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Purpose: This experiment investigated the effects of a book-sharing intervention implemented in coparenting homes on the conversations of preschoolers with their parents. Method: A multiple baseline design across behaviors was used to evaluate the effects of embedding decontextualized language utterances during book-sharing delivered by four families. A visual analysis, a two-level mixed-effects model, and a social validity evaluation were used to examine the varying effects of the program on mothers and fathers' storybook conversations. Results: Embedding decontextualized language prompts in books not only increased parental decontextualized language utterances, but most parents were able to maintain use of strategies without prompts in the books. The intervention effects were consistently higher for parents than for their children. Social validity results demonstrated parental satisfaction with program delivery and content. Conclusion: This study adds to the limited literature on father-child and mother-child decontextualized conversations during book-sharing and illustrates a feasible and adaptable way of promoting language experiences in the home that yield engaging decontextualized conversations in meaningful book-reading contexts.

Purpose Many preschoolers, especially those from low-income households, would benefit from instruction to enrich their vocabulary and language repertoires. Yet, explicit instruction of vocabulary and language skills generally occurs infrequently in early childhood education settings. This study investigated the additive effects of teacher-led, classwide review strategies to a previously studied small-group intervention on children's learning of academic vocabulary. Method Participants included 23 children with limited oral language skills at risk for reading difficulties enrolled in single-case experimental designs. Effects of the classroom strategies alone also were examined in 10 children with above-average language abilities from 2 classrooms. Results Visual analyses of the adapted alternating treatments designs showed consistent learning improvements when vocabulary instruction was extended into the classroom for 12 children, ceiling effects were evident for 3 participants regardless of condition, and inconsistent or minimal effects were demonstrated by 8 participants. Multilevel modeling used to evaluate the effects statistically revealed strong treatment effects. In addition, the 10 children with above-average language showed impressive learning of vocabulary words from books subject to teacher review strategies in comparison to words from books to which they were not exposed. Teachers varied in the extent to which they implemented review strategies in their classrooms. Nevertheless, their responses to social validity assessments were positive, supporting the feasibility of this intervention. Conclusions The addition of classwide review and practice opportunities is an effective means of enhancing the effects of an easy-to-implement small-group intervention that teaches challenging vocabulary words within prerecorded stories. This approach holds promise as a way to shrink the pervasive word gap that typically exists when children in high-poverty communities enter school.

Purpose: This article describes the iterative development of a home review program designed to augment vocabulary instruction for young children (ages 4 and 5 years) occurring at school through the use of a home review component. Method: A pilot study followed by two experiments used adapted alternating treatment designs to compare the learning of academic words taught at school to words taught at school and reviewed at home. At school, children in small groups were taught academic words embedded in prerecorded storybooks for 6 weeks. Children were given materials such as stickers with review prompts (e.g., \"Tell me what brave means\") to take home for half the words. Across iterations of the home intervention, the home review component was enhanced by promoting parent engagement and buy-in through in-person training, video modeling, and daily text message reminders. Visual analyses of single-subject graphs, multilevel modeling, and social validity measures were used to evaluate the additive effects and feasibility of the home review component. Results: Social validity results informed each iteration of the home program. The effects of the home program across sites were mixed, with only one site showing consistently strong effects. Superior learning was evident in the school + home review condition for families that reviewed words frequently at home. Although the home review program was effective in improving the vocabulary skills of many children, some families had considerable difficulty practicing vocabulary words. Conclusion: These studies highlight the importance of using social validity measures to inform iterative development of home interventions that promote feasible strategies for enhancing the home language environment. Further research is needed to identify strategies that stimulate facilitators and overcome barriers to implementation, especially in high-stress homes, to enrich the home language environments of more families.

Purpose: Many preschoolers, especially those from low-income households, would benefit from instruction to enrich their vocabulary and language repertoires. Yet, explicit instruction of vocabulary and language skills generally occurs infrequently in early childhood education settings. This study investigated the additive effects of teacher-led, classwide review strategies to a previously studied small-group intervention on children's learning of academic vocabulary. Method: Participants included 23 children with limited oral language skills at risk for reading difficulties enrolled in single-case experimental designs. Effects of the classroom strategies alone also were examined in 10 children with above-average language abilities from 2 classrooms. Results: Visual analyses of the adapted alternating treatments designs showed consistent learning improvements when vocabulary instruction was extended into the classroom for 12 children, ceiling effects were evident for 3 participants regardless of condition, and inconsistent or minimal effects were demonstrated by 8 participants. Multilevel modeling used to evaluate the effects statistically revealed strong treatment effects. In addition, the 10 children with above-average language showed impressive learning of vocabulary words from books subject to teacher review strategies in comparison to words from books to which they were not exposed. Teachers varied in the extent to which they implemented review strategies in their classrooms. Nevertheless, their responses to social validity assessments were positive, supporting the feasibility of this intervention. Conclusions: The addition of classwide review and practice opportunities is an effective means of enhancing the effects of an easy-to-implement small-group intervention that teaches challenging vocabulary words within prerecorded stories. This approach holds promise as a way to shrink the pervasive word gap that typically exists when children in high-poverty communities enter school.

