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Language and Drawing Development after a Combined Intervention: A Single-Subject Case Study

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Title: Language and Drawing Development after a Combined Intervention: A Single-Subject Case Study
Language: English
Authors: Ceyhun Servi (ORCID 0000-0002-3960-347X)
Source: British Journal of Special Education. 2024 51(1):35-49.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 15
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Descriptors: Freehand Drawing, Language Skills, Communication Skills, Skill Development, Reading Writing Relationship, Females, Young Children, Developmental Delays, Teaching Methods, Program Implementation, Art Education, Individual Characteristics, Communication Research
DOI: 10.1111/1467-8578.12496
ISSN: 0952-3383
1467-8578
Abstract: Language and drawing each have their own sets of symbols that they use to convey messages. It is still unclear whether the development of these two expression mechanisms is similar or distinct. There are various approaches to supporting language and communication skills, including structured and naturalistic methods. The goal of this in-depth case study is to find out how a combined intervention affects the language and drawing abilities of a three-year-old girl with developmental delay. Structured implementations and milieu teaching strategies were used in the same session, but not simultaneously. The participant's language and communication skills improved at the end of the programme. Interestingly, even though there was no drawing-related goal, her drawings evolved too. Even though this is a single-subject case study, it suggests that if a child's cognitive and language skills develop, his/her drawing skills do as well.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1416969
Database: ERIC
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  Value: <anid>AN0176077527;bmp01mar.24;2024Mar19.07:38;v2.2.500</anid> <title id="AN0176077527-1">Language and drawing development after a combined intervention: A single‐subject case study </title> <p>Language and drawing each have their own sets of symbols that they use to convey messages. It is still unclear whether the development of these two expression mechanisms is similar or distinct. There are various approaches to supporting language and communication skills, including structured and naturalistic methods. The goal of this in‐depth case study is to find out how a combined intervention affects the language and drawing abilities of a three‐year‐old girl with developmental delay. Structured implementations and milieu teaching strategies were used in the same session, but not simultaneously. The participant's language and communication skills improved at the end of the programme. Interestingly, even though there was no drawing‐related goal, her drawings evolved too. Even though this is a single‐subject case study, it suggests that if a child's cognitive and language skills develop, his/her drawing skills do as well.</p> <p>Keywords: developmental delay; drawing; intervention; language development</p> <hd id="AN0176077527-2">Key Points</hd> <p></p> <ulist> <item> The results demonstrated that a combined intervention programme consisting of structured working memory support activities and naturalistic language and communication promotion strategies is effective for a child with developmental delay.</item> <p></p> <item> Despite the fact that this was not the intended outcome of the intervention, the results demonstrated that the participant's drawing skills also improved. Therefore, it can be asserted that enhancing working memory skills is effective for enhancing language and communication skills, and that enhancing drawing skills is also a significant method.</item> <p></p> <item> In this study, teachers can discover examples of activities and a detailed description of a session to use with students with special needs.</item> <p></p> <item> Assessment is a fundamental aspect of special education for monitoring the development of students and the efficacy of interventions. Therefore, teachers can use this study as a model for intervention and monitoring student development through formal and informal assessment instruments.</item> </ulist> <hd id="AN0176077527-3">INTRODUCTION</hd> <p>Children's developmental stages are not reached simultaneously. Some children do not reach developmental milestones as fast as their peers do, or they may have only recently caught up to the developmental stage of their peers (Fielding‐Gebhardt & Warren, [<reflink idref="bib18" id="ref1">18</reflink>]). The entire developmental stage of a child may experience delays in one area. To reach the expected performance level of children of the same age, an intervention is likely to be required, to minimise the negative effects of delay, to maximise the child's developmental capacities, and/or to boost the child's performance (Casto & Mastropieri, [<reflink idref="bib12" id="ref2">12</reflink>]; Guralnick, [<reflink idref="bib23" id="ref3">23</reflink>]). Early intervention techniques for supporting the performance of children with developmental delay (DD) include home‐based, parent‐mediated (Roberts & Kaiser, [<reflink idref="bib60" id="ref4">60</reflink>]) and centre‐based therapies (McWilliam & Bailey Jr, [<reflink idref="bib46" id="ref5">46</reflink>]; Nores et al., [<reflink idref="bib50" id="ref6">50</reflink>]). Parents, primary caregivers or experts may employ various strategies in both types of intervention methods (McWilliam & Bailey Jr, [<reflink idref="bib46" id="ref7">46</reflink>]; Nores et al., [<reflink idref="bib50" id="ref8">50</reflink>]; Roberts & Kaiser, [<reflink idref="bib60" id="ref9">60</reflink>]). It is perhaps not surprising that language and communication skills are the most affected areas in children with DD (Khan & Leventhal, [<reflink idref="bib40" id="ref10">40</reflink>]).