A month-long intervention improves children’s communication skills—and provides valuable experience to Sargent graduate students. Photo by Michael D. Spencer

Many children with language impairment fail to make progress over the summer months without the support of clinicians and teachers, and as a result are even further behind their typically developing peers when they return to school in the fall. But some preschoolers with language disorders are leaping forward during the break, thanks to an intensive program offered at Sargent.

Michelle Mentis, chair of the speech, language, and hearing sciences program
Michelle Mentis, chair of the speech, language, and hearing sciences program. Photo by Chitose Suzuki

The four-week intervention—designed by faculty and delivered by graduate students in the speech-language pathology program—improves children’s communication skills through individual and group therapy sessions that are based around stories, games, and play. It also provides a training experience for graduate students interested in working with preschoolers and allows researchers to study the effectiveness of intensive therapy for young children, says Michelle Mentis, a clinical professor who helped design and launch the intervention in 2015. An expert in pediatric language disorders, Mentis and her colleagues, Kerry Howland (MED’09) and Meghan Graham, are compiling data on children’s progress in the program for eventual publication and have presented its treatment strategies at several national conferences.

Each spring, Mentis, chair of the speech, language, and hearing sciences department, and her colleagues review applications for their summer program and select six participants (children ages 3 to 5) who are all working on similar language goals. “Children with developmental language disorders tend to have their greatest difficulties in the areas of syntax and storytelling, so we focus heavily on both of those areas,” says Howland, a clinical assistant professor and program cofounder who specializes in pediatric language and reading disorders.

children at play
Photo by Michael D. Spencer

“Every moment of the two and a half hours that the child is with us, we’re building language skills.”

—Kerry Howland

Children with language disorders struggle to form clear sentences to express their thoughts and feelings and often have difficulty understanding what others say. Language disorders are fairly common and can occur in isolation or in conjunction with other diagnoses, such as autism or attention deficit disorder. Because language disorders can affect the way children learn and socialize, says Mentis, it’s important to intervene as early as possible. Common goals for those attending the Sargent summer program include extending noun and prepositional phrases (from “car” to “the blue car” to “the blue car in the street”), extending verb phrases (from “car stop” to “car is stopping”), and telling multipart stories in proper sequence.

The children attend the program on the Boston University campus for two and a half hours a day, four days a week, for four weeks in July. Four graduate students lead them through their daily routines, beginning with circle time, where all the children hear a story and join in full-group activities. After a snack, they move on to individual and small-group activities and then finish with quiet play and a review of the day’s concepts.

While this may sound like a typical morning of preschool, says Howland, director of clinical education for the master’s in speech-language pathology program, it’s much more. “Every moment of the two and a half hours that the child is with us, we’re building language skills,” she says. “There is essentially no downtime in terms of language facilitation and continual focus on the children’s goals.”

If the day’s circle-time story is The Very Busy Spider by Eric Carle, for example, the clinicians use the repetitive storyline to help children recognize elements of a narrative and practice specific syntactic structures. In the story, a series of animals ask a spider to join in an activity, but the spider doesn’t answer because she’s spinning a web. As a clinician reads, she might ask the children to hold up a special “character” icon each time a new character enters the story. Children with language disorders may not intuitively understand narrative concepts, such as setting and character, and their own storytelling improves once they learn these underlying structures, says Graham, a clinical assistant professor who helped create the preschool program and serves as its lead clinician and supervisor.

The children might then reenact the story using toy animals. As each animal speaks, the clinician asks, “Why doesn’t the spider answer?” A child responds, “Because she was busy spinning her web.”

The word “because” is known as a causal conjunction, says Graham. “Causals are really important in the preschool years, and most of our kids don’t have a grasp of these forms,” she says, “so we reiterate them a lot.” The clinicians repeatedly model the phrases for the children, and then they find multiple ways to elicit the phrases from the children.

The spider story is also useful for identifying story settings (“Where does the pig want to roll?”) and for practicing prepositional phrases (“In the mud!”).

Most children don’t need this much repetition and instruction to learn language. For reasons not fully understood, says Mentis, children with language disorders require much more input than their typically developing peers. “These children need the language they hear to be made more salient for them, presented in a form that they can access and learn from, and at a sufficiently high density and frequency that they can infer the underlying patterns,” she says.

“There is essentially no downtime in terms of language facilitation and continual focus on the children’s goals.”

—Kerry Howland

At Sargent, this input is delivered while children are listening to and telling stories, playing games, eating snacks, and doing other typical preschool activities. This approach—teaching language skills in contexts that are meaningful for the children—makes the program so effective, says Howland. “If you try to do discrete, drill-type activities, devoid of actual communication, the children don’t make the same kind of progress,” she says. “They might learn to memorize what they’re supposed to say, but they don’t use that language functionally in real-life interactions.”

The program’s intensity—40 hours of therapy in just one month—and its combination of group therapy with highly focused individual therapy are also keys to its success, says Mentis. But she agrees with Howland that the program’s teaching methods are what make it work—and what make its results repeatable, even for clinicians who can’t offer daily intervention. “We are embedding very specific language facilitation and language elicitation strategies into functional, meaningful, communicative contexts,” Mentis says. Any therapist can do that, she says, “even if you’re seeing a kid individually, for one hour a week.”

Parents can use the methods at home, too. Sargent’s program includes a weekly 30-minute workshop for them; they are also invited to observe the daily sessions through two-way mirrors. Many parents naturally begin carrying over those methods at home, says Howland, embedding language practice into play, stories, meals, baths, and other everyday activities.

To set goals and measure progress, clinicians conduct detailed evaluations of each child before, during, and after the program. With just six children enrolled each year, the data set is small, says Mentis, “but the bottom line is, we’ve seen very impressive results.” Children show, for example, increases in utterance length, greater use of complex sentences, and the ability to tell more detailed stories that include more elements.

The program also provides a unique growth opportunity for Sargent graduate students. “Very seldom will students get the chance in their clinical placements to work as intensively as they do in this program,” says Howland. “That art of embedding everything into play—and yet being very productive in their sessions—is challenging. And we see enormous growth over four weeks in their clinical skills.”

The clinical placement allows students like Kara Sheftic (Sargent’18, Sargent’19) to work with children—as well as prepare daily lesson plans and progress notes—in a group setting for the first time, and to develop close relationships with children during individual sessions. “That’s what I learned the most from it—how to make it fun and how to help at the same time,” says Sheftic.

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