Purpose Many children begin school with limited vocabularies, placing them at a high risk of academic difficulties. The goal of this study was to examine the effects of a vocabulary intervention program, , designed to improve vocabulary knowledge of at-risk preschool children. Method Twenty-four early-childhood classrooms were enrolled in a cluster-randomized design to evaluate the effects of a revised curriculum. In each classroom, three to four preschoolers were identified as having poor language abilities, for a total of 84 participants. In treatment classrooms, explicit vocabulary instruction was embedded in prerecorded storybooks and opportunities for review and practice of target vocabulary were integrated into classroom and home practice activities. In comparison classrooms, prerecorded storybooks included target vocabulary, but without explicit instruction, and classroom and home strategies focused on general language enrichment strategies without specifying vocabulary targets to teach. Intervention activities took place over 13 weeks, and 36 challenging, academically relevant vocabulary words were targeted. Results Children in the treatment classrooms learned significantly more words than children in the comparison classrooms, who learned few target words based on exposure. Large effect sizes (mean = 1.83) were evident as the treatment group averaged 42% vocabulary knowledge versus 11% in the comparison group, despite a gradual decline in vocabulary learning by the treatment group over the school year. Conclusions Findings indicate that a carefully designed vocabulary intervention can produce substantial gains in children's vocabulary knowledge. The program is feasible for delivery in early childhood classrooms and effective in teaching challenging vocabulary to high-risk preschoolers. Supplemental Material https://doi.org/10.23641/asha.13158185.

Poor reading levels is a pervasive problem in the US. For example, two of every three eigth grade students in the US are estimated to demonstrate insufficient reading comprehension skills. Early use of decontextualized language, in which the language expressed is removed from the here and now, serves as a precursor of academic language proficiency. Starting as early as the third year of life, decontextualized language is less likely to be practiced in lower socio-economic status (SES) households. Although storybooks offer a rich context for practicing the language with young children, reading storybooks alone is not adequate to promote conversational turn taking. Incorporating decontextualized language during storybook sharing delivered by mothers and fathers has potential benefits as a means for parents to prompt rich conversations with their children. Such conversations with decontextualized language during storybook sharing may help to narrow the 30-million word gap. Three studies comprising this dissertation investigate how to implement a feasible, effective parent-child book-sharing intervention program that promotes decontextualized language conversations of parents with their preschool aged children. The first study examined the effects of embedding decontextualized language cues during book-sharing delivered by four fathers living in low SES in Istanbul, Turkey. This study featured a multiple baseline design across behaviors and utilized visual analysis, Tau-U effect size estimates, and a social validity questionnaire to analyze the effects of the book-sharing program. The second study replicated the first study by examining the effects of implementing the same book-sharing program delivered by both mothers and fathers in four families living in Tampa, Florida. This second study extended the results of the first study. The analysis of the second study included multilevel models to reveal the magnitude of the intervention effect on participants and the differential effects of mothers and fathers on their child’s decontextualized language utterances. Results from these two studies showed that embedding decontextualized language cues during storybook sharing is functionnally related to increases in decontextualized language utterances of mother-child and father-child dyads living in lower SES households. When written cues were removed after two shared reading sessions, all but one family in the second study maintained their use of decontextualized language albeit with slightly depressed frequency. The intervention effects in the second study were consistently higher for parents than for their children. These children used significantly more decontextualized language utterances when responding to their mothers than to their fathers. The third study in this dissertation investigated how parent gender, household SES levels, and parenting indicators relate to parents’ storybook selection. This explanatory mixed-method study used qualitative content analysis to elaborate results from quantitative regression and hierarchical regression models. A total of 167 parents (91 mothers and 76 fathers) recruited from Amazon Mechanical Turk completed six surveys on parenting and demographics, selected children’ storybook topics, and then selected a book from two choices that differed based on coding of their difficulty. Results showed that parent gender and household SES levels do not predict the difficulty levels of storybooks selected by parents. Parenting style was the only significant predictor of the difficulty level of storybooks that parents select. Parents who demonstrated more inconsistent, harsh, or excessively lax parenting styles tended to select easier storybooks. Qualitative analyses identified four themes that did not reflect book difficulty. These themes were a) family and child relation with storybooks, b) instructional context of storybooks, c) physical characteristics of storybooks, and d) storybook appeal. In addition, 15% of parents’ comments indicated general appeal of particular storybooks as a criterion while selecting storybooks, using vague descriptions, such as “cute book” and “pleasing book.” Early language intervention programs with the individualized and explicit instruction with ongoing guidance seem to represent effective ways of prompting conversations with decontextualized language cues during book-sharing. These studies could influence the ways that parent-child storybook sharing programs are implemented and the classification systems used to provide parents with objective information for selecting storybooks. Such studies can help to improve the effects of early language intervention programs that could eventually lead to social policy changes to narrow the 30-million word gap.

