JSLHR

Research Article

Monolingual or Bilingual Intervention for Primary Language Impairment? A Randomized Control Trial Elin Thordardottir,a,b Geneviève Cloutier,a Suzanne Ménard,c Elaine Pelland-Blais,d and Susan Rvachewa

Purpose: This study investigated the clinical effectiveness of monolingual versus bilingual language intervention, the latter involving speech-language pathologist–parent collaboration. The study focuses on methods that are currently being recommended and that are feasible within current clinical contexts. Method: Bilingual children with primary language impairment who speak a minority language as their home language and French as their second (n = 29, mean age = 5 years) were randomly assigned to monolingual treatment, bilingual treatment, and no-treatment (delayed-treatment) conditions. Sixteen sessions of individual language intervention were offered, targeting vocabulary and syntactic skills in French only or bilingually, through parent collaboration during the clinical sessions. Language evaluations were conducted before and after treatment by blinded examiners; these evaluations targeted French as well as the home languages. An additional evaluation was conducted 2 months after completion of treatment to assess maintenance of gains.

Both monolingual and bilingual treatment followed a focused stimulation approach. Results: Results in French showed a significant treatment effect for vocabulary but no difference between treatment conditions. Gains were made in syntax, but these gains could not be attributed to treatment given that treatment groups did not improve more than the control group. Home language probes did not suggest that the therapy had resulted in gains in the home language. Conclusions: The intervention used in this study is in line with current recommendations of major speech-language pathology organizations. However, the findings indicate that the bilingual treatment created through collaboration with parents was not effective in creating a sufficiently intense bilingual context to make it significantly different from the monolingual treatment. Further studies are needed to assess the gains associated with clinical modifications made for bilingual children and to search for effective ways to accommodate their unique needs.

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recommend in their position statements that bilingual children be given some form of treatment that targets both languages, or at least the stronger language, even if that is not the language of the surrounding community (American Speech-Language-Hearing Association [ASHA], 1985; Crago & Westernoff, 1997; Fredman, 2006). These recommendations recognize the fact that bilingual children’s language knowledge and communicative needs encompass both of their languages. In a survey of actual practices in 10 member countries of the International Association of Logopedics and Phoniatrics (IALP), it was revealed that in spite of these recommendations, the great majority (more than 80%) of bilingual children are offered monolingual treatment in the majority language of the community in which they live (Jordaan, 2008). The main reason cited was the lack of bilingual therapists and lack of resources to implement other recommendations such as working with interpreters. The gap between recommended and actual clinical practices thus appears to be particularly large for bilingual children;

ne of the first questions that arises in the clinical intervention of bilingual children who have language impairment is in which language they should be treated. The American, Canadian, and international associations of speech-language pathologists (SLPs) a

McGill University, Montréal, Québec, Canada Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) c Jewish Rehabilitation Hospital, Laval, Québec, Canada d Montréal Children’s Hospital, Montréal, Québec, Canada b

Correspondence to Elin Thordardottir: [email protected] Geneviève Cloutier is now with Cause and Effect Early Intervention Services, Calgary, Alberta, Canada. Suzanne Menard is now with McGill University, Montréal, Québec, Canada. Elaine Pelland-Blais is no longer with the Montréal Children’s Hospital. Editor: Rhea Paul Associate Editor: Margarita Kaushanskaya Received October 9, 2013 Revision received March 25, 2014 Accepted September 24, 2014 DOI: 10.1044/2014_JSLHR-L-13-0277

Disclosure: The authors have declared that no competing interests existed at the time of publication.

Journal of Speech, Language, and Hearing Research • Vol. 58 • 287–300 • April 2015 • Copyright © 2015 American Speech-Language-Hearing Association

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ethical implications have been discussed, for example, by Stow and Dodd (2003). To help resolve this situation, more research is urgently needed, including efficacy studies investigating ideal methods of intervention as well as studies of the effectiveness of actual current practices—interventions that can realistically be implemented in clinics at this time. This study is of the latter type. The most obvious advantage of bilingual intervention, theoretically, is that it targets both languages. Targeting the stronger language allows therapy to build on and extend the child’s highest linguistic attainment. Working on the weaker language is not recommended but is most often implemented (see further discussion in Elin Thordardottir, 2010). However, beyond theoretical support for bilingual intervention, little published evidence has been available on language intervention for bilingual children. A recent review revealed that available studies were few in number, targeted few subjects, and had low levels of experimental controls (Elin Thordardottir, 2010). The conclusion of this review of studies focusing mainly on preschool-age children was that no study suggested that monolingual treatment was superior to bilingual treatment, whereas some studies suggested that bilingual intervention was superior to a monolingual intervention in that (a) it promoted gains in both languages (Tsybina & Eriks-Brophy, 2010) and/or (b) the second language (L2) learning was more efficient when the home language (L1) was included in therapy (Perozzi & Sanchez, 1992; Elin Thordardottir, Weismer, & Smith, 1997). Two larger-scale group studies that were not available when this study was conducted constitute an important addition to this literature. Restrepo, Morgan, and Thompson (2013) compared monolingual and bilingual vocabulary instruction for more than 200 preschool children enrolled in Head Start programs, with random assignment to therapy conditions; this comparison included a no-treatment group. Children in an English-only condition made significant gains in English, whereas children in a condition with both Spanish and English sessions made significant gains in both languages. In fact, English gains were comparable in the two treatment conditions. Ebert, Kohnert, Pham, Disher, and Payesteh (2014) conducted a study of school-age children in which they compared a treatment focusing on nonlinguistic cognitive processing, English-only language treatment, and a bilingual language treatment focusing primarily on Spanish and secondarily on English. Significant gains were made on target skills in all treatments; the greatest language gains occurred in treatments that targeted language skills. These two studies confirm the findings of the previous smaller studies in showing that bilingual intervention certainly does not slow learning but has the potential of advancing both languages. However, contrary to the previous findings of Perozzi and Sanchez (1992) and Elin Thordardottir et al. (1997), the results did not suggest a facilitative effect of L1 inclusion on L2 or, in general, that therapy gains transfer from one language to the other. Instead, they indicate that gains in either language require direct targeting of that language. A brief description of the target population is in order to set the context for this study. Montréal is in the

