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***** I would like to use the Reversal Design (ABA) to conduct research on the number of correct homework completion with  the addition of an intervention. 

Designing Research
In this section, you will now consider a research study you would be interested in conducting. Considering all of material from this course, please answer the following prompts that would be in your introduction and methods section. Introduction (30 points) 

  1. a)  Topic: Briefly describe your topic of interest and why it is important. Importance should be related to previous research in the field and need to assess the intervention. (5 points)   
  2. b)  Literature Review: Locate an article related to your topic of interest. Indicate how it is related to your topic of interest. Be sure to cite it in APA style. (5 points)   
  3. c)  Research Question :Create a research question based on the topic. Remember to include all of the components of a good research question. (10 points)   
  4. d)  Independent Variable: Identify the intervention or treatment package. (5 points)   
  5. e)  Dependent Variable: Identify the target behavior(s). (5 points)   

Method (70 points) 

  1. a)  Participant(s):Describe the population and justify why they were selected for your study. (5 points)   
  2. b)  Measurement Procedure: Identify how you will capture the dependent variable and include whether the measurement you selected is continuous or discontinuous. (10 points)   
  3. c)  Design: Select one single-case design and justify the reason for selection. (10 points)   
  4. d)  Measurement Integrity: Based on your measurement procedure and design, indicate which IOA procedure you will use. (10 points)   
  5. e)  Procedural Integrity: Describe how you will account for treatment integrity. (5 points)   

EDF 6437 FINAL PROJECT  Method (70 points) Continued 

  1. f)  Maintenance and Generalization: Describe considerations for maintenance and generalization. (10 Points)   
  2. g)  Social Validity :Defend how your study has social validity(5points)   
  3. h)  Ethical Considerations: Identify any ethical considerations in your research,   such as consent, assent, conflicts of interest, etc. (5 points)   
  4. i)  General: Indicate where your visual display of data be located in a scientific   paper. (5 points)   
  5. j)  General: Indicate where you would place the implications of your results in   a scientific paper? (5 points)   

LSHSS

Research Article

Explicit Grammar Intervention in Young
School-Aged Children With Developmental

Language Disorder: An Efficacy Study
Using Single-Case Experimental Design

Samuel D. Calder,a Mary Claessen,a Susan Ebbels,b,c and Suze Leitãoa

Purpose: This study evaluated the efficacy of an explicit,
combined metalinguistic training and grammar facilitation
intervention aimed at improving regular past tense marking for
nine children aged 5;10–6;8 (years;months) with developmental
language disorder.
Method: This study used an ABA across-participant
multiple-baseline single-case experimental design.
Participants were seen one-on-one twice a week for 20-
to 30-min sessions for 10 weeks and received explicit
grammar intervention combining metalinguistic training
using the SHAPE CODING system with grammar facilitation
techniques (a systematic cueing hierarchy). In each session,
50 trials to produce the target form were completed,
resulting in a total of 1,000 trials over 20 individual therapy
sessions. Repeated measures of morphosyntax were
collected using probes, including trained past tense verbs,
untrained past tense verbs, third-person singular verbs
as an extension probe, and possessive ’s as a control
probe. Probing contexts included expressive morphosyntax
and grammaticality judgment. Outcome measures also

included pre–poststandard measures of expressive and
receptive grammar.
Results: Analyses of repeated measures demonstrated
significant improvement in past tense production on trained
verbs (eight of nine children) and untrained verbs (seven of
nine children), indicating efficacy of the treatment. These gains
were maintained for 5 weeks. The majority of children made
significant improvement on standardized measures of expressive
grammar (eight of nine children). Only five of nine children
improved on grammaticality judgment or receptive measures.
Conclusion: Results continue to support the efficacy
of explicit grammar interventions to improve past tense
marking in early school-aged children. Future research
should aim to evaluate the efficacy of similar interventions
with group comparison studies and determine whether
explicit grammar interventions can improve other aspects
of grammatical difficulty for early school-aged children
with developmental language disorder.
Supplemental Material: https://doi.org/10.23641/asha.
11958771

