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Grammar intervention in children with specific language impairment: an integrative literature review

ABSTRACT

Aim:

to review the literature reporting grammar-based interventions designed to improve morphosyntactic skills among children with specific language impairment (SLI).

Methods:

several studies reporting grammar-based interventions were analyzed. The criteria for selecting the articles were determined as follows: a) publication date within the last ten years; b) studies that reported a grammar-based intervention; c) groups of study constituted by children with SLI, aged 3.0 to 12.0 years; d) design including Pre and Post measures; e) articles reporting quantitative/qualitative data analyses. The databases selected for this review were: Lilacs, PubMed, Embase, Scopus, ISI-Web of Science, and EBSCOhost.

Results:

most studies reported interventions focused on expressive grammar, providing no particular details about the specific grammar contents considered. Interventions usually consisted of implicit approaches implemented as individual therapy. Studies reported children with SLI as generally improving on intervened skills.

Conclusion:

all of the grammar-based intervention programs described in the selected studies, seemed to be equally adequate when working with children with SLI.

Keywords:
Child Language; Language Disorders; Language Therapy; Speech, Language and Hearing Sciences

RESUMEN

Objetivo:

revisar la literatura que aborda la intervención gramatical destinada a incrementar las habilidades morfosintácticas en niños con TEL.

Métodos:

se analizaron diferentes artículos que exponían el tema de la intervención gramatical en niños con TEL. Los criterios de selección fueron: a) ser publicados en los últimos 10 años, b) exponer la aplicación de un programa gramatical, c) contar con un grupo de estudio constituido por niños con TEL, cuyas edades fluctuaran entre 3.0 y 12.0 años, d) considerar evaluaciones previas y posteriores a la aplicación y e) informar sobre los análisis cualitativo o cuantitativo utilizados para la obtención de los resultados. Las bases de datos utilizadas fueron: Lilacs, Pubmed, Embase, Scopus, ISI-Web of Science y EBSCOhost.

Resultados:

la mayoría de las investigaciones muestran una tendencia a trabajar la gramática expresiva, sin definir contenidos específicos. Las aplicaciones propenden a usar un enfoque implícito en un modo de terapia individual. Los estudios señalan que los niños con TEL tienden a beneficiarse de la intervención implementada.

Conclusión:

los trabajos analizados no permiten identificar un tipo de intervención gramatical que sea más apropiado para los niños con TEL.

Descriptor:
Lenguaje Infantil; Trastornos del Lenguaje; Terapia del Lenguaje; Fonoaudiología

Introduction

Specific Language Impairment (SLI) is generally defined as a disorder of the linguistic development, which occurs in the absence of evident neurological damage, hearing deficit, severe environmental deprivation or mental retardation11. Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433.. It has been estimated that this disorder affects approximately 7% of children22. Tomblin J, Records N, Buckwalter P, Zhang X, Smith E, O'Brien M. Prevalence of specific language impairment in kindergarten children. J Speech Lang Hear Res. 1997;40(6):1245-60.,33. Leonard LB. Children with specific language impairment. 1°ed. Cambridge (MA): MIT Press;1998. and that it persists until adolescence44. Stothard S, Snowling M, Bishop D, Chipchase B, Kaplan C. Language-impaired preschoolers. J Speech Lang Hear Res. 1998;41(2):407-18.,55. Johnson C, Beitchman J, Young A, Escobar M, Atkinson L, Wilson B et al. Fourteen-year follow-up of children with and without speech/language impairments. J Speech Lang Hear Res. 1999;42(3):744-60..

One of the most outstanding linguistic characteristics in children with SLI is their grammatical problems66. Aguado G. Apuntes acerca de la investigación sobre el TEL. Rev Logop Foniatr Audiol. 2007;27(3):103-9.. These are generally considered one of the nuclear symptoms of this disorder77. Leonard L. Specific language impairment across languages. In: Bishop B, Leonard L (orgs). In speech and language impairments in children. New York: Psychology Press;2014. p.115-30.. In addition, there are children with SLI who are characterized by only demonstrating difficulties in grammatical aspects88. De Anda S, Blossom M, Abel A. A complexity approach to treatment of tense and agreement deficits: a case study. Commun Disord Q. 2019:1-11..

