# Recasting and book reading under ideal (dose-controlled) and typical (dose-variable) conditions: The role of fidelity and adherence in production and comprehension outcomes for children with DLD

> **NIH NIH R01** · UNIVERSITY OF DELAWARE · 2024 · $5,494

## Abstract

Project Summary
Developmental Language Disorder (DLD) is a disorder in language learning and use that affects 7% of the
population. Grammatical difficulties are a hallmark characteristic of this disorder during childhood. Long-term
academic and quality of life outcomes are poor. The development of broadly adoptable techniques to
remediate comprehension and production of complex syntax prior to attainment of fluent reading would
increase access to the academic curriculum earlier and improve long-term outcomes of individuals with DLD. It
is unlikely that recast therapy, the current standard of care, is delivered effectively within the constraints of
current service delivery approaches and reimbursement models. Thus, there is a need to either demonstrate
that recasts are a superior intervention method worthy of the effort required for faithful implementation, or to
identify and develop an alternative approach that is feasible for administration to children older than 3 who are
not yet fluent readers. Illustrated syntax stories i.e., specially constructed stories loaded with the target
grammatical form that can be read aloud by a caregiver, could be that more feasible approach. Literacy, while
not universal, is more accessible than recast therapy to a broad range of adults and high rates of input can be
rapidly and consistently provided. This approach has previously been shown to increase the production and
comprehension of passives, reported speech, and conjoined clauses in typical preschoolers and school age
children. Our own preliminary data suggests that illustrated syntax stories could also be effective for children
with DLD. Here, we carry out a randomized controlled trial, enrolling 140 children with DLD between the ages
of 4 and 7 who score below 40% correct on the use of passives and object relative clauses. Children receive
one of four possible treatments (recasts at home, recasts in the lab, syntax stories at home, syntax stories in
the lab) for one grammatical structure for 10 weeks and then outcomes are re-assessed for both the treated
and untreated structures. Comparison of the two different treatment approaches in the lab under dose
controlled conditions informs us as to the mechanism of action for language learning. Specifically in Aim 1, we
contrast interactive, feedback-based learning (recast therapy) with concentrated systematic exposure
(illustrated syntax stories). In Aim 2, we consider the influence of the delivery mechanism on the ultimate dose
delivered when treatment is provided by caregivers. We ask whether there is sufficient difference between the
two delivery methods in terms of the dose provided by caregivers such that it cascades down to affect child
outcomes. Combining outcomes data with quantitative information about the degree of fidelity and adherence
and qualitative information reasons for these behavior patterns (Aim 3) will provide critical information about
the circumstances under which these treatments can be p...

## Key facts

- **NIH application ID:** 11064508
- **Project number:** 3R01DC018276-04S1
- **Recipient organization:** UNIVERSITY OF DELAWARE
- **Principal Investigator:** Amanda Jean Owen Van Horne
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $5,494
- **Award type:** 3
- **Project period:** 2020-09-01 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11064508

## Citation

> US National Institutes of Health, RePORTER application 11064508, Recasting and book reading under ideal (dose-controlled) and typical (dose-variable) conditions: The role of fidelity and adherence in production and comprehension outcomes for children with DLD (3R01DC018276-04S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/11064508. Licensed CC0.

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