D
evelopmental language disorder (DLD) refers to
a condition in which children experience lan-
guage difficulties in the absence of known bio-

medical conditions or acquired brain injury (Bishop,

Snowling, Thompson, Greenhalgh, & CATALISE-2 Con-
sortium, 2017). Compared to typically developing peers,
children with DLD present with particular difficulties in
morphosyntactic skills, such as the use (Rice, Wexler, &
Hershberger, 1998) and judgment (Rice, Wexler, & Redmond,
1999) of grammatical morphemes associated with tense.

Finiteness marking is challenging for children with
DLD (see Leonard, 2014, for a review). Finiteness refers
to the obligatory marking of verbs indicating subject–verb
agreement and tense, including affixation of morphemes –ed
(e.g., the girl walked) and –s (e.g., the girl walks) to verbs
for past and present tenses, respectively. Within English and
cross-linguistically, finiteness is a quality of well-constructed
clauses (Dale, Rice, Rimfeld, & Hayiou-Thomas, 2018).
There is evidence supporting disordered finiteness as a
distinct etiological construct and predictive marker of lan-
guage growth for DLD (Bishop, Adams, & Norbury, 2006).

aSchool of Occupational Therapy, Social Work and Speech Pathology,
Curtin University, Perth, Western Australia
bMoor House Research and Training Institute, Moor House School
& College, Oxted, United Kingdom
cLanguage and Cognition, University College London, United Kingdom

Correspondence to Samuel D. Calder:
samuel.calder@postgrad.curtin.edu.au

Editor-in-Chief: Holly L. Storkel
Editor: Amanda J. Owen Van Horne

Received March 19, 2019
Revision received July 1, 2019
Accepted October 5, 2019
https://doi.org/10.1044/2019_LSHSS-19-00060
Publisher Note: This article is part of the Forum: Morphosyntax
Assessment and Intervention for Children.

Disclosure: The authors have declared that no competing interests existed at the time
of publication.

Language, Speech, and Hearing Services in Schools • Vol. 51 • 298–316 • April 2020 • Copyright © 2020 American Speech-Language-Hearing Association298

Children’s grammar difficulties are a primary source of pa-
rental concern when considering referral for clinical services
(Bishop & Hayiou-Thomas, 2008).

Grammar Interventions
Treatment for DLD aims to accelerate language growth

and remove barriers to functional communication by har-
nessing strengths (Justice, Logan, Jiang, & Schmitt, 2017).
Ebbels’s (2014) review indicates an emerging evidence base
for the effectiveness of grammar intervention for school-
aged children with DLD. Current evidence is parsed into
implicit and explicit approaches to intervention. According
to Ebbels’s framework, implicit interventions target production
and understanding of grammar using grammar facilitation
techniques implicitly by responding to children’s errors in a
naturalistic way (Fey, Long, & Finestack, 2003). Children’s
learning and the knowledge acquired are not necessarily
associated with awareness. Explicit interventions target in-
creased awareness of the goals of intervention with a pre-
established concept of the criteria for success: Learning is
conscious and deliberate, and information can be recalled
on demand (Shanks, 2005). Within each approach to inter-
vention, specific techniques are used to improve acquisition
of grammar.