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Canadian province of Québec, whose sole official language is French. Within the city, however, both English and French are widely spoken as native languages by monolingual and bilingual speakers of all ages. A third population referred to as allophones comprises those whose first language is neither French nor English. Children from such backgrounds, by law, attend school in the official language, French. Certain allophone populations, such as Greek and Italian speakers, are well established and involve large multigenerational communities of native speakers. Saturday schools are operated in several of these languages, and native-speaking bilingual speech-language pathologists (SLPs) may also be available, although not in sufficient numbers. However, many allophones are recent immigrants from a wide variety of backgrounds who do not benefit from such established communities. Montréal public schools count among their students speakers of 150 different home languages (Commission scolaire de Montréal, 2013). It is commonplace for French-speaking SLPs to have children on their caseloads from various home languages, none of which the SLP speaks and with no possibility of referral to an SLP who speaks that language. A further complication is that the allophone parents’ proficiency in French (or English) varies and is, in many cases, extremely limited. This clinical situation, common in large cities in Canada and in many settings worldwide, has been the subject of little systematic research. It differs substantially from the predominantly Spanish–English contexts described in the studies reviewed in the previous section. In situations in which the treating SLP does not speak the native language of the child, position statements such as that of the IALP (Fredman, 2006) recommend the use of interpreters. However, the effectiveness of interpreters in clinical intervention with children has not been documented. Another alternative or complementary option is to enlist the parents as therapy agents or participants (e.g., Tsybina & Eriks-Brophy, 2010). Other modifications have been recommended that aim to promote a bicultural focus without directly targeting both languages, such as the introduction of materials from their L1 culture and the demonstration of respect for their home language and culture (Kayser, 2002). Such strategies are said to promote generalization by providing a bridge between the therapy and home environments and to increase motivation and enhanced learning by promoting a positive attitude toward both languages and cultures. Whether such strategies translate into better therapy results, however, remains to be demonstrated. The inclusion of interpreters in treatment involves a significant cost as well as added organizational load. The efficacy of including parents from multicultural backgrounds is also largely untested. Important cultural differences exist in the ways that children are talked to in their natural environments and how they are expected to respond (Johnston & Wong, 2002; Simmons & Johnston, 2007; van Kleeck, 1994). Those treatments reported on in published studies have been developed within the context of a particular culture, most often a middle-class, White, English-speaking context. It is conceivable, even likely, that such treatments do not

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have universal applicability, depending on the type and degree of cultural variation in communication styles. Bilingual children residing in cities such as Montréal, however, are learning to be bicultural at the same time that they learn to become bilingual. They are exposed to the communication styles of the majority culture in their day care or school environment, which increases the likelihood that they can benefit from treatments suited to the majority population. Immigrant parents sometimes lag behind their children in gaining familiarity with the dominant culture. In this study, we compared the effectiveness of a monolingual French and a bilingual French/home language (L1) treatment implemented in collaboration with a Frenchspeaking SLP and L1-speaking parents. Two aspects of these treatments are considered experimental. First, both treatment conditions use a focused stimulation approach—a semistructured hybrid intervention method that uses natural situations engineered to permit focused, yet meaningful, stimulation of therapy targets. This method is widely used in Montréal clinics. The focused nature permits modeling and repetition of therapy targets; the natural setting promotes real understanding of the meaning of the targets, which along with the similarity between therapy and other settings promotes generalization and retention over time. The efficacy of this type of approach has been demonstrated for English-speaking children with language impairment (Camarata, Nelson, & Camarata, 1994; Fey, Cleave, & Long, 1997; Fey, Cleave, Long, & Hughes, 1993; Kouri, 2005; Law, Garrett, & Nye, 2004). Here, we extended the use of this method to French and to a bilingual population. Second, the implementation of a bilingual intervention rests on the active participation of the child’s parent in the session, whereby the SLP and the parent deliver the intervention together. Previous studies have shown that parents are able to be effective agents of intervention when they receive training and supervision from an SLP (Fey et al., 1993; Girolametto, Weitzman, & Greenberg, 2003, 2004; Tannock & Girolametto, 1992). However, studies have also shown that parents produce less consistent results than SLPs (see, e.g., Fey et al., 1993). Studies of parental participation primarily involve English-speaking middle-class parents, often highly motivated self-referred participants. Therefore, the second experimental aspect of the treatments under study here was the inclusion of direct parental participation in clinical treatment involving minority-language bilingual children. The parental participation strategy used in this study did not involve training parents to work independently with their children at home. Rather, our strategy was that the SLP and parent work together within the therapy session, thus creating bilingual intervention sessions. The reasons for this choice are twofold. First, the treatment strategy was meant to replicate the previous single-subject study of Elin Thordardottir et al. (1997), which used both languages within the same session (albeit by a bilingual SLP). Other studies as well have successfully used bilingual treatment sessions implemented by a bilingual SLP (e.g., Ebert et al., 2014). A second reason for the choice of strategy is that due to language and cultural barriers, effectively training parents

to work independently at home would have presented significant challenges. Because of the variety of languages, group training sessions were not possible. Further, explaining to each parent, in some cases through interpreters, the rationale of strategies and how to implement them soon proved to be rather fruitless outside the therapy context. Direct modeling of strategies appeared a reasonable method to promote parent involvement and was presumed to be able to lead the parents to use similar strategies at home. Whereas parents were present during each therapy session in both treatment conditions, only the parents in the bilingual condition participated directly. This does limit the study’s ability to evaluate the variables of language use and parental participation separately. However, due to their presence in the sessions, parents in both conditions had ample opportunities to observe the therapy methods and specific therapy targets, and children in both conditions had the comfort of their parents’ presence. A potential way to better isolate the language versus parental participation issue would have been to have the parents in the monolingual condition participate in French. However, this was not possible due to the fact that many of the parents were not sufficiently fluent in French to do so. Homework assignments were identical in both conditions: Parents were not asked to carry out any specific tasks at home but were strongly encouraged to stimulate the child’s language at home by talking to them in the home language using strategies similar to those used in therapy. The goal of this study was to use a randomized control trial method to compare the effectiveness of a monolingual intervention, a bilingual intervention, and a no-treatment control condition and to measure the effect of intervention on both languages of the child. The bilingual treatment was hypothesized to be superior to the monolingual treatment in two ways. First, it targets both languages. Second, following Elin Thordardottir et al. (1997), it (a) allows the child to use all (vs. part) of his or her language resources; (b) increases communicative success, thereby increasing motivation and decreasing frustration; and (c) promotes a positive respectful attitude toward both languages. This study focused on the effectiveness of methods that are feasible within most clinical settings rather than on ideal methods involving a bilingual treatment that, although performed by a bilingual SLP, can rarely be implemented.

Method Participants To participate in the study, children needed to meet two inclusionary criteria: They needed to have primary language impairment (PLI)1 and speak a minority native language. The primary criterion for identification of language impairment was previous clinical identification by a certified 1 The term primary language impairment here refers to the population of individuals that have what is referred to elsewhere as specific language impairment.

