| Leonard L, et al. 20082323. Leonard L, Camarata S, Pawlowska M, Brown B, Camarata M. The acquisition of tense and agreement morphemes by children with specific language impairment during intervention: phase 3. J Speech Lang Hear Res. 2008;51(1):120-5.
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4 weekly sessions of 30 minutes each. 96 sessions were performed in 24 weeks. |
It is not specified in the article but it can be inferred that it is individual. |
Implicit |
3 programs were developed. In two of them a specific agreement morpheme was stimulated in a focused manner and in the third one general language was stimulated. Each one of them consisted in two activities. The first one consisted in telling a story using toys that performed the scenes, where the structures to be stimulated were used (12 times). The second one consisted in a conversation where using a game, reformulations were made (12 reformulations). In the group that received a general stimulation of language, third person of the plural was used for the story and for the conversation.
Both group 1 and 2 showed an improvement after intervention and did not regress after one month. |
Both group 1 and group 2 improved after the intervention and did not regress after one month. In the group of children who had global intervention the results in general terms were lower. It is concluded that a grammatical intervention with objective morphemes is better than addressing grammatical stimulation globally. |
| Leonard, L. el al. 20172424. Leonard L, Haebig H, Deevy P, Brown B. Tracking the growth of tense and agreement in children with specific language impairment: differences between measures of accuracy, diversity, and productivity. J Speech Lang Hear Res. 2017;60:3590-600.
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96 sessions: two times per week |
individual |
Implicit |
Treatment was based on implicit approaches. The session was divided in two parts. In the first part the clinician read a story to the child, represented with dolls. In each story the third person singular appeared 12 times on at least 6 different verbs. Once the reading was over, the second part started, using reformulation. Using the past tense “ed”, copulative and auxiliaries “is”, “are”,”am”, “was” and “were” was avoided. |
Children’s language samples indicated that the group had an increase in the use of past tense morphemes, auxiliaries, the third singular person and verbal consistency.
In addition, an increase in time use and concordance with limited diversity and productivity was observed in the initial measures. In the latest measures it is observed that increase in diversity and productivity occurs with little change in accuracy. |
| Motsch H, et al. 20082525. Motsch H, Riehemann S. Effects of 'Context-Optimization' on the acquisition of grammatical case in children with specific language impairment: an experimental evaluation in the classroom. Int J Lang Commun Disord. 2008;43(6):683-98.
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12 hours of therapy.
The sessions lasted 17 minutes, 4 times per week, for 12 weeks. |
Common classroom most of the time. The support was given in a group or individual setting, on some occasions. |
Implicit |
Context-Optimization (CO) intervention strategy. It is a method of grammatical facilitation that optimizes naturally presented contexts. Children are required to focus on the objective structure. The processing and structure chosen is made explicit. In this method the professional adapts the articulation, facilitating the perception with extensions, intonations, etc. There is a varied use of resources to support children.
In the control group modeling approaches were used to support students, for example, corrective feedback. |
Classroom CO therapy is effective for both accusative and dative, while traditional methods are only effective for accusatives.
The group to which CO was applied achieved better performance than the control group, to which a traditional method was applied. |
| Camarata S, et al. 20092626. 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.
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24 sessions for 12 weeks.
Two times per week, for one hour. |
Individual therapy at a treatment center. |
Implicit |
The intervention techniques used were imitation, modeling, conversational reformulation and Milleu Teaching (teaching of the middle). The description of this method is found in the article by Yoder et al, 2011. |
The group of children who had expressive language intervention showed a significant increase in receptive language scores. These gains were significantly greater than those observed in the control group. |
| Yoder P, et al. 20112727. Yoder P, Molfese D, Gardner E. Initial mean length of utterance predicts the relative efficacy of two grammatical treatments in preschoolers with specific language impairment. J Speech Lang Hear Res. 2011;54(4):1170-81.
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30 minutes sessions, three sessions per week, for 6 months. |
At a university clinic, individual sessions. |
Implicit |
Two methods of grammatical intervention were used:
Milieu language teaching (MLT): a system of gradual and environmental aids is used to generate specific linguistic structures and functional or verbal rewards. The context was directed game. For example, if a child at the one-wordstage says “ball” while stretching to take a ball, the adult may hold the ball while looking expectantly at the child. If the child does not respond, the adult may ask: “What do you want?” If the child still does not respond while looking at the ball the adult can say: “Say, ‘I want the ball’”, provoking an imitation request. If the child says: “I want ball,” the adult could say, “You want the ball” and give the child the ball. An aid is provided only to obtain the desired response, and once this aid is obtained it disappears.