Implicit Interventions Using Grammar Facilitation
Intervention and scaffolding techniques used in im-

plicit approaches are described as grammar facilitation (e.g.,
Fey et al., 2003), which aims to facilitate the acquisition of
grammar by increasing the frequency and quality of target
forms in input and output. Greater exposure to and oppor-
tunities to learn and use language theoretically accelerates
the likelihood of language growth (Leonard, 2014). Studies
have empirically tested grammar facilitation techniques sup-
porting their use with expressive morphosyntax targets,
including imitation (Nelson, Camarata, Welsh, Butkovsky,
& Camarata, 1996), modeling (Weismer & Murray-Branch,
1989), focused stimulation (Leonard, Camarata, Brown, &
Camarata, 2004), and conversational recasting (see Cleave,
Becker, Curran, Van Horne, & Fey, 2015, for a review).
Recently, Van Horne, Fey, and Curran (2017) reported on
a primarily implicit intervention, in which procedures in-
cluded a combination of sentence imitation, observational
modelling, storytelling and focused stimulation, recasting,
and cueing for incorrect responses. All eighteen 4- to 10-year-
old children with DLD enrolled in the study improved
their use of regular past tense. Notably, as participants
were dismissed from the study following 36 sessions, many
still did not achieve mastery of the intervention target. In
general, outcomes following implicit intervention are favor-
able for morphosyntax in preschool-aged children (Leonard,
2014); however, mastery of intervention targets is rarely
reported.

Explicit Intervention Using Metalinguistic Training
Difficulties with morphosyntax often persist into

school age for children with DLD (Bishop, Bright, James,

Bishop, & Van der Lely, 2000). An alternative approach
may be required because children with DLD may have
difficulty learning grammar through implicit grammar fa-
cilitation. Metalinguistic training aims to improve children’s
learning of the rules of grammar by creating conscious
awareness of grammar through explicit metacognitive teach-
ing (Ebbels, 2014), allowing children to actively reflect on
language targets. Meta-awareness is enhanced, so rules of
grammar are learned explicitly in a compensatory way.

Metalinguistic techniques can be used explicitly to
teach grammar through metacognitive strategies using visual
supports and graphic organizers (Ebbels, 2014). The SHAPE
CODING system is designed to explicitly teach oral and
written syntax to children with language disorder (Ebbels,
2007). Ebbels, van der Lely, and Dockrell (2007) compared
use of the SHAPE CODING system with semantic therapy
and a no-treatment control group with 27 children with
DLD aged between 10 years and 16;1 (years;months). The
authors concluded that the SHAPE CODING system is a
viable and efficacious treatment approach to improve verb
argument structure in older school-aged children. Although
evidence for improvement in grammar comprehension is
mixed (e.g., Zwitserlood, Wijnen, van Weerdenburg, &
Verhoeven, 2015), children may be able to consciously re-
flect upon the rules of grammar through explicit interven-
tions in the presence of receptive language difficulties to
improve understanding, especially older children (Ebbels,
Marić, Murphy, & Turner, 2014).

Grammar intervention approaches effective for chil-
dren above 8 years old should be tested with younger chil-
dren to address the concerning gap in evidence for this age
group (Ebbels, 2014). Furthermore, Ebbels (2014) suggested
there may be benefit to integrating therapy techniques to
include grammar facilitation and metalinguistic training in
a range of activities (e.g., Fey et al., 2003). Combined ap-
proaches are yet to be explored extensively.

Combined Intervention Approaches
In an early-stage efficacy study, Finestack (2018)

used a combined implicit/explicit metalinguistic approach
compared to an implicit approach to teach novel morphemes
to 6- to 8-year-old children with DLD. The combined ap-
proach was more efficacious than the implicit approach,
with gains being maintained and generalized. In a random-
ized controlled trial of 31 preschool-aged children, Smith-
Lock, Leitão, Prior, and Nickels (2015) used explicit teaching
principles combined with a systematic cueing hierarchy,
which was effective in improving use of expressive morpho-
syntax when compared to conversational recasting alone.
Importantly, the study included a metalinguistic component
where children in the explicit group were aware of the thera-
peutic goal (Smith-Lock et al., 2015). Kulkarni, Pring, and
Ebbels (2013) conducted a clinical evaluation of the SHAPE
CODING system combined with elicited production and
recasting to improve the use of past tense for two children
with DLD aged 8;11 and 9;4. Both made significant gains
in their use of the target structure.

