This paper describes an approach to teaching grammar which has been designed for school-aged children with SLI. The approach uses shapes, colours and arrows to make the grammatical rules of English explicit. Evidence is presented which supports the use of this approach with older children with SLI in the areas of past tense morphology, comprehension of dative structures and comparative questions. I conclude that there is sufficient evidence that this kind of intervention can be efficacious with these older children. This challenges the current move to reduce direct intervention for school-aged children.

Four hours of semantic therapy on discrete semantic categories led to significant gains on a general standardized test of word finding, enabling the participants to begin to close the gap between their performance and that of their typically developing peers. These gains were maintained after 5 months. A small amount of therapy can lead to significant gains even with secondary aged pupils with severe language difficulties. However, further studies are needed to find ways of improving word-finding abilities in discourse.

This article summarizes the evidence as regards the effectiveness of therapy for grammar for school-aged children with language impairments. I first review studies focusing on specific areas of grammar (both expressive and receptive targets) and then studies aiming to improve language more generally, several of which focus more on the effectiveness of different methods of delivery. I conclude that while there is a growing body of evidence in this area, there are still many gaps. The most concerning gap is the small amount of evidence of effectiveness of intervention for children with receptive as well as expressive language impairments. The evidence to date seems to indicate that these children need specialist, intensive help in order to make progress with their language. Further research is also needed to consider the relative impact of different types of interventions (or their combination) on children of different ages and with different language profiles, including establishing the most effective and/or cost-effective methods of delivery of these interventions.

Both methods of argument structure therapy were effective. Comparisons of their effectiveness in specific areas led to the hypotheses that the pupils' initial difficulties with linking resulted from ill-defined semantic representations, whereas their limited use of arguments may have resulted from syntactic difficulties. When therapy is theoretically grounded, it can inform theories, be time limited, and be effective for older children with SLI.

SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost-effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches.

The results of a pilot study into meta-syntactic therapy using visual coding for four children (age 11-13 years) with severe receptive and expressive specific language impairment (SLI) are presented. The coding system uses shapes, colours and a system of arrows to teach grammatical rules. A time-series design established baseline pre-therapy measures of comprehension and production of both passives and 'wh' questions. All participants made progress with passives and this was significant in three cases of the four. Comprehension and production of 'wh' questions also improved in all participants, although this did not always reach statistical significance. The results indicate that meta-syntactic therapy of grammatical rules, capitalizing on visual strengths, can improve both comprehension and production in secondary age children with severe persistent SLI.

Background: Little evidence exists for the effectiveness of therapy for children with receptive language difficulties, particularly those whose difficulties are severe and persistent. Aims: To establish the effectiveness of explicit speech and language therapy with visual support for secondary school-aged children with language impairments focusing on comprehension of coordinating conjunctions in a randomized control trial with an assessor blind to group status. Methods & Procedures: Fourteen participants (aged 11;3-16;1) with severe RELI (mean standard scores: CELF4 ELS = 48, CELF4 RLS = 53 and TROG-2 = 57), but higher non-verbal (Matrices = 83) and visual perceptual skills (Test of Visual Perceptual Skills (TVPS) = 86) were randomly assigned to two groups: therapy versus waiting controls. In Phase 1, the therapy group received eight 30-min individual sessions of explicit teaching with visual support (Shape Coding) with their usual SLT. In Phase 2, the waiting controls received the same therapy. The participants' comprehension was tested pre-, post-Phase 1 and post-Phase 2 therapy on (1) a specific test of the targeted conjunctions, (2) the TROG-2 and (3) a test of passives. Outcomes & Results: After Phase 1, the therapy group showed significantly more progress than the waiting controls on the targeted conjunctions (d = 1.6) and overall TROG-2 standard score (d = 1.4). The two groups did not differ on the passives test. After Phase 2, the waiting controls made similar progress to those in the original therapy group, who maintained their previous progress. Neither group showed progress on passives. When the two groups were combined, significant progress was found on the specific conjunctions (d = 1.3) and TROG-2 raw (d = 1.1) and standard scores (d = 0.9). Correlations showed no measures taken (including Matrices and TVPS) correlated significantly with progress on the targeted conjunctions or the TROG-2. Conclusions & Implications: Four hours of Shape Coding therapy led to significant gains on comprehension of coordinating conjunctions which were maintained after 4 months. Given the significant progress at a group level and the lack of reliable predictors of progress, this approach could be offered to other children with similar difficulties to the participants. However, the intervention was delivered one-to-one by speech and language therapists, thus the effectiveness of this therapy method with other methods of delivery remains to be evaluated.Keywords: intervention, randomized control trial, language impairment, language disorder, receptive language, Shape Coding, adolescents. What this paper adds?What is already known on this subject? Many children supported by speech and language therapy services have receptive language impairments. However, there is little evidence of the effectiveness of speech and language therapy for receptive language difficulties, particularly in older children and those with severe receptive language difficulties.Address correspondence to: Susan Ebbels, Moor House School, Mil...

The intervention delivered one-to-one by the participants' usual SLT was effective in teaching new vocabulary to older children with language disorders. This shows that older children with language disorders can make progress with direct one-to-one intervention focused on vocabulary.