Grammar difficulties occur both at an expressive and comprehensive level. In this regard, it has been observed that expressive morphosyntactic disturbances are more evident in young children (up to 8 years) and that receptive errors are expressed even in adolescence99. Rice M, Hoffman L, Wexler K. Judgments of omitted BE and DO in questions as extended finiteness clinical markers of Specific Language Impairment (SLI) to 15 years: a study of growth and asymptote. J Speech Lang Hear Res. 2009;52(6):1417-33.. Although grammatical errors are a transversal symptom, difficulties may manifest differently in speakers of different languages11. Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433.,1010. Leonard L. Some reflections on the study of children with specific language impairment. Child Lang Teach Ther. 2009;25(2):169-71.. For example, English-speaking children show mainly a compromise in the morphology of verbs, in particular related to the use of third person singular and to the morphemes of the past tense of regular verbs1111. Norbury C, Bishop D, Briscoe J. Production of English finite verb morphology. J Speech Lang Hear Res. 2001;44(1):165-78.. On the other hand, Spanish speakers, in addition to their difficulties with verbs, exhibit difficulties with the use of articles, clitic pronouns and prepositions1212. Anderson R, Souto S. The use of articles by monolingual Puerto Rican Spanish-speaking children with specific language impairment. Appl Psycholinguist. 2005;26(04):621-47.

13. Bedore L, Leonard L. Verb inflections and noun phrase morphology in the spontaneous speech of Spanish-speaking children with specific language impairment. Appl Psycholinguist. 2005;26(02):195-225.
-1414. Morgan G, Restrepo M, Auza A. Comparison of Spanish morphology in monolingual and Spanish-English bilingual children with and without language impairment. Biling Lang Cogn. 2013;16(03):578-96..

The Procedural Deficit Hypothesis is one of the explanations proposed to understand the grammatical difficulties of children with SLI. This hypothesis states that grammar involves the learning of rules, which requires the use of procedural memory. Instead, lexical knowledge depends on declarative memory. In children with SLI, procedural memory would be compromised and therefore grammatical areas would be affected. In contrast, declarative memory would be unscathed11. Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433..

The relevance of grammatical difficulties in children with SLI requires developing interventions that contribute to overcome or compensate this problem.

Kamhi1515. Kamhi A. Improving clinical practices for children with language and learning disorders. Lang Speech Hear Ser. 2014;45(2):92-103. states that in therapy, there can be a differentiation between the approaches (referring to the how) and the contents (referring to the what) that should be used. Regarding the approaches, Ebbels1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40. distinguishes two types: implicit and explicit. Implicit approaches address the teaching of grammatical aspects through procedures such as reformulation, imitation, expansion or modeling. This perspective seeks that children are able to infer morphosyntactic rules without being explicitly instructed. From this approach, it has been found that the use of reformulation is appropriate for children with SLI when programs with specific grammatical objectives are applied1717. Cleave P, Becker S, Curran M, Owen A, Fey M. The efficacy of recasts in language intervention: A systematic review and meta-analysis. Am J Speech Lang Pathol. 2015;24(2):237-55..

In turn, explicit approaches directly teach the rules of grammar, through procedures that involve metalinguistic reflection, which is generally based on visual clues1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40.. It is argued that visual clues are useful to support the teaching of grammar, because children with SLI have strong visual skills1818. Ebbels S. Teaching grammar to school-aged children with specific language impairment using Shape Coding. Child Lang Teach Ther. 2007;23(1):67-93..

According to Kamhi1515. Kamhi A. Improving clinical practices for children with language and learning disorders. Lang Speech Hear Ser. 2014;45(2):92-103., the approaches just described correspond to the same intervention model that varies in intensity and specificity. Thus, at one end of the therapy specter would be the explicit approach in which specific grammatical structures are explicitly taught through metalinguistic reflection. At the other extreme would be the implicit approach where, through procedures such as modeling or reformulation, these structures are learned, without direct instruction.

