CClinicalTrials.gg
CompletedNCT04531514Updated Oct 27, 2025

A Framework For Linking Sequential Pattern Rules in DLD: Perception in Toddlers

An interventional study of Sensitivity to phonological rules & referents OR: Toddlers and Sensitivity to phonological rules & referents FR: Toddlers in Developmental Language Disorder, Speech Sound Disorder and Specific Language Impairment, sponsored by Father Flanagan's Boys' Home. Completed at 1 site in United States. Open to participants aged 19 Months to 36 Months, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-10-27.

Sponsored by Father Flanagan's Boys' Home · Not applicable, Interventional, and Basic science

Phase
Not applicable
Study type
Interventional
Enrollment
105
Allocation
Randomized
Ages
19 Months to 36 Months
Sex
All
01

Study summary

This broad aim of this clinical study is to assess the hypothesis that morphological and phonological deficits are linked by a broader deficit in sequential pattern learning. This hypothesis applies to learning in general, but is especially critical as an avenue for developing earlier assessments and more powerful interventions for children with developmental language disorder (DLD; AKA specific language impairment). Other populations, such as at-risk toddlers, may also benefit from this new approach.

Read the detailed description

The developmental approach taken here combines what we already know about morpho-syntactic deficits in DLD with recent developments in the fields of linguistics and language acquisition. First, it is possible to divide phonological and morphological patterns into three pattern types (Single Feature, OR/Disjunction, Family Resemblance/Prototype), with these types having a long history of study in visual pattern learning. Importantly, children with DLD appear to have maximum difficulty with morpho-syntactic patterns of the OR type (e.g., regular past tense; add a "t" if the final consonant is voiceless OR a "d" if the final consonant is voiced). In contrast, studies using artificial grammars show that infants who are typically developing are highly adept at learning Single Feature and OR pattern types; Family Resemblance patterns may be weaker. Family resemblance patterns relate to similarity, and may be more closely tied to the lexicon than to grammar (e.g., beagles and terriers are similar and they are both dogs; the words "goat" and "boat" are similar). Typical adults are adept at Single Feature and Family Resemblance patterns, but appear to be, at least superficially, more like children with DLD in their performance on the OR pattern.

With these intriguing findings as a starting point, the proposed research links phonological and morphological sequence learning in children with developmental language disorder (DLD). In the studies focused on children, we ask if 4- to 6-year-olds who are typically developing as well as those with DLD (both with and without co-occurring speech sound deficits) and speech sound disorder (SSD; without co-occurring morpho-syntactic deficits) are sensitive to input examples that fit one of these three patterns. Our hypothesis is that, consistent with their long-documented morpho-syntactic deficit, children with DLD will have particular difficulty with the OR pattern. Consistent with their intact morpho-syntactic skills, children with SSD should show no deficits in the OR pattern, revealing a link between OR pattern learning, phonology, and morpho-syntax. Our endpoint measure is that children with DLD (both with and without an accompanying SSD) do not show sensitivity to the OR pattern, as measured by sound pattern (e.g., phonetic accuracy, syllable sequence stability) and motor learning (e.g., articulatory and acoustic variability) measures.

This hypothesis is assessed by indexing the learning trajectory across the training period and during generalization to new nonwords that are consistent or inconsistent with the training pattern. In the generalization phase, children are asked to name new novel words that are either consistent (i.e., that fit the training rule) or inconsistent (i.e., that do not fit the training rule) nonwords. It is predicted that children with TD and SSD, who are still in a period of language learning plasticity (they can still learn the sound patterns and grammar of a second language) will be sensitive to all three patterns. However, children with DLD (both with and without accompanying SSD) are predicted to show sensitivity to the family resemblance and single feature patterns, but not to the critical OR pattern-the one associated with sound pattern and grammatical learning, This would reveal an important connection between sound pattern and grammatical learning, which could lead to earlier diagnosis (phonological patterns emerge earlier than grammar) and to more general intervention practices that focus on sequential pattern learning rather than specific language goals may be efficacious.

A second aim explores whether the inclusion of a semantic subcategory cue facilitates learning the OR pattern. The hypothesis is that children with DLD (as well as typical adults) who initially are predicted to have the most difficulty with the OR pattern, will show increases in sensitivity following the addition of a semantic category cue (e.g., animals for the voiced consonant rule OR tools for the voiceless consonant rule). This result would be especially important for learners with DLD, as it may provide a pathway for intervention of a core learning deficit.

Critically, these studies are developmental in nature. In the adult component of this research, we ask if adults are sensitive to input examples that fit one of these three patterns. Our hypothesis, based on previous findings from the Gerken lab, is that adults, like children with DLD, do not show sensitivity to the OR pattern. However, adults are sensitive to single feature and Family Resemblance patterns. Adults still learn words readily and are sensitive to family resemblance prototype relationships. For adults, perceptual measures index sensitivity. Similar to the children with typical development, DLD and SSD, we explore whether the inclusion of a semantic subcategory cue facilitates learning the OR pattern in adults. The hypothesis is that all learners, including adults, will show increases in sensitivity following the addition of a semantic category cue (e.g., animals for voiced rule OR tools for voiceless rule). The findings from adults contribute to a dynamic developmental framework. Because of the dramatic developmental changes in sensitivity to phonological sound patterns and the presumed linkage of such patterns to morpho-syntax, the data from adults are essential in identifying the underlying mechanism(s) of DLD and to suggesting possible intervention strategies, such as employing semantic cues to the OR pattern and strengthening lexical organization.