Calder et al.: Grammar Intervention in Young Children With DLD 299

Although grammar facilitation is generally considered
implicit (Ebbels, 2014; Fey et al., 2003), there is evidence
that the techniques can be used explicitly. In a pilot efficacy
study, Calder, Claessen, and Leitão (2018) combined the
SHAPE CODING system with the systematic cueing hier-
archy detailed in Smith-Lock et al. (2015) to improve gram-
mar in three children with DLD aged 7 years. Importantly,
systematic cueing as a grammar facilitation technique in
this study was explicit. Cues ranged from least to most sup-
port, and there was a focus on teaching correct production
of grammar through errors to avoid the child perceiving
the error to be semantic in nature, as may be the case when
using conversational recasting without stating the goal of
intervention first. The findings provided early evidence
supporting the use of combined intervention approaches to
improve receptive and expressive grammar, particularly
production of regular past tense following 5 weeks of inter-
vention. Notably, participants made gains in expressive
grammar following only 10 intervention sessions across
5 weeks, which is markedly shorter duration than reported
in many intervention studies. However, the authors ac-
knowledge that including measures of teaching, maintenance,
and generalization (e.g., Finestack, 2018) would have broad-
ened understanding of treatment effects and that a longer
period of intervention might be necessary.

Grammar Interventions in Clinical Practice
Recently, Finestack and Satterlund (2018) reported

on a national survey of speech-language pathology practice
in the United States. Past tense verb production was a
common intervention goal for practitioners in both early
(40%) and elementary education settings (60%). Interest-
ingly, overall between 60% and 70% used explicit presenta-
tions as an intervention procedure, despite relatively little
investigation in this area until recently. Therefore, it appears
explicit instruction to improve past tense may not only be
supported by an emerging evidence base but is also fre-
quently used in clinical practice.

The Current Study
For early school-aged children, preliminary data sug-

gest that explicit, combined metalinguistic and grammar
facilitation approaches are efficacious in treating the use of
tense marking and for improving receptive grammar more
generally (Calder et al., 2018). Building on early-stage
studies of treatment efficacy is required to determine if treat-
ment procedures are considered evidence based. Fey and
Finestack (2008) outline the need for a programmatic ap-
proach to pursuing intervention research, specifically noting
the value of small-scale studies aimed at exploring and
identifying specific components of intervention approaches
and their effects on specific populations. This study forms
a part of a program of research to design, develop, and
evaluate the efficacy of an explicit, combined grammar in-
tervention in line with Robey’s phases of clinical research
(Robey, 2004). We report on a range of measures to evaluate
the efficacy of explicit intervention to improve grammar.

Single-case experimental design (SCED) methodology was
used to test the following confirmatory hypotheses and is
reported as per the Single-Case Reporting guideline In
BEhavioural interventions (Tate et al., 2016):

1. For young school-aged children with DLD (specifically
aged 5;10–6;8), there will be a significant treatment
effect on trained past tense verbs and a generalized
effect to untrained verbs across 20 sessions of explicit
intervention combining metalinguistic and grammar
facilitation techniques.

2. These children will improve significantly on pre–
poststandardized measures of expressive and receptive
grammar.

Method
Research Design
Design

The current study was an ABA across-participant
multiple-baseline SCED, including a minimum of five data
points (i.e., sessions) for each phase (Kratochwill et al.,
2012). Multiple baselines were conducted for varied dura-
tions across participants, and introduction of treatment to
participants was staggered. Repeated measures were col-
lected throughout the intervention phase and posttreatment
maintenance phase (Dallery & Raiff, 2014), including the
target behavior (past tense verbs), an extension of the tar-
geted behavior (third-person singular [3S] verbs), and a
control behavior (possessive ’s). This design is noted for
robustness regarding strengths of internal validity and exter-
nal validity when compared to other SCEDs (Tate et al.,
2016). As a Phase I–II study, we replicated and built on
findings from Calder et al. (2018) by refining intervention
protocols, determining optimal dosage, and evaluating du-
ration of therapeutic effect (Robey, 2004).