Regarding which approach is best for children with SLI, it seems that the explicit ones would be more appropriate. This is because these children show difficulties with implicit grammatical learning, due to their issues in procedural memory11. Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433.,1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40.. On the other hand, declarative memory, based on explicit learning, would not be affected11. Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433.,1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40..

Also, it has been proposed that at different stages and ages children respond differently to each of these approaches. Thus, implicit approaches would be more suitable for young children1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40., while explicit ones are more appropriate for older children1818. Ebbels S. Teaching grammar to school-aged children with specific language impairment using Shape Coding. Child Lang Teach Ther. 2007;23(1):67-93.. The previous statement is consistent with a study in which speech therapists reported that the most used procedures vary according to the school period in which the child is. Thus, in pre-school stage, modeling is the most used procedure, followed by reformulation and imitation (implicit approach). In the school stage, modeling is practically not used and the most common procedure is explicit teaching (explicit approach)1919. Finestack L, Satterlund K. Current practice of child grammar intervention: a survey of speech-language pathologists. Am J Speech Lang Pathol. 2018;27(4):1329-51..

Finally, it is important to point out that implicit approaches fundamentally help children with morphosyntactic expression difficulties1515. Kamhi A. Improving clinical practices for children with language and learning disorders. Lang Speech Hear Ser. 2014;45(2):92-103.. On the other hand, explicit approaches support mainly schoolchildren with receptive grammatical difficulties1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40..

As previously stated, in addition to the approaches that are used in an intervention, there are grammatical contents that must be addressed1515. Kamhi A. Improving clinical practices for children with language and learning disorders. Lang Speech Hear Ser. 2014;45(2):92-103.. The establishment of these contents should consider the language spoken by the child, since grammatical difficulties manifest differently in each language11. Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433.,1010. Leonard L. Some reflections on the study of children with specific language impairment. Child Lang Teach Ther. 2009;25(2):169-71.. In English, the contents most commonly addressed in the pre-school stage, according to language therapists, are plural form and verbs in present progressive. In the school period the contents most usually applied are regular and irregular verbs in the past tense, pronouns and plurals1919. Finestack L, Satterlund K. Current practice of child grammar intervention: a survey of speech-language pathologists. Am J Speech Lang Pathol. 2018;27(4):1329-51..

Another topic that has been discussed regarding grammatical intervention in children with SLI is the duration that the session should have for the treatment to be beneficial. Recent work shows that there are no differences between sessions that last fifteen minutes and the ones that last thirty minutes. Consequently, it is suggested to prefer a shorter session2020. Plante E, Mettler H, Tucci A, Vance R. Maximizing treatment efficiency in developmental language disorder: positive effects in half the time. Am J Speech Lang Pathol. 2019;28(3):1233-47..

Despite the importance of treating grammatical difficulties in children with SLI, it is noteworthy that there are significant gaps in the literature on the effectiveness and efficiency of the intervention, both in children with receptive grammatical problems and those with expressive grammatical difficulties1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40..

Thus, the question of how the intervention used to support grammatical development in children with SLI is, turns out to be relevant and valid. Therefore, the objective of this paper is to review the literature that addresses grammar intervention aimed at increasing morphosyntactic abilities in children with SLI.

Methods

Literature Search Procedures

An integrative review of the literature was carried out between August and October of 2018. For this review, two procedures were used.

The first one consisted in researching the following databases: Lilacs, PubMed, Embase, Scopus, ISI-Web of Science and EBSCOhost. These were chosen because they address issues related to therapeutic intervention, grammar and SLI. Thus, some focus primarily on biological and medical sciences and others address content both related to philosophy and humanities. The cross-reference between databases that address medical and biological contents and the ones that address philosophy and humanities allowed to find the articles analyzed in this review.