</p> <hd id="AN0176077527-4">Promoting language and communication skills in children with developmental delay</hd> <p>There are several intervention programmes that are based on different approaches to support the language and communication skills of children with DD (Ogletree et al., [<reflink idref="bib51" id="ref11">51</reflink>]). Arguably, most language and communication intervention programmes are built around the principles of behaviourism, such as Discrete Trial Training (DTT), Contemporary Applied Behaviour Analysis (CABA) and Developmental Social Pragmatic (DSP) methods, especially for children with autism spectrum disorders (ASD) (Ingersoll, [<reflink idref="bib29" id="ref12">29</reflink>]; Jennett et al., [<reflink idref="bib30" id="ref13">30</reflink>]). However, behaviouristic approach‐based interventions are strongly criticised because of their didactic, structured, expert‐centred focus, which is far removed from the generalisation of the skills in daily life (Paul, [<reflink idref="bib54" id="ref14">54</reflink>]).</p> <p>According to the DSP approach, opportunities for naturalistic communication and daily routines serve to foster language and communication abilities in everyday situations (Prizant et al., [<reflink idref="bib57" id="ref15">57</reflink>]). In particular, communication skills are frequently aided by natural developmental and behavioural interventions (Schreibman et al., [<reflink idref="bib62" id="ref16">62</reflink>]), and it is reported that this kind of intervention is effective in children with DD (Akamoglu & Meadan, [<reflink idref="bib3" id="ref17">3</reflink>]). Environmental arrangement, modelling, mand‐modelling and time delay are further naturalistic techniques (Meadan et al., [<reflink idref="bib47" id="ref18">47</reflink>]) that are reported to be beneficial for children with ASD (Kaiser et al., [<reflink idref="bib33" id="ref19">33</reflink>]), Down syndrome (Fey et al., [<reflink idref="bib17" id="ref20">17</reflink>]) and DD (Yoder & Warren, [<reflink idref="bib67" id="ref21">67</reflink>]). Although it is well known that DSP‐based strategies are successful in promoting children's development, educators and/or parents who took the courses claim that responding to target behaviour, reinforcing the desired behaviour, and setting up the performance of the target skills are not as simple as reported, and that skills gained during the programme were only externalised after a certain length of time (Brassart & Schelstraete, [<reflink idref="bib10" id="ref22">10</reflink>]).</p> <p>A method known as the 'mixed method' is also seen as valuable. This method combines both behaviouristic and naturalistic perspectives (Kasari et al., [<reflink idref="bib39" id="ref23">39</reflink>]; Paul et al., [<reflink idref="bib55" id="ref24">55</reflink>]; Rogers et al., [<reflink idref="bib61" id="ref25">61</reflink>]; Tsiouri et al., [<reflink idref="bib64" id="ref26">64</reflink>]). CABA‐based language and communication methods include milieu teaching (Kaiser et al., [<reflink idref="bib35" id="ref27">35</reflink>]), the natural language paradigm and incidental teaching (Hart, [<reflink idref="bib26" id="ref28">26</reflink>]). Another mixed‐method approach that has been demonstrated to be particularly successful in children with lower expressive language performance than their peers is enhanced milieu teaching (EMT) (Hancock & Kaiser, [<reflink idref="bib25" id="ref29">25</reflink>]). EMT leads to a rapid improvement in the communication abilities of children with developmental delays who have verbal imitation, can express at least 10 words, and have a mean length of utterance between 1 and 3.5 (Hancock & Kaiser, [<reflink idref="bib25" id="ref30">25</reflink>]). The underlying basis of EMT is its theoretical framework. With its antecedent‐behaviour‐consequence analysis, the EMT model is both behaviouristic and naturalistic, since it makes use of social interaction and initiative in speaking situations (Hancock & Kaiser, [<reflink idref="bib25" id="ref31">25</reflink>]).