AJSLP
Research Article
Children’s Responses to Telegraphic
and Grammatically Complete
Prompts to Imitate
Shelley L. Bredin-Ojaa and Marc E. Feya
Purpose: The purpose of this study was to determine
whether children in the early stage of combining words are
more likely to respond to imitation prompts that are telegraphic
than to prompts that are grammatically complete and whether
they produce obligatory grammatical morphemes more reliably
in response to grammatically complete imitation prompts than
to telegraphic prompts.
Method: Five children between 30 and 51 months of age
with language delay participated in a single-case alternating
treatment design with 14 sessions split between a grammatical
and a telegraphic condition. Alternating orders of the 14 sessions
were randomly assigned to each child. Children were given
15 prompts to imitate a semantic relation that was either
grammatically complete or telegraphic.
M
any speech-language pathologists (SLPs) working
with families of young children with language
delay shorten their utterances and encourage
parents and other professionals to shorten their utterances so
that they more closely match the child’s expressive language
level. When such shortening involves stripping grammatical
morphemes from otherwise acceptable phrases or sentences,
the result is reduced or telegraphic models. The following
examples contrast a telegraphic utterance (a) followed by a
corresponding grammatically complete utterance (b).
1a. boy in house
1b. the boy is in the house
2a. girl walk
2b. the girl is walking
3a. baby like milk
3b. the baby likes milk
a
University of Kansas Medical Center, Kansas City
Correspondence to Shelley L. Bredin-Oja: sbredin-oja@kumc.edu
Editor: Carol Scheffner Hammer
Received December 7, 2012
Revision received May 7, 2013
Accepted June 15, 2013
DOI: 10.1044/1058-0360(2013/12-0155)
American Journal of Speech-Language Pathology • Vol. 23 • 15–26 • February 2014 • A American Speech-Language-Hearing Association
Results: No differences between conditions were found for
the number of responses that contained a semantic relation.
In contrast, 3 of the 5 children produced significantly more
grammatical morphemes when presented with grammatically
complete imitation prompts. Two children did not include a
function word in either condition.
Conclusion: Providing a telegraphic prompt to imitate does
not offer any advantage as an intervention technique. Children
are just as likely to respond to a grammatically complete
imitation prompt. Further, including function words encourages
children who are developmentally ready to imitate them.
Key Words: children, early intervention, language disorders,
morphology, syntax
To many, the use of telegraphic models in language
intervention is intuitively sensible. Adults use telegraphic
models based on the belief that the reduced input will lighten
the child’s comprehension burden by removing potentially
competing elements that perform principally formal gram-
matical functions, such as articles, auxiliaries, and bound
morphemes. Such short utterances without grammatical detail
are presumed to make the meaning of the adult utterance
more accessible, thus rendering them easier to imitate and,
ultimately, to produce spontaneously and creatively. On the
basis of this logic, many language intervention approaches
have recommended the use of telegraphic input with children
with language impairments (e.g., Hancock & Kaiser, 2006;
MacDonald & Blott, 1974). For these models of intervention,
adult prompts for verbal imitation represent a key ingredient
and are assumed to be central to program success. Therefore,
a crucial assumption in these approaches that recommend the
use of telegraphic imitative stimuli is that utterances contain-
ing language intervention targets are more reliably imitated
when they are shortened by stripping them of grammatical
functors (i.e., function words) than they would be if they were
presented with all grammatical details intact. In this study,
we put this assumption directly to test. The purpose of this
study, therefore, is not to test the impact of an intervention
Disclosure: The authors have declared that no competing interests existed at the
time of publication.
15
over time but, rather, to test the immediate response of a child
when presented with a prompt to imitate.
Reasons to Question the Use of Telegraphic Models
There are many reasons to believe that the use of tele-
graphic speech may not be beneficial to young language
learners and that, in fact, telegraphic input may complicate
learning processes. First, there is substantial evidence that
children do not comprehend adult utterances more readily
when grammatical functors are removed (see Fey, 2008, and
van Kleeck et al., 2010, for a review). With few exceptions
(e.g., Smith, 1973), these studies either indicate no signifi-
cant difference in comprehension between grammatical and
telegraphic sentences or favor the grammatical models
(van Kleeck et al., 2010).
Second, it is well documented that children have the
most difficulty learning grammatical forms that are sparsely
represented and/or optional in the language (cf. Leonard
et al., 2003; Leonard, Eyer, Bedore, & Grela, 1997; Rice &
Wexler, 1996). For example, in English, use of tense and
agreement inflections on verb forms has been shown to be
difficult for English-speaking children with typical develop-
ment and exceedingly difficult for children with specific
language impairment (SLI; Leonard, Camarata, Brown, &
Camarata, 2004; Leonard, Camarata, Pawłowska, Brown, &
Camarata, 2006; Rispoli, Hadley, & Holt, 2012). One factor
responsible for this delay appears to be that verbs are not
marked consistently for tense and agreement in English. For
example, past tense is unmarked on some forms (e.g., hit, put),
lexically marked in others (e.g., went, hid), and inflected
with a phonologically conditioned suffix in others (e.g., walked,
posed). The third person singular –s is another obvious case
in point; the marking of present tense and number is limited
to the third person. In contrast, despite the richness and
complexity of verb morphology in many languages, such as
Italian and Hebrew, children with SLI who are learning these
languages do not show a profile of special difficulty with in-
flected verb forms (Bedore & Leonard, 2001; Dromi, Leonard,
& Shteiman, 1993; Leonard & Bortolini, 1998). Use of tele-
graphic models has the effect of making the overall use of
grammatical forms less consistent. Rather than simplifying
language learning, use of telegraphic adult input may provide
positive evidence to children that grammatical details are
optional rather than obligatory, thus making them more
difficult to learn.
Third, there is evidence that even certain types of
grammatically correct input can have negative consequences
if they are not fully processed by young language learners.