The terms used for the search were traced in English and Spanish. English was chosen because it is the language in which most scientific works are disseminated. As a matter of fact, abstracts of articles published in any language count with an English translation. In addition to the aforementioned, it is known that evidence on grammar in children with SLI has been obtained mainly from studies conducted with English speakers2121. Leonard L, Kueser J. Five overarching factors central to grammatical learning and treatment in children with developmental language disorder. Int J Lang Commun Disord. 2019;54(3):341-61.. On the other hand, Spanish was privileged as it is the most spoken Romance language in the world2222. Zambrana JR. La situación actual de la lengua española en el mundo. [septiembre 2009]. Disponible en http://www.eumed.net/rev/cccss/05/jrz.htm
http://www.eumed.net/rev/cccss/05/jrz.ht...
. Along with the above, most journals that address the issue of language difficulties in Latin America and Spain disseminate their articles in Spanish. finally, Brazilian magazines disseminate articles in Portuguese and English and some of them accept works in Spanish.

The terms used in English were: "classroom and grammar and intervention", "grammar and intervention", "intervention and grammar and SLI", "classroom and children and SLI and grammar", "grammatical and treatment and SLI". In turn, the words used in Spanish were: “sala de clase y gramática e intervención” “gramática e intervención”, “intervención y gramática y TEL”, “sala de clase y niños y TEL y gramática” and “gramática y tratamiento y TEL”. The terms “intervention / intervención” and “treatment / tratamiento” were used because they involve the idea of therapy, support plans, programs and training. On the other hand, the words "grammar / gramática" and "grammatical / gramatical" were used since they include the concepts of morphology and syntax. The descriptor “classroom / sala de clases” was included, because when using only the descriptors “grammar / gramática”, “intervention / intervención” and “SLI / TEL” very few articles were found. Thus, when considering it within the search, more studies emerged.

All descriptors were examined without limiting the search, with the exception of Scopus database, in which the search for all terms was limited to the option of “title, abstract and keywords”, because when considering all fields, many articles appeared which did not relate to the topic.

For the rest of the databases, there was only restriction of the terms “Grammar and intervention”. In the case of PubMed and Embase, the search was limited to the title and the abstract simultaneously. In ISI, Lilacs and Ebscohost, which did not present the simultaneity option, the exploration was restricted to the title. This is because when these terms were not limited, the number of articles without relation to the topic increased considerably.

The second procedure consisted in searching for articles from the ones already selected in the mentioned databases. Specifically, the references found in those articles were placed in the Google Scholar search engine. All those that appeared in the Related Articles section were reviewed and those that met the inclusion criteria were selected.

Inclusion Criteria for Articles

  1. Articles must contain original data.

  2. Articles should report on applications of grammar intervention programs exclusively for children with language difficulties.

  3. Articles should have been published in the last 10 years, that is, between 2008 and 2018.

  4. The research design should include: a) study group, b) evaluation pre and post program implementation and c) quantitative or qualitative analysis of the data.

  5. The intervention must be carried out in preschoolers and / or in schoolchildren with SLI.

  6. The age range of children with SLI should fluctuate between 3.0 years and 12.0 years.

Accepted Articles and Rejected Articles

The databases showed 1,171 articles and 4 articles were found through the Google Scholar search engine, and 1,057 articles were excluded due to their titles, 73 for being duplicated, 15 after the revision of the abstract and 7 after reading the complete text. Finally, there were 23 articles left which met the inclusion criteria, consequently they were analyzed in their full version.

Image 1 summarizes the search process performed for the selection of articles.

Figure 1:
Flowchart for article selection

It should be noted that when the descriptors were tracked in Spanish, no results were obtained in any database. The only exception was EBSCOhost which when using the terms “sala de clases y niños y TEL y gramática” showed 10 articles. None were considered into the analysis, because they did not meet the inclusion criteria. Due to the aforementioned, the tables presented contain information on the articles that correspond to the search performed with the terms in English.

Table 1 shows the total number of articles found (number on the left) and the total number of articles selected (number on the right). Table 2 shows the distribution of the selected articles by their source. The numbers correspond to the ones under which they are found in the references section.