</p> <p>There are studies that investigate the effects of a combination of different approaches (Biller et al., [<reflink idref="bib8" id="ref32">8</reflink>]; Kaiser et al., [<reflink idref="bib34" id="ref33">34</reflink>]; Kasari et al., [<reflink idref="bib38" id="ref34">38</reflink>]) and the comparison of different strategies (Paul et al., [<reflink idref="bib55" id="ref35">55</reflink>]; Rogers et al., [<reflink idref="bib61" id="ref36">61</reflink>]) for language and communication skills. Findings indicate that a combination of these strategies, as well as individual use of them, has positive effects, but this effect may differ based on the characteristics of the children. For example, Paul et al. ([<reflink idref="bib55" id="ref37">55</reflink>]) stated that children with better joint attention performance improved more than children with poorer performance. In addition, children with higher receptive language skills showed more improvement when natural teaching techniques were employed, while children with lower receptive skills showed more improvement through teaching with discrete trials (Paul et al., [<reflink idref="bib55" id="ref38">55</reflink>]). In their case study, Biller et al. ([<reflink idref="bib8" id="ref39">8</reflink>]) conducted an intervention with a three‐year‐old boy with ASD in which natural teaching strategies and discrete teaching strategies were used. In the study five different activities were carried out in a single session, with target words being studied during sensory play, gross motor and fine motor exercises, story reading exercises, symbolic or free play exercises, and speech production. Biller et al. ([<reflink idref="bib8" id="ref40">8</reflink>]) concluded that speech had improved at the end of the implementation. Supporting language and communication abilities has a positive impact on the capacity for self‐expression of individuals with DD. In addition to spoken language, the use of non‐verbal communication techniques improves social communication abilities and language use of those with developmental disabilities (Barnhill et al., [<reflink idref="bib5" id="ref41">5</reflink>]). Individuals can also express themselves through pictures and thus drawing skills. Drawing is one of the ways in which people express themselves, and it may be stated that drawing skills are similar to language skills.</p> <hd id="AN0176077527-5">Relationship between language and drawing skills</hd> <p>Improvements in symbolic representation performance in language and communication skills are shown in playing performance and also in drawing abilities (Callaghan, [<reflink idref="bib11" id="ref42">11</reflink>]). There are four different views of the relationship between language and drawing performance (Panesi & Morra, [<reflink idref="bib53" id="ref43">53</reflink>]). The first view is influenced by Piaget's ([<reflink idref="bib56" id="ref44">56</reflink>]) symbolic development theory and argues that language and drawing have similar symbolic components. It also states that both are communication systems. The second view is totally opposite to that of Piaget, stating that language and drawing systems are two separate systems. In this view, language is considered to be a symbolic system which is acquired via the language acquisition device (Chomsky, [<reflink idref="bib13" id="ref45">13</reflink>]), while drawing is related to motor development. The third view argues that drawing is a form of language (Willats, [<reflink idref="bib66" id="ref46">66</reflink>]). It can be said that lexical items in language, such as phonemes, morphemes, words and sentences, correspond to graphemes in drawing, such as points, lines and shapes. Structures in drawings come together through several combinations, creating pictures, just as language structures constitute discourses (Cohn, [<reflink idref="bib15" id="ref47">15</reflink>]).</p> <p>The fourth and last view supports the idea that drawing is affected by language (Panesi & Morra, [<reflink idref="bib53" id="ref48">53</reflink>]). Executive functioning and the capacity of working memory, which affect language performance positively, also affect drawing performance (Morra, [<reflink idref="bib48" id="ref49">48</reflink>]; Panesi & Morra, [<reflink idref="bib53" id="ref50">53</reflink>]). A significant improvement in children's working memory performance is needed in order to progress from scribblings to representative drawings, which usually happens in the third year of life (Morra & Panesi, [<reflink idref="bib49" id="ref51">49</reflink>]). It is also suggested that inhibitory control predicts the first meaningful scribblings (Freeman & Adi‐Japha, [<reflink idref="bib19" id="ref52">19</reflink>]), representative drawings (Riggs et al., [<reflink idref="bib59" id="ref53">59</reflink>]), and human body figure drawings (Lange‐Küttner et al., [<reflink idref="bib41" id="ref54">41</reflink>]). In one of the studies focusing on the relationship between working memory and language, Marton ([<reflink idref="bib44" id="ref55">44</reflink>]) found that children with specific learning difficulties performed at a lower level than their typically developing peers in visual–spatial working memory tasks. Therefore, they suggested that it may be insufficient to state that only verbal working memory is related to language.</p> <p>Inhibitory control is claimed to predict grammatical skills in studies that looked at language abilities (Ibbotson & Kearvell White, [<reflink idref="bib28" id="ref56">28</reflink>]), as well as enhancing pragmatic and morpho‐syntactic structures (Blain‐Brière et al., [<reflink idref="bib9" id="ref57">9</reflink>]; Gandolfi & Viterbori, [<reflink idref="bib20" id="ref58">20</reflink>]). Kapa and Colombo ([<reflink idref="bib36" id="ref59">36</reflink>]) concluded that children with more flexible thinking and shifting skills perform better in language learning. It is stated that predictors of morphological and syntactic skills of flexible thinking and shifting, which are executive functions, increase as the age of three is reached (Viterbori et al., [<reflink idref="bib65" id="ref60">65</reflink>]).