Clinical trial NCT06866223: Emergent Bilinguals: Child Language Proficiency and Language of Treatment
Official title: Emergent Bilinguals: the Relationship Between Child Language Proficiency and Language of Treatment on the Outcomes Children with Developmental Language Disorder
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Developmental Language Disorder
Language Impairment
Lead sponsor: University of Houston
Sponsor class: OTHER
Collaborators: name: National Institute on Deafness and Other Communication Disorders (NIDCD)
name: University of Delaware
First posted: 2025-03-10
Enrollment: 40
Sex: ALL
Minimum age (years): 4
Maximum age (years): 6
Standard ages: CHILD
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: Participants will be randomly assigned to one of two conditions: monolingual recast therapy delivered in English or Spanish, and interleaved therpay (bilingual therapy) Schools are randomly assigned to first treatment target (conditional adverbial clause; complement clause). The investigators use a cross-over design such that all children eventually receive treatment for all targets. Pretesting will be completed for both targets in both languages. Children will be stratified based on bilingual proficiency (Spanish-dominant (receptive English or simple sentences in English), English-dominant, Balanced) and randomly assigned to language of intervention. Children will receive 16 hours of recast therapy. After, both structures will be tested in both languages again. Then, treatment target will switch and children will receive an additional 16 hours of treatment for the second structure. At post-test, both structures will be tested in both languages.
Primary purpose: TREATMENT

Brief summary: Of the 12 million children in the USA growing up bilingual, about 1 million experience Developmental Language Disorder (DLD), a disorder in language learning and use. Currently there is no guidance for speech language pathologists (SLPs) as to the language of intervention for emergent Spanish-English bilingual children with DLD. This project will examine the relationship between language proficiency and the language of intervention, considering monolingual intervention (Spanish or English) and interleaved Spanish-English intervention with the goal of improving language outcomes and thereby strengthening long-term academic achievement

Detailed description: More than 8.5 million children in the USA speak Spanish at home (U.S. Census Table S1601, 2020) with about a half million experiencing Developmental Language Disorder (DLD), a disorder in language learning and use not attributed to limited language exposure, autism, intellectual disability, etc. (Norbury et al., 2016). Bilingual children with DLD experience language-learning difficulties in both languages, including documented difficulty with complex syntax (Gutiérrez-Clellen, 1998; Jasso et al., under review). While it is self-evident that a monolingual child should be treated in their first language, currently there is no guidance for speech-language pathologists as to the language of intervention for bilingual children (Kohnert, et al., 2005). This is exacerbated by the fact that DLD varies in severity and bilingualism exists across a continuum, ranging from nearly monolingual in either language A or B to balanced bilingualism with good fluency in both languages. Furthermore, children who enter school with only limited proficiency in the majority language (e.g., English) rapidly become more proficient. This continuum is exemplified in our data. Recast therapy, an evidence-based intervention for grammatical difficulties (Cleave et al., 2015), is thought to work via mechanisms similar to priming (Leonard, 2011). Critically, cross-linguistic priming in bilingual children depends on proficiency (Vasilyeva et al., 2010) suggesting a need to align recast therapy with the child's proficiency profile (Gutiérrez-Clellen et al., 2012).

Eligibility criteria: Inclusion Criteria:

1. parent concerns and/or a history of receiving services in the public schools
2. age-specific cutoffs for the morphosyntax subtests for their best language (English or Spanish) on the Bilingual English Spanish Assessment. The cut-off score for best language for 4-year-olds is 84, for 5-year-olds is 85, and for 6-year-olds is 81.

   Using the best-language approach, these scores have a sensitivity over 90% and specificity over 80% for children between 4;0 and 6;11 years of age , which is considered acceptable for studies of diagnostic accuracy.
3. nonverbal IQ, as measured by the Kaufman Brief Intelligence Test-2, matrices subtest, will be at or above a standard score of 70.
4. pass a hearing screening test
5. participants must be emergent bilingual, that is children must be producing at least simple sentences in spontaneous speech in either Spanish or English and be exposed to both langauges
6. participants must be able to benefit from treatment for both conditional adverbial clauses and complement clauses, as evidenced by accuracy below 40% on 10-item elicited production probes in both languages

Exclusion Criteria:

1) children with significant sensory-motor concerns or psychiatric disorders per parent report will not be enrolled.

Primary outcomes:
measure: Accuracy on elicited production probes (conditional or nominal)
timeFrame: ~1 month before (Pre), 2 weeks before second structure (Mid) and 2 weeks after treatment (Post test)]
Secondary outcomes:
measure: Mean Length of Utterance and Subordination Index in English
timeFrame: ~1 month before (Pre), 2 weeks before second structure (Mid) and 2 weeks after treatment (Post test)]
Other outcomes:
Locations:
city: Houston
country: United States
facility: University of Houston
state: Texas
Study officials:
References: