Tech Tuesday: Summer Study Series on an RCT of Narrative Intervention for Adolescents

In this July edition of the “Summer Study Series” describing research relevant to narrative language intervention, we look at an exciting piece of research from last summer (July/August 2019), Improving storytelling and vocabulary in secondary school students with language disorder: a randomized controlled trial* (full article available at link). In this article, Joffe, Rixton and Hulme describe a randomized controlled trial (RCT) involving both narrative and vocabulary intervention for secondary students in the UK. It is notable because RCTs in language intervention are relatively rare, and considered a high level of evidence. ASHA, on a scale of evidence quality, rates “well designed randomized controlled trials” as level 1b, 2nd on a 6-point scale of evidence; these are research studies in which intervention groups are compared to a control group in which no intervention was provided. Additionally, interventions for adolescents with persistent language problems are less researched, so this study is an important one!

The researchers describe the following within their study:

• As students mature, they are expected “to tell stories with increasing sophistication, show appreciation of emotion and motivation of characters, and draw upon advanced social skills such as persuasion and negotiation,” and these skills have been shown to be strong predictors of literacy and academic achievement. Additionally, they highlight the connection between language development and social/emotional functioning.
• In addition, the authors note the lack of research available for this age group; a systematic review of narrative-based language interventions (Petersen, 2011) had only one of nine studies including adolescents in looking at the expression of oral and written narratives.
• The study qualifies as “well-designed” and significantly subscribed, with 358 subjects with a mean age of 12.8 sorted into experimental groups in which narrative intervention, narrative plus vocabulary intervention, and vocabulary intervention only were compared with a control group with no intervention provided. For the purposes of this post, we will focus on the narrative aspects, though you may find the vocabulary discussion valuable as well.
• Participants were assessed with several subtests of the CELF-5 related to sentence production, as well as a standardized measure of narrative skills (Expression, Reception and Recall of Narrative Instrument-ERRNI) and a qualitative story generation task. This looked at “organization of the narrative, sequencing, character descriptions, reference to time and place, discrete episodes of events, reactions and resolutions, emotional or cognitive responses of the characters, presence of a climax, integration of story elements, use of dialogue, onomatopoeia and sound effects, appropriate use of anaphoric referencing and idioms,” and was based on a story grammar framework (Stein & Glenn, 1979). Additionally, students engaged in a metalinguistic task exploring their knowledge of story structure and other indicators.
• Stein & Glenn’s framework, not readily available online, was modified for the intervention protocol which focused on story structure as well as exposure to different types of stories and narrative genres. One can assume a synergy with the comprehensive narrative intervention framework provided by Story Grammar Marker^®.
• Interestingly, and partly because of “the limited availability of speech and language therapy and specialist support in secondary schools in the UK,” interventions were performed by teaching assistants (TAs) who were trained in the support techniques over four days. Interventions took place in the classroom setting for 45–60 min, three times per week over 6 weeks.
• Post-measures mirrored the assessments administered pre-intervention and found moderate effect sizes in all three groups. Interestingly, this included the vocabulary only group, which did not show significant improvement in vocabulary measures but did so in narrative! The authors’ analysis of this was that “all three programmes involved getting students to produce language in a structured and supportive environment with feedback. It can be argued that the changes in narrative skills observed here may reflect ‘generative’ language skills; applying common strategies that generalize to different language contexts.” So, structure is the key!

So, two practical ideas related to this research study:

1. This study establishes the importance of teaching story grammar elements to improve the narrative language skills of adolescents. Your MindWing manuals, particularly the ThemeMaker^® manual, provide minimized grayscale icons particularly suitable for older students. In THIS POST and in our recent webinar, “Intersecting Story Grammar Marker^® with Technology & Telepractice: Distance Learning During COVID19 Crisis and Beyond,” I describe how the provided PDF language maps can be annotated and used in teletherapy and also in-person therapy. Don’t miss the more recent and relevant webinar (same launch page) “11 Elements of the Story Grammar Marker Treatment Process for Older Students.”
2. Keeping it simple and visual is helpful in working with adolescents. Resources such as Visual Writing Prompts and this resource from the New York Times, as well as motivating videos from YouTube (I love MovieClips’ channel for narrative retelling) can be good motivational starting points.

* International Journal of Language and Communication Disorders, July/August 2019, Vol. 54, N0. 4, 656–672