Randomization
To improve internal validity further, participants

were randomly assigned to one of three predetermined
staggered onset to intervention conditions. To ensure con-
cealed allocation, participants were assigned a code that
was entered into a random list generator by a blinded re-
searcher. Participants received five (P1, P3, P8), seven (P5,
P7, P9), or nine (P2, P4, P9) pre-intervention baseline
sessions over as many weeks; 20 intervention sessions over
10 weeks; and five postintervention sessions to evaluate
maintenance. Participants were also randomized to gram-
maticality conditions described below.

Blinding
Participant caregivers and teachers were aware chil-

dren were receiving grammar intervention but were blinded
to the intervention target. Postintervention measures were
collected via blinded assessment using trained student speech-
language pathologists (SLPs).

300 Language, Speech, and Hearing Services in Schools • Vol. 51 • 298–316 • April 2020

Participants
Selection Criteria

Participants included nine early school-aged children
diagnosed with DLD. The inclusion criteria were aged
between 5;6 and 7;6, English as a primary language, and
grammar difficulties associated with DLD. Exclusionary
criteria included a neurological diagnosis, a cognitive im-
pairment, and hearing outside normal limits. Participants
were recruited from a specialized educational program for
students diagnosed with DLD. Ethical approval for the
study was obtained from the Curtin University Human
Research Ethics Committee (approval number: HRE2017-
0835) and the Western Australian Department of Educa-
tion. The principal consented school participation and
then provided information letters and consent forms to the
parents/carers of potential participants identified by SLPs
and teachers employed at the educational program. Parents
returned the completed consent forms if they wished their
child to participate. The study reached capacity at nine
participants so we could achieve three replications over three
baseline conditions as per reporting standards (Kratochwill
et al., 2012).

Participant Characteristics
The participants’ school enrolment package was

accessed, including the assessment protocol and the most
recent standardized assessment scores available. Data in-
cluded Clinical Evaluation of Language Fundamentals
Preschool–Second Edition (Wiig, Secord, & Semel, 2004),
a test of nonverbal IQ, and a comprehensive exploration
of previous medical history to identify contributing factors
to language difficulties, such as acquired neurological dam-
age, or hearing loss. These factors combined are consid-
ered evidence of a diagnosis for DLD (Bishop, Snowling,
Thompson, Greenhalgh, & CATALISE Consortium, 2016).
Participants then passed a hearing acuity test. All partici-
pants passed the Phonological Probe from the Test of Early
Grammatical Impairment (Rice & Wexler, 2001) for artic-
ulation of phonemes necessary for morphosyntactic pro-
duction targets.

All demographic information is presented in Table 1.
Participants included eight boys and one girl aged between
5;10 and 6;8 at initial assessment. Ages at enrolment to

the specialist school varied from 3;8 to 5;11. P1, P2, P4,
and P8 were in their third year of placement at the school;
P3, P5, P7, and P9 were in their second; and P6 was in her
first.

Measures
Repeated Measures

Repeated measures of morphosyntax were collected
at every data point using various probes, including trained
probes, untrained probes, an extension probe, and a control
probe (elaborated in the following sections). Probing con-
texts included both expressive morphosyntax and grammati-
cality judgment. Grammaticality judgment was selected
as a method of measuring grammatical progress, as there
is evidence performance on such tasks mirrors production
tasks (Rice et al., 1998, 1999). As grammaticality judgment
is a clinical marker of DLD (Dale et al., 2018; Rice et al.,
1999), identification of grammatically correct sentences in
the studied participants was expected to be below chance
levels of accuracy prior to intervention.