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SLP in a clinical or school setting. In their diagnostic work, SLPs rely on formal assessments primarily in the L2 (in this study, French) as well as consideration of background variables and informal assessments of proficiency in the L1. As part of the native language criterion, participating children also needed to have had significant bilingual exposure involving French. At a minimum, participants had to have had at least 6 months of regular French exposure, such as within a day care setting (this is the minimum requirement used at the Montréal Children’s Hospital for children to be assessed in French). Recruitment was done through the speech-language pathology departments of two major Montréal hospitals, a Montréal rehabilitation center providing language intervention for children, and French public schools, particularly ones with high numbers of immigrant children. In spite of the fact that this study provided free intervention to children who would otherwise be on a waiting list for up to 18 months, many recruitment efforts— including ones conducted by native speakers through ethnic community centers—proved fruitless. This underscores an apparent reluctance on the part of many allophone parents to engage their children in French language therapy (see, e.g., Kummerer, Lopez-Reyna, & Hughes, 2007, regarding cultural differences in views on language impairment and therapeutic approaches) and has implications for the generalizability of the feasibility of the approach used. Participants who completed the study included 29 children (26 boys and three girls) with a mean age of 59.56 months (SD = 5.9, range = 45–68). First languages included Arabic (one participant), Bangla (one participant), Bengali (three participants), Chinese (two participants), Dutch (one participant), English (one participant), Japanese (one participant), Kabyl (one participant), Punjabi/Urdu (eight participants), Russian (two participants), Sinhalese (one participant), Spanish (four participants), and Tamil (three participants). All the children were referred by SLPs who had previously evaluated them and, in some cases, had provided them intervention prior to this study. An intake assessment was performed to establish baseline performance and to confirm diagnostic status. These evaluations were conducted by the treating SLPs, trained research assistants, and interpreters. Some interpreters were available through the hospital or schools; others were recruited from among international graduate students at McGill University. The assessment involved a series of standardized tests in French: (a) the Échelle de vocabulaire en images Peabody (EVIP; Dunn, Thériault-Whalen, & Dunn, 1993); (b) the Expressive One-Word Picture Vocabulary Test (EOWPVT; Gardner, 1983) in a French adaptation with norms by Groupe coopératif en orthophonie (1999); (c) the Reynell Developmental Language Scales (RDLS; Edwards et al., 1997) in a translation/adaptation by the Montréal Children’s Hospital; (d) mean length of utterance in words (MLUw) and mean length of utterance in morphemes (MLUm) based on 100 utterances of a conversational language sample scored according to the French procedure developed by Elin Thordardottir (2005); (e) nonword repetition (NWR; Elin Thordardottir et al., 2011); and (f ) Sentence Imitation

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(Elin Thordardottir, Kehayia, Lessard, Sutton, & Trudeau, 2010). For diagnostic status to be confirmed, children had to score at or below −1.5 SD of the mean on at least one measure as per normative data for monolingual children (Elin Thordardottir et al., 2010). Research evidence suggests that a cutoff of −1 SD is appropriate for the identification of PLI in monolingual speakers of French at age 5 years (Elin Thordardottir et al., 2011). The minimum criterion of −1.5 SD for the bilingual children was adopted in the absence, at the time of study, of detailed information on the typical performance of young bilingual French speakers. Since then, a series of studies conducted in Montréal (Elin Thordardottir, 2011, in press; Elin Thordardottir & Brandeker, 2013) have documented bilingual performance in relation to previous language exposure in 5-year-old Montréal children. These studies suggest that bilingual children with PLI can be expected to score from −1.5 SD to −2.5 SD below monolingual typically developing French speakers, depending on their amount of previous exposure to French (Elin Thordardottir, in press); this indicates that the −1.5 criterion was correct for part of the children but not sufficiently strict for others. The relative standing of the intake group means of each of the three treatment groups (see Table 1) compared to monolingual normative data is as follows: EVIP: all groups: −3.5 to −3.7 SD; Sentence Imitation: MT: −3.4 SD, BT and NT: −2.5 SD; NWR: MT: −1.9 SD, BT: −3.3 SD, NT: −1.9 SD; and MLUm: all groups: −2.2 SD. Note that the −1.5 SD criterion was a minimum requirement and that the principal inclusionary criterion was previous clinical identification. As a further confirmation of PLI, participants were required to pass a clinical test of nonverbal cognition (scoring above a standard score of 70 on the Brief IQ subscale of the Leiter International Performance Scale–Revised; Roid & Miller, 1997), and a hearing screening was performed using a portable audiometer at octave frequencies from 0.5 Hz to 4 kHz at 10 dB HL. The cognitive criterion was set at 70 rather than 85 because the goal was to rule out intellectual disability that would have warranted identification as such; setting the criterion at 85 would leave those children scoring between 70 and 85 in no clinical group. Participant characteristics and language scores at intake are displayed in Table 1. The amount of time spent in the home language and in French over the child’s lifetime as well as other relevant background information was assessed by a detailed parent questionnaire developed in previous studies (Elin Thordardottir, 2011; Elin Thordardottir, Rothenberg, Rivard, & Naves, 2006). Percentage exposure to French refers to the proportion of waking hours since birth spent in French contexts of potential meaningful communication (e.g., television watching was not included). All of the children were exposed to their L1 at home and to their L2 (French) in a setting outside the home, including day care and preschool. In that sense, all had an environmental separation between an L1 and L2. On average, the age of first significant French exposure was around 3 years. However, the group varied in this respect—a few children had been exposed to French from birth or before age 6 months,

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Table 1. Participant characteristics and preintervention scores on French language tests and home language (L1) MLU for children assigned to monolingual treatment, bilingual treatment, and no-treatment (control) conditions.

Measure Age (months) Nonverbal cognition scorea Maternal education (years) French, lifetimeb (%) French, last yearc (%) Age at first French exposure (months) EVIP raw score EOWPVT raw scored RDLS raw scoree Sentence imitation (% words) Nonword repetition (% phonemes) MLUm score in French MLUw score in French MLUw score in L1

Monolingual (n = 11) M (SD)

Bilingual (n = 9) M (SD)

Control (n = 9) M (SD)

61.6 (4.7) 90.5 (11.6) 13.7 (2.7) 17.3 (17.1) 37.0 (13.3) 36.0 (15.2) 14.0 (5.8) 6.1 (4.0) 22.4 (11.4) 19.6 (11.7) 68.8 (11.7) 2.86 (1.08) 2.46 (0.89) 2.28 (0.86)

58.6 (4.6) 89.5 (9.7) 14.3 (5.1) 20.3 (11.9) 37.8 (7.2) 29.3 (16.9) 15.2 (5.5) 6.3 (3.1) 29.7 (10.8) 33.8 (20.6) 55.6 (26.9) 2.80 (0.67) 2.31 (0.43) 2.57 (0.97)

58.6 (7.8) 91.7 (7.2) 15.0 (2.6) 14.6 (11.5) 33.0 (12.8) 30.3 (21.1) 15.4 (9.4) 12.0 (6.1)* 27.4 (13.9) 31.5 (24.6) 67.3 (14.3) 2.85 (0.89) 2.37 (0.71) 2.96 (0.97)

Note. EVIP = Échelle de vocabulaire en images Peabody (Dunn, Thériault-Whalen, & Dunn, 1993); EOWPVT = Expressive One-Word Picture Vocabulary Test (Gardner, 1983); RDLS = Reynell Developmental Language Scales (Edwards et al., 1997); MLUm = mean length of utterance in morphemes; MLUw = mean length of utterance in words. a

Brief IQ scale of the Leiter International Performance Scale–Revised (Roid & Miller, 1997). bPercentage of waking hours spent in French communicative environments since birth. cPercentage of waking hours spent in French in the last year. dFrench translation by the Groupe coopératif en orthophonie. eFrench translation from the Montréal Children’s Hospital.