Table 1:
Quantity and distribution of the articles found and selected, according to descriptor and database used
Table 2:
Distribution of the selected articles, according to descriptor and source

Review of Literature

Tables 3 and 4 can be found below, which summarize the most important information from the selected articles. The complete bibliographic information of the articles analyzed is in the references section and they are marked with an asterisk.

Table 3 shows the objectives / hypotheses, the participants to whom the grammatical intervention was applied and the language spoken by the children.

Table 3:
Objectives/hypotheses, participants and language

The data in Table 3 indicate that 83% of the researches are carried out in English-speaking children. This implies a limitation because the results cannot always be extrapolated to children who speak other languages, since the grammatical difficulties in children with SLI manifest differently in each language1010. Leonard L. Some reflections on the study of children with specific language impairment. Child Lang Teach Ther. 2009;25(2):169-71.. This is consistent with what has been previously stated by Leonard2121. Leonard L, Kueser J. Five overarching factors central to grammatical learning and treatment in children with developmental language disorder. Int J Lang Commun Disord. 2019;54(3):341-61., regarding the fact that the greatest amount of information about grammar comprehension in children with SLI has been obtained from studies with English speakers.

Another noteworthy aspect is that 87% of the interventions focus on supporting expressive grammar. These findings agree with what Ebbels’1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40. proposes, which indicates that there are persistent gaps in the intervention, in particular in treatments aimed at receptive aspects. It is important to note that 3 investigations (in which the therapies were not focused on grammatical comprehension) showed that children also benefited at a comprehensive level. Thus, the work of Calder et al.4242. Calder S, Claessen M, Leitão S. Combining implicit and explicit intervention approaches to target grammar in young children with developmental language disorder. Child Lang Teach Ther. 2017;34(2):171-89., which uses combined approaches, Zwitserlood et al4040. Zwitserlood R, Wijnen F, van Weerdenburg M, Verhoeven L. 'MetaTaal': enhancing complex syntax in children with specific language impairment-a metalinguistic and multimodal approach. Int J Lang Commun Disord. 2015;50(3):273-97., which uses the metalinguistic approach and Camarata et al.2626. Camarata S, Nelson K, Gillum H, Camarata M. Incidental receptive language growth associated with expressive grammar intervention in SLI. First Lang. 2009;29(1):51-63. that uses implicit approaches to work expressive grammar, indicated that children were favored both expressively and comprehensively. These results suggest that the approach to grammatical comprehension can be performed indirectly, in particular the explicit or metalinguistic approach seems to be useful for receptive grammatical difficulties. Ebbels1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40. also agrees that explicit approaches are appropriate to support students with receptive grammatical difficulties.

In addition, it can be observed that the age ranges are different in the studies. Thus, it is appreciated that 78% of the participants are preschoolers whose ages range between 2 and 6 years old. Moreover, in 26% of the studies the subjects are under 5 years old, which is controversial since before this age the diagnosis of SLI is debatable. This is because it is possible to confuse this diagnosis with a language delay. This may impact the results of the investigation, given that children with language delay generally progress faster than children with SLI when an intervention program is applied4545. Ramírez-Santana G, Acosta-Rodríguez V, Moreno-Santana A, del Valle-Hernández N, Axpe-Caballero Á. El uso combinado de narraciones orales y actividades morfosintácticas para mejorar habilidades gramaticales de alumnado con trastorno específico del lenguaje (TEL). Revista de Psicodidáctica. 2018;23(1):48-55..

Regarding the type of studies, it is observed that 83% of them compare independent samples, that is, they contrast groups that receive different types of interventions or groups with different diagnosis (SLI and TD) to which the same intervention is applied.

Table 4 shows the characteristics of the treatment and the conclusions obtained after the intervention.

The characteristics of the treatment were analyzed using the following categories: modality (individual and group), dose (number of sessions, session length and duration of treatment), approach and intervention techniques or procedures. The elements referred to the dose are relevant to specify the nature of the treatment1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40.. Finally, it is important to note that the approach was inferred from information about the techniques or procedures of the treatment.