Broad target recasts (BTR): This intervention is based on the child’s play, talk revolves around what the child is paying attention to, the child is asked about what they are doing and recast is doneconcerning what the child said. This means that much of the child says is repeated, but adding grammatical and semantic content. The child is not forced to produce a specific grammatical expression.
In short, MLT and BTR are child centered. Both userecast as a result of the child’s expressions. MLT uses a previously selected target grammar structure level, while BTR uses grammar targets selected in the moment. MLT seeks to obtain an immediate production of the given model or imitate the recast, which does not occur in BTR. |
MLT enablesan improvement in
Grammar, more than BTR in children who were initially in Stage I of Brown.
The effects are maintained 5 months after the end of the treatment. |
| Yoder P, et al. 20132828. Yoder P, Molfese D, Murray M, Key A. Normative topographic ERP analyses of speed of speech processing and grammar before and after grammatical treatment. Dev Neuropsychol. 2013;38(8):514-33.
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30 minutes sessions, three sessions per week, for 6 months |
At a university clinic, individual sessions. |
Implicit |
In the experimental group some children received therapy with Milieu language teaching (MLT) and others with Broad target recasts (BTR). |
Speech processing speed was higher in children with typical development, before treatment.
After 6 months of treatment, children with SLI increase their speech processing speed. This processing speed did not show differences between both types of treatment.
The change in Speech processing speed is positively related to the improvement rate of grammar during treatment in the group of children with SLI. |
| Gallego JL. 20122929. Gallego JL. La enseñanza de habilidades lingüísticas en morfosintaxis: evaluación de un programa de intervención. Investigación en la escuela. 2012;76:77-91.
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1 weekly session of 30 minutes. The number of weeks is not informed. |
In small groups and on some occasions, there was individual intervention with children who presented a slower learning rhythm and progress. |
Implicit |
Program for the Development of Morphosyntax (PO.DE.MOS). This is an open program that is structured around five series with which different basic grammatical structures are stimulated. The difficulty of the activities is progressive.
It is pointed out that it is not a grammar program, but an expression program, formulated in grammatical terms.
When the child made a mistake in one of the stimulated structures, direct correction was avoided, since first there was an attempt to help them notice the error through questions. If this did not happen, the error was corrected and explanations were delivered.
Care was taken to positively reinforce children’s achievements. |
There are significant differences between the groups,fact thatis attributed to the PO.DE.MOS program.
It is indicated that this program was useful for increasing morphosyntactic skills in the children who were intervened. |
| Kulkarni A, et al. 20133030. Kulkarni A, Pring T, Ebbels S. Evaluating the effectiveness of therapy based around Shape Coding to develop the use of regular past tense morphemes in two children with language impairments. Child Lang Teach Ther. 2013;30(3):245-54.
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Once a week for 10 weeks, sessions of 30 minutes. An assistant was present during the sessions, who repeated it during the week, but at home. The therapy was suspended for 6 weeks. Then, it was resumed for 5 more sessions. |
The first 10 sessions were individual.
Of the last 5 sessions, 4 were in the classroom with a communication partner and 1 of them at home with the parents.
There was also a meeting only with parents. |
Explicit |
The individual sessions progressed as follows: 1. Introduction to Shape Coding 2. Word identification 3. Clarification of the present versus the past 4. Introduction of the arrows to mark forms 5. Completion of sentences and correction of written and spoken errors 6. Production of written and spoken sentences. |
One of the participants improved significantly in the completion of sentences, which was used to measure the progress through the sessions, but the generalization was only achieved after specific activities aimed at generalization.
The other child made more modest progress in completing sentences and seemed to generalize without resorting to directed activities. |
| Hoover J, et al. 20133131. Hoover J, Storkel H. Grammatical treatment and specific language impairment: Neighbourhood density & third person singular -s. Clin Linguist Phon. 2013;27(9):661-80.
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2 sessions of 30 minutes every week, for 6 weeks. Each child received 12 sessions. |
It is not specified in the article but it can be inferred that it is individual. |
Implicit |
Therapy began with a short story which was supported with pictures of the verbs to work (6 verbal presentations per story). Then the examiner obtained productions by verb, by means of a combination between direct repetition and spontaneous production. When a child omitted the target structure, the examiner rephrased the sentence. Each child received 72 exposures to the structure (36 through auditory exposure and 36 through child production and reformulation). The treatments only differed in the verbs used. |
The gains in treatment and generalization were greater for children with the treatment of rare verbs. |
| Washington K, 20133232. Washington K. The association between expressive grammar intervention and social and emergent literacy outcomes for preschoolers with SLI. Am J Speech Lang Pathol. 2013;22(1):113-25.