*p < .05.

and several other children had received their first exposure in prekindergarten at the age of 4 years. The group was mixed with regard to classification as simultaneous and sequential bilinguals if the traditional definition based on first exposure before and after age 3 years is applied strictly. However, given that the children have language impairment, it is likely that all of the children were exposed to French at or before the time that their language level was comparable to that of a 3-year-old with typical language development. A one-way analysis of variance (ANOVA) revealed no significant difference between the three groups on age, maternal education, nonverbal IQ, percentage exposure to French, or age at first exposure to French. Further, no significant differences were found between the groups on these intake language measures with the exception of the EOWPVT, on which the control group scored significantly higher than the other two groups, who did not differ significantly from each other. Pretreatment MLUw in the home languages is displayed in Table 1. For each of the groups, group means for pretreatment MLUw in French and in the home language are not significantly different; however, we acknowledge that direct comparison of MLU across languages has limited interpretability.

Attrition and Dismissal From the Study Six children who underwent the initial evaluation did not meet all inclusionary criteria and were excluded by the researchers. Reasons included additional complicating factors such as mutism, epilepsy, and lack of cooperation. Contact was lost after several phone calls with the parents of five children who had expressed interest in the study. In addition, five children who qualified for the intervention

phase withdrew from the study. Two of those children did not start therapy: One was admitted to an English school, and the parents decided not to participate in therapy involving French. The parents of the other child had difficulty traveling to the intervention site. The remaining three children withdrew after two, three, and six intervention sessions, respectively. Two had been assigned to bilingual treatment and one to monolingual treatment. In two cases, the reason appeared to be lack of motivation on the part of the parents but also included family situations such as younger siblings making it hard for the family to participate. In the one remaining case, motivation was high, but the family had to leave on short notice due to immigration issues.

Procedure Random assignment was accomplished using the “Research Randomizer” website (http://www.randomizer.org), generating six sets of six numbers per set. This set size was used because it was not known how many children would be recruited; however, this arrangement was unknown to the treating SLP and research assistants. The order of randomization was kept in sealed numbered envelopes. Once a participant met all inclusionary criteria, his or her envelope was opened, revealing the treatment condition. No change was made from the randomly assigned condition for any participant, with one exception involving a child for whom it became apparent immediately after the intake that his family needed to go away on an extended trip, which would have made intervention impossible at that point. This participant was selected to serve as a delayed-treatment control without random assignment. This decision was made in light of the very poor level of success of participant recruitment at the

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beginning of the study, which subsequently picked up with the participation of the schools. Eleven children who completed the study were assigned to monolingual intervention, nine to bilingual intervention, and nine to a delayed-treatment condition. Following intake assessment, children assigned to treatment received 16 weekly intervention sessions, each lasting 50 min. Missed sessions were rescheduled and made up with the result that all participating children except one completed all 16 sessions (one child completed 14 sessions). Children assigned to the no-treatment group were not seen for the same time period. As part of the consent for participation in this study, parents accepted that their child would receive no other clinical language intervention for the duration of the study. Children assigned to the no-treatment group were offered treatment at the end of the control period. As compensation for waiting for treatment, however, the parents of this group of children were offered a choice of monolingual and bilingual intervention. Of the nine sets of parents, seven opted for bilingual and two opted for monolingual intervention. Treatment outcomes for these nonrandomized implementations of the intervention are not reported here. Immediately following the 16-week intervention period, a postintervention assessment was completed for all children by a trained research assistant blinded to the treatment condition of the children. Measures used to track progress included standardized tests and therapy probes assessing specific therapy targets. The probes are described in a subsequent section. Pre–post assessment of the L1 was limited to language sampling. Two months after the completion of treatment, the therapy probes were administered once again to track retention of gains.

Selection and Assessment of Treatment Goals The treatments were conducted by two certified and experienced SLPs. Both SLPs conducted both monolingual and bilingual treatments. Specific therapy objectives could be formulated only in French, given that the treating SLPs did not speak the children’s home languages. Targets included, for each child, a vocabulary target and a syntactic target. The specific vocabulary and grammatical targets were tailored to each child individually based on his or her language level and needs but with great similarity between children. Vocabulary training for each child involved, in each session, four verbs and six nouns, selected for each child from a larger list of 47 age-appropriate vocabulary items based on the MacArthur–Bates Communicative Development Inventory (CDI) in Québec French (Trudeau, Frank, & Poulin-Dubois, 1999). The subset selected for each session included five words that the child comprehended but did not produce and five words that the child neither comprehended nor produced based on baseline probing. If, during the course of intervention, a child mastered words on his or her initial 10-word list, new words were added to that child’s list using the same criteria such that each session targeted four verbs and six nouns appropriate for the child’s level. Progress on this vocabulary activity is reported by pre- and postintervention

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probes involving the entire list of 47 words, which included 12 action verbs and 35 nouns (five referring to vehicles, eight referring to clothing, eight referring to food items, four referring to insects, eight referring to body parts, and two referring to concepts; see full list and administration procedure in Appendix A). Some variability was found in the specific syntactic goals targeted in treatment; however, a common goal included the production of sentences with a basic subject–verb–object structure and, for some children, longer sentences with more constituents. To assess progress in the production of targeted sentences of the type, a story retell probe was constructed following guidelines and scoring suggestions by Lahey (1988, Chapter 13). Two equivalent stories were constructed for administration before and after treatment, with order of administration counterbalanced across children. Each of the two stories contained 21 sentences representing the content categories of existence, action, locative action (bringing), locative state (being somewhere), possession, and quantity ( plural). Each sentence contained two, three, or four sentence constituents (reference, subject, verb, direct object, indirect object, location adverbial). Each story was presented with a wordless picture book (Man’s Work and Baby Sitter, both by Annie Kubler, 1999a, 1999b). As suggested by Lahey (1988), to distinguish this task from a sentence imitation task and to reflect the goals of the syntactic intervention, we did not require the children to repeat the sentences verbatim in order to score a point, but, rather, we gave them 1 point for each sentence constituent that they included (e.g., agent, action), even if paraphrasing occurred. Scoring ignored aspects such as morphological errors if the meaning was still clear. As an example of scoring, a child who said “Claire met du lait” (“Claire puts milk”) for the target sentence Claire verse du lait pour Marie (Claire pours milk for Marie) would get 3 of 4 possible points—one for each of the underlined constituents, even though verse was changed to met. The child did not get a point for the fourth constituent pour Marie because it was not expressed. Code switching occurred infrequently in this task, but when it did, credit was given for the constituent in question. Constituents that were added to the target sentence were not given credit (e.g., if the child had said “Claire verse toujours le lait” (“Claire always pours the milk”), no credit would have been given for toujours, and the child still would have received 3 of 4 points. Story A, “La gardienne,” appears in Appendix B along with a description of the administration procedure. The vocabulary and story retell probes assess skills directly targeted in therapy and, therefore, are expected to be more sensitive to treatment effects than more general language tests or spontaneous language. These are the main outcome measures of this study, although pre- and postscores are also reported for other language measures. All assessment and treatment sessions were audioand video-recorded. Posttreatment assessment and scoring were done by research assistants blinded to the children’s treatment conditions. Language samples in French were transcribed and coded by trained research assistants based on the score forms filled out during testing and the video

