A Comparison of Syntax Training for Students with Developmental Disabilities Utilizing Clinician-Directed versus Self-Determined Session Paradigms

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1 A Comparison of Syntax Training for Students with Developmental Disabilities Utilizing Clinician-Directed versus Self-Determined Session Paradigms Jane O Regan Kleinert, Ph.D. Division of Communication Disorders University of Kentucky American Speech-Language Hearing Association Annual Convention Miami, 2006

2 The Issues 90% of school-based SLPs report treating students with Developmental Disabilities (DD) in their caseloads (ASHA, 2000; Kleinert, 2004). Best practice for students with DD includes an emphasis on Self-Determination (SD), that is

3 Self-Determination Self-determination is a combination of skills, knowledge, and beliefs that enable a person to engage in goal directed, self-regulated, autonomous behavior (Council for Exceptional Children position paper, 1998) Self-determination has been recognized as a critical life outcome, especially for individuals with developmental disabilities who are at risk for being denied such opportunities (Bambara & Koger, l996; Brown, Gothelf, Guess, & Lehr, l998; Field, Martin, Miller, Ward & Wehmeyer, 1998a; Holub, Lamb, & Bang, l998; Martin & Marshall, 1995; Ryan & Deci, 2000; Wehmeyer & Schalock, 2001; Wehmeyer & Schwartz, 1998).

4 SD Behaviors Include Choice making Planning Selecting goals Expressing preferences and dislikes Self-evaluation/self-monitoring Self-assertion/self-advocacy ALL COMMUNICATION RELATED ACTIVITIES AND SKILLS

5 However LESS THAT HALF of SLPs responding to a survey re: SLP knowledge and involvement in SD programming for students with DD indicated: familiarity with the concept of SD for students with DD or Involvement in program development for SD for students with DD

6 Communication Disorders and Self-Determination Currently, almost no contribution to literature of self-determination by Communication Disorders people cannot be fully self-determined without being competent communicators and conversely people cannot become competent communicators without being self-determined (Light and Gulens, 2000) The SLP s role is to help maximize a child s ability to communication his or her preferences. Consequently, the SLP may play a critical role in the effort to maximize each child s potential for self-determination (Wilkinson, 2006 ASHA Div.1 Perspectives)

7 Self-Determination and Communication Disorders Increased focus on SD in Special Education Limited contributions to this literature by CD Limited knowledge and participation in such programming by SLPs SLPs already have overwhelming caseloads

8 The Task: To Design a Study to Determine.. Can SLPs foster SD skills with students with developmental disabilities Without disrupting other SLP programming By comparing the typical clinician directed therapy paradigm with a therapy paradigm which incorporates elements of SD Utilizing functional language targets for a given population of students with developmental disabilities seen in the public school setting and Comparing effectiveness and efficiency of the approaches

9 Research Questions Will a clinician-directed treatment program increase the use of correct syntax targets with students having developmental disabilities? Will a syntax treatment program including a selfdetermination package increase the use of correct syntax targets with students having developmental disabilities? Is a clinician directed syntax treatment program or a syntax treatment program which includes a selfdetermination package more efficient in teaching correct syntax targets to students with developmental disabilities?

10 Methodology: Research Design Single Subject Adapted Alternating Treatment Design Single subject research is used with low-incidence populations where group designs are not feasible. This design is used when comparing two or more independent variables on two or more equivalent dependent variables Experimental control is established when the dependent variable assigned to one intervention is acquired more rapidly than the other dependent variable assigned to the other intervention regardless of the sequence of application (Johnson, Schuster, & Bell, 1996, p. 446).

11 Methodology Participants: 4 students with Down syndrome Ages 7 to 13 years Inclusion Criteria: Developmental Disability: Down syndrome Expressive syntax deficit Oral speaker with adequate hearing Attends public school Could attend for minutes in structured speech/language therapy session

12 Target: Syntax Usage Syntax errors remain prominent in the language of individuals with Down syndrome (DS) as they age Improved syntax provides perceived maturity to expressive output of speaker Syntax goals are a typical goal for verbal students with developmental disabilities in public school settings

13 Independent Variables Procedure 1: Clinician-Directed Model (CD) Clinician selected targets and reinforcing activities Scheduled reinforcing activities and Judged accuracy of production Mand-model approach with drill-play Procedure 2: Self-Determination Package Model (SD): (Clinician selected targets) Students selected reinforcing activities (choice-making) Scheduled reinforcing activities (planning) Self-evaluated productions Mand-model approach with drill play