Table 4:
Characteristics of the treatment and conclusions of the intervention

Table 4 shows that 60% of the studies are carried out individually. This suggests that there is some consensus that individual therapy is more appropriate for children with SLI than group therapy. This may be due to the fact that the persistence and severity of this disorder would require focused support for these children. This result differs from a study4646. Eidsvåg S, Plante E, Oglivie T, Privette CH, Mailend M. Individual versus small group treatment of morphological errors for children with developmental language disorder. Lang Speech Hear Ser. 2019;50:237-52. in which it was found that the individual modality shows a similar effect as group therapy. It should be noted that in the mentioned study each subject had their own therapeutic goal. Consequently, the results, rather than favoring a treatment modality, indicate the importance of the intervention being specific and directed to a particular grammatical aspect.

Regarding the frequency and duration of the sessions, it is noted that 65% of the studies perform between 1 and 2 sessions per week and their duration is variable, fluctuating between 5 minutes and 1 hour. It is noteworthy that the highest percentage was 39%, which corresponds to studies that carried out therapy sessions of 30 minutes.

In relation to the length of the treatment, the data shows that the duration ranges from 1 week to 8 months. However, there is a tendency to execute treatments that last between 10 and 12 weeks. It is important to note that the Ramírez-Santana4545. Ramírez-Santana G, Acosta-Rodríguez V, Moreno-Santana A, del Valle-Hernández N, Axpe-Caballero Á. El uso combinado de narraciones orales y actividades morfosintácticas para mejorar habilidades gramaticales de alumnado con trastorno específico del lenguaje (TEL). Revista de Psicodidáctica. 2018;23(1):48-55. study implements the treatment for more than 1 year.

Despite the importance of evaluating the dose (number and duration of sessions / length of treatment), it was found that only the study by Smith-Lock et al3535. Smith-Lock K, Leitão S, Lambert L, Prior P, Dunn A, Cronje J et al. Daily or weekly? The role of treatment frequency in the effectiveness of grammar treatment for children with specific language impairment. Int J Speech Lang Pathol. 2013;15 (3):255-67. analyzes some aspects of it. The purpose of this study was to determine which dose was most effective. Their results showed that weekly therapy, carried out for 8 weeks, was more effective than daily treatment. The findings of this investigation are consistent with what was raised by Kamhi1515. Kamhi A. Improving clinical practices for children with language and learning disorders. Lang Speech Hear Ser. 2014;45(2):92-103.. This author mentions that a higher dose in therapy will not always lead to better results. It is suggested that progress may depend on other aspects such as the area to be supported and the level of development that the child manifests in that area.

This is also consistent with what is proposed by Proctor-Williams and Fey4747. Proctor-Williams K, Fey M. Recast density and acquisition of novel irregular past tense verbs. J Speech Lang Hear Res. 2007;50(4):1029-47. who express that therapy is effective when it provides varied and repeated learning opportunities that are distributed over a considerable period of time.

In relation to the approaches used, there is a tendency to perform the intervention with one type of approach. Thus, 60% of the studies were carried out with the implicit approach, 26% used therapies with the explicit or metalinguistic approach and 14% used both approaches. The results of the investigations showed that children in treatment, independent of the approach, show improvements in the areas that are stimulated. These findings are not in accord with the proposal by Ullman & Pierpont11. Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433. and Ebbels1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40. in which the metalinguistic approach would be better for children with SLI, since this approach is based on declarative memory, which is not compromised11. Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433..

The predominance of treatments that use implicit approaches may be due to the age of the subjects who are supported with such treatments. Thus, 13 of the 14 studies in which the implicit approach is used work with participants who are under 6 years old. In contrast, of the 6 works in which the explicit approach is used, 5 were applied to children who were 6 years old or older. This relationship between age and type of approach is consistent with what is proposed by Ebbels1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40.,1818. Ebbels S. Teaching grammar to school-aged children with specific language impairment using Shape Coding. Child Lang Teach Ther. 2007;23(1):67-93.. The author indicates that implicit approaches are more suitable for younger children1616. Ebbels S. Effectiveness of intervention for grammar in school-aged children with primary language impairments: a review of the evidence. Child Lang Teach Ther. 2014;30(1):7-40. and explicit ones are more suitable for older children1818. Ebbels S. Teaching grammar to school-aged children with specific language impairment using Shape Coding. Child Lang Teach Ther. 2007;23(1):67-93..