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recordings. For reliability, an independent transcriber listened to all the samples and verified the initial transcription and coding. Any discrepancies were settled by consensus. Language samples in the home languages were recorded, transcribed, and analyzed for MLUw by interpreters trained for this study. The reliability of their transcriptions could not be rechecked for lack of resources and manpower.

Intervention Conditions and Treatment Method In both treatment conditions, the clinician addressed the vocabulary goal for approximately 20 min of each session, through various activities and games, using preselected materials that allowed for modeling of the specific vocabulary to be targeted in the session (e.g., dressing a doll, making fruit salad with toy fruit). The clinician kept a list of the target words and proceeded to systematically work on each target word within preplanned focused play. Syntactic goals were targeted for approximately 20 min of each session. The clinician used various games such as card games (e.g., “go fish”); bingo; picture series depicting short stories; and manipulation of concrete objects to model and elicit sentences including a subject, verb, and complement (or, in more advanced cases, other constituents). In both conditions, one of the child’s parents attended all therapy sessions, and those in the bilingual condition participated directly. Although both parents were allowed to alternate their attendance, for most children, the same parent attended all sessions. In most, but not all, cases, it was the mother. The parents who participated in therapy sessions were shown how to participate through instructions—in some cases, in French with the help of interpreters and, in other cases, in English if that was more convenient for the parent—and through demonstration and modeling. Only some of the parents had conversational fluency in French. Parents were asked to participate by engaging in the play, modeling the target words and sentences in their language, and responding to their child’s homelanguage utterances. Emphasis was placed on the importance of abundant modeling in meaningful contexts, repetition, responsiveness to child utterances, and positive reinforcement. It proved difficult in many cases to keep the parents involved, and this required continuous prompts in many cases. Some parents appeared to feel uncomfortable in the therapy activities. It was found, over the course of treatment, that the participation of parents to address specific therapy targets was far more straightforward in the vocabulary part, as they could repeat and model the target nouns and verbs in their language and embed them in short sentences. In addition, the treating SLP could, over time, learn many words in the various languages and target them bilingually. Parents of children in the monolingual treatment condition had no role in the treatment sessions. They were allowed to be present in the therapy room, and all chose to do so. However, they were asked to stay in the background and not participate directly.

Fidelity of Treatment Implementation of the bilingual treatment condition relied on a collaboration with the parents, whereby they

provided models of therapy targets in their respective languages. To assess the extent to which parents did provide home language models within the therapy sessions, an independent scorer (research assistant not otherwise involved in the study and blinded to its purpose) viewed the video recording of 13 individual therapy sessions and counted the number of utterances produced by the parent and the child in French and in the home language during the whole session. The 13 sessions were selected randomly, but with the restriction that they represent both treatment conditions. They included seven bilingual treatment (BT) and six monolingual treatment (MT) sessions. The coder was not told to which condition each session belonged. The mean number of parent home language utterances was 1 (SD = 2) in the MT sessions and 47.6 (SD = 44.1) in the BT sessions, t(11) = −2.567, p = .000. The mean number of parent French utterances was 0.50 (SD = 0.837) in the MT sessions and 7.29 (SD = 15.9) in the BT sessions ( p = .069). The mean number of child home language utterances was 1.17 (SD = 1.60) in the MT sessions and 16.0 (SD = 23.4) in the BT sessions, t(11) = −1.539, p = .007. The number of child utterances in French was 169.3 (SD = 48.9) in the MT sessions and 282.6 (SD = 139.6) in the BT sessions ( p = .091). This pattern shows that parental participation was next to none in the MT condition (as planned) but that parents in the BT condition produced mainly L1 utterances and some French utterances. As a further check of the number of models of target vocabulary items provided in the two treatment conditions, an independent blinded scorer counted the number of times in which target vocabulary was modeled by the clinician (in French) and the parent (in home language). The scorer was able to ascertain that the parent was producing the target word because parents did so immediately after the clinician had said the word or following a prompt by the clinician. No specific number of models per session was stipulated a priori because the method used was only semistructured and thus was partly directed by the child’s behavior. A total of 30 randomly selected therapy sessions from 12 different children (16 monolingual sessions from six children; 14 bilingual sessions from six children) were reviewed from video recordings. The 12 children were selected randomly; sessions were selected to represent equivalent session numbers across the two conditions because it was noted that more therapy models tended to be presented in later sessions than in earlier sessions, possibly reflecting a more comfortable rapport between the child and clinician. Sessions ranged from the fourth to the 12th (monolingual mean = 8.8, SD = 2.7; bilingual mean = 8.5, SD = 3.0). In the monolingual sessions, the mean number of French models of target vocabulary words provided by the clinician was 123.4 (SD = 57.6), and the number of homelanguage words provided by the parent was 0.75 (SD = 1.48). In the bilingual sessions, the corresponding numbers were 87.7 (SD = 53.5) models by the clinician and 14.1 (SD = 12.2) models by the parent, for a total of 101.9 (SD = 56.6) models. An ANOVA revealed a significant difference across treatments in the mean number of parent models, F(1, 29) = 19.106, p = .000, but no significant

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difference in the mean number of clinician models ( p = .091) or the total number of models ( p = .295).

Figure 2. Scores on story retell probes at Time 1 (intake, pretreatment), Time 2 (posttreatment phase), and Time 3 (follow-up at 2 months posttreatment completion) for the three groups: monolingual treatment group (MT), bilingual treatment group (BT), and no-treatment (control) group (NT).