14 Dependent Variables Effectiveness of each approach Efficiency: rate of acquisition of two equivalent syntax targets (comparing sessions, time, and errors to criterion)

15 Methodology: Target Selection Full communication assessment Age and developmentally appropriate targets Equivalent but Functionally Independent*

16 Table 2.9 Example of Equivalent, Non-Independent Syntax Targets Target Brown s (1973) Five Stages of Sentence Construction Number of morphemes Relationship Subject Understands Form Receptively I first person singular personal pronoun am copula verb May occur in a noun phrase alone at Stage I and with a verb form in Stage II 1 I is necessary for use of am which is an interfering relationship Stage II 1 am is an auxiliary or copula verb, which can only be used with pronoun I which is an interfering relationship Table 2.10 Example of Equivalent and Independent Syntax Targets Target Plural morpheme s Regular past tense ed Brown s (1973) Five Stages of Sentence Construction Number of morphemes Stage II 2 Noun + s Stage II 2 Uninflected verb + ed Relationship No interfering relation between the two syntactic forms No interfering relation between the two syntactic forms Yes Yes Subject Understands Form Receptively yes yes

17 Subject Target Brown s (1973) Five Stages of Sentence Construction Number of morphemes Compounding Relationship with Other Target Subject Understands Form Receptively MLU Jan Possessive forms of nouns using the s form Stage II 2 No Yes MLU: 2.4 at Stage II First person singular subjective pronoun I used with a verb. Stage I and refines at later stages 2 No Yes Lucy Tom Third person singular present progressive verb ending ing Possessive form of nouns using the s ending Possessive noun form using the s Regular past tense ed Stage II 2 No Yes MLU: 3.24 at State III Stage II 2 No Yes Stage II 2 No Yes MLU: 4.56 at Stage V Stage II 2 No Yes Joe First person singular pronoun I used with a simple verb Stage I and refines at later stages 2 No Yes MLU: 2.9 at Stage III Article a used with a noun Stage I as nomination and refines at later stages 2 No Yes

18 Procedures Students attended twice per week 2 segments per each session: CD and SD Segments counterbalanced across students and conditions Full sessions were minutes in length Each segment contained 30 instructional trials and 10 probe trials Reinforcing activity completed after each 5 instructional trails 2 reinforcing activities per segment

19 Opening of Session Clinician greets subject and gives overview of the session and explain the 2 conditions Instructional Phase for Segment I A. Introduction of the condition B. Selection of reinforcing activities C. Clinician modeling of 10 exemplars D. Instruction 5 trials 1 st Reinforcing activity 5 trials 1 st Reinforcing activity 5 trials 1 st Reinforcing activity 5 trials 2 nd Reinforcing activity 5 trials 2 nd Reinforcing activity 5 trials 2 nd Reinforcing activity Probe Phase for Segment I: 10 probe trials Break: 8-10 minutes Instructional Phase for Segment II Repeat of Segment I Instructional Phase using opposite condition Probe Phase for Segment II: 10 probe trials End of Session

20 Reliability: Independent Variables Procedural Reliability: Segments included up to items checked in each Reliability data taken on at least 20% of the sessions Average procedural reliability across all 4 subjects was 96.5% with a range of 94% to 98.7%. Procedural reliability data were calculated by dividing the number of observed clinician behaviors by the number of planned clinicians behaviors for each step of the instructional program and multiplying by 100.

21 Reliability: Dependent Variables Baselines: 100% across the 4 subjects taken on % of all baseline sessions. Probe sessions: 96.8% with a range of 88.8 % to 100% taken on 20-25% of all sessions. Using a point by point procedure

22 Results: Effectiveness Both procedures were highly effective with students achieving criterion on both targets with an unexpectedly rapid rate. Criterion was achieved for all targets within a range of 3-9 sessions or 2.5 to 5 weeks The two conditions were equally effective in maintaining the new targets for 3 of the 4 students, and the CD condition was only slightly more effective for maintenance for 1 student (85% for CD versus 80% for SD).

23 Results: Generalization Structured generalization: the conditions were equally effective for 1 student; the SD condition was slightly more effective for 1 student (90% versus 85%) and the CD condition slightly more effective for 2 students (50% versus 45%) and (100% versus 90.8%). Naturalistic Generalization: The CD condition was slightly more effective in naturalistic generalization for 3 students (74.6% versus 63.6%),(77.6% versus 65.7%), and (94% versus 90.8%) and the SD condition was slightly more effective for 1 student (76.1% versus 59.3%).