Purpose This study evaluated the effects of an automated, small-group intervention designed to teach preschoolers challenging vocabulary words. Previous studies have provided evidence of efficacy. In this study, we evaluated the effects of the program after doubling the number of words taught from 2 to 4 words per book. Method Seventeen preschool children listened to 1 prerecorded book per week for 9 weeks. Each storybook had embedded, interactive lessons for 4 target vocabulary words. Each lesson provided repeated exposures to words and their definitions, child-friendly contexts, and multiple opportunities for children to respond verbally to instructional prompts. Participants were asked to define the weekly targeted vocabulary before and after intervention. A repeated acquisition single-case design was used to examine the effects of the books and embedded lessons on learning of target vocabulary words. Results Treatment effects were observed for all children across many of the books. Learning of at least 2 points (i.e., 1 word) was replicated for 74.5% of 149 books tested across the 17 participants. On average, children learned to define 47% of the target vocabulary words (17 out of 36). Conclusions Results support including 4 challenging words per book, as children learned substantially more words when 4 words were taught, in comparison to previous studies. Within an iterative development process, results of the current study take us 1 step closer to creating an optimal vocabulary intervention that supports the language development of at-risk children.

Purpose: This study evaluated the effects of an automated, small-group intervention designed to teach preschoolers challenging vocabulary words. Previous studies have provided evidence of efficacy. In this study, we evaluated the effects of the program after doubling the number of words taught from 2 to 4 words per book. Method: Seventeen preschool children listened to 1 prerecorded book per week for 9 weeks. Each storybook had embedded, interactive lessons for 4 target vocabulary words. Each lesson provided repeated exposures to words and their definitions, child-friendly contexts, and multiple opportunities for children to respond verbally to instructional prompts. Participants were asked to define the weekly targeted vocabulary before and after intervention. A repeated acquisition single-case design was used to examine the effects of the books and embedded lessons on learning of target vocabulary words. Results: Treatment effects were observed for all children across many of the books. Learning of at least 2 points (i.e., 1 word) was replicated for 74.5% of 149 books tested across the 17 participants. On average, children learned to define 47% of the target vocabulary words (17 out of 36). Conclusions: Results support including 4 challenging words per book, as children learned substantially more words when 4 words were taught, in comparison to previous studies. Within an iterative development process, results of the current study take us 1 step closer to creating an optimal vocabulary intervention that supports the language development of at-risk children.

BackgroundTo evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition.MethodsA prospective cohort study (TR-ROP) was performed between 1 April 2016 and 30 April 2017 in 69 neonatal intensive care units (NICUs). Infants with a birth weight (BW)≤1500 g or gestational age (GA)≤32 weeks and those with a BW>1500 g or GA>32 weeks with an unstable clinical course were included in the study. Predictors for the development of ROP were determined by logistic regression analyses.ResultsThe TR-ROP study included 6115 infants: 4964 (81%) with a GA≤32 weeks and 1151 (19%) with a GA>32 weeks. Overall, 27% had any stage of ROP and 6.7% had severe ROP. A lower BW, smaller GA, total days on oxygen, late-onset sepsis, frequency of red blood cell transfusions and relative weight gain were identified as independent risk factors for severe ROP in infants with a BW≤1500 g. Of all infants, 414 needed treatment and 395 (95.4%) of the treated infants had a BW≤1500 g. Sixty-six (16%) of the treated infants did not fulfil the Early Treatment for Retinopathy of Prematurity requirements for treatment.ConclusionsScreening of infants with a GA≤34 weeks or a BW<1700 g appears to be appropriate in Turkey. Monitoring standards of neonatal care and conducting quality improvement projects across the country are recommended to improve neonatal outcomes in Turkish NICUs.Trial registration number NCT02814929, Results.