ࡱ> 4( ,=/ 00DArial NarrowD8| )0Y 0X"DTimes New Roman8| )0Y 0 DComic Sans MSn8| )0Y 0XB0DArialSans MSn8| )0Y 0X" a.  @n?" dd@  @@`` hZd>D       0e0e A@A5%8c8c     ?1d0u0@Ty2 NP'p<'pA)BCD|E||S"@8-.7 uʚ;BS%ʚ;g42d2d )0ppp@ <4!d!d 0D9<4dddd 0D9?>$ *EBP Extravaganza 2008O =)/Cracking Into Language6VPaediatric Language EBP Group Leader: Brooke Funnell Brooke.Funnell@sswahs.nsw.gov.au *W5!"-  05U0Our Team 6KSCH Liverpool Auburn USYD Dubbo CHC And many new members from across SydneyLL1Clinical Question 16What techniques are effective for improving word-finding difficulties in children aged 2  12 years old? Clinical Bottom Line: Strategies in discourse such as request for associations, request for clarification, confirmation, reconstruction, and phonological cueing or at single word level such as phonological association cues and syllables, may reduce word-finding errors. hjZZhc"CCcC4Clinical Question 16References Stiegler, L.N. & Hoffman, P.R. (2001). Discourse-based intervention for word finding in children. Journal of Communication Disorders, 34, 277-303. German, D. J, (2002). A phonologically based strategy to improve word finding abilities in children. Communication Disorders Quarterly, 23:4, 179-192. German, D. and Newman, R. (June 2004). The impact of lexical factors on children s word finding errors. Journal of Speech, Language & Hearing Research, 47, 624-636. ZZ b"t!y. 7 "Implications for Clinical Practice##6There are a variety of strategies available for assisting in children with word finding difficulties. It helped to clarify for us what types of WFE there are (blocked and phonological) and then to discern which cues work for which errors 2Clinical Question 26Does the use of books and narratives increase expressive language in 2-4 year old children? Clinical Bottom Line: Training parents and teachers in using books and narratives can be effective in increasing the expressive language of 2-4 year old children in the general population.B]ZZ]"5Clinical Question 26.References Arnold, D.H., Lonigan, C.J., Whitehurst, G.J., Epstein, J.N. (1994). Accelerating language development through picture book reading: replication and extension to a videotape training format. Journal of Educational Psychology, 86(2), 235-243. Whitehurst, G.J., Falco, F.L., Lonigan, C.J., Fischel, J.E., DeBaryshe, B.D., Valdez-Menchaca, M.C., Caulfield, M. (1998). Accelerating language development through picture book reading. Developmental Psychology, 24(4), 552-559. Peterson, C., Jesso, B. & McCabe, A. (1999). Encouraging narratives in preschoolers, an intervention study. Journal of Child Language, 26, 49-67. Wasik, B.A. & Bond, M.A. (2001). Beyond the pages of a book: Interactive book reading and language development in preschool classrooms. Journal of Educational Psychology, 93(2), 243-250. $ !~! ~8 "Implications for Clinical Practice##6*Supports our knowledge that book reading assists language development in children Encourages us to train parents and teachers more explicitly on how to use books with children Beneficial for preschool projects in using books and extension activities (theme-based) to improve vocabulary development ++3Clinical Question 36What strategies facilitate word learning in children with an average age of 4;0  5;11 (2;3  8;2)? Clinical Bottom Line: Certain strategies can facilitate word learning under specific conditions. These strategies include emphatic stress, frequency of exposure, shape and function cues, phonemic cues, and a supported learning context.PeZZd"6Clinical Question 36References Kieran, B., Gray, S. (1998). Word learning in a supported-learning context by preschool children with SLI. Journal of Speech, Language, & Hearing Research, 41(1). Weismer, S. & Hesketh, L. (1998). The impact of emphatic stress on novel word learning by children with SLI. JSLHR, 41, 1444-1458. Gray, S. (2003). Word-learning by preschoolers with SLI: what predicts success? JSLHR, 46, 56-67. ZZ k/va ,9Clinical Question 36~References Alt, M., Plante, E. & Creusere, M. (2004). Semantic features in fast-mapping: Performance of preschoolers with SLI versus preschoolers with normal language. JSLHR, 47, 407-420. Riches, N.G., Tomasello, M. & Conti-Ramsden, G. (2005). Verb learning in children with SLI: Frequency and spacing effects. JSLHR, 48, 1397-1411. Gray, S. (2005). Word learning by preschoolers with SLI: Effect of phonological or semantic cues. JSLHR, 48, 1452-1467. Capone, N. & McGregor, K. (2005). The effect of semantic representation on toddler s word retrieval. JSLHR, 48, 1468-1480. Z5Z sv>  m; "Implications for Clinical Practice##6There are lots of cues and supports that we can use (and probably already are) to assist word learning. Further studies need to look at what happens when we combine some of these cues together; does it detract from or enhance word learning?: Where to from here???6Finish collating articles for CATs Clinical questions: In school aged children with SLI, is an in-class, school based model better than a withdrawl model in managing SLI in the classroom? In school aged children with SLI, is a school based treatment model an effective way of managing SLI in the classroom? In preschool children with SLI, what techniques are effective In improving children s comprehension? Increase attendance to meetings Utilise teleconferencing for our meetings Academic involvementv7ZbZ_Z7#w#e#_,g e< ZThank you for everyone s contribution in 2007..6UContact: Brooke Funnell Liverpool Hospital 9828 4776 Brooke.Funnell@sswahs.nsw.gov.au(V5 b$/>?