</p> <p>In their study, Panesi and Morra ([<reflink idref="bib53" id="ref61">53</reflink>]), who thoroughly analyse the connections between drawing and language abilities, working memory and executive functions, argue that these are two representation systems with a high correlation between them. In other words, children's language and drawing abilities are regarded as two distinct forms of self‐expression. There are many similarities between these two structures in terms of their executive functions and working memory properties. In addition, Panesi and Morra ([<reflink idref="bib53" id="ref62">53</reflink>]) state that executive abilities such as inhibition, shifting and updating, and working memory capacity, are predictors of both language and drawing abilities. Also, it is argued that until children develop representational drawing skills at the level of scribbling, their language abilities have an impact on their drawing abilities. Additionally, it is reported that children begin to specialise in language between the ages of three and six years, and that their language and drawing abilities develop independently under the impact of similar cognitive traits (Panesi & Morra, [<reflink idref="bib53" id="ref63">53</reflink>]).</p> <p>Panesi and Morra ([<reflink idref="bib52" id="ref64">52</reflink>]) have also claimed that language development has a direct impact on the drawing abilities of two‐year‐olds. Furthermore, it is stated that once a child masters representational drawing, language and drawing abilities begin to be distinct from each other and grow independently from the point at which the child moves from scribbling to representational drawing (Panesi & Morra, [<reflink idref="bib52" id="ref65">52</reflink>]).</p> <hd id="AN0176077527-6">METHOD</hd> <p></p> <hd id="AN0176077527-7">Case study</hd> <p>In this case study, the effects of an intervention programme on the language and communication abilities of a three‐years‐and‐nine‐months‐old girl with DD were investigated. The intervention programme included both naturalistic strategies to promote language and communication skills and structured activities to support working memory and vocabulary. Although not a specific aim of the intervention, the participant's drawing skills were also investigated, as part of the skills of self‐expression. There are some studies on language development and drawing skills which analyse these separately. However, the number of studies examining language development and drawing skills of children together is limited. In the process of supporting the language and communication skills of a child with DD, a case study in which drawing skills are monitored at the same time may produce significant findings in terms of the course of language and drawing development. As one of the qualitative research approaches, this study is designed as a case study (Creswell & Poth, [<reflink idref="bib16" id="ref66">16</reflink>]).</p> <hd id="AN0176077527-8">Participant</hd> <p>Ayla, the study's participant, was a two‐years‐and‐nine‐months‐old girl when she was diagnosed with DD. Her diagnosis was completed by a child and adolescent psychiatrist. To maintain anonymity, the participant's real name is not given. Ayla's parents are university graduates. She is the only child of a middle‐to‐upper socio‐economic‐class family, in which both parents are present. The only language used in the home is Turkish. The diagnosis of Ayla's DD is not due to hearing, visual, motor, sensory or cognitive impairment.</p> <p>Ayla's family consulted a child and adolescent psychiatrist because of speech and language problems in September 2020. The psychiatrist's developmental evaluation stated that Ayla could not express herself, might have difficulty in taking instructions and in following rules in games, in maintaining games, as well as in theory‐of‐mind skills. It was also stated that Ayla should receive special education support and should also attend pre‐school education. After this evaluation, the family decided to send Ayla to a pre‐school institution in January 2021, but they did not start any special education intervention programme for her.</p> <p>The child development specialist working in the pre‐school institution which Ayla attended made similar assessments, and added that Ayla had difficulty in verbal communication with her peers, exhibited problem behaviours when her requests were not met, and was overly fond of certain objects.</p> <p>In June 2021, Ayla went for a second medical check‐up and the psychiatrist, who did not see any improvement in Ayla, diagnosed an urgent need for special education support.</p> <p>As a result, the researcher was contacted by the child development specialist, and the study was set up. The needs of the family and Ayla were discussed with them by the researcher before the intervention. The initial evaluation of Ayla, in August 2021, was conducted after the family had signed an informed consent form. In other words, the intervention programme for Ayla started approximately one year after the initial diagnosis. In this case, the period between the time of diagnosis and the time of starting special education occurred as a result of family reluctance to seek an earlier intervention. Commonly, families experience a waiting period between diagnosis and intervention, albeit for a variety of reasons (Mandell et al., [<reflink idref="bib43" id="ref67">43</reflink>]; Masefield et al., [<reflink idref="bib45" id="ref68">45</reflink>]).