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10 interventions of 20 minutes, once a week. |
11 children through a computer.
11 children on clinician-client therapy. |
Explicit |
11 participants received computer-assisted treatment. A software was used called My Sentence Builder (Washington and Warr-Leeper, 2006). This program presents the necessary elements to create a present progressive sentence. In addition, each element of the sentence has a visual representation. Children are supported and guided by the speech therapist.
The other 11 participants had a conventional treatment. Visual support was given through pages of books, objects, and illustrated cards with actions to facilitate grammatical productions in a game format. To facilitate the understanding of the elements of the sentence, prosodic emphasis was placed on each of them.
The social skills and knowledge of letters, words and books (print concept) were addressed in the same session in which the grammar content was worked on in both groups. |
Both groups of participants who received grammatical intervention were positively affected in social skills and print concept. This did not happen in the control group. These gains were maintained 3 months after the intervention.
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| Washington K, et al. 20133333. Washington K, Warr-Leeper G. Growth in expressive grammar following intervention for 3- to 4-year-old preschoolers with SLI. JCPSLP. 2013;15(1):7-12.
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20 minutes sessions, once a week for 10 weeks. |
11 children through a computer.
11 children on clinician-client therapy. |
Explicit (computer) and Implicit (Board game) |
One group was assisted by computer (My Sentence Builder) which has visual aids to represent semantic and syntactic elements of the sentence. Besides this there was modeling and repetition. For another group there was table-top intervention. In this group the therapist made verbal and non-visual emphasis on grammar and there were specificaids only for the semantic elements of the sentence. |
Both intervened groups obtained better results than the non-intervened group. These differences were maintained over time. The two interventions did not differ statistically. |
| Washington K, et al. 20133434. Washington K, Warr-Leeper G. Visual support in intervention for preschoolers with specific language impairment. Top Lang Disord. 2013;33(4):347-65.
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20 minutes sessions, once a week, for 10 weeks. |
11 children through a computer.
11 children on clinician-client therapy. |
Explicit (CAI) and Implicit (TTI) |
Two methods were used: Computer Assisted Intervention (CAI) and (TTI). The difference was that the first one incorporated visual support for both semantic and grammatical sentences while TTI included only visual support for semantic elements and emphasis on grammatical elements. The fundamental difference between the interventions were the types of visual support: In the CAI, the My sentence builder program was used (each syntactic element had a figure or color). The TTI used images and toys. In both programs, in addition to the visual, modeling, repetition, a significant context and a game format were used. |
The group that used CAI outperformed the TAI group in efficiency and syntactic growth. This study showed that the use of multiple visual aids in expressive grammar training enabled a therapeutic advantage in grammar learning from session to session for preschoolers with SLI. |
| Smith-Lock K, et al. 20133535. 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.
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For both experimental groups therapy lasted 1 hour. 8 sessions were performed. Group 1 had daily sessions and group 2 weekly sessions. |
A first instruction directed at the whole classroom. Then small groups within the common classroom (3 to 5 children, according to performance). |
Implicit |
The speech therapist conducted a group lesson with one objective and then each group performed 3 activities for their specific objective.
The sessions consisted of game-based activities.
Focused stimulation techniques: modeling, imitation, direct teaching and reformulation. |
The expressive grammar intervention was most effective when the frequency of the sessions was weekly. |
| Smith-Lock KM, et al. 20133636. Smith-Lock KM, Leitao S, Lambert L, Nickels L. Effective intervention for expressive grammar in children with specific language impairment. Int J Lang Commun Disord. 2013;48(3):265-82.
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1 weekly session of 1 hour for 8 weeks. |
A first instruction directed at the whole classroom. Then small groups within the common classroom (3 to 5 children, according to performance). |
Implicit |
The speech therapist conducted a group lesson with one objective and then each group performed 3 activities for their specific objective.
The sessions consisted of game-based activities.
Focused stimulation techniques: modeling, imitation, direct teaching and reformulation. |
Grammar performance improved after grammar treatment. The group of children who received a control intervention showed no differences after treatment. |
| Smith-Lock KM et al. 20153737. Smith-Lock KM, Leitão S, Prior P, Nickelsa L. The effectiveness of two grammar treatment procedures for children with SLI: a randomized clinical trial. Lang Speech Hear Ser. 2015;46(4):312-24.