Results Vocabulary and Story Retell Probes Pre- and Posttreatment To assess treatment effects, difference scores were computed by subtracting pretest scores from posttest scores for each child. The difference scores were analyzed by a one-way ANOVA. Scores on the vocabulary probes are displayed in Figure 1. At pretest, no significant difference was found between the three groups on the receptive vocabulary probe ( p = .335). An ANOVA of the pre–post difference scores revealed a significant group difference, F(2, 26) = 10.362, p = .000, h2 = .463. Post hoc tests (Fisher least significant difference [LSD]) revealed that the NT group had a significantly lower difference score than each of the treatment groups ( p = .000 and p = .003). The MT and BT groups did not differ significantly from one another ( p = .263). For the expressive vocabulary probe, a significant group difference was found at pretest, F(2, 25) = 3.874, p = .034, h2 = .236. Post hoc tests revealed that the NT group’s mean score was significantly higher than that of the MT group at pretest. An ANOVA of the pre–post difference scores revealed a significant group difference, F(2, 27) =14.186, p = .000, h2 = .532. Post hoc tests revealed the same pattern as for the receptive probe: The NT group differed significantly from both other groups ( p = .000 and p = .001), but the two treatment groups did not differ from one another ( p = .203). For the story retell syntactic probe (see Figure 2), no significant group differences were revealed on an ANOVA of the pretest scores ( p = .230). An ANOVA of the difference scores revealed no significant effect. Figure 1. Scores on receptive and expressive vocabulary probes at Time 1 (intake, pretreatment), Time 2 (posttreatment phase), and Time 3 (follow-up at 2 months posttreatment completion) for the three groups: monolingual treatment group (MT), bilingual treatment group (BT), and no-treatment (control) group (NT).

Maintenance of Gains After Completion of Treatment The two treatment groups were assessed on the vocabulary and retell probes a third time 2 months after the completion of treatment. The NT group was not administered the maintenance probe at this time because this group started treatment immediately after their posttest. Progress over the three test times (Time 1 = pretest, Time 2 = posttest, Time 3 = 2 months postcompletion) was assessed by means of repeated measures ANOVAs, with Time as the within-subjects factor and Group (MT and BT) as the between-subjects factor. For the receptive vocabulary probe, there was a significant effect of Time, F(2, 32) = 97.734, p = .000, h2 = .859. No other effects were significant. Post hoc tests (Fisher LSD) revealed a significant increase in scores from Time 1 to Time 2, and from Time 1 to Time 3, with no significant change from Time 2 to Time 3. The same pattern was obtained for the expressive vocabulary probe, with a significant effect of Time, F(2, 34) = 98.694, p = .000, h2 = .853. Post hoc tests revealed the same pattern as for the receptive vocabulary probe. For story retell as well, the only significant effect was that of Time, F(2, 28) = 18.745, p = .000, h2 = .572. Post hoc tests revealed a different pattern than the vocabulary probes: No significant change in scores was seen between Time 1 and Time 2 or between Time 2 and Time 3 (although Time 2 to Time 3 approached significance at p = .071). A significant change occurred between Time 1 and Time 3 ( p = .009). The Time × Group interaction approached significance ( p = .055). The increase from Time 1 to Time 3 was somewhat larger for the BT group (41.9% to 74.1%) than for the MT group (53.1% to 67.6%), although not sufficiently large to produce a significant result.

Pre- and Posttest Scores on Formal Language Tests The pre- and posttest scores on the EVIP (receptive vocabulary), the EOWPVT (expressive vocabulary), and

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the RDLS (receptive language) are displayed in Table 2. An ANOVA of difference scores revealed no significant group differences. Means increased on the EVIP, EOWPVT, and RDLS for all the groups. However, only the RDLS approached significance ( p = .057). The group means on the RDLS do suggest that both treatment groups increased their RDLS score by almost twice as much as the notreatment group.

Figure 3. Mean length of utterance in words (MLUw) in French and in home languages at Time 1 (intake, pretreatment) and Time 2 (posttreatment phase) for the three groups: monolingual treatment group (MT), bilingual treatment group (BT), and no-treatment (control) group (NT).

Changes in L1 and L2 MLUw Every effort was made to secure interpreters to record and transcribe L1 spontaneous language samples for each child, resulting in completion of such samples for 21 children at pre- and posttest: eight in the MT group, eight in the BT group, and five in the NT group. Difference scores between pre- and posttest scores were computed for MLUw in L2 (French) and in L1. Because of the reduced sample size of children for whom data were available in the home language, group differences were compared by nonparametric testing (Kruskal–Wallis), revealing no significant difference in difference scores for either MLUw in French ( p = .517) or in the home language ( p = .079). Group means increased for all groups in French. In L1, MLUw increased only for the MT group and decreased slightly for the other two groups (see Figure 3).

Discussion In relation to the first study question of whether the treatments provided in this study produced significant gains, results of the treatment probes for vocabulary and syntactic goals tell a mixed story: Significant gains occurred in French vocabulary as a result of treatment as shown by clear differences between treated and untreated groups. In contrast, gains in French syntax occurred in all groups but could not be related to the therapy given that the untreated Table 2. Pre- and posttreatment scores on standardized language tests for children assigned to monolingual treatment, bilingual treatment, and no-treatment (control) conditions. Raw score EVIP MT BT NT EOWPVT MT BT NT RDLS MT BT NT

Pretreatment

Posttreatment

14.0 (5.8) 15.2 (5.5) 15.4 (9.4)

20.18 (9.5) 19.3 (11.0) 21.4 (13.7)

6.1 (4.0) 6.3 (3.1) 12.0 (6.1)

11.1 (5.8) 9.7 (4.0) 12.9 (9.3)

22.4 (11.4) 29.8 (10.8) 27.45 (13.9)

38.7 (10.1) 43.3 (8.3) 36.0 (11.0)

Note. EVIP = Échelle de vocabulaire en images Peabody; MT = monolingual treatment; BT = bilingual treatment; NT = no treatment; EOWPVT = Expressive One-Word Picture Vocabulary Test; RDLS = Reynell Developmental Language Scales.

group improved as much as the treated groups and that improvement continued at a similar pace during and after the treatment phase. Examination of the efficacy of a focused stimulation approach in French was an important goal of this study. The intervention used is typical of that used in major hospitals and clinics in Montréal (two large hospitals participated in this study, including planning the therapy approach and setting goals). However, efficacy studies in French are scarce. In fact, to our knowledge, no previous efficacy study has been published targeting this type of intervention in French. The lack of results for the syntactic goals call for continued research on the appropriateness of both the goal setting and the intervention method. On the second main question of how the bilingual and monolingual therapy conditions compared in their effectiveness, the results are clear in that the two produced indistinguishable results. It had been hypothesized at the outset that bilingual treatment would yield better results than monolingual treatment, on the basis of a previous study by Elin Thordardottir et al. (1997), which this study set out to replicate using a group design, and another study by Perozzi and Sanchez (1992). This hypothesis was not borne out. With comparable L2 gains in both treatments, the results are in line with the recent group studies of Restrepo et al. (2013) and those of Ebert et al. (2014), both of which indicated that L2-only therapy can advance the L2 but that gains are made only in the language(s) directly targeted. In this respect, it is important to note that we had not hypothesized that bilingual intervention would result in transfer of skill between languages; rather, we hypothesized, as outlined in the introduction, that a bilingual context would allow the child to build on his or her entire knowledge base and that such a context would provide a more positive learning environment. In fact, the findings of Restrepo et al. do suggest that some learning advantage is associated