24 Maintenance Maintenance probes 7 weeks after treatment was terminated indicated that the average level of maintenance across all 4 subjects for the two conditions was equal at 92.5% each. It should be noted that there were gains for all targets for all subjects on the naturalistic generalization probes over the scores on that task which had been obtained at the end of the study.

25 Results: Efficiency The CD condition was slightly more efficient in reaching criterion, requiring 17 sessions to criterion versus 20 sessions for the SD condition across all subjects. SD more efficient for 1 student CD more efficient for 3 of 4 student BUT For 2 of these 3 students, there was a difference of only 1 session between the 2 conditions* SD condition included an additional component, self-evaluation, a major skill of SD

26 Self-evaluation Results Data for all 4 students indicated success 3 of the students reached criterion so quickly on their SD targets (within 3-4 sessions) that it was difficult to make statements about their performance on the self-evaluation task This high rate of correct responses resulted in a limited number of opportunities to differentiate between correct and incorrect responses. However

27 Emergence of Self-Correction Usage Tom: Began self-correction behaviors on his SD targets on the third instructional day, and during the generalization probe for the CD target on the 5th day of his participation in the study. Jan and Joe: evidenced self-correction during SD generalization probes Joe: self-corrected during a probe session for his SD goal and selfcorrected on his CD target once in spontaneous speech Lucy: Began to analyze her spontaneous speech for correct forms of her SD target on day 2 of instruction. It would be of interest to know if the emphasis on self-evaluation contributed to each of subjects spontaneous evidence of selfcorrection during the study.

28 Summary of Results Both procedures highly effective CD slightly more efficient for 3 of 4 students The self-evaluation element of SD condition may have resulted in more rapid onset of selfcorrection Considering the small difference in efficiency, the limited sacrifice in efficiency may be worth the emphasis in self-evaluation and possible resultant self-correction

29 1. Demonstrated Functional Relationship of Variables in Single- Subject Designs The study demonstrated a functional relationship between dependent and independent variables because it fulfilled requirements described by Horner, et al., 2005 (p. 171). (a) an immediacy of effects following the onset and/or withdrawal of the intervention, (b) no data points in adjacent phases that overlap in level (c) a large magnitude of change in the dependent variable, and (d) a consistency of data patterns across multiple presentations of intervention and nonintervention conditions

30

31

32 Figure 3.9 Efficiency for CD Condition for Subject 3: Tom Figure 3.10 Efficiency for SD Condition for Subject 3: Tom

33

34 2. Effectiveness The self-determination package (SD) was equally effective and only slightly less efficient than the traditional clinician directed approach (CD) and thus offers SLPs an evidenced-based alternative that: Fosters Self-Determination Fosters Self-Evaluation Fosters Interdisciplinary Teaming Provides intervention that aligns with the student s education program and IEP as mandated by IDEA Maximizes the number of interdisciplinary instructional targets without disrupting established CD programming

35 3. Effect Size Was in the highly meaningful (>0.67) (Lipsey & Wilson, 1993) range for both conditions for each student

36 4. Evidence-Based Practice There is a lack of CD input to literature in Self- Determination This study includes elements required for SS designs to add to evidence-based literature (Horner et al., 2005), by complying to the following: operationally defined procedures; a well defined context for use of the practice; fidelity in implementation; demonstration of a functional relationship between the dependent and independent variables; and sufficient replication of results which has occurred across studies, researchers, and subjects- Not Yet

37 5. Contributions to the Literature of Single-subject Design Generative language targets vs. discrete targets Use of a grid to determine equivalent/independent targets Syntax acquisition in students with Down syndrome Effectiveness of mass practice to teach new information for older students with developmental disabilities

38 Limitations of the Study Difficulty in selection of equivalent targets Limited maintenance and generalization data Limited generalization of a Single Subject Design (SS requires repeated studies for generalization) Fatigue and scheduling of sessions which may have affected engagement behaviors Clinic vs. School setting

39 Future Research The relationship between self-evaluation and selfcorrection with students with developmental disabilities Replication with alterations for: fatigue, setting, etc. Instructional formats for older students with developmental disabilities-interdisciplinary research studies: massed practice vs. distributive practice vs. a combined approach; block scheduling of SLP treatment in the school? Determining which communication skills are most important to the development of self-determination Evidenced-based research on self-determination

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