The authors of this article declare no conflict of interest.
The main objective of this study was to verify the effectiveness of an intervention program on cohesion in pupils with typical development and with developmental language disorder. A total of 99 5-year-old pupils from schools in the island of Tenerife (Canary Islands, Spain) participated. For the narrative analysis, a story retelling task was used, studying cohesive resources such as ellipsis, anaphora, possessives, and connectors. The intervention program was organized at different levels of practice and involved teachers and speech language therapists. The results indicated that the pupils diagnosed with developmental language disorder initially presented worse performance in cohesion than their peers with typical development. Finally, the two groups of children who received the intervention program showed significantly higher gains than the two groups without treatment, with medium or small effect sizes.
El objetivo principal del presente estudio ha sido comprobar la efectividad de un programa de intervención en la cohesión de alumnado con desarrollo típico y con trastorno del desarrollo del lenguaje. Participaron 99 alumnos de 5 años de colegios de la isla de Tenerife (Islas Canarias, España). Para el análisis narrativo se utilizó el recontado de un cuento, estudiándose recursos cohesivos como las elipsis, las anáforas, los posesivos y los conectores. El programa de intervención se organizó en diferentes niveles de práctica y contó con la colaboración entre el profesorado y las logopedas. Los resultados indicaron que el alumnado diagnosticado con trastorno del desarrollo del lenguaje presentaba inicialmente un peor rendimiento en cohesión que sus compañeros con desarrollo normal. Finalmente, los dos grupos de niños que recibieron el programa de intervención mostraron ganancias significativamente más altas que los dos grupos sin tratamiento, con tamaños de efecto medianos o pequeños.
Cohesion is one of the main aspects of the narrative discourse. It can be defined as the concurrence of syntactic and semantic mechanisms that facilitate thematic continuity in a discourse and clarify relations of local coherence (
Pupils with language difficulties tend to manifest considerable limitations when organizing a narrative discourse. A good example of this can be found in pupils diagnosed with Developmental Language Disorder (DLD). This group regularly presents numerous language difficulties affecting phonological, grammatical, lexico-semantic, pragmatic, and discursive elements of language (
Past research has shown (
The use of fewer cohesion mechanisms leads to greater narrative ambiguity in pupils with DLD, who tend to be unclear about who is performing the action and omit certain main ideas (
Given the above, it would seem reasonable to assume that intervention programs addressing narrative discourse would give priority to helping pupils with DLD improve their use of cohesion mechanisms. However, there is actually a clear predominance of programs aiming to optimize formal structure and grammatical expression in a narrative discourse. Some of these have become very widespread, such as
The present research defines two main hypotheses: first, pupils diagnosed with DLD will have more difficulties using cohesive resources than pupils with typical language development and second, pupils diagnosed with DLD will show greater gains in the use of cohesive resources in oral narrative after participating in an intervention program than a control group of pupils with typical development and another control group of pupils with DLD.
The longitudinal design included four groups: two groups of pupils with DLD, one experimental and one control and two groups of pupils with typical development, one experimental and one control. The independent variables were the group and the longitudinal variable of the repeated measures (with two levels), time of assessment; the dependent variable was narrative cohesion, more specifically measured as the number of uses of ellipsis, possessives, anaphora, and connectors, with all variables measured using a ratio scale. Once the participants and control variables had been identified, the pre-intervention assessment was conducted. Then, the intervention program was run, followed by post-intervention assessment. Both assessments and program were carried out in pupils’ schools. Prior consent was obtained from schools and families. Compliance with ethical standards was also positively evaluated by the university’s Ethics Committee.
A total of 99 pupils participated, all of whom were enrolled in early childhood education in schools in the island of Tenerife (Canary Islands, Spain) in the 2017-2018 school year. They were divided into four groups: (1) a group of pupils with DLD receiving treatment (DLD-T), (2) a group of pupils with DLD not receiving treatment (DLD-C), (3) a group of pupils with typical language development receiving treatment (TD-T), and (4) a group of pupils with typical language development not receiving treatment (TD-C). The Kolmogorov-Smirnov test was employed to assess normality of age,
The schools’ teams of guidance counsellors referred to us a total of 147 boys and girls, to whom the Clinical Evaluation of Language Fundamentals-CELF-4 test (
Pupils with typical development were selected to ensure the greatest possible uniformity among the four groups in age and sex. A total of 50 pupils with typical development were selected from amongst the classmates of pupils with DLD.