In their study of the role that yes–no questions have on the
acquisition of auxiliaries, Fey and Loeb (2002) hypothesized
that exposing children to sentence-initial auxiliaries would
increase the saliency and, therefore, lead to greater auxiliary
development. The researchers exposed 3-year-old children
with SLI and 2-year-old typically developing children who
were not yet producing auxiliaries to either play sessions in
which the adult produced frequent auxiliaries in declarative
sentences or an experimental protocol in which auxiliaries
16 American Journal of Speech-Language Pathology • Vol. 23 • 15–26 • February 2014
were presented as recasts in interrogative form (e.g., Child:
“Baby eat.” Adult: “Will the baby eat?”). The results indi-
cated that not only did the use of auxiliary-fronted questions
fail to facilitate auxiliary development but also the children in
the experimental group used (numerically, but not statisti-
cally) fewer auxiliaries than did the children in the play group.
On the basis of these results, the researchers reasoned that if
children early in development do not fully process the aux-
iliary immediately before the sentence subject, frequent
adult use of subject–auxiliary reversals may wrongly convey
to the child that unmarked strings such as “the baby eat”
are acceptable in main clauses. Theakston and colleagues
(Theakston & Lieven, 2008; Theakston, Lieven, & Tomasello,
2003) provided experimental support for the hypothesis that
unmarked strings found in auxiliary-fronted questions neg-
atively impact typically developing children’s use of finite
markers. Other researchers (e.g., Hadley, Rispoli, Fitzgerald,
& Bahnsen, 2011; Leonard & Deevy, 2011) who considered
other forms in adult language have also concluded that input
devoid of overt tense and agreement marking leads children
to consider forms that incorrectly lack tense and agreement
as acceptable. If strings of words not fully processed within
grammatical input can lead the child to an incorrect hypoth-
esis about the obligatory nature of morphological markers,
what impact does telegraphic input have, especially in the case
of imitative prompts in which the child is explicitly instructed
to produce an ungrammatical utterance? Finally, there
is a great deal of evidence that children are aware of gram-
matical morphemes and recognize some of these morphemes’
grammatical functions well before they produce them (Eyer
et al., 2002; Höhle & Weissenborn, 2003; Höhle, Weissenborn,
Kiefer, Schulz, & Schmitz; 2004; Olguin & Tomasello, 1993;
Shi, Marquis, & Gauthier; 2006; Tomasello & Olguin, 1993).
As one example, Fernald and Hurtado (2006) directly com-
pared 18-month-old toddlers’ recognition of words in contexts
with grammatical detail (e.g., look at the baby) to contexts
with all grammatical detail omitted (Look. baby.). The results
showed that the children were significantly faster to respond
accurately to target words when those words are presented
in a short grammatical sentence. Thus, it appears that com-
plete phrases and sentences with preserved prosodic contours
and predictable co-occurrences of forms, such as determiners
with nouns, offer an advantage rather than a disadvantage
to young children learning language.
Is Telegraphic Speech Necessary for Improving
Expressive Language?
Given the evidence that telegraphic input to young
children may be contraindicated and may even slow down the
rate of language development in some cases, then what are the
effects of regularly omitting them in language intervention?
There is no question that language interventions that require
children with language impairment to repeat telegraphic
stimuli can be efficacious. For example, enhanced milieu
teaching (Hancock & Kaiser, 2006), which advocates the use
of telegraphic prompts for imitation and explicitly teaches
parents to use these forms, has been widely studied and shown
to be an efficacious language intervention approach. Thus,
the real question is not whether intervention packages that use
requests to imitate telegraphic input can be effective; they
clearly can be, especially when the goals are early develop-
mental achievements. The real question is, does the imita-
tion of telegraphic models optimize the efficacy of these
approaches?
The only published study that directly compares tele-
graphic models with grammatically complete models is a
small clinical experiment conducted by Willer (1974). This
study investigated the hypothesis that telegraphic models
increase the expressive language skills of children with
intellectual disabilities primarily because telegraphic models
are easier to imitate. The participants were 10 children, ages
5;6 (years;months) to 13;6, with moderate intellectual dis-
abilities who were using only single words. The children were
arranged into matched pairs and randomly assigned to either
a grammatical stimulus group or a telegraphic stimulus
group.
Each child received a 15-min intervention session once
a day, five times a week, for 5 weeks. The lessons were iden-
tical for each group, with one exception: Children in the
telegraphic stimulus group received only prompts that were
devoid of all determiners, auxiliary verbs, and copula BE
forms (e.g., ball; boy running; ball on table). Children in the
grammatical group received complete phrases (e.g., the ball;
the boy is running; the ball is on the table). Responses to the
imitative trials were judged as correct if the equivalent of the
telegraphic model was produced by the child, regardless of
the type of imitative prompt presented. That is, the children
were not expected to imitate functors properly to receive
credit for imitation.
Results of the daily performance showed that children
in the telegraphic group performed significantly better on
imitative trials and responsive language trials (i.e., responding
appropriately to questions about each of the vocabulary
items) by the end of each lesson—that is, by the last class of
each section (class numbers 5, 10, 15, 20, and 25). Posttesting
was conducted to compare the two groups’ imitative language
performance when presented with both types of models—
that is, with telegraphic models as well as with grammatically
complete models. The results of these tests revealed that chil-
dren in the telegraphic group performed significantly better
when presented with telegraphic models. The telegraphic
group also did better when presented with grammatically
complete models, but this difference was not statistically
significant.
Willer (1974) concluded that sentences containing
function words were more difficult to imitate and subsequently
master by children with cognitive and language impairments.
He cautioned, however, that although his study revealed
that language targets were achieved more quickly using
telegraphic prompts to imitate, there was evidence that these
attainments were somewhat stereotypical and were not highly
productive language forms.
The results of Willer’s (1974) small study offer the only
support for the use of telegraphic prompts as an intervention
technique to increase children’s productive language skills.
From an evidence-based perspective, this hardly seems suf-
ficient to support the technique when there is reason to believe
that it may negatively impact grammatical development
among children with cognitive and language impairment.
This experiment was designed to address the following
two questions. First, do children in the early stage of com-
bining words imitate simple constructions containing early
semantic relations more consistently when presented with
elicited imitation prompts that are telegraphic than with
elicited imitation prompts that are grammatically complete?