Trained probes. Regular past tense (–ed) repeated
measures of trained verbs were probed in two conditions:
12 –ed verbs trained within sessions were measured, and
12 –ed verbs from the previous session were measured. All
–ed verbs were predetermined at the outset of intervention
and selected based on their suitability to intervention activi-
ties. We also chose verbs that were not in the Grammar
Elicitation Test (GET; described below; Smith-Lock, Leitão,
Lambert, & Nickels, 2013) to allow comparison between
trained and untrained verbs. These probes were adminis-
tered during the intervention phase at the end of Session 2
(i.e., data point B1 the first week of intervention) and every
even session thereafter.

Untrained probes. Repeated measures of untrained
expressive morphosyntax probes were selected from an
adapted version of the GET. This experimental test was
designed to elicit multiple instances of specific expressive
morphosyntax targets, including 30 items probing the treated
grammatical structure (–ed). Repeated measures were also
developed for a grammaticality judgment task including
30 –ed probes. Videos of actions depicting the declarative
clauses containing –ed were created as stimuli for untrained
probes. Accompanying audio for each task item, both

Table 1. Demographic information.

Participant ID Sex
Age at enrolment to school

(years;months)
Current year at specialized

educational program
Age at initial assessment
for study (years;months)

P1 Male 4;0 3rd 6;3
P2 Male 3;11 3rd 6;2
P3 Male 4;7 2nd 5;10
P4 Male 5;4 3rd 6;8
P5 Male 5;2 2nd 6;6
P6 Female 5;11 1st 6;2
P7 Male 5;3 2nd 6;7
P8 Male 3;8 3rd 6;0
P9 Male 4;9 2nd 6;1

Calder et al.: Grammar Intervention in Young Children With DLD 301

grammatical and ungrammatical (e.g., The girl painted a
picture. vs. The girl paint* a picture.), was recorded by a
woman with an Australian accent, blinded to the purpose
of the research. Each video with corresponding audio was
embedded into a Microsoft PowerPoint presentation.
Participants wore Sony noise-cancelling headphones during
administration and were required to decide if the sentence
“sounded right” by pressing “yes” or “no” on a tablet app.
Items were counterbalanced for grammaticality, so partici-
pants did not receive the same combination of grammatical/
ungrammatical items, and there was no pattern in the pre-
sentation of grammatical/ungrammatical items to counter-
act a priming effect.

Complete sets of 30 untrained –ed verbs were probed
pre- and postintervention. Sets were randomized for ad-
ministration at the initial assessment (Timepoint 1), 1 week
prior to intervention commencing (Timepoint 2), 1 week
following intervention (Timepoint 3), and 5 weeks following
cessation of intervention (Timepoint 4). Both expression
and grammaticality judgment were assessed.

Reduced randomized sets were generated for each
other data point using nine expressive probes and 12 gram-
maticality judgment probes. All possible allomorphs were
included (i.e., [d], [t], and [əd]) and equally distributed. Probes
were administered via laptop during the pre-intervention
baseline phase, at the beginning of Session 3 (i.e., data point
B2 in the second week of intervention) and every odd ses-
sion thereafter during the intervention phase, and in the
postintervention maintenance phase.

Extension probes. Expressive repeated measures of
3S served as an extension of the treated structure. Items in-
cluded 30 probes and were taken from the GET. A gram-
maticality judgment task was also developed as per the
untrained –ed probes (e.g., The man sneezes. vs. The man
sneeze*.). 3S was considered an extension measure due to
the structure’s relative complexity compared to –ed, since
bare stem forms are grammatical when used with first-
person subject pronouns or plural subject nouns (e.g., I like
ice cream vs. The boys like ice cream vs. The boy likes ice
cream). We also expected there might be improvement in
3S due to the frequent instances of input during therapy
(see Intervention section) and increased awareness of the
need for tense marking.

