###### Abstract  
The adoption of tablets by young children has raised enthusiasm and concern among speech and language pathologists. This study investigated whether tablet games can be used as effectively as real play objects in vocabulary intervention for children with developmental language disorder (DLD). A randomized, controlled non-inferiority trial was conducted with 70 3-year-old children with DLD. The novel intervention group (\(n=35\)) received 12 10-min scripted intervention sessions with symbolic play using a tablet game spread out over 8-9 weeks. The standard intervention group (\(n=35\)) received the same amount of intervention with real objects using the same vocabulary scripts. In each session, children were exposed to 22 target words. The primary outcome was the number of new target words learned. This was measured using a picture selection task including 22 target words and 22 control words at 3 time intervals: before the intervention, immediately post-intervention, and 5 weeks later. In both intervention groups, the children learned significantly more target words than control words. No significant differences in gains between the two intervention conditions were found. This study provides evidence that vocabulary intervention for toddlers with DLD using a tablet game is equally as effective as an intervention using real objects. vocabulary intervention; DLD; tablet gaming; speech and language therapy; RCT design 2020 December 20211 February 20220201 February 202201 February 2020201 February 2020201 February 2020201 February 2020201 February 2020201 February 2020201 February 2020201 February 2020201 February 2020201 February 2020201 February 2020201 February 202020201 February 202020201 February 20  
Interactive devices such as tablets have very rapidly found their way into today's families and are among the most frequently used mobile devices among children. A report from Common Sense Media [6] showed that 98% of homes in the United States with children under the age of 8 years had at least 1 mobile device such as a tablet, smartphone, e-reader, or gaming console. [PERSON] et al. [7] used the same Common Sense survey for a study on 0-4-year-old children from low-income families. The study revealed that almost all children (96.6%) used mobile devices, and most started using them before the age of 1 year. At 2 years old, most children used a device daily and spent comparable screen time on television and mobile devices. Most 3- and 4-year-olds used devices without help, and one third engaged in media multitasking [7]. A more recent study reported that 85% of Dutch children in primary education play video games on portable media, with 38% playing games daily and boys doing so more than girls [5]. The advantages of tablets with touch screens over traditional personal computers are their multisensory character and more direct interaction with the user ([PERSON] et al., 2019). Moreover, tablets are handy devices because they are flat and lightweight with built-in audio and video, which makes them easy to handle and employ in an interactive therapy setting with children. Learning via these devices can be very motivating for children, and there is growing evidence that they can be beneficial to the acquisition of language and literacy in kindergarten and preschool children and support storybook comprehension in 2- and 3-year olds [8; 9]. The almost universal adoption of interactive tablets by children and their potential to support learning have resulted in an increasing interest in using tablets and games in speech and language therapy. The Dutch SLPs we consulted to validate our research question recognize that for most children, gaming is fun, and it would be interesting to see if games can be added to the set of therapy materials in a meaningful way. However, they had mixed feelings and also expressed concerns that tablet games restrict the use of language-facilitating techniques and language interaction between the SLP and child and that tablet games might be too distracting.