The goal of this proposal is to examine the efficacy of a manualized treatment intervention, AMALS: Addressing Multiple Aspects of Language Simultaneously, which is designed to remediate semantic, morphological, and syntactic aspects of language in preschool children with language impairment. A randomized clinical trial (RCT) will be conducted comparing an integrated approach to treatment, AMALS, with an additive approach to therapy, Discrete Trial Approach (DTA). This study will target preschool children with language impairment living in a region characterized by nonmainstream dialects. It is expected children participating in AMALS treatment will exhibit greater semantic, morphological, and syntactic complexity on multiple outcome measures at the completion of the intervention compared to the DTA group, and that these gains will be maintained at one-month follow up. Language sample analysis will be used to measure changes in semantic, syntactic, and morphological abilities as well as classify dialect type and rate. Results will answer questions regarding treatment efficacy and the impact of dialect on variables of interest, specifically morphosyntactic abilities. This goal is critical because the vast majority of interventions for language impairment, including AMALS, have been tested using small-N and single case designs. Results from such studies, though informative and suggestive, require extensive replication to support treatment efficacy and generalizability. Although evidence suggests treatments such as AMALS hold great promise, it is now imperative that such treatments be evaluated using RCT in targeted populations. Further, children from diverse populations have been underrepresented in the literature due to methodological constraints. In this study, rather than restrict the ethnic and cultural backgrounds of this population, children's use of dialect will be uniquely identified and examined. Classifying dialect type and rate distinguishes this proposal from other RCTs targeting preschool children with language impairment. Examination of dialect type and rate will have significant implications regarding interpretation and generalization of findings, thus increasing the innovative nature of this study.
Addressing needs in children with disabilities in regions speaking nonmainstream dialects meets a primary goal of Healthy People 2010, which is to reduce health disparities across different segments of the population. Further this proposal meets focus area goal 6, which is to promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities. Addressing treatment efficacy in preschool children increases their health, increases their ability to perform within school communities, and prevents future difficulties.
