the selection and programming of treatment targets and provide sample case profiles for early intervention through adolescence. They also identify a number of basic principles of effective intervention regardless of client age or disorder. These include:
Intervention strategies for various age ranges are outlined in the sections below. Older individuals with severely impaired language may be functioning at developing language levels. Rather than being based on developmental sequences, interventions for these individuals may be more functional in nature, focusing on building independence in everyday settings.
In typically developing preschool children, language is developing at a rapid pace; their vocabularies are growing, and they are beginning to master basic sentence structures. For children with language difficulties, this process may be delayed. For children in this population, areas targeted for intervention typically include:
morphology and syntax
See social communication disorder for more information about pragmatics.
See the treatment section of the Written Language Disorders Practice Portal page.
The focus of language intervention for elementary school children with language difficulties is to help the child acquire the language skills needed to learn and succeed in a classroom environment. Interventions are curriculum-based, that is, goals address language needs within the context of the curriculum where these skills are needed.
Interventions may also address literacy skills (e.g., improving decoding, reading comprehension, and narrative and expository writing), as well as metacognitive and metalinguistic skills (e.g., increasing awareness of rules and principles for use of various language forms, improving the ability to self-monitor and self-regulate) that are critical for the development of higher-level language skills. See the treatment section of the Written Language Disorders Practice Portal page.
For children who speak a language other than English in the home, it may be necessary to use the home language as a mechanism for transitioning the child to using the language of the school. Planning and implementing an effective language intervention program is often a coordinated effort involving the SLP, classroom teacher(s), and other school specialists.
Areas targeted for this population typically include
morphology and syntax
As students enter their adolescent years, curriculum demands increase. Children with language disabilities may have difficulty meeting increased demands of secondary school. Although basic language skills are still taught, it may not be possible to close the gap between skill level and grade level. At this point, interventions tend to focus on teaching ways to compensate for language deficits. Student involvement is important at this age to foster a feeling of collaboration and responsibility for developing and achieving intervention goals and to learn self-advocacy skills for the classroom (e.g., requesting priority seating in front of classroom).
Instructional strategies approaches that focus on teaching rules, techniques, and principles to facilitate acquisition and use of information across a broad range of situations and settings are often used with older students. Enhancing metalinguistic and metacognitive skills is fundamental to learning new strategies. The emphasis is on how to learn, rather than what to learn. Classroom assignments are often used to teach strategies for learning academic content. Some instructional strategies are discipline-specific, and others are generalizable across disciplines (Faggella-Luby & Deshler, 2008). Examples include strategies for using
Also see the treatment section of the Written Language Disorders Practice Portal page.
Difficulties experienced by children and adolescents with language impairment can continue to impact functioning in post-secondary education and vocational settings. When compared with typically developing peers, fewer individuals with language impairment complete high school or receive an undergraduate degree (Johnson, Beitchman, & Brownlie, 2010). The majority of young adults with specific language impairment who pursue education after high school seek vocational rather than academic qualifications (Conti-Ramsden & Durkin, 2012). In addition, individuals with speech and language impairment tend to be employed in lower-skilled jobs than their typically developing peers (Conti-Ramsden & Durkin, 2012; Johnson, Beitchman, & Brownlie, 2010).
The data on educational and vocational outcomes for individuals with speech and language disorders highlight the need for continued support to facilitate a successful transition to young adulthood. These supports include, but are not limited to, the following:
Transition Planning—the development of a formal transition plan in high school that includes career goals and educational needs; academic counseling (including discussion about requirements for admission to post-secondary schools); career counseling; opportunities for work experience; and community networking
Transition Goals—goals for successful transitioning to post-secondary school or employment that can include preparing a resume; completing a job or college application; effectively presenting skills and limitations during an interview; expressing concerns to authority figures about academic or job performance; stating or restating a position to effectively self-advocate in academic and employment settings
Disability Support Services—individualized support for college-level students that can include accommodations, such as extended time for tests and the use of assistive technology (e.g., to help with reading and writing tasks)
Vocational Support Services—include testing to identify vocational strengths, career counseling, vocational training, job search assistance, and job coaching
Secondary school personnel can assist the student in transition by
(National Joint Committee on Learning Disabilities, 1994)
The treatment modes/modalities described below may be used to implement various treatment options.
