Micro-Trial of a Narrative Learning Component to Enhance Learning of ER Skills Among Children with Language Delays and Behavior Problems

Introduction: Children with language delays and disruptive behavior problems are at extremely high risk for ongoing problems.  Language delays may also reduce children’s ability to learn new skills in interventions.  In a previous RCT evaluating a multi-component indicated intervention (Rochester Resilience Project; RRP) that teaches 1^st-3^rd graders emotion self-regulation (ER) skills, younger children gained less ER skill knowledge and less improvement in internalizing and externalizing problems.  Although language skills were not assessed, qualitative reports suggested that younger children lacked language to comprehend and retain new ER skills.  To address the intervention needs of children with less developed language, we developed a narrative learning component to supplement standard RRP and tested impact on a proximate outcome: children’s knowledge of ER skills. 

Methods: 39 1^st-3^rd graders with elevated behavior problems were randomly assigned to standard RRP or RRP plus narrative learning activities.  RRP consisted of 14 skill lessons with an individual mentor over 3-4 months teaching emotion self-regulation skills, plus periodic coaching to support skill use.  Parents were also engaged to support skill use (~60% of parents participated). Narrative component consisted of 8 brief (~10-15 min) activities that included storybook creation, verbal reminiscence and other strategies to promote children use of decontextualized language to describe their use of the ER skills.  Language skills were assessed at baseline.  At baseline and 1-month follow-up, children’s knowledge of ER skills taught in the intervention was assessed by an individual interview that was videotaped and scored. 

Results:  Children in both conditions increased in knowledge of ER skills from baseline to 1-month follow-up.  A significant condition (RRP vs. RRP+Narrative) by baseline language score interaction was found in models predicting follow-up ER skill, controlling for baseline.  Children with low expressive language skills in the RRP plus Narrative gained more verbal knowledge compared to the standard RRP condition. 

Conclusion: By showing that adding narrative activities increase knowledge of ER skills among children with low language skills, this study points to the promise of using narrative learning activities to supplement, or to adapt, interventions that teach skills, particularly skills involving language, for young children and children with delayed language.  Although behavioral functioning was not measured, and is a limitation, measuring a key proximate outcome of the intervention – namely, ER skill knowledge – could be accomplished in a short time period to assess promise of this approach.