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with a bilingual intervention in that children in that condition achieved English gains comparable to those seen in the children treated in English only, and this in addition to their Spanish gains. In the present study, L1 effects were measured in terms of MLU rather than vocabulary; therefore, a direct assessment of any L1 vocabulary gains cannot be made. For bilingual children, the efficacy of a treatment approach should include an assessment of both languages. Although it may be seen as a main goal for these children to achieve as high a proficiency as possible in the language of school (in this study, French), L1 remains a crucial communication tool in these children’s lives and is regarded as a necessary support for maximal L2 learning (cf. Kohnert, Yim, Nett, Kan, & Duran, 2005). Our prediction that L1 MLUw measures would increase the most in the BT group, given the L1 inclusion in that condition, was not borne out. In fact, to the extent that a trend for group differences was found, these differences went in the opposite direction, with somewhat greater L1 gains in the MT group. It must be kept in mind that cross-linguistic comparison of MLUw is questionable given that languages vary in structure. Our previous study of MLUs of English- and French-speaking children revealed that these children were much more similar in MLUw than in MLUm (Elin Thordardottir, 2005). However, it cannot be assumed that MLUw is directly comparable across languages. Possible reasons for the L1 MLU findings may be that MLU may not be sufficiently sensitive to a 16-week change in language in either L1 or L2, or that using MLU across these various languages is not valid. Conversations with parents over the course of treatment revealed additional factors that may have contributed to the unexpected result of L1 MLU increasing somewhat more in the monolingual treatment group. As noted previously, the majority of the parents of children in the control group opted for a bilingual treatment. From our perspective (given our bias related to the theoretical grounds for a bilingual treatment being more efficacious), it appeared that this choice reflected the parents’ desire to acknowledge and strengthen the home language. However, many of the parents revealed, when asked, that their purpose in selecting the bilingual treatment was to be allowed to participate in sessions with the purpose of learning techniques that they could use at home to strengthen their child’s skills in French. This observation, although anecdotal, underscores the disparities that can exist between the goals pursued by therapists and those pursued by parents as well as differences not only in cultural views but also in perceived needs and the means to achieve them. Current guidelines strongly recommend that parents speak to their children in their home language (Fredman, 2006), and many authors have urged SLPs to abandon the traditional practice of counseling parents to switch to the mainstream language of the community to make it easier for them to learn that language (cf. Juarez, 1983). In other words, this formerly common practice—now seen as outdated—is widely seen as originating with the inappropriate counseling practices of monolingual therapists.

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However, in this study—after they completed therapy— many parents reported using this strategy in spite of our explicit recommendations against it. It is possible that these parents’ efforts contributed to the French learning of the children. By the same token, this strategy may have limited gains in the home language. Does this study indicate that bilingual treatment is not necessary or worthwhile? It might be tempting to conclude that such modifications are not worth pursuing, considering that (a) L2 gains can be obtained through L2-only intervention even when the L2 is clearly the weaker language and (b) the bilingual modification apparently added nothing. The present study is robust in that it included careful experimental controls, including random assignment to treatment conditions, a no-treatment control group, and blinded assessment. As a result, the finding of no difference between bilingual and monolingual treatments for either L1 or L2 gain needs to be given serious consideration. However, several factors need to be considered before any final conclusions are reached on the merits of monolingual versus bilingual treatment. Unlike the previous study of Elin Thordardottir et al. (1997)—in which treatment was provided by a bilingual SLP who was also familiar with the child’s home culture, child-rearing practices, and communication patterns—bilingual treatment in this study relied on parental participation and was thus partly outside the clinician’s control. This is not to say that parents cannot be efficacious agents of language instruction for bilingual children; an earlier study by Tsybina and Eriks-Brophy (2010) showed that they can. However, it is important to consider the population targeted in this study. The participating parents come from a variety of language and cultural backgrounds. A recheck of the therapy sessions showed that parental utterances in the home language and home language modeling of target vocabulary words essentially occurred only in the bilingual condition. However, parental participation was, overall, fairly low and quite variable between sessions that were rechecked in terms of total number of utterances throughout the session. On average, only 14% of vocabulary targets that were presented in the bilingual sessions were in the home language (14 of 101 models). It must be considered, then, that the type of collaboration used in this study (i.e., between SLP and parents) may not have created a sufficiently intense bilingual context to lead to the benefits potentially associated with such a context. Contributing factors may also include the difficulty in communicating efficiently with the parents and the fact that the SLPs’ constant efforts to prompt parental participation may have offset the SLPs’ effectiveness in addressing therapy targets. The communicative needs of bilingual children are not adequately met unless both languages show improvement. It is necessary to continue to explore ways in which this can be achieved in clinical contexts and to test the effectiveness of the recommendations that are given to clinicians. Qualified bilingual clinicians are not readily available for numerous minority groups. The procedures used in this study followed the recommendations made by major professional organizations (Canadian Association of

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Speech-Language Pathologists and Audiologists [CASLPA]2, ASHA, and IALP). Unfortunately, such recommendations are fairly vague and largely untested. For example, the recommendation to work with interpreters does not specify exactly what their role should be. As another example, the recommendation to work with parents calls for consideration of cultural differences, acknowledging that views on the nature of language impairments, how they should be treated, and the ways in which adults and children communicate vary significantly across cultures (see, e.g., Van Kleeck, 1994) but does not provide a solution to this complication or acknowledge its magnitude. The results of this study are, in many ways, quite sobering. Although the intent of the study was to use methods that are feasible in clinical settings, it did in many ways surpass the means available to many clinicians, such as access to interpreters and the collection and analysis of home language samples. The provision of bilingual services required extraordinary efforts at times. In spite of this, it appears that the effort did not pay off. A key question that remains unanswered is whether the various bilingual modifications that are being made in clinics around the world really make a difference in proportion to the good intentions and efforts that go into such modifications. The effect sizes of the treatment effects for the vocabulary probes are fairly large, indicating that between 40% and 50% of the variance in gain was associated with being in treatment. The formal language tests administered pre- and posttherapy provide an indication of the practical significance of the treatment. Beyond the specific words and sentences targeted in intervention, did the children’s language skill advance appreciably in a more general sense? Only the RDLS scores approached significance pre- to posttreatment. The vocabulary probe scores show that children who improved their scores the most learned some 30 new French words over the course of 14 weeks, but a more typical gain was on the order of 15 to 20 words—significant results but hardly sufficient to help the children close the gap with peers who do not have language impairment. However, anecdotal evidence shows that the children’s teachers reported noticeable and even dramatic changes in some of the children’s communication skills in the classroom. Overall, then, the impact of this therapy appears rather modest—a concern raised also by Ebert et al. (2014) regarding their therapy results. Meta-analyses of the efficacy of language intervention have indicated that treatment gains, even when statistically significant, tend to be fairly modest, and this may be related to insufficient intensity of treatment (Law et al., 2004). This study, therefore, appears to be in line with many previous studies in this respect, and it was in line with the allocation of SLP services in Québec. In contrast, both Restrepo et al. (2013) and Ebert et al. (2014) offered far more intensive services, with multiple sessions per week. It is not clear, however, whether the much greater intensity was preferable overall. It appears that the number of L2 words learned by