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1 weekly session of 1 hour, for 8 weeks. |
A first instruction directed at the whole classroom. Then small groups within the common classroom (2 to 5 children, according to performance). |
Implicit (recasting approach) and Explicit (cueing approach)
|
The Speech Therapist conducted a group lesson with an objective. Then, each group did 3 activities for their specific objective.
The sessions consisted of recreational activities.
In both groups if the child responded correctly, the teacher or speech therapist directed them to provide another model of the goal and some phrase like «very good.»
Treatments differ when the child makes a mistake. In the recasting approach group, after an error the correct answer was delivered, but without trying to get the child to produce it properly.
In the cueing approach group if the child was wrong, the teacher or speech therapist followed a hierarchy of signals designed for the child to produce the correct answer. These signals progressively provided more support. |
Cueing approach led to a greater treatment effect than recasting approach.
The success of the treatment was not related to the grammatical objective that was stimulated in the intervention. |
| Plante E, et al. 20143838. Plante E, Ogilvie T, Vance R, Aguilar J, Dailey N, Meyers C et al. Variability in the language input to children enhances learning in a treatment context. Am J Speech Lang Pathol. 2014;23(4):530-46.
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Daily 30 minutes therapy sessions, until completing 24 sessions. |
Individual therapy. |
Implicit |
The treatment consisted of reformulation in conversation.
The children were assigned one of two therapyoptions: One of high variability where 24 verbs were used in which reformulation was delivered in the conversation and one of low variability where 12 verbs were used and each reformulation given twice.
The sessions had different materials and the children selected them depending on their interest. Example: dialogic book, reading, board games, craft projects, costumes, flash cards, activitiesand free play. There were 3 activities per session.
Reformulation was defined as an issuance of the clinician which was followed by an attempt of the child that could be right or wrong. Right and the wrong were reformulated.
In both treatment conditions, clinicians created contexts in which the child should use the objective morpheme. |
The condition of high variability only produced significant changes in the use of morphemes trained in children, but not in other morphemes.
More children in the condition of high variability than in the one of low variability showed an effect ofthe treatment and on the production of expressions containing the treated morphemes. |
| Hsu HJ, et al. 20143939. Hsu HJ, Bishop D. Training understanding of reversible sentences: a study comparing language-impaired children with age-matched and grammar-matched controls. Peer J. 2014;2:e656.
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One session per day for a period between 4 and 6 days. Each session lasted between 5 and 7 minutes. |
Each child with a computer. Individual |
Explicit |
The computerized training program was based on the one used by Bishop, Adams & Rosen (2006).
The children moved some images either up / down or before / after in relation to the sentence they heard. A format similar to a game was adopted using an error-free learning procedure. If the child gave a correct answer there was a visible reward. If theyanswered incorrectly, the child had the opportunity to try again. |
Control group 1 was eliminated from the analysis because all but 1 child scored over 90% in the pretreatment.
The children to whom the program was applied, showed better performance in repeated sentences than in the sentences presented only once.
Overall, children’s scores improved with training, with the exception of the TROG-E test (receptive grammar) in which neither children with SLI nor their controls showed improvement in grammatical agreement.
The training used in the study was not enough to make the performance of children with SLI equal to a group of children with typical development of the same age. |
| Zwitserlood R, et al. 20154040. 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.
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Twice a week for 5 weeks. 10 sessions in total. 5 hours in total. |
Individual |
Explicit |
MetaTaal metalinguistic intervention approach. It uses images to represent coordination or subordination. The instruction was mostly verbal. Minor reading and writing activities were included. Conversations, photos, stories were used to elicit the children’s production. Each therapy session also had a game activity to consolidate the syntactic structures that were being stimulated. |
This study supports the evidence that grammar skills in older school-aged children with SLI can be remedied by direct intervention using a metalinguistic approach.
It is noted that 5 hours of intervention in 5 weeks, with a metalinguistic training, can contribute to the improvement of the production of relative clauses in school-age children, but not in their understanding. |
| Meyers-Denman Ch., et al. 20164141. Meyers-Denman Ch, Plante E. Dose schedule and enhanced conversational recast treatment for children with specific language impairment. Lang Speech Hear Ser. 2016;47:334-46.
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For both experimental groups the therapy was daily and lasted 30 minutes, for 5 weeks. For group 1 the 30 minutes were continued and for group 2 it was divided in 3 sessions of 10 minutes each, within 4 hours. |
Individual |
Implicit |
To determine the appropriate target morpheme, during the first three days, 4 to 6 morphemes were tested for each child. The clinicians had to cause the child to issue the morpheme 10 timesin conversation, through play. Two morphemes were selected, one of them would be treated (objective morpheme) and the other tracked but not treated (control morpheme).