Finally, it is important to note that the studies analyzed do not show explicit criteria to determine the contents that will be applied in therapy. In general, syntactic structures are mentioned, but their selection is not substantiated. This indicates that this aspect of therapy is not a focus of attention when assessing the treatments.

The limitations of this review are related to the age of the subjects and one of the inclusion criteria. The age range to which the search was limited restricted the analysis of interventions for older children with SLI. In this regard, it is important to review treatments in older subjects, because the linguistic aspect of grammar acquires relevance when learning the written language. The inclusion criterion which considered studies exclusively with grammatical interventions, limited the analysis of treatments where the grammatical component works in conjunction with other linguistic aspects in children with SLI.

Conclusion

The review of the articles shows that in 10 years of studies analyzed, research on grammatical treatments in children with SLI is scarce, since only 23 articles were found using the established criteria. In addition, most of them have been done with English-speaking children. Regarding the modality and the dose, the treatments tend to be individual, predominantly with therapies of one or two weekly sessions of 30 minutes. The intervention period tends not to exceed 6 months. Concerning the approach, most treatments use the implicit therapy and the results indicate that children with SLI benefit from any type of approach. In regards to the intervention of expressive or comprehensive aspects, there is a prevalence of studies in which expressive grammar is intervened. Finally, aspects related to grammatical contents are not specified. This suggests that there is a gap regarding the criteria applied to select the grammatical contents that can be used to support the morphosyntactic difficulties in children with SLI.

REFERENCES

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    Ullman M, Pierpont E. Specific language impairment is not specific to language: the procedural deficit hypothesis. Cortex. 2005;41(3):399-433.
  • 2
    Tomblin J, Records N, Buckwalter P, Zhang X, Smith E, O'Brien M. Prevalence of specific language impairment in kindergarten children. J Speech Lang Hear Res. 1997;40(6):1245-60.
  • 3
    Leonard LB. Children with specific language impairment. 1°ed. Cambridge (MA): MIT Press;1998.
  • 4
    Stothard S, Snowling M, Bishop D, Chipchase B, Kaplan C. Language-impaired preschoolers. J Speech Lang Hear Res. 1998;41(2):407-18.
  • 5
    Johnson C, Beitchman J, Young A, Escobar M, Atkinson L, Wilson B et al. Fourteen-year follow-up of children with and without speech/language impairments. J Speech Lang Hear Res. 1999;42(3):744-60.
  • 6
    Aguado G. Apuntes acerca de la investigación sobre el TEL. Rev Logop Foniatr Audiol. 2007;27(3):103-9.
  • 7
    Leonard L. Specific language impairment across languages. In: Bishop B, Leonard L (orgs). In speech and language impairments in children. New York: Psychology Press;2014. p.115-30.
  • 8
    De Anda S, Blossom M, Abel A. A complexity approach to treatment of tense and agreement deficits: a case study. Commun Disord Q. 2019:1-11.
  • 9
    Rice M, Hoffman L, Wexler K. Judgments of omitted BE and DO in questions as extended finiteness clinical markers of Specific Language Impairment (SLI) to 15 years: a study of growth and asymptote. J Speech Lang Hear Res. 2009;52(6):1417-33.
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  • Research support Source: Regular FONDECYT nº1170705 from Comisión Nacional de Investigación y Tecnología (CONICYT); Basal Fund for Centers of Excellence, project FB0003 from PIA-CONICYT.

Publication Dates

  • Publication in this collection
    25 Nov 2019
  • Date of issue
    2019

History

  • Received
    30 May 2019
  • Accepted
    07 Oct 2019
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