We expected that there would be no clear differences between
children’s imitative responses to telegraphic and grammatical
prompts to imitate. Second, do children in the early stages
of multiword combinations produce obligatory grammatical
morphemes more reliably in response to grammatically com-
plete imitative prompts than to telegraphic prompts? Because
grammatical morphemes were present only in the gram-
matical prompts, we predicted that any differences in imitative
responses would favor the fully grammatical stimuli. Given
the potential for harm suggested by the relevant extant lit-
erature, if both of our predictions were correct, it would be
extremely difficult to defend any intervention approach that
requires clinicians or other intervention agents to elicit imi-
tations using telegraphic prompts.
Method
Participants
Five children with expressive language delay between
the ages of 30 and 51 months served as participants in this
single-case experiment. Three children (P2, P3, and P4) were
receiving speech-language services at the time of their study
enrollment. According to parent report, therapy goals did not
specifically address morphosyntax. One child (P1) was en-
rolled in therapy at the end of his participation in the study;
the other child (P5) attended an early Head Start program and
was being monitored by the Center for Child Health and
Development at The University of Kansas Medical Center
(KUMC).
Eligibility Criteria
Children were seen on two separate occasions in their
home to determine eligibility. During the first qualifying
session, the parents were asked to complete the MacArthur–
Bates Communicative Development Inventories: Words
and Sentences (CDI:WS; Fenson et al., 2007), and a 60-min
language sample was collected using a standard set of toys.
This sample was digitally recorded and transcribed by the first
author using the Systematic Analysis of Language Transcripts
(SALT) program (Miller & Iglesias, 2006) to determine the
child’s mean length of utterance in morphemes (MLUm) and
to document use of semantic relations. To document the
child’s willingness to imitate, we asked the child to imitate
10 words that were reported on the CDI:WS. In addition, the
motor imitation portion of the Screening Tool for Autism
in Two-Year-Olds (STAT; Stone, Conrod, Turner, & Pozdol,
2004) was administered. This measure includes four tasks:
Bredin-Oja & Fey: Children’s Responses to Prompts 17
(a) rattle: the examiner shakes a rattle, then encourages the
child to do the same; (b) car: the examiner rolls a small car
back and forth across the table, then encourages the child to
do the same; (c) drum hands: the examiner alternately drums
her hands on the table, then encourages the child to do the
same; and (d) hop dog: the examiner hops a small dog across
the table, then encourages the child to do the same. During
the second session, which occurred a few days later, the child
was given the Leiter International Performance Scale—Revised
(Leiter–R) Brief IQ test (Roid & Miller, 1997), a hearing
screening using a portable audiometer and play audiometry,
and a language elicitation task designed to measure the
child’s productive use of semantic relations that were identi-
fied from the spontaneous language sample. To be considered
productive, the child needed to use a semantic relation at
least two times during the play-based language sample, but
it had to be spontaneously produced in no more than three out
of five opportunities during the language elicitation task.
The language elicitation task was modeled after Scherer and
Olswang’s (1989) elicitation task. The examiner manipulated
objects known to be familiar to the child and prompted for
a verbal response by asking a wh-question. For example,
to elicit the semantic relation, agent–action, the examiner
showed the child a figure of a man kicking a ball and asked,
“What’s happening?”; to elicit the semantic relation action–
object, the examiner made a boy puppet eat a cookie and
asked, “What’s the boy doing?” Selection of targets then were
based on the child’s spontaneous use of the semantic relations
during the language sample and limited use during the elic-
itation task. Qualifying children met the following criteria:
1. Passed a hearing screening of 25 dB HL at 500, 1000,
2000, and 4000 Hz
2. Reported to produce at least 100 words as determined
by the CDI:WS (Fenson et al., 2007)
3. Obtained a standard score within the average range
on the Leiter–R Brief IQ test (Roid & Miller, 1997)
4. Produced at least two examples of two different
semantic relations, excluding functional relations,
such as recurrence and existence, during a 60-min
language sample
5. Produced the two semantic relations from the language
sample in no more than three out of five opportunities
during the language elicitation task (errors on this task
included one-word responses not containing the target
relation rather than no responses)
6. Produced a MLUm between 1.2 and 2.1 based on a
100-utterance sample collected during play with the
examiner
7. Responded correctly with the target word on six out
of 10 elicited imitation prompts of single words known
to be used by the child
8. Complied with all four motor imitation tasks from the
STAT
Twelve children were evaluated in this manner; five
children met the eligibility criteria and were randomly
18 American Journal of Speech-Language Pathology • Vol. 23 • 15–26 • February 2014
assigned an alternating order of the grammatical and tele-
graphic conditions as they entered the study. Pre-experimental
child characteristics are presented in Table 1.
Experimental Design
We used a single-case alternating treatments design
(ATD) to determine whether telegraphic prompts to imi-
tate or grammatically complete prompts to imitate result in
more reliable imitations by children who are just beginning
to produce semantic relations. The ATD is one of the most
powerful and practical designs in all of time-series methodol-
ogy (Hayes, Barlow & Nelson-Gray, 1999). An ATD is a
strong, clinically useful strategy that does not require a baseline
or a withdrawal phase as other single-subject designs such
as do the multiple-baseline or variations of the A-B-A design.
A baseline phase is not necessary because the purpose is to
compare the effect of two conditions rather than to document
improvement over time (Barlow & Hersen, 1984). Further-
more, in their proposal of design standards to be implemented
by the What Works Clearinghouse (WWC), Kratochwill
et al. (2010) stated that one way for an ATD to Meet Evidence
Standards (without reservation) is to have “two alternating
treatments compared with each other” ( p. 15).
The ATD directly compares two distinct conditions
while avoiding the problem of intersubject variability. Osten-
sibly, extraneous factors that may affect the performance of
a participant will have an equal effect on both conditions.
A further benefit of the ATD is its superior control over other
threats to internal validity, such as history and maturation.
This does not imply that the ATD is ideally suited for all
single-subject research. For example, the ATD may suffer
from interference of multiple interventions—that is, the effects
of one experimental intervention may interfere with the effects
of the other (Barlow, Nock, & Hersen, 2009). Specifically,
order effects and carryover effects are a concern.