2

CASLPA is now Speech-Language and Audiology Canada (SAC).

children in the study of Restrepo et al. in 12 weeks of multiple sessions per week does not exceed the number of words learned by children in this study. Further, in the study by Ebert et al., nonattendance was fairly common. More research is needed on the level of intensity that optimizes children’s rate of learning.

Limitations of the Study It may be seen as a limitation of this study that it focused on children from a variety of language backgrounds. This presented restrictions in the way in which (a) treatment could be delivered and (b) treatment gains could be measured. However, the multiple languages also represent a clinical reality: Many of the approaches used in studies that look at one language combination, such as L1 group sessions, cannot be implemented with this population. Another limitation of this study is the lack of L1 vocabulary measures; this would have provided a more direct comparison of L1 and L2 gains. Finally, as discussed in the introduction, this study could not fully isolate the effect of the language(s) used in the session from the effect of parental participation in the session, given that parents participated actively only in the bilingual sessions. This limitation may be mitigated somewhat by the fact that the parents were present in sessions of both treatments; however, the difference in direct parental participation remains. Future studies may be able to separate these factors more effectively. What this study does show is that neither the addition of the home language by the parents nor the attempt to have the parents participate actively in the sessions had a measurable impact on the outcomes of the children.

Acknowledgments This study was funded by a research grant from The Canadian Language and Literacy Research Network (CLLRNet 27061801), awarded to Elin Thordardottir (PI) and to Susan Rvachew and Mela Sarkar (collaborators), with the Montréal Children’s Hospital and the Jewish Rehabilitation Hospital in Laval as partners. Thanks are extended also to the Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) for supporting the project. We are grateful to the children and parents who participated in the project as well as to the SLPs in clinics and in the schools who helped recruit participants and coordinate intervention schedules.

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MacArthur Communicative Development Inventory]. Journal of Speech-Language Pathology and Audiology, 23, 31–73. Tsybina, I., & Eriks-Brophy, A. (2010). Bilingual dialogic book reading intervention for preschool children with slow expressive vocabulary development. Journal of Communication Disorders, 43, 538–556. Van Kleeck, A. (1994). Potential cultural bias in training parents as conversational partners with their children who have delays in language development. American Journal of SpeechLanguage Pathology, 3, 67–78.

Appendix A Items on Vocabulary Probe (Receptive and Expressive) Verbs boit (drink) ouvre (open) attrape (catch) verse (pour) coupe (cut) souffle (blow) tire (pull) lance (throw) colle (glue) dessine (draw) écoute (listen) regarde (look)

Transport

Clothing

Food

Insects

autobus (autobus) hélicoptère (helicopter) motocyclette (motorbike) avion (airplane) bicyclette (bike)

lunette (eyeglasses) jupe (skirt) mitaine (mitten) pantalon (pants) chapeau (hat) robe (dress) cravate (tie) ceinture (belt)

oeuf (egg) fraise (strawberry) raisins (raisins) poire (pear) soupe (soup) maïs/blé d’inde (corn) broccoli (broccoli) salade/chou (salad)

chenille (caterpillar) mouche (fly) coccinelle (ladybug) abeille (bee)

Body parts

Concepts

cou (neck) coule (sink) joue (cheek) flotte (float) coude (elbow) menton (chin) doigt (finger) oreille (ear) genou (knee) sourcil (eyebrow)

Note. The administration procedure was as follows: A set of pictures depicting the objects and actions of the target words were assembled from various sources. To assess production, a binder with one picture on each page was used. For each picture, the child was asked to name what was in the picture (prompted by the question, “What is this?”). If the response was incorrect, the child was not corrected. To assess comprehension, a binder was used that had four pictures per page, with only one being the correct answer. The child was asked to point to the picture that corresponded to the word said by the examiner. No corrective feedback was given.

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Appendix B Retell Probe: Story: “La Gardienne” (The Babysitter) No.

Content

Target

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

EXIST EXIST ACT LOC ACT LOC ACT + QUANT ‘des’ ACT ACT + QUANT/POSS ‘ses’ ACT LOC ACT + SPEC ‘le’ ACT ACT + SPEC ‘du’ ACT ACT + POSS ‘son’ ACT ACT ACT + POSS/QUANT ‘ses’ ACT + POSS ‘son’ LOC STATE + SPEC ‘le’ ACT ACT LOC STATE + QUANT ‘les’

C’est Claire. C’est Marie. Claire garde Marie. Claire verse du lait pour Marie. Marie apporte des biscuits au salon. Claire joue. Marie mange ses biscuits. Claire fait un camion pour Marie. Marie tire le camion dans le salon. Claire lit une histoire à Marie. Marie joue du tambour. Claire joue de la flûte. Marie met son pyjama. Elle se cache. Marie fait pipi. Elle brosse ses dents. Marie lit une histoire dans son lit. Marie est dans l’escalier. Elle rit. Claire dort dans la chaise. Les parents sont là.

Score constituents R R S S S S S S S S S S S S S S S S S S S

S S V V V V V V V V V V V V V V V V V V V

O O O O O O O O O O O O O P P P

Total

I P I P I

P

12 12 123 1234 1234 12 123 1234 1234 1234 123 123 123 12 123 123 1234 123 12 123 123

Note. R = referent; S = subject (agent, person); V = verb (action); O = direct object; I = indirect object; P = prepositional phrase (location adverbial). The administration procedure was as follows: The examiner first read the entire story to the child, showing the child each picture and reading the corresponding sentence. After this first presentation of the entire story, the examiner returned to the beginning and reread the first three pages to the child. The child was then asked to retell those three pages. The clinician held the book, stopping at each page and asking the child, “What happened in this picture?” This procedure was repeated, three pages at a time, to the end of the story. The child’s responses were recorded verbatim.

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Journal of Speech, Language, and Hearing Research • Vol. 58 • 287–300 • April 2015

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