The clinician rephrased the conversation with the child focused on the morpheme to be treated, performed 1 time (called simple reformulation). When performing the correct reformulation, the clinician did not ask the child to say it again or correct if they repeated the error. The dose was 24 reformulations per day (8 every 10 minutes) directed to a specific grammatical morpheme.
The clinicians were free to select the activities that seemed appropriate and entertaining for the children but had to perform at least three different activities per day with varied material. Before the reformulation the clinician had to make sure he had the child’s attention. |
Treated morphemes showed more improvement than untreated ones.
The children who received therapy under the condition of 30 continued minutes showed no difference from those who received the 30 minutes in interventions of 10 minutes each in a period of 4 hours.
Regarding long-term performance, children were assessed between 7 and 11 weeks after treatment. There were no differences in the performance of the target morpheme between groups. |
| Calder S, et al. 20174242. 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.
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10 sessions. During 5 weeks, two times per week. 45 minutes sessions. |
Individual |
Explicit |
The treatment was based on explicit grammatical intervention approaches using the Metacognitive training techniques of Shape Coding (Ebbels, 2007) which was combined with a hint hierarchy procedure, called Cueing hierarchy. |
Two of the three participantsadvanced in the standardized tests for receptive and expressive grammar.
One participant continued to improve five weeks after treatment in expressive grammar.
The findings suggest that this approach was effective. |
| Owen, M. et al. 20174343. Owen A, Fey M, Curran M. Do the hard things first: a randomized controlled trial testing the effects of exemplar selection on generalization following therapy for grammatical morphology. J Speech Lang Hear Res. 2017;60(9):2569-88.
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36 visits maximum. Ranging between 12 and 36 visits, of approximately 45 minutes each. |
Individual |
Implicit |
The treatment was based on implicit approaches. The visits included three parts: imitation of sentences, modeling and reading stories represented with toys. In a latter instance, reformulation wasused. In each of these parts the focus was verbal morphology. |
Children who began therapy with more difficult verbs hadbetter results than those who began with easier verbs. Improvement is observed both in verbs that were trained and in verbs that were not trained. |
| Owen, A. et al., 20184444. Owen A, Curran M, Larson C, Fey M. Effects of a complexity-based approach on generalization of past tense -ed and related morphemes. Lang Speech Hear Ser. 2018;49:681-93.
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36 visits maximum. Ranging between 13 and 36 visits, of approximately 45 minutes each. |
It is not specified in the article but it can be inferred that it is individual. |
Implicit |
Same treatment performed in the study by Owen et al., 2017 |
Children who started therapy with the condition of difficult verbs showed a greater improvement in the use of the «ed» morpheme for the past tense of regular verbs. This gain was observed in both language samples and structured assessments. |
| Ramírez-Santana G, et al. 20184545. 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.
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216 sessions of 40 minutes each, two times per week. |
It is not specified in the article but it can be inferred that it is individual. |
Explicit |
The program combines fictional stories with morphosyntactic activities.
In the first part (30 min), the retelling of fictional stories is sought. For this, the child is told a story with icons supporting it. Then the child is asked to retell it. The next step is telling the story without the help of icons. If the child omits information or makes mistakes, the therapist uses strategies such as questions or grammar activities in which reformulation is performed to model and correct. The materials that were used were: sheets, comics or cartoons that represent the story, different stories, icons that represent the basic categories of the narrative structure, cards and pictograms, stickers to generate stories, notebooks and pencils.
In a second part (10 min), the creation of stories is sought. Specific morphosyntax activities are conducted aimed at the adequate production of different syntactic structures. This part uses sheets containing graphic organizers or icons that include all the elements of the formal structure in sequential order and in separate squares. Grammar facilitation procedures such as modeling, reformulation, vertical structuring and imitation are delivered.
The most specific work of grammatical production involves a series of morphosyntactic activities aimed at facilitating the knowledge, understanding and production of different syntactic structures. Activities were used such as completing sentences, crossing out the incorrect words in sentences, sorting sentences presented in a disorganized manner, organizing and verbalizing sequences of actions using drawings, placing sentences on their respective balloons, organizing sentences with the help of cards and using graphic supports to associate a phrase with its drawing. For this, materials such as comics, exercise cards and card kits are used. |
The group with SLI improved compared to controls, because they reduced the number of ungrammatical sentences, which was reflected in the decrease in syntactic and morphological errors. |
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