McKean Cristina, Jack Christine, Pert Sean, Letts Carolyn, Stringer Helen, Masidlover Mark, Trebacz Anastasia, Rush Robert, Armstrong Emily, Conn Kate, Sandham Jenny, Ashton Elaine, Rose Naomi
Speech and Language Sciences, Newcastle University, Newcastle upon Tyne, UK.
Department of Education, University of Oxford, Oxford, UK.
Int J Lang Commun Disord. 2025 May-Jun;60(3):e70036. doi: 10.1111/1460-6984.70036.
Children's language abilities set the stage for their education, psychosocial development and life chances across the life course.
To compare the efficacy of two preschool language interventions delivered with low dosages in early years settings (EYS): Building Early Sentences Therapy (BEST) and an Adapted Derbyshire Language Scheme (A-DLS). The former is informed by usage-based linguistic theory, the latter by typical language developmental patterns.
We conducted a pre-registered cluster randomized controlled trial in 20 EYS randomized to receive BEST or A-DLS. Children aged 3;05-4;05, who were monolingual, with comprehension and/or production scores ≤ 16th centile (New Reynell Developmental Language Scales-NRDLS) and no sensorineural hearing impairment, severe visual impairment or learning disability were eligible. A total of 102 children received the intervention. Speech and language therapists delivered interventions with high fidelity in 15-min group sessions twice weekly for 8 weeks. Baseline (T1), outcome (T2), and follow-up (T3) measures were completed blind to the intervention arm. Outcomes were NRDLS comprehension and production standard scores (SS), measures of language structures targeted in the interventions and communicative participation (FOCUS-34).
Both interventions were associated with significant change from T1 to T2 and from T1 to T3 in all outcomes. There were no differences between interventions in gains in NRDLS comprehension SS at T2 or T3. BEST produced greater gains in NRDLS production SS between T1-T2 (d = 0.40) and T1-T3 (d = 0.55) and in BEST-targeted sentences (d = 0.77). Children receiving BEST made significantly more progress after intervention (T2-T3) in both comprehension and production. Both interventions were associated with large, clinically significant changes in communicative participation as measured by teacher reports (FOCUS-34).
A low-dosage intervention can produce language gains with moderate to large effects. The accelerated progress after the BEST intervention underscores the significant potential of interventions designed with reference to usage-based theory, which precisely manipulates language exposure to promote the specific cognitive mechanisms hypothesized to promote language learning.
What is already known on the subject Early language development sets the stage for children's educational and psychosocial development and their life chances into adulthood. Early language interventions can be effective; however, there is a need to develop and evaluate early interventions which bring large effects and which can be delivered within the constrained resources of early years provision. Usage-based linguistics have not been explicitly applied to the design of early language interventions. There is evidence that the Derbyshire Language Scheme (DLS) promotes positive outcomes in comprehension abilities and BEST in production. What this paper adds to the existing knowledge Findings from a cluster-randomized controlled trial demonstrate that BEST, an 8-week, 15-min, small-group intervention, delivered twice weekly can produce moderate to high effects in expressive language outcomes for 3-4-year-old children with low language. A-DLS and BEST bring similar gains in comprehension standard scores but BEST leads to larger and more sustained progress in expression. Faster progress after intervention for BEST supports the hypothesis that it promotes the development of abstract representations of predicate-argument structures, supporting generalization and accelerating language learning. What are the potential or actual clinical implications of this work? BEST, a low-dosage, manualized intervention delivered with high fidelity can be effective for children from a range of socio-economic backgrounds bringing moderate to high effects. Effective and efficient intervention can be delivered through the precise manipulation of active ingredients within intervention sessions (in this case, the cognitive mechanisms hypothesized to promote language learning and abstract knowledge in usage-based theory).
儿童的语言能力为他们一生的教育、心理社会发展和生活机遇奠定了基础。
比较在早期教育环境（EYS）中低剂量实施的两种学前语言干预措施的效果：构建早期句子疗法（BEST）和改编的德比郡语言方案（A-DLS）。前者以基于使用的语言理论为依据，后者以典型的语言发展模式为依据。
我们在20个早期教育环境中进行了一项预先注册的整群随机对照试验，随机分配接受BEST或A-DLS。年龄在3;05 - 4;05岁之间、单语、理解和/或表达分数≤第16百分位（新雷内尔发育性语言量表-NRDLS）且无感觉神经性听力障碍、严重视力障碍或学习障碍的儿童符合条件。共有102名儿童接受了干预。言语和语言治疗师在每周两次、每次15分钟的小组课程中高保真地实施干预，为期8周。基线（T1）、结果（T2）和随访（T3）测量在对干预组不知情的情况下完成。结果指标为NRDLS理解和表达标准分数（SS）、干预中针对的语言结构测量以及沟通参与度（FOCUS-34）。
两种干预措施在所有结果指标上均与从T1到T2以及从T1到T3的显著变化相关。在T2或T3时，干预措施在NRDLS理解标准分数的提高方面没有差异。BEST在T1 - T2（d = 0.40）和T1 - T3（d = 0.55）以及在BEST针对的句子方面（d = 0.77）在NRDLS表达标准分数上有更大的提高。接受BEST干预的儿童在干预后（T2 - T3）在理解和表达方面都取得了显著更大的进步。根据教师报告（FOCUS-34）测量，两种干预措施在沟通参与度方面都带来了巨大的、具有临床意义的变化。
低剂量干预可以产生中等至较大效果的语言提升。BEST干预后加速的进步凸显了参考基于使用的理论设计的干预措施的巨大潜力，该理论精确地控制语言接触，以促进假设的促进语言学习的特定认知机制。
关于该主题已有的知识 早期语言发展为儿童的教育和心理社会发展以及他们成年后的生活机遇奠定了基础。早期语言干预可以是有效的；然而，需要开发和评估能够带来巨大效果且能在早期教育有限资源范围内实施的早期干预措施。基于使用的语言学尚未明确应用于早期语言干预的设计。有证据表明德比郡语言方案（DLS）在理解能力方面促进了积极结果，而BEST在表达方面有促进作用。本文对现有知识的补充 一项整群随机对照试验的结果表明，BEST，一种为期8周、每周两次、每次15分钟的小组干预措施，对语言能力较低的3 - 4岁儿童的表达性语言结果可以产生中等至高的效果。A-DLS和BEST在理解标准分数方面带来了相似的提升，但BEST在表达方面带来了更大且更持续的进步。BEST干预后更快的进步支持了这样的假设，即它促进了谓词-论元结构抽象表征的发展，支持泛化并加速语言学习。这项工作的潜在或实际临床意义是什么？BEST，一种高保真实施的低剂量手册化干预措施，对来自不同社会经济背景的儿童可能是有效的，能带来中等至高的效果。可以通过在干预课程中精确操纵有效成分（在这种情况下，是基于使用的理论中假设的促进语言学习和抽象知识的认知机制）来实施有效且高效的干预。