@ABCDEF ` f3"V+Nf` ff3f|` www333www` 3f3f3f` /.fRP̙` f"ffH>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> ( (  T   "  H",$D 0$   BCPE(F"2@ 8ApP XP@  `"@   n0e0e  ?BCE<F&2@5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E?||FP P  - ffFF@    `"\   BCETF.@' EuOE[: :Pf@      `"   0e0e  ?BCE`F2@5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E?||hD[Drmq>uJ^_! BE@       `"$  S BhC! E<F&@! v" bN'\h4ht-2.#; [! ! @    `"    0e0e  ?BCETF.@5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E?||$ )  _s0|d T A% :$@      `"y    r0e0e  ?BdCHEHF*@5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E?||A @<PdT H"k=_ E;W@     `"Y  s *o "P  T Click to edit Master title style! !  s * t "``  D* 2  s *x "`   F*(2  s *0| "`   F*(2$  0 "  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     Sr  Z2޽h))?? f3"V+Nf RibbonsC  @Y(  T   "  H",$D 0$   BCPE(F"2@ 8ApP XP@  `"@   n0e0e  ?BCE<F&2@5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E?||FP P  - ffFF@    `"\   BCETF.@' EuOE[: :Pf@      `"   0e0e  ?BCE`F2@5%8c8c     ?1d0u0@Ty2 NP'p<'p @A)BCD|E?||hD[Drmq>uJ^_! BE@       `"$  S BhC! E<F&@ ! v" bN'\h4ht-2.#; [! ! @    `"    0e0e  ?BCETF.@5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E?||$ )  _s0|d T A% :$@      `"y    r0e0e  ?BdCHEHF*@5%8c8c     ?1d0u0@Ty2 NP'p<'p @A)BCD|E?||A @<PdT H"k=_ E;W@     `"Y  s *tp "p  T Click to edit Master title style! !  c $DO " `    W#Click to edit Master subtitle style$ $  6P{ "``  B*  6 ż "`   D*  6 "`   D*r  Z2޽h))? ? f3"V+Nf 0 p(    0<* P    T*    0x.     V*  d  c $ ?    0   @  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  6 `P   T*    6@ `   V*  H  0޽h ? ̙33 LH(  L L 0 P    B*  L 0X     D*  L 6 `P   B*  L 6 `   D* H L 0޽h ? ̙33 0*(  x  c $ p  r  S p      H  0޽h ? :XZI7ml̙  P$(  r  S  P   r  S   H  0޽h ? f3"V+Nf<   |(    S L P<$D 0     S M<$  0  H  0޽h ? f3"V+Nf  $(  r  S O P   r  S w  H  0޽h ? f3"V+Nf<  $|(  $ $ S s  P<$D 0    $ S k<$  0  H $ 0޽h ? f3"V+Nf<  |(    S  P<$D 0     S H<$  0  H  0޽h ? f3"V+Nf  $(  r  S     r  S L  H  0޽h ? f3"V+NfH  ((  ( ( c $:  P<$D 0    ( c $@<$  0  H ( 0޽h ? f3"V+Nf<    |(      S  <$D 0      S p0P<$  0  H   0޽h ? f3"V+Nf  @$(  r  S  P   r  S L  H  0޽h ? f3"V+Nf  `$(  r  S      r  S   H  0޽h ? f3"V+NfH  p,(  , , c $,  P<$D 0    , c $<$  0  H , 0޽h ? f3"V+Nf<   |(      S  p<$D 0      S ܒ<$ 0  H   0޽h ? f3"V+Nf 4$(  4r 4 S X* 0p  r 4 S +  P`   H 4 0޽h ? f3"V+Nf  0 x p 8 (  8X 8 C    p  8 S 8Z @   nAs you can see, our question involves a very broad age group but with only 4 articles, we couldn t narrow the age groups down otherwise we d end up with one article per age group. We re sure there are more articles as it is an area that s growing in its research base but we had difficulty accessing them. Why did we choose to look at WFD? WFDs impact on functional communication in a range of contexts so we wanted to start looking at the efficacy of different strategies in treating WFDs. Request for associations, Request for clarification, Confirmation, Reconstruction, Phonological cueing  were used by steigler et al as online feedback to assist the subjects in realising a communication breakdown had occurred and to systematically assist the subject through the word finding process. Phonological association cues  used when blocked errors are likely to teach words from sparse lexical neighbourhoods (German et al 04) Linking syllables to mneumonic cues  used when phonological errors are likely to teach words from sparse lexical neighbourhoods (German et al 04) (I8PVy L vH 8 0޽h ? ̙33  0   <V (  <X < C     < S   @   XSteigler  more evidence required but it implied that discourse-based intervention is a possible way of treating WFD in children. They used picture-elicited narrative, story re-telling narrative, and conversation on a familiar topic and all 3 subjects produced fewer overt word finding behaviours. Also found longer more complex communication units were associated with significantly higher levels of linguistic non fluency including overt word finding difficulties. German (2002)  children that make phonemic word-finidng errors found strategies comprising of syllabification, pairing the target words with phonemic neighbour cue words and rehearsal, effective in establishing and generalising specific vocabulary. German et al (2004)  found that children with word finding difficulties make more errors on naming target words from sparse lexical neighbourhoods and which are lower frequency words. They also found that blocked and phonological errors are influenced by word frequency, age of acquisition and lexical neighbourhood.$ H < 0޽h ? ̙33,  0 @|(  @X @ C     @ S  @   ~6The Arnold and Whitehurst articles looked not only at using books to stimulate language but the Arnold article also examined face to face training versus video training. They found that shared book reading is effective in improving the expressive language skills in 2-3 year olds and that surprisingly, video-training was more effective (though this was in middle high SES families and the children s language was initially average to above average). The peterson article was quite robust and well written article, and a level 2 to boot!! (we don t get many of those). It found that training parents to use narrative elicitation techniques are effective in improving the vocabulary and narrative skills of children from low SES Wasik et al also found that training teacher in the use of books and language extension activities at preschool to teach vocabulary can increase vocabulary development in low SES 4 year olds., H @ 0޽h ? ̙33 0 0D@(  DX D C     D S  @   B Again, this clinical question is has a broad age range and we couldn t pin it to one age population such as preschoolers, toddlers etc. Most of the subjects in the articles fell in the preschool age group though. And we found each article seemed to be looking at a different age group and cue rather than multiple articles on one type of cue or one specific population. We re sure there are more articles out there, particularly by Gray that could fall under this question. This question evolved from our original question of  In preschool children, what techniques are effective for improving lexical difficulties?  as you can see, quite broad. Children with SLI not only have trouble accessing their lexical systems, but also have difficulty learning new words. So from this we felt it would be useful to know which strategies can be effective in facilitating word learning in this population.H D 0޽h ? ̙33 0 NF`P(  PX P C    F P S |5 @   But sadly lost our wonderful Linda So as a bit of a background. Over the last 2 years we have been steadily working through articles looking at word finding errors, intervention for 4 year olds with SLI and strategies for assisting children with lexical difficulties. We had designed clinical questions but when it came time to putting together the CATs we realised there was just too much variability amongst the articles. So we looked at all the articles again and grouped the ones that were looking at similar areas and then rewrote a clinical question around them. Not quite how it s supposed to be done but at least we have a group of articles answering a specific clinical question. So what were these questions???_rH P 0޽h ? ̙33v  0 6.T(  TX T C    . T S  @   Unfortunately the articles didn t use large cohorts and they were spread across age rangesH T 0޽h ? ̙33 0 Xb(  XX X C     X S  @   dPThis question evolved through our investigations of strategies for lexical difficulties in 4 year olds. But when we started grouping our capped articles we realised that shared book reading is one of those basic strategies recommended to parents and teachers to stimulate language and improve vocabulary for our preschoolers. Not only this but we often encourage parents to become involved in their child s treatment and train them in strategies for assisting their children at home, but maybe not in a formal training format. And working in the public system, we are always trying to find more efficient and effective methods of providing a service to our growing populations.H X 0޽h ? ̙33 0 P\(  \X \ C     \ S p @    H \ 0޽h ? ̙33>  0 `(  `X ` C     ` S ( @   ZThere s too many articles to go through them in detail but basically there are whole range of cues that can be used to assist children with word learning. We know that children with language impairments are often more visual learners than auditory so visual cues such as gesture (shape and function cues from Gray) are likely to assist. Weismer looked at using emphatic stress to assist word learning and there are other researchers and clinicians in the field who are starting to think about the benefits of keeping function words in sentences and emphasising the key words rather than only use key words. What would be nice to look at is what happens when we combine these cues. 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