Order effects refer to the fact that Treatment B might
be different if it always follows Treatment A. Randomizing
the order of conditions alleviates this problem.
Carryover effects refer to the influence of one treatment
on an adjacent treatment, regardless of the overall order.
Providing only one condition per session and separating
sessions by at least 1 day are recommended practices to
minimize carryover effects (Barlow et al., 2009). To enhance
external validity—that is, the generalizability of findings to
other similar participants—the experiment was conducted five
times with four additional participants at a similar stage of
development. Although it is typical for single-subject studies
to demonstrate effects with at least three different participants
(Horner et al., 2005), five participants were enrolled in this
study to increase generalizability of the findings. Replication
across five different cases exceeds the Meet Evidence Standards
criteria put forth by the WWC (Kratochwill et al., 2010).
Each child participated in seven sessions involving
grammatically complete elicited prompts alternating with
seven sessions involving telegraphic elicited prompts for
a total of 14 sessions. This also exceeds the Meet Evidence
Standards criteria put forth by the WWC (Kratochwill et al.,
Table 1. Preexperimental participant characteristics.
Participant ID Sex Race/Ethnicity Age (in mos)
P1 Male Black 35
P2 Male More than 1 race 51
P3 Female Hispanic White 33
P4 Male Black 33
P5 Male White 30
Note. mos = months; MLU/m = mean length of utterance in morphemes; CDI:WS = MacArthur–Bates Communicative Development Inventories:
Words and Sentences; vocabulary checklist, total words used.
2010). For an ATD with two levels, the number of ways
in which a unique random order occurs is calculated by the
following formula:
Number of ways ¼ N!=n1 !n2 !;
where N = total number of sessions, n1 is the number of
sessions for Treatment A, and n2 is the number of sessions
for Treatment B.
Fourteen sessions of two equal numbers of prompt
conditions results in 3,432 possible random orders [14!/7!7! =
3,432]. Not all of these orders are desirable, however. For
example, one order involves seven Condition A sessions
followed by seven Condition B sessions. This would essen-
tially result in an AB design, and possible order effects could
make the results difficult to interpret. To ensure greater
alternation of conditions, we restricted the design so that
randomization of conditions resulted in no more than three
consecutive sessions of the same condition. This restriction
resulted in 1,972 possible random orders of seven sessions
per condition.
Experimental Procedure
Assigning a different semantic relation to each condi-
tion would require that the two semantic relations be at the
same developmental level and be matched perfectly for degree
of difficulty; however, it is difficult to ascertain that the dif-
ficulty between any two semantic relations is equivalent for a
given child. Therefore, after identifying two target relations
that were produced but not mastered, one randomly selected
relation served as a target in both the grammatical and tele-
graphic conditions until the child demonstrated mastery-level
performance of the semantic relation. Mastery level was
defined as 13 out of 15 multiword responses to prompts
to imitate in two consecutive sessions. If a child produced
13 utterances containing the target semantic relation in re-
sponse to the prompt during two consecutive sessions, a
second semantic relation was introduced as the target in both
conditions. This graduation to a second goal was necessary
for only one child, identified as P5.
To minimize carryover effects, specific examples of
the target semantic relation were kept different for the two
conditions. For example, the specific imitative prompt of Say,
duck walking occurred only in the telegraphic condition.
MLUm/100 utterances Brown’s stage Leiter–R Brief IQ CDI:WS
1.80 Late I 97 106
2.10 II 97 540
1.44 Early I 115 335
1.77 Late I 103 117
1.85 Late I 103 319
The grammatically complete version of this example (i.e.,
Say, the duck is walking) was never used in the grammatical
condition. Similarly, a child who received the stimulus,
Say, the boy is jumping, in the grammatical condition would
never encounter the model, Say, boy jumping, in the tele-
graphic condidition. To facilitate this separation of tokens
of the child’s target across conditions, different sets of toys
were used for each condition.
The children were seen in their homes or at their day-
care either two or three times per week, with at least 1 day
between consecutive sessions, for a total of 14 sessions. Only
one condition was given during a session, and each condition
occurred seven times. As described earlier, the conditions
were alternated in a semirandomized fashion with the stipu-
lation that no condition was presented during more than
three consecutive sessions. Randomizing the conditions
controlled for order effects; providing each condition on a
different day with at least 1 day between sessions should have
reduced carryover effects (Barlow et al., 2009).
Fifteen elicited prompts were presented during the
context of a 20- to 30-min play session. Other intervention
studies used (a) a range of 10–20 prompts to imitate, (b) adult
models, or (c) expansions of child comments (cf. Loeb &
Armstrong, 2001; Scherer & Olswang, 1989; Willer, 1974).
A study by Fey, Yoder, Warren, and Bredin-Oja (2013) had a
targeted rate of 60 prompts in 60 min; however, the prompts
used in their study ranged from a nonintrusive time delay to
a more intrusive prompt to imitate. Because the only prompt
used in this study was the intrusive elicited imitation prompt,
a maximum of 15 trials per session was imposed to prevent
child fatigue and to enhance compliance. Results from a pilot
study indicated that 15 prompts in a 20- to 30-min session
yielded sufficient responses from the child without causing
aversion to the prompts.
The sessions adhered to the basic principles of enhanced
milieu teaching; specifically, each testing episode was made
relevant by arranging the play context to increase the likeli-
hood that the child would need to produce utterances contain-
ing the target relation and by following the child’s attentional
lead (Hancock & Kaiser, 2006). For example, the target se-
mantic relation action + object may have consisted of specific
prompts to imitate push (the) button, open (the) box, kick (the)
ball, and so on. Each specific prompt contained lexical items that
were known by the child as evidenced by the language sam-
ple, CDI:WS, and observations during previous experimental
Bredin-Oja & Fey: Children’s Responses to Prompts 19
sessions. Results of a pilot study showed that children pro-
duced consistent two-word responses to most if not all of the
15 prompts after the fifth session in both conditions. To guard
against these ceiling effects, each specific type (e.g., Say,
the duck is walking) was presented in no more than three
tokens during a single session. Further, if a specific semantic
relation type was spontaneously produced by the child dur-
ing two consecutive sessions, then that specific type was
replaced with another example of the same semantic relation.