Augmentative and Alternative Communication (AAC)—supplementing or replacing natural speech and/or writing with aided (e.g., picture communication symbols (PECS), line drawings, Blissymbols, speech generating devices, and tangible objects) and/or unaided (e.g., manual signs, gestures, and finger spelling) symbols. Whereas aided symbols require some type of transmission device, production of unaided symbols only require body movements. See ASHA's Practice Portal page on Augmentative and Alternative Communication.
Computer Based Instruction—use of computer technology (e.g., iPads) and/or computerized programs for teaching language skills, including vocabulary, social skills, social understanding, and social problem solving.
Video-Based Instruction (also called Video Modeling)—use of video recordings to provide a model of the target behavior or skill. Video recordings of desired behaviors are observed and then imitated by the individual. The learner's self-modeling can be videotaped for later review.
There are a number of different approaches and strategies for individuals with language disorders. Interventions can vary along a continuum of naturalness (Fey, 1986), ranging from contrived or drill-based activities in a therapy room (clinician directed) to activities that model play or other everyday activities in more natural settings (child centered), to those that use activities and settings that combine both approaches (hybrid).
Below are brief descriptions of general and specific treatments for addressing language disorders. Some attempt has been made to organize treatment options into broader categories, recognizing that intervention approaches do not always fit neatly into one particular category. Several of the approaches listed below are most often associated with treatment for social communication disorder and autism spectrum disorder. These approaches are included here, because they are also used with a broader population of children with language disorders. This list is not exhaustive, and the inclusion of any specific treatment approach does not imply endorsement from ASHA.
SLPs and educators determine which methods and strategies are effective for a particular student by taking into consideration the individual's language profile; the severity of the language disorder; factors related to language functioning (e.g., hearing and cognitive functioning); cultural background and values; learning style; and communication needs.
Behavioral interventions and techniques are designed to reduce problem behaviors and teach functional alternative behaviors using the basic principles of behavior change. These methods are based on behavioral/operant principles of learning; they involve examining the antecedents that elicit a certain behavior, along with the consequences that follow that behavior, and then making adjustments in this chain to increase desired behaviors and/or decrease inappropriate ones. Behavioral interventions range from one-to-one, discrete trial instruction to naturalistic approaches.
Discrete Trial Training (DTT)—one-on-one instructional approach utilizing behavioral methods to teach skills in small, incremental steps in a systematic, controlled fashion. The teaching opportunity is a discrete trial with a clearly identified antecedent and consequence (e.g., reinforcement in the form of praise or tangible rewards) for desired behaviors. DTT is most often used for skills that learners are not initiating on their own; have a clear, correct procedure; and can be taught in a one-to-one setting.
Early Intensive Behavioral Interventions—one-on-one comprehensive treatment programs that teach appropriate behaviors using discrete trial training, natural environment teaching, and analysis of verbal behaviors. Treatment typically begins in the young child's home and expands to include early education settings, the community, and other settings as new skills are acquired.
Functional Communication Training (FCT)—a behavioral intervention program that combines the assessment of the communicative functions of maladaptive behavior with behavioral procedures to teach alternative responses. Problem behaviors can be eliminated through extinction and replaced with alternate, more appropriate forms of communicating needs or wants (Carr & Durand, 1985).
Incidental Teaching—a teaching technique that utilizes behavioral procedures; naturally occurring teaching opportunities are provided, based on the child's interests. Following the child's lead, attempts to communicate are reinforced as these attempts get closer to the desired communication behavior.
Lovaas Therapy—a comprehensive, early intensive behavioral intervention program targeting skills that complement and build on one another (Lovaas, 1987). Treatment is based on principles of applied behavioral analysis. The Lovaas treatment model begins with 10–15 hours per week of therapy, gradually increasing to 35–40 hours per week.
Milieu Therapy—a range of methods (including incidental teaching) that are integrated into a child's natural environment. It includes training in everyday environments and during activities that take place throughout the day, rather than only at "therapy time."
Pivotal Response Treatment (PRT)—a play-based, child-initiated behavioral treatment formerly referred to as the Natural Language Paradigm (NLP). The goals of PRT are to teach language, decrease disruptive behaviors, and increase social, communication, and academic skills. Rather than target specific behaviors, PRT targets pivotal areas of development (response to multiple cues, motivation, self-regulation, and initiation of social interactions) that are central to—and result in improvements across—a wide range of skills (Koegel & Koegel, 2006). PRT emphasizes natural reinforcement (e.g., the child is rewarded with an item when a meaningful attempt is made to request that item).
Some language intervention programs target specific language skills (e.g., phonology, semantics, syntax, morphology), while others are more holistic in nature, targeting a broader range of language and communication skills (e.g., expressive language interventions and receptive language interventions). Language intervention approaches can include the following.
Clinician-Oriented—the clinician selects the goals and the treatment setting and determines the stimuli to be used and the type and schedule of reinforcement for accurate responses. These approaches utilize operant procedures and are often used to teach language form (e.g., syntax and morphology).
Child-Oriented—the clinician utilizes indirect language stimulation techniques and follows the child's lead in more natural, everyday settings and activities in an effort to stimulate language growth. These approaches are typically used with young children but can be modified for use with older children. Examples include
Hybrid—the clinician develops activities that are very natural, but at the same time, allow opportunities for the child's spontaneous use of utterances containing the targeted language forms. Examples include
Narrative interventions focus on improving a child's story-telling ability, including the ability to provide context for the listener; use narrative structures (story grammars) to organize events; and utilize microstructure (e.g., syntactic complexity, temporal and causal conjunctions, coordinating conjunctions, elaborated phrases, and adverbs) to enhance the clarity of the narrative. Narratives can provide a naturalistic means of targeting specific language difficulties.
Parent-mediated or implemented interventions consist of parents' using direct, individualized intervention practices with their child to increase positive learning opportunities and acquisition of skills.
Peer-mediated or implemented treatment approaches incorporate peers as communication partners for children with language disorders in an effort to provide effective role models and boost communication competence. Typically developing peers are taught strategies to facilitate play and social interactions; interventions are commonly carried out in inclusive settings where play with typically developing peers naturally occurs (e.g., preschool setting).
Pragmatics/social communication/discourse approaches are designed to increase social skills and promote socially appropriate behaviors and communication, using social group settings and other platforms to teach peer interaction skills.
Relationship-based practices in early intervention are aimed at supporting parent-child relationships. Greenspan/DIR/Floortime is a relationship-based intervention that promotes development by encouraging children to interact with parents and others through play. The model focuses on following the child's lead; challenges the child to be creative and spontaneous; and involves the child's senses, motor skills, and emotions (Greenspan, Weider, & Simons, 1998).
Sensory-based therapies are used to treat dysfunction in sensory processing or integration. Many of these interventions are based on, or derived from, the principles of sensory integration theory and involve providing enriched or specialized sensory input to the child.
Auditory Integration Therapy(e.g., the Berard method)—involves exercising the middle ear muscles and auditory nervous system to treat distortions/dysfunctions of the auditory system (Berard, 1993).
According to ASHA's position statement titled, Auditory Integration Training, "The 2002 ASHA Work Group on AIT, after reviewing empirical research in the area to date, concludes that AIT has not met scientific standards for efficacy that would justify its practice by audiologists and speech-language pathologists" (ASHA, 2004, para. 1).
Fast ForWord®—a computer-based program designed to strengthen memory, attention, processing rate, and sequencing in children with temporal processing abnormalities. Strengthening these cognitive skills are thought to improve language and reading skills (e.g., phonological awareness, vocabulary, decoding, and comprehension; Tallal, 2004; Institute of Educational Sciences, 2006).
See the Service Delivery section of the Spoken Language Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
In addition to determining the type of speech and language treatment that is optimal for children with spoken language disorders, SLPs consider other service delivery variables—including format, provider, dosage, and timing—that may impact treatment outcomes.
This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA.
Al Otaiba, S., Puranik, C. S., Ziolkowski, R. A., & Montgomery, T. M. (2009). Effectiveness of early phonological awareness interventions for students with speech or language impairments. The Journal of Special Education, 43(2), 107-128.
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American Speech-Language-Hearing Association. (1995). Facilitated communication [Position statement]. Available from www.asha.org/policy/.
American Speech-Language-Hearing Association. (2004). Auditory integration training [Position statement]. Available from www.asha.org/policy/.
American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language pathology [Scope of practice]. Available from www.asha.org/policy/.
American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. Available from www.asha.org/policy/.
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Brinton, B., Spackman, M. P., Fujiki, M., & Ricks, J. (2007). What should Chris say? The ability of children with specific language impairment to recognize the need to dissemble emotions in social situations. Journal of Speech, Language, and Hearing Research, 50(3), 798-811.
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