BYU For the Benefit of the World Conference<br><br>Title: Assessing the generalization effects of a complexity-based approach for treating grammar<br><br>Summary (734/750):<br><b>Introduction</b><br>Children with language disorders represent between 7%–11% of the population (Norbury et al., 2016; Tomblin et al., 1997). Children frequently impacted by language disorders include children with developmental language disorder (DLD) and children with Down syndrome (DS; see Bishop et al., 2017). A hallmark of language disorder is a difficulty to learn and utilize grammar correctly. The ability to study and learn the gospel rests upon our ability to learn and understand language, including grammar, which is an essential framework for successful communication (Parker & Riley, 2010). As such, children with language disorders are born with circumstances that increase the difficulty with which they may learn and progress in the gospel of Jesus Christ. This study focuses on one element of health and human flourishing: the quality of a complexity-based approach to grammatical treatment as measured by generalization effects. The ultimate goal of this work is to bless the lives of God’s children by providing the best care to the most “vulnerable and disadvantaged” (Renlund, 2021).<br>Traditional approaches for treating grammatical difficulties associated with language disorder require large investments of time yet typically yield only modest improvements (Law et al., 2004; Plante et al., 2018). The Complexity Account of Treatment Efficacy (Thompson et al., 2003) suggests that training more complex grammatical targets in therapy will also cause improvements with untrained, yet related simpler grammatical structures, without the need for additional direct intervention. The complexity approach counters the idea that we must provide only small amounts of information in graduated progression to create change on treated grammatical structures. Rather, it suggests that by strategically selecting more complex treatment targets than might otherwise be selected using a traditional approach, the rich grammatical information may simultaneously foster progress with untreated grammatical structures, supporting further educational and gospel-related growth. This work is founded upon the premise that “Jesus Christ sees divine potential no matter where we start” (Gilbert, 2021) and that “our potential is unlimited” (Nelson, 1998).<br><b>Present Study</b><br>Previous work has demonstrated the efficacy of using complexity to cause grammatical change in a clinical context (Hannig Russell et al., 2024). However, it may be that this approach may also improve grammatical skills in a naturalistic context; indicative of lasting change to children’s linguistic systems. This investigation expanded on the previous study and examined (1) the extent to which targeting a complex BE question structure (e.g., <i>Is he jumping?</i>) may have generalized to the use of simpler BE structures (e.g., BE sentences: <i>He is jumping; He is happy</i>) in naturalistic contexts, and (2) the extent to which other grammatical improvements to the linguistic system were observed.<br><b>Methods</b><br>To capture the potential effects of targeting a complex BE question structure during treatment on participants’ overall linguistic systems (i.e., generalization effects), the language skills of three children with DLD (aged 5;1 to 8;2) and three children with DS (aged 7;3 to 12;8) were measured before and after treatment using the Test of Grammatical Impairment (TEGI; Rice & Wexler, 2001)—which promoted the naturalistic production on the BE verb structures measured in this study—and narrative language sampling (i.e., story-telling) which allowed for spontaneous use of and measurement of several different grammatical skills.<br><b>Results</b><br>Comparison of pre- and post-treatment scores revealed generalization to naturalistic contexts occurred for all participants, indicating the complexity-based treatment was associated with lasting improvements to the linguistic system. Specifically, all participants increased their correct productions of the treated BE verb question structure and the simpler untrained BE structures in the naturalistic contexts of the TEGI and narrative samples. Additionally, all participants demonstrated improvement with at least one other grammatical structure (e.g., asking DO questions; using past tense). Most participants also demonstrated increased length of sentences and fewer grammatical errors when producing those sentences. Qualitatively, parents of the participants reported observing these same improvements in conversational contexts at home. They also reported additional generalization effects, including improved comprehension skills and self-confidence during communication interactions.<br><b>Implications</b><br>This descriptive study provided preliminary support for associations between the use of a more complex target for grammatical treatment and generalized improvements to children’s overall linguistic systems. Future work is ongoing to expand our understanding of the complexity approach, including examining a wider range of possible generalization effects—such as comprehension skills—and an increased range of grammatical structures. Specific aims seek to determine the drivers of change associated with treatment and identify for whom this approach may be most beneficial.<br><br><br><br><br><br><br><br><br><b>References</b><br>Ayala, G. X., & Elder, J. P. (2011). Qualitative methods to ensure acceptability of behavioral and social interventions to the target population. <i>Journal of Public Health Dentistry, 71</i>, S69–S79. https://doi.org/10.1111/j.1752-7325.2011.00241.x<br>Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. <i>Nurse Education Today, 24</i>(2), 105–112. https://doi.org/10.1016/j.ned.2003.10.001<br>Gresham, F. M., & Lopez, M. F. (1996). Social validation: A unifying concept for school-based consultation research and practice. <i>School Psychology Quarterly, 11</i>(3), 204. https://doi.org/10.1037/h0088930<br>Lyons, R. Carroll, C., Gallagher, A., Merrick, R., & Tancredi, H. (2022). Understanding the perspectives of children and young people with speech, language and communication needs: How qualitative research can inform practice. <i>International Journal of Speech-Language Pathology, 24</i>(5), 547–557. https://doi.org/10.1080/17549507.2022.2038669<br>Mazaheri, M., Eriksson, L. E., Heikkilä, K., Nasrabadi, A. N., Ekman, S. L., & Sunvisson, H. (2013). Experiences of living with dementia: Qualitative content analysis of semi‐structured interviews. <i>Journal of Clinical Nursing, 22(</i>21–22), 3032–3041. https://doi.org/10.1111/jocn.12275<br>Miltenberger, R. G. (1990). Assessment of treatment acceptability. <i>Topics in Early Childhood Special Education, 10</i>(3), 24–38. https://doi.org/10.1177/027112149001000304<br>Rice, M. L., & Wexler, K. (2001). Test of early grammatical impairment. The Psychological Corporation.<br>Vaismoradi, M., Jones, J., Turunen, H., & Snelgrove, S. (2016). Theme development in qualitative content analysis and thematic analysis. <i>Journal of Nursing Education and Practice, 6</i>(5), 100–110. https://doi.org/10.5430/jnep.v6n5p100<br>Thompson, C. K., Shapiro, L. P., Kiran, S., & Sobecks, J. (2003). The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: The complexity account of treatment efficacy (CATE). <i>Journal of Speech, Language, and Hearing Research, 46</i>(3), 591–607. https://doi.org/10.1044/1092-4388(2003/047)<br>Becoming more in Christ: The parable of the slope, 2021<br>We are children of God, Russell Nelson, 1998<br><i>Renlund, Infuriating Unfairness</i>, April 2021