Control probes. Similarly, expressive repeated measures
of possessive ’s served as a control probe. Items included
30 probes and were taken from the GET. As above, a
grammaticality judgment task was developed (e.g., The
spider is living on a leaf. This is the spider’s leaf. vs. The spi-
der is living on a leaf. This is the spider* leaf.). For ’s, still
images of nouns depicting ownership were retrieved from
copyright-free image sources. ’s was considered a control
as this noun possession was not taught as part of therapy
and therefore should remain stable throughout the inter-
vention period.

For extension and control probes, all possible allo-
morphs were included (i.e., [s], [z], [əz]) and equally distributed.
Randomized sets of nine expressive and 12 grammaticality
judgment items were generated and administered as per the

untrained –ed probes during pre-intervention, intervention,
and postintervention phases.

Pre–Post
The Structured Photographic Expressive Language

Test–Third Edition (SPELT-3; Dawson, Stout, & Eyer,
2003) and the Test of Reception of Grammar Version 2
(TROG-2; Bishop, 2003) were administered both pre- and
postintervention as expressive and receptive standardized
grammar measures, respectively. The SPELT-3 measures
expressive morphosyntax using 54 items across a range of
structures and was normed on children aged 4–9 years. To
address discriminant accuracy of the test, Perona, Plante,
and Vance (2005) determined 90% sensitivity and 100% sen-
sitivity at 95 cutoff (−0.33 SD). This cutoff score was used
for the current study based on the recommendation, al-
though it is noted that while other studies applied this cut-
off with older children (e.g., Van Horne et al., 2017), Perona
et al. (2005) sampled children aged 4–5 years. The TROG-2
measures a total of 20 different grammatical structure con-
trasts and was normed on children aged 4–16 years. Dis-
criminant accuracy was evaluated on a sample of 30 children
aged 6;2–10;11, which confirmed the test is sensitive to
identifying communication difficulties in children (Bishop,
2003). Both tests have strong reliability and appropriate
validity.

Reliability
A blinded researcher scored 20% of all measures au-

dio- and video-recorded throughout the study. Interrater
reliability for experimental measures was calculated using
intraclass correlation coefficients (ICCs) using absolute
agreement and single measures in a two-way mixed-effects
model. Interpretation of ICC values is as follows: < .40 =
poor, .40–.59 = fair, .60–.74 = good, and .75–1.00 = excel-
lent (Cicchetti, 1994). For trained –ed probes, the ICC for
expressive measures was .879, and the ICC for grammati-
cality judgment was .977. The ICC for expressive un-
trained –ed, 3S, and ’s probes was .937, and the ICC for
the grammaticality judgment of untrained –ed, 3S, and ’s
probes was .985. Therefore, excellent agreement was observed
across all experimental measures.

Intervention
All intervention sessions were videotaped and carried

out in a quiet space at the site of the educational program.
Procedures were similar to those reported by Calder et al.
(2018) and are explained within the model suggested by
Warren, Fey, and Yoder (2007) for describing treatment
intensity. The dose was 50 trials within 20- to 30-min ses-
sions; dose form was explicit intervention combining meta-
linguistic training using the SHAPE CODING system
(Ebbels, 2007) with a systematic cueing hierarchy (Smith-
Lock et al., 2015); dose frequency was twice a week, total
intervention duration was 10 weeks, and cumulative interven-
tion intensity was 50 trials × 2 times per week × 10 weeks,
resulting in a total of 1,000 trials over 20 individual

302 Language, Speech, and Hearing Services in Schools • Vol. 51 • 298–316 • April 2020

therapy sessions through roughly 7–10 hr of therapy. This
is double the intervention duration in the pilot study (Cal-
der et al., 2018), where authors suggested that participants
may demonstrate larger treatment effects following a lon-
ger duration. Training of morphosyntax was embedded
within engaging and naturalistic activities suited to early
school-aged children, including playdough, board
games, and playing with puppets as well as farm and sea
creature manipulatives. Target morphemes were presented
in syntactic structures as they occurred felicitously within
these activities. The first author (S. D. C.), a trained
SLP, delivered a

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