Once the child was prompted to imitate and was given
an opportunity to respond, the examiner provided natural
consequences such as responding appropriately to the child’s
request or comment and by continuing the interaction. A
recast of the child’s verbal response to the prompt was not
provided as the last step in a request for imitation sequence, as
is recommended for enhanced milieu teaching (Hancock &
Kaiser, 2006). This deviation from the enhanced milieu
teaching technique was planned because although we wanted
to encourage compliance to imitative prompts, we did not wish
to hasten the child’s mastery of a new relation beyond the
facilitation provided by child’s imitation.
The third child enrolled in the study (P3) frequently
responded to the imitative prompts with only a single word,
regardless of the condition. To ensure that this did not occur
with future participants, we implemented the enhanced milieu
teaching technique of providing corrective prompts for the
fourth and fifth participants (Hancock & Kaiser, 2006). A
corrective prompt is an immediate and identical second prompt
if the child fails to produce a target response. For example,
Adult: Say duck walking. Child: walking. Adult: Say duck
walking. The interventionist ended the sequence by providing
a natural consequence regardless of the child’s response to
this corrective prompt. Examples of specific prompts and
adult responses during a grammatical and telegraphic
session are available (see online supplemental materials).
Each session was digitally audio recorded for data
collection purposes; the number of prompts administered and
the number of responses given by the child were tallied for
each session. A response was credited as imitated if the child’s
production was equivalent to the telegraphic version of the
prompt, regardless of the condition of the session. An exact
imitation of a grammatically complete phrase was not required
during a session using grammatical prompts. For example,
a response of “roll ball” was judged to be correct in either
a telegraphic session or a grammatical session. Similarly, a
response of “duck walking” or “duck walk” was credited
regardless of the prompt used. Child responses that included
function words (e.g. “roll the ball”; “the duck is walking”)
were tallied separately and analyzed independently. Addi-
tionally, to determine whether children were more reluctant
to respond to the longer, grammatically complete prompts,
all “no” responses to the prompts for each session were tallied
and analyzed separately.
Data Analysis
The data were analyzed two ways. First, data from each
session was plotted, and the two data lines were visually
20 American Journal of Speech-Language Pathology • Vol. 23 • 15–26 • February 2014
examined to determine whether there was overlap or com-
plete separation of the lines. In interpretation of this visual
inspection, both conditions are found to be similarly effective
when the data lines overlap. When there is clear divergence
between the data lines, differential effectiveness of conditions
is indicated (Barlow et al., 2009).
Fisch (2001) suggested that experiments that use single-
subject designs and rely only on visual inspection to eval-
uate the efficacy of interventions often miss treatment effects.
Therefore, to augment visual inspection of the data, the com-
puter program Single-Case Randomization Tests (SCRT),
developed by Onghena and Van Damme (1993; Edgington &
Onghena, 2007), was used to conduct a randomization test
for restricted ATD to test the null hypothesis. The null hypoth-
esis can be stated as follows: For each of the experimental
sessions, the responses are independent of the prompt con-
dition given at that time. That is, the observed responses
would have occurred regardless of the type of prompt given.
Randomization Tests
Randomization tests are a subclass of statistical tests
called permutation tests (Edgington & Onghena, 2007)—tests
in which the p value is the proportion of data permutations
or configurations providing a test statistic as large as the
value for the observed results. Any test statistic that is
sensitive to the predicted effect can be used with random-
ization tests (Bulté & Onghena, 2008). In this investigation,
any differences in the level of child responses to prompts
for verbal imitation were of primary interest; therefore, the
test statistic used was the difference between the mean scores
of Condition A and Condition B sessions. Randomization
tests provide valid alternatives to nonparametric tests and
have even greater sensitivity because they do not discard
information in the data by reducing them to ranks (Todman
& Dugard, 2001). The permutation method gives an unbiased
estimate of the p value without relying on the assumption of
normally distributed errors (Hayes, 1996). The only assump-
tion required for a randomization test is the assumption of
exchangeability. This assumption establishes that all possi-
ble data permutations must be equally likely under the
null hypothesis. The most effective way to ensure exchange-
ability is to randomly assign an order of conditions prior to
data collection (Hayes, 1996). When the exchangeability
assumption is met, the randomization test can be a valid and
highly accurate method of computing statistical significance
(Hayes, 1996).
A conservative two-tailed or nondirectional randomi-
zation test was used to determine the p value of the observed
test statistic. To achieve a p value (two-tailed) of at least .05,
the observed test statistic—that is, the absolute difference
between the mean of Condition A and the mean of Condition
B—had to be equal to or greater than the test statistic for 49 of
the possible 1,972 restricted random orders. Fourteen sessions
were deemed adequate to find a statistically significant dif-
ference between the two conditions. Note that the highest
level of significance that can be obtained in a two-tailed test
with 1,972 permutations is .001.
Fidelity of Conditions
For each participant, four sessions or 28.6% of the
total, two from each condition, were chosen at random by a
graduate student in speech-language pathology for a check
of fidelity to the experimental procedure. The graduate
student was not informed of the research question or of the
total number of prompts per session that was required. Ses-
sions were relabeled so that the temporal order of the sessions
could not be determined by the student. The student listened
to all four sessions and reported the number of prompts for
imitation that were given. She also judged whether all prompts
adhered to the same condition during a session, that no more
than three specific examples of a prompt were used in the
same session, and that a specific prompt from one condition
did not occur in the other condition. Any deviation from these
procedures was considered a violation. Fidelity of the exper-
imental procedure was 98%. During one session in the tele-
graphic condition, the examiner gave one extra prompt for
one of the children. For this session, the child’s response
to the 16th prompt was excluded from the analyses.