To obtain the oral corpora required for this study, “Tito the greedy dog” story was used. This is a story told only through images. The script reads as follows:
Once upon a time there was a dog called Tito who lived in a pretty little garden. Tito liked to eat so much that he was the greediest dog in the world. In the garden, a little mouse also lived amongst the plants. One day, Tito’s owner, a lady named Ana, put out his food and took him for a walk. When Tito came back from his walk, he saw that the food had disappeared. So Tito began to search all over the garden for it. Looking at the ground, he saw bits of food near one of the plants, and to his surprise, he saw the mouse in his burrow, with all of the food he had stolen. Tito tried to enter, but he couldn’t fit through the entrance, because it was a very small burrow. The dog was so hungry that he wouldn’t stop barking. At that moment, he thought, “What can I do? I need to get to the food!” Then, the dog started digging to make the entrance larger, but there was a huge stone in his way. So Tito, who was very stubborn, used all his strength to move the stone, and finally he reached the food. As he was very greedy, he started to eat very, very quickly. But just at that moment, when he looked at the mouse, he saw that he was very sad and he thought, “I’ll share my food with him!”. In the end, the two animals were happy because they had both got something to eat. And from that day onward, Tito always left a little food in the garden for his friend the mouse.
A retelling task was selected, in which the evaluator tells the story and then asks the child to retell it using the pictures as a guide (
Then, an analysis was conducted of the cohesive resources, identifying all uses of ellipsis, anaphora, connectors, and possessives.
The intervention program was made up of 55 sessions lasting 20 minutes each, organized into four phases (the second of which was the longest, with 25 sessions: 10-25-10-10). It was based mainly on the contributions of Gillam and
Pupils were encouraged to participate actively in the sessions and were given a number of opportunities to retell the stories. To this end, the sessions broadly followed the response to intervention models employing a multilevel approach, as proposed by
First, an ANOVA was run for each dependent variable using the pre-test measures to evaluate the initial differences between the groups and establish a baseline. Then, a second ANOVA was run on the pretest-posttest difference to identify any differential gains following the intervention. As a preliminary step for all the ANOVAs, homogeneity of variance was determined using Levene’s test. In the contrasts showing homogeneity, the robust Welch’s test was used. Orthogonal contrasts were run as post-hoc comparisons for evaluations showing significant differences, to identify which groups showed these differences. Generalized η2 was used as an indicator of effect size for both main effects and simple effects from the ANOVAs. A measure of η2 of approximately .01 is considered a small effect size, η2 of approximately .06 shows a medium effect size, and η2 greater than .14 is a large effect size. All analyses were run using the program SPSS v26.
1 Welch’s F.
*p = .05, **p = .01, ***p = .001.
In all of the elements showing differences, the two groups of pupils with DLD (DLD with treatment and DLD without treatment) showed results that were significantly lower than those of the two groups of pupils with TD (Control with treatment and control without treatment), with medium or large effect sizes, while the equivalent groups, DLD-C vs DLC-T and TD-C vs TD-T, did not show any differences between them.
1 Welch’s F.
*p = .05, **p = .01, ***p = .001.
In all of the elements showing differences, the two groups of pupils who received the intervention program (DLD and TD with treatment) showed gains that were significantly greater than those of the two groups without treatment, with medium or small effect sizes. Also, the groups with treatment showed no differences between them; the same was the case for two groups without treatment.
Oral narratives are a key aspect of participation and progress for pupils with DLD, not least because they create many opportunities for improving socioemotional skills and academic success. However, we often find that these pupils present serious narrative deficits. As the present study has shown, they perform worse in the use of cohesion markers as compared to their typically developing peers. There are few studies analyzing cohesion difficulties in children with DLD. One such study is that of
Turning now to the intervention program’s effectiveness, gains were observed in both the DLD and the TD groups that received the program, affecting use of the reflexive anaphora “se”, and the two types of connectors. For the gains in the use of the reflexive anaphora “se”, it must be recalled that the program was run with participants in their initial phases of development. Indeed, when considered in terms of early childhood development, one is more likely to find correct use of reflexives than of pronouns in this age group. One reason for this might be that reflexive antecedents are found in the same sentence, while the antecedents for pronouns are outside the sentence (
Beyond the statistical significance, it is notable that clinical significance was also achieved, that is, there were gains in the remaining skills as well (nominal ellipsis, verbal ellipsis, possessives, pronominal anaphora, and lexical anaphora) in the group receiving the intervention program; such gains were not always observed in the two control groups.
Furthermore, these findings should be considered, as stated by
The present study reveals a weakness in the ability exhibited by pupils in early childhood education in general, and in pupils with DLD in particular, to tell stories that are coherent and cohesive. For this reason, as suggested by
Cite this article as: Delgado-Cruz, A., Ramírez-Santana, G. M., & Acosta-Rodríguez, V. M. (2021). Intervention in the cohesion of narrative discourse in pupils with developmental language disorder.
Funding: This research was done as part of the “Intervención en comprensión lectora en alumnado de riesgo: Retraso de Lenguaje (RL) y Trastorno Específico de Lenguaje (TEL)” Research Project (Reference No. EDU2017-84193-R). Funding provided by the Ministry of Economy and Competitiveness of the Government of Spain.