Ebbels Susan H, Wright Lisa, Brockbank Sally, Godfrey Caroline, Harris Catherine, Leniston Hannah, Neary Kate, Nicoll Hilary, Nicoll Lucy, Scott Jackie, Marić Nataša
Moor House School & College, Oxted, UK.
Division of Psychology and Language Sciences, University College London, London, UK.
Int J Lang Commun Disord. 2017 Jul;52(4):528-539. doi: 10.1111/1460-6984.12297. Epub 2016 Nov 18.
Evidence of the effectiveness of therapy for older children with (developmental) language disorder (DLD), and particularly those with receptive language impairments, is very limited. The few existing studies have focused on particular target areas, but none has looked at a whole area of a service.
To establish whether for students with (developmental) language disorder attending a specialist school, 1:1 intervention with an SLT during one school term improves performance on targeted areas, compared with untreated control areas. Also, to investigate whether gender, receptive language status, autism spectrum disorder (ASD) status, or educational Key Stage affected their response to this intervention.
METHODS & PROCEDURES: Seventy-two students (aged 9-17 years, 88% of whom had receptive language impairments) and all speech and language therapists (SLTs) in our specialist school for children with Language Disorder, most of whom have DLD participated in this study over one school term. During this term, the SLTs devised pre- and post-therapy measures for every student for each target they planned to treat 1:1. In addition, for each target area, a control measure was devised. The targets covered a wide range of speech, language and communication areas, both receptive and expressive. Post-therapy tests were administered 'blind'.
OUTCOMES & RESULTS: During the term, SLTs and students worked 1:1 on 120 targets, the majority in the areas of expressive and receptive language. Targets and controls did not differ pre-therapy. Significant progress was seen both on targets (d = 1.33) and controls (d = 0.36), but the targeted areas improved significantly more than the controls with a large and clinically significant effect size (d = 1.06). There was no effect of language area targeted (targets improved more than their controls for all areas). Participants with versus those without receptive language difficulties, co-occurring ASD diagnosis or participants in different educational Key Stages did not differ significantly in terms of the progress they made on target areas.
CONCLUSIONS & IMPLICATIONS: Direct 1:1 intervention with an SLT can be effective for all areas of language for older children with (D)LD, regardless of their gender, receptive language or ASD status, or age. This adds to the relatively limited evidence base regarding the effectiveness of direct SLT intervention for school-aged children with (D)LD and for children with receptive language impairments. If direct 1:1 intervention can be effective with this hard-to-treat group, it may well also be effective with younger children with (D)LD. Thus, direct SLT services should be available for school-aged children with (D)LD, including older children and adolescents with pervasive difficulties.
关于（发育性）语言障碍（DLD）大龄儿童，尤其是接受性语言障碍儿童的治疗效果证据非常有限。现有的少数研究聚焦于特定目标领域，但没有一项研究考察过整个服务领域。
确定对于在特殊学校就读的（发育性）语言障碍学生，与未接受治疗的对照领域相比，在一个学期内由言语和语言治疗师（SLT）进行一对一干预是否能提高目标领域的表现。此外，调查性别、接受性语言状况、自闭症谱系障碍（ASD）状况或教育关键阶段是否会影响他们对这种干预的反应。
72名学生（年龄9 - 17岁，其中88%有接受性语言障碍）以及我们这所针对语言障碍儿童的特殊学校的所有言语和语言治疗师（大多数患有DLD）参与了这一为期一个学期的研究。在这个学期中，言语和语言治疗师为他们计划一对一治疗的每个目标为每名学生设计了治疗前和治疗后的测量方法。此外，为每个目标领域设计了一个对照测量方法。目标涵盖了广泛的言语、语言和沟通领域，包括接受性和表达性方面。治疗后的测试是“盲测”。
在这个学期里，言语和语言治疗师与学生一对一处理了120个目标，大多数在表达性和接受性语言领域。目标和对照在治疗前没有差异。在目标（d = 1.33）和对照（d = 0.36）方面都有显著进展，但目标领域的改善明显超过对照，具有较大且具有临床意义的效应量（d = 1.06）。所针对的语言领域没有影响（所有领域的目标都比其对照改善得更多）。有与没有接受性语言困难、同时患有ASD诊断的参与者或处于不同教育关键阶段的参与者在目标领域取得的进展方面没有显著差异。
由言语和语言治疗师进行直接一对一干预对于患有（发育性）语言障碍的大龄儿童的所有语言领域都可能有效，无论其性别、接受性语言或ASD状况或年龄如何。这增加了关于言语和语言治疗师直接干预对学龄期患有（发育性）语言障碍儿童以及患有接受性语言障碍儿童有效性的相对有限的证据基础。如果直接一对一干预对这个难以治疗的群体有效，那么对年龄更小的患有（发育性）语言障碍儿童可能也有效。因此，应该为学龄期患有（发育性）语言障碍的儿童，包括有广泛困难的大龄儿童和青少年提供直接的言语和语言治疗服务。