Interrater Reliability
The graduate student transcribed the same four sessions
chosen for the fidelity check and independently scored them
for reliability. Interrater reliability agreement was based on a
point-by-point agreement for the child responses. Interrater
agreement was calculated by using the percentage of agree-
ment index (Suen & Ary, 1989): the number of agreements
divided by the sum of the number of agreements and the
number of disagreements, multiplied by 100. Interrater reli-
ability was 93%, 95%, 98%, 93%, and 95% for participants
P1–P5, respectively.
Results
Data for P1
The target semantic relation throughout the experi-
mental protocol for this child was agent (patient) + action.
Examples of prompts are Say: The frog is jumping and Say:
Dog driving for the grammatical and telegraphic conditions,
respectively. Figure 1 displays his pattern of responses for
the target semantic relation as well as the number of responses
that contained a function word. The lines representing each
of the experimental conditions cross and do not diverge sub-
stantially, indicating clearly that there was no effect of con-
dition. Further, it is important to note that there is no upward
trend in the data for either condition. This suggests that P1
did not learn the semantic relation and utilize this learning to
support a generally strong performance across conditions.
In other words, the similarity across conditions does not
appear to be the result of carryover.
The analysis of the visually displayed data is supported
by the statistical analysis. The mean difference between P1’s
numbers of imitations across conditions was 0. He had a
mean of 7 (range = 5–8, SD = 1.07) responses that contained
the target semantic relation for the grammatical condition
Figure 1. Number of responses containing a target semantic relation
and number of responses also containing a function word. Fcn Wd
Gram = functional word in grammatical condition; Fcn Wd Tele =
functional word in telegraphic condition.
and a mean of 7 (range = 5–10, SD = 1.85) responses for the
telegraphic condition. Given that the average difference be-
tween P1’s imitations in the telegraphic and grammatical
conditions was 0, the proportion of random data permutations
yielding a between-conditions difference at least this large
was 1.00 ( p = 1.0, two-tailed). There was also no statistically
significant difference in the number of times P1 provided
no response to an imitative prompt between conditions
(Mgrammatical = 7.0, Mtelegraphic = 6.43; |A–B| = 0.57; p = .612).
In contrast, as also shown in Figure 1, there was a
remarkable difference for the number of times the child in-
cluded a grammatical function word as well as the target se-
mantic relation in his imitative response. At Session 7, the line
representing the grammatical condition goes up and remains
distinctly higher than that for the telegraphic condition,
which remains virtually at 0 across all of the sessions. P1 pro-
duced a mean of 3.43 function words (range = 0–7, SD = 2.23)
in the grammatical condition and a mean of 0.14 function
words (range = 0–1, SD = 0.35) in the telegraphic condition,
resulting in a test statistic of 3.29 with a statistically significant
p of .002.
Data for P2
The target semantic relation for all 14 sessions for P2
was also agent (patient) + action. Examples of prompts used
for this child are Say: The bug is flying and Say: Duck walking
for the grammatical and telegraphic conditions, respectively.
The data are presented in Figure 2. In Figure 2, we illus-
trate unambiguously that there was no difference in P2’s level
of responding across conditions. As for P1, the pattern of
the lines, which trends downward over later sessions, does not
suggest that early differences led to learning in one condi-
tion, which carried over to influence responding in the other
condition.
P2 had a mean of 7.29 (range = 4–12, SD = 3.25)
responses for the grammatical condition and a mean of 8.86
(range = 6–11; SD = 2.12) responses for the telegraphic
Bredin-Oja & Fey: Children’s Responses to Prompts 21
Figure 2. Participant P2’s number of responses containing a target Figure 3. Participants P3’s number of responses containing a target
semantic relation and number of responses also containing a function semantic relation and number of responses also containing a function
word. word.

condition. This resulted in a nonsignificant test statistic of not occur with future participants, we saw this child for an
1.57, which has a p value of .35. There was also no statistically additional six sessions to pilot the use of corrective prompts.
significant difference in the number of times P2 provided no Recall that a corrective prompt is an immediate and identical
response to a prompt between conditions (Mgrammatical = 4.0, second prompt to be used only if the child fails to produce
Mtelegraphic = 4.29; |A–B| = 0.29; p = .89). a target response to the first prompt—in this case, a two-word
Figure 2 also illustrates P2’s use of grammatical func- semantic relation. The two conditions were alternated, with
tors in his imitation of semantic relations. Visual inspection each condition occurring three times. The only change in pro-
shows clearly that P2 imitated at least a small number of these cedure was the use of corrective prompts, which were included
forms, but these productions occurred only in the grammat- in each of the total 15 prompts given per session.
ical condition. P2 produced a mean of 1.86 responses that Figure 4 displays the pattern of responses that con-
contained a function word (range = 0–5, SD = 1.95) in the tained at least a target semantic relation for these six sessions.
grammatical condition and a mean of 0 responses that con- The mean number of responses is identical for both conditions
tained a function word (range = 0, SD = 0) in the telegraphic (M = 8.67), and the ranges of scores are similar (i.e., gram-
condition, resulting in a significant test statistic of 1.86, which matical range = 5–12, telegraphic range = 6–12). There is no
has a p of .025. clear divergence of the lines, indicating that both conditions
were similarly effective. A randomization test could not be
Data for P3 completed on these data because the order of sessions was not
randomly assigned. Regardless, the procedure of corrective
P3 rarely responded to the prompts for her target of prompts was judged to be effective in eliciting multiword
agent (patient) + action by producing a semantic relation. responses and, therefore, was used with the final two partic-
Examples of imitative prompts for P3 are Say: The dog is ipants when necessary.
sleeping and Say: Bear driving. Instead, she frequently re-
sponded with just a single word regardless of the condition. Figure 4. Participant P3’s number of responses to corrective prompts
The numbers of responses containing a semantic relation are that contained a target semantic relation.
displayed in Figure 3. Despite the infrequent production of
her target semantic relation, the lines clearly overlap, indi-
cating no difference in her level of responding for either
condition. P3 had a mean of 0.29 responses that contained
a semantic relation (range = 0–1, SD = 0.49) in the gram-
matical condition and a mean of 0.57 responses (range = 0–1,
SD = 0.53) in the telegraphic condition. The resulting non-
significant test statistic is 0.29 ( p = .54). There was also no
statistically significant difference in the number of times
P3 provided no response to a prompt between conditions
(Mgrammatical = 5.43, Mtelegraphic = 5.86; |A–B| = 0.43; p = .75).