From previous work, we know that infants are sensitive to the OR rule. In the studies focused on toddlers, we ask if dependence on the associatively organized lexicon can account for the infant-to-adult developmental changes observed for the OR pattern (which is not associatively organized) and thereby explores the possibility that children with DLD rely on their lexicons to compensate for their sequential pattern learning deficit. The hypothesis is that 20-month-old children, who are just entering a period of rapid vocabulary learning, will show increased sensitivity (based on looking time to words that are consistent vs. inconsistent within the training set) in the family resemblance condition when a visual referent (i.e., semantic cue) is added, but decreased sensitivity in the OR condition when a visual referent is added. These results will also be related to vocabulary size as reported on the CDI, with the prediction that robust patterns are smaller for children who received referents or who have smaller vocabularies for the OR pattern and greater for children who received referents or who have larger vocabularies for the family resemblance pattern. The results from toddlers, who are just entering a period of rapid vocabulary learning, provide an essential framework for understanding how different types of phonological patterns apply to lexical and morpho-syntactic learning, The results of the proposed study provide a critical developmental framework for identifying the underlying mechanism(s) of DLD. These findings will also lead to the development of intervention strategies, such as strengthening lexical organization, to support problematic aspects of sequential pattern learning.

02

Conditions studied

  • Developmental Language Disorder
  • Speech Sound Disorder
  • Specific Language Impairment
03

In context

Language Development Disorders

114 studies on the registry are indexed under Language Development Disorders; 47 are open to participants now.

This study's enrollment of 105 is above the median of 71 across 100 interventional studies indexed under Language Development Disorders.

Browse Language Development Disorders studies →

Lead sponsor

Father Flanagan's Boys' Home is the lead sponsor of 18 studies on the registry; 7 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
19 Months to 36 Months
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

Toddlers will, based on parent case history report, have

  • normal hearing
  • no medical or developmental concerns
  • Language, speech, social, and motor development will be reported as within the expected range
  • dominant exposure to English from infancy
  • expressive vocabulary above the 10th percentile on the MacArthur-Bates Communicative Development Inventory (CDI; Fenson et al., 2006).

Exclusion criteria

Exclusion Criteria:

Participants will be excluded who have

  • hearing impairment
  • intellectual impairment
  • autism
  • significant motor impairment
  • reported histories of developmental, speech, language, or hearing disorders
05

Study design

Phase
Not applicable
Primary purpose
Basic science
Allocation
Randomized
Intervention model
Single group
Masking
Double (Participant, Care provider)
Enrollment
105 participants (actual)

Study arms

  • Experimental
    Sensitivity to phonological rules & referents OR: Toddlers

    OR condition

    Other: Sensitivity to phonological rules & referents OR: Toddlers

  • Experimental
    Sensitivity to phonological rules & referents FR: Toddlers

    Family Resemblance condition

    Other: Sensitivity to phonological rules & referents FR: Toddlers

Interventions

  • OtherSensitivity to phonological rules & referents OR: Toddlers

    Assess whether the inclusion of a semantic reference decreases OR phonological rule learning

  • OtherSensitivity to phonological rules & referents FR: Toddlers

    Assess whether the inclusion of a semantic reference increases FR phonological rule learning

06

What researchers measure

Primary outcomes

  1. Toddlers' ability to learn different types of sound patterns measured by listening times

    Learning will be assessed during the generalization phase. First, each toddler will be given a difference score resulting from mean listening time for consistent minus mean listening time for inconsistent test trials. It is predicted that toddlers will show increased learning of the OR rule in the non-referential condition. Higher vocabulary on the CDI will correspond with weaker performance.

    Time frame: Generalization Phase which will last 3-5 minutes

07

Study locations

1 site
  • Boys Town Hospital
    Omaha, Nebraska 68131, United States
08

References and documents

Individual participant data

Plan to share: Undecided — These data are transferring from University of Arizona to Boys Town National Research Hospital following the death of Dr. LouAnn Gerken. If the IRB allows, de-identified data will be posted on open science framework.

No publications or documents are linked to this record.

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Oct 27, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04531514
Lead sponsor
Father Flanagan's Boys' Home
Responsible party
Lisa Goffman (Senior Scientist, Father Flanagan's Boys' Home) — Principal investigator
First posted
Aug 28, 2020
Start date
Aug 3, 2020
Primary completion
May 17, 2025
Completion
May 17, 2025
Last update
Oct 27, 2025

Study contacts

Lisa Goffman, PhD
principal investigator · Father Flanagan's Boys' Home

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Oct 2025. You cannot join it, but the record below documents what was studied.

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