What works in therapy: Further thoughts on improving clinical practice for children with language disorders

Purpose: In this response to Kamhi (2014), the author reviewed research about what does and does not help children with language impairment (LI) to learn grammatical features and considered how that research might inform clinical practice. Method: The author reviewed studies about therapy dose (the number of learning episodes per session) and dose frequency (how learning episodes are spaced over time) and also reviewed studies about dose form, including input characteristics and therapy strategies. Conclusion: Although the research is limited, it offers implications for how clinicians do therapy. Children with LI need many learning episodes clustered together within sessions but spread out over time across sessions. Input must be grammatical and consistent while providing varied exemplars of the target features. Learning episodes should actively engage children in producing utterances with the target form, but only after they have had the chance to hear some utterances with that feature. The author suggests a session plan that starts with a structured activity and then incorporates the target form into an embedded activity such as storytelling.