As Figure 3 also shows, P3 did not produce any function
words in response to the prompts in either condition.
As noted above, P3 frequently produced a single word
in response to the prompts to imitate. To ensure that this did

22 American Journal of Speech-Language Pathology • Vol. 23 • 15–26 • February 2014

Data for P4 Figure 6. Participant P5’s number of responses containing a target
semantic relation and number of responses also containing a function
The target semantic relation for P4 was action + object. word. The bar indicates when a second target semantic relation
Examples of imitative prompts for this child are Say: Pull the was introduced.
tube and Say: Roll ball for the grammatical and telegraphic
conditions, respectively. Figure 5 displays P4’s pattern of
responses. As with the first three participants, P4 responded
similarly in both conditions, as can be discerned from the
overlapping lines. Here, too, the lack of upward trend in either
line suggests that carryover from one condition to the other
is not a concern. P4 had a mean of 2.71 responses (range = 1–5,
SD = 1.38) in the grammatical condition and a mean of 2.29
responses (range = 1–4, SD = 1.11) in the telegraphic con-
dition. The resulting test statistic of 0.43 ( p = .69) was not
significant. Likewise, there was no significant difference be-
tween conditions in the number of times P4 failed to respond
to a prompt (Mgrammatical = 0.57, Mtelegraphic = 1.28; |A–B| =
0.71; p = .40). P4 did not produce any function words in
response to the prompts for imitation in either condition, as
also shown in Figure 5.

Data for P5
P5 began the experimental protocol with the semantic
relation of action + object as his target. During the fourth
and fifth sessions, he imitated 13 out of 15 prompts, meeting
the ceiling criterion for a target. Therefore, his second target
semantic relation, agent (patient) + action, was used for all
remaining sessions. Examples of imitative prompts for this
child are Say: Throw the ball [action + object] or Say: The fish
is swimming [agent (patient) + action] and Say: Blow fan [action
+ object] or Say: Bug crawling [agent (patient) + action] for
the grammatical and telegraphic conditions, respectively.
After changing goals, P5’s level of correct responding im-
mediately dropped far below the ceiling, indicating that
agent (patient) + action was a more appropriate target.
Despite this change of targets, P5 responded similarly in both
conditions. Figure 6 displays his pattern of responses; the
vertical line at Session 6 indicates when the second target was
Figure 5. Participant P4’s number of responses containing a target
semantic relation and number of responses also containing a function
word.
introduced. The pattern resembles the previous four cases.
There is no clear divergence of lines, demonstrating that P5’s
level of responding did not differ across conditions. In addi-
tion, both lines trend downward for the final two sessions,
indicating that carryover does not appear to account for
the similarity of responses. P5 had a mean of 6.0 responses
(range = 2–13, SD = 3.61) in the grammatical condition and a
mean of 6.14 responses (range = 2–13, SD = 4.78) in the
telegraphic condition. This resulted in a nonsignificant test
statistic of 0.14 with a p of 1.0. As with the previous four
participants, there was no statistically significant difference in
the number of times P5 provided no response to a prompt
between conditions (Mgrammatical = 5.43, Mtelegraphic = 7.43;
|A–B| = 2.0; p = .25).
P5 had a significant difference for the number of re-
sponses that contained a function word as well as the target
semantic relation. These results are also displayed in Figure 6.
When action + object was the target semantic relation, P5
frequently imitated the function word, but only in the gram-
matical condition. After the ceiling criterion was met and
the second target was introduced, P5 imitated fewer func-
tion words, but, again, these productions occurred only
in the grammatical condition. P5 produced a mean of 4.43
responses that contained a function word (range = 0–12,
SD = 3.95) in the grammatical condition and a mean of 0
responses that contained a function word (range = 0, SD = 0)
in the telegraphic condition, resulting in a significant test
statistic of 4.43, with a p of .008.

Discussion
This investigation sought to determine whether chil-
dren with language impairment who are just beginning to
combine words to express semantic relations produce utter-
ances containing target semantic relations more reliably in
response to prompts to imitate that are telegraphic than to
prompts that are grammatically complete. Our single-case

Bredin-Oja & Fey: Children’s Responses to Prompts 23

experimental design with four replications provides an un-
equivocal answer: The children in this study responded just as
reliably to grammatical as to telegraphic prompts to imitate.
For all five children, using either visual or statistical criteria,
the level of target responses did not differ across the two
conditions. In addition, because the number of no responses
was not significantly different for the two conditions, we can
conclude that the children did not find the grammatically
complete prompts to be functionally more complex or in any
way aversive.
On the other hand, children’s use of grammatical
morphology along with the target semantic relation occurred
almost exclusively in the grammatical condition. This effect
was visually discernible and statistically significant for three
of the five children.
It may be that the other two children, P3 and P4, were
not at the developmental level necessary to fully respond
to the grammatically complete prompts, as appeared to be
the case for the 3-year-old children with SLI studied by Fey
and Loeb (2002). In their study on children’s readiness to
move from single words to two-word semantic relations, Bain
and Olswang (1995) determined that children’s potential for
immediate change can best be described by observing their
responsiveness to adult prompts. Children who are ready for
immediate change will respond to less supportive prompts,
whereas those who are less ready will need more support. A
prompt for a verbal imitation is highly supportive, and yet
these two children were unable to imitate a function word.
Under Bain and Olswang’s (1995) model of dynamic as-
sessment, the production of function words was outside of
these children’s zone of proximal development (Olswang,
Bain, & Johnson, 1992; Vygotsky, 1978).
For the three children who imitated some function
words, the pattern is clear. Including function words in the
prompt to imitate encouraged these children to produce them
along with the target semantic relation, demonstrating a level
of language processing and, perhaps, ability that was not yet
observable from their spontaneous language. Excluding
function words in the prompts stripped the models of gram-
matical features and virtually eliminated any probability that
the children would use a function word in their response to
the stimulus.
Study Limitations
There are limitations of the study that must be con-
sidered when interpreting the outcomes and considering their
implications. First, the first author (SLB) also served as the
examiner who delivered the prompts and may have shown
bias in her response to the participants. Reliability checks
were undertaken involving a listener who was blind to the
study questions and hypotheses; however, using a trained
clinician who was unaware of the study’s hypotheses would
have strengthened the design and reduced or eliminated bias.
Second, it is possible that the addition of corrective
prompts for P4 and P5 resulted in a different pattern of
responses from the first three participants. This possibility
seems unlikely, however, for two reasons: (a) the change to
24 American Journal of Speech-Language Pathology • Vol. 23 • 15–26 • February 2014
the use of corrective prompts occurred in both telegraphic and
grammatical conditions for P4 and P5. Therefore, any effects
on child performance should have been distributed equally
across each condition; and (b) the results for P4 and P5 mirror
those for P1–P3; significant numbers of sentences containing
grammatical morphology occurred only in the grammati-
cal condition.
Third, this study focused on one aspect of a broader
intervention technique—namely, a prompt to imitate, the
most supportive prompt in a hierarchy of prompts in
enhanced milieu teaching and many other language inter-
vention approaches. The dependent variable was children’s
frequency of imitative responses to these prompts and not
evidence of learning grammatical morphology. Prompts to
imitate are judged to be an important if not the central
ingredient in enhanced milieu teaching and other related
language interventions that have demonstrated efficacy
(Hancock & Kaiser, 2006). Therefore, because full grammat-
ical prompts resulted in as many or more complete imitative
responses, interventions that provide grammatical prompts
should have learning effects as broad as or broader than those
that provide telegraphic models. Nevertheless, we acknowl-
edge that to directly compare the effects of telegraphic and
grammatically complete input on children’s grammatical
development, children’s spontaneous use of treatment targets
must be observed following interventions that are alike in all
respects except for the contrastive use of telegraphic and
grammatical models.
Clinical Implications
There is no question that verbal input to young children
must be simplified in terms of its relational and referential
content, its vocabulary, and its grammatical structure to ac-
commodate the child’s likely comprehension weaknesses (cf.
Leonard, 2009) and to maximize communication potential.
These simplifications often will result in incomplete phrases
and even one-word utterances that may be viewed as prag-
matically appropriate, given the physical and discourse con-
text (e.g., CookieMonster! a big one; (you) kicked it again;
my spoon, not yours). When considered along with the evi-
dence presented in our introduction, however, our results
provide compelling evidence that these simplifications should
not compromise the boundaries of grammatical acceptability.
More specifically, simplifications of adult input to young
children should not involve removal of obligatory grammatical
functors from target utterances. It appears that such modifi-
cations are not likely to make adult messages more compre-
hensible or repeatable, and they may complicate processing.
More directly, our results show that removal of grammatical
morphology from adult models robs the child of opportuni-
ties to detect, process, and learn to use free and bound gram-
matical morphemes, some of which provide children with
their greatest language learning challenges (Hadley et al.,
2011; Leonard et al., 2004, 2006; Rice & Wexler, 1996).
Therefore, it now seems legitimate to hold fully gram-
matical prompts as the default evidence-based option in child
language interventions that call for the use of prompts for
verbal imitation. Special justification should be required for
the use of imitative prompts that are telegraphic in form. For
example, an evidence-based clinician could have internal
evidence that a particular child responds better to telegraphic
than to grammatical models. In such situations, continued use
of telegraphic models could be justifiable and appropriate.
This raises questions about how to teach parents to
simplify their language to young children in ways that will
maintain grammaticality and facilitate development without
potentially producing negative side effects. We have three
related suggestions.
1. Talk about the toys your child is interested in and what
the toys are doing. Toy talk (Walsh, 2010) is about
things that are interesting to the child. It naturally tends
to be simple but grammatical. Toy talk is also good
because it naturally increases the numbers of sentences,
in English, that contain subject–verb structure and sen-
tences in the third-person singular, present tense (e.g.,
The farmer is driving the truck. He likes to drive. He goes
everywhere.; Hadley et al., 2011). In typical parent–child
play interactions, these types of sentences do not occur
very often.
2. Be grammatical. If you attempt to simplify your
message, ask whether your words would sound okay to
other adults in very informal situations. If the answer
is no and your message sounds like something that would
be unacceptable for adults in a relaxed context, you
may have crossed the line between what is simple but
grammatical and what is ungrammatical.
3. Avoid simple formulas for making speech to your
child more complex or simpler. For example, some
programs coach parents to increase or decrease
the complexity of utterances to their children by
adding or taking away “one word.” This is a nice,
simple rule, but it invites ungrammatical models. For
example, using the one-word rule, the request, get a
cookie, could be simplified to get one or a cookie; both
of which are acceptable. Unfortunately, it could also
be shortened to get cookie, which no adult or language
competent child or youth would say in any likely
setting.
In this study, we considered the transitional develop-
mental period from producing mostly single words to pro-
ducing semantic relations. Our results indicated that reducing
adult sentences to the point of being ungrammatical offered
no benefit to any of the children, whereas prompting with
longer, grammatically complete sentences led to more com-
plete processing of grammatical functors for three of the
children. Given these findings, it seems unlikely that the use
of telegraphic input would lead to better outcomes for children
at higher levels of language development who are actively
engaged in the acquisition of English grammatical morpho-
syntax. Previous research has shown that very young chil-
dren rely on information found in grammatically complete
sentences long before they produce them. Therefore, we
recommend that SLPs avoid—and teach parents to avoid—
the use of ungrammatical or telegraphic speech when talking
to young children at any stage of development.
Acknowledgments
This study was supported by National Institute of Child
Health and Human Development Center Grant P030 NICHD HD
002528. We gratefully acknowledge Erin Schmitt for her contribu-
tions, and we thank the families who participated. This article is
based on the doctoral dissertation of the first author. Data were pre-
viously presented in a poster session at the June 2013 Symposium
on Research in Child Language Disorders, Madison, WI.
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