</p> <p>Ayla's pre‐school teacher was similarly interviewed by the researcher before the intervention, to learn more about the child's verbal, communicative and social performance. These meetings, which were all conducted as semi‐structured interviews, were repeated following the intervention.</p> <hd id="AN0176077527-9">Data collection tools</hd> <p>In this single‐subject case study, four data analysis tools were used: Raven's Coloured Progressive Matrices (CPM) test; the Turkish Early Language Test (TEDIL), a standard assessment tool for language and communication skills; spontaneous language sample analysis (SLSA); and a drawing checklist developed by the researcher were used to assess Ayla's language, communication and drawing abilities. These evaluation tools were all employed before, during and following the intervention programme.</p> <hd id="AN0176077527-10">Raven's Coloured progressive matrices (CPM) test</hd> <p>CPM is used to determine the non‐verbal intelligence performance of children aged four to six years. The Turkish standardisation of the CPM test was carried out by Bildiren and his colleagues in a 2017 study involving children aged 48 to 72 months old. There is no verbal instruction in the test, which has 30 items. The first five items are answered by the child together with the practitioner. For these items, the practitioner can help the child with the process. For the remaining items, the practitioner simply shows the items and waits for the child to say or show the answer. The raw scores are obtained based on the total number of items answered correctly, and a result is obtained regarding the percentile of the child according to his/her calendar age (Bildiren et al., [<reflink idref="bib7" id="ref69">7</reflink>]), with 'intellectually average' being used to describe scores falling between the 25th and 75th percentiles (Raven et al., [<reflink idref="bib58" id="ref70">58</reflink>]).</p> <p>The presence of verbal instructions in other tools used to measure cognitive performance may not reflect the actual performance of children with language difficulties (Kasari et al., [<reflink idref="bib37" id="ref71">37</reflink>]). The CPM was used to ensure that Ayla's performance in language and speaking skills did not adversely affect her cognitive performance.</p> <hd id="AN0176077527-11">Turkish early language test (TEDIL)</hd> <p>TEDIL is a formal assessment tool in the Turkish version of the Test of Early Language Development (TELD‐3). TEDIL is used to evaluate the receptive and expressive language performance of children between the ages of 2 and 7 years and 11 months (Hresko et al., [<reflink idref="bib27" id="ref72">27</reflink>]). There are 25 items in the receptive language part of the forms and 39 items in the expressive language part. During the evaluation, the participant is expected to show some items, describe some items, fulfil some instructions and verbally answer the questions asked. TEDIL covers three of the five components (semantics, morphology and syntax) of the language system (Güven & Topbaş, [<reflink idref="bib24" id="ref73">24</reflink>]). The test–retest reliability coefficient of the TEDIL A form has been calculated as 0.96 for receptive language and 0.89 for expressive language (Güven & Topbaş, [<reflink idref="bib24" id="ref74">24</reflink>]).</p> <hd id="AN0176077527-12">Spontaneous language sample analysis (SLSA)</hd> <p>SLSA is an evaluation technique that involves recording a 15‐minute conversation between adults and children while they play games together, transcribing the recording, and then using SALT RV18 (Systematic Analysis Language Transcriptions) to analyse the transcripts (Acarlar et al., [<reflink idref="bib2" id="ref75">2</reflink>]). As it permits data collection in the natural setting, SLSA is regarded as the analytic method that can produce results that are most similar to a child's actual language performance (Acarlar et al., [<reflink idref="bib2" id="ref76">2</reflink>]). The SALT RV18 programme's outcomes make it possible to make a comparison with the results in the database which were taken from children of 2 years and 6 months, to 9 years and 6 months. Using SLSA, researchers can obtain several findings, including the mean length of utterance (MLU), number of total words (NTW), total number of different words (NDW), question response percentage and linguistic maze ratio. The MLU develops in parallel with increases in age and is defined as the ratio of a person's grammatical structures to their overall frequency of speaking, or the number of utterances (Acarlar, [<reflink idref="bib1" id="ref77">1</reflink>]). The MLU gives more information about individuals' performance on syntax, morphology and grammar. The NDW refers to the number of different words used during the conversation, while the NTW refers to the overall number of total words used by the individual during the conversation. These two variables provide information about vocabulary and its usage. The question–response percentage reveals details about the child's participation in the conversation, how frequently they speak when it is their turn, and how well they utilise pragmatic component of language (Acarlar, [<reflink idref="bib1" id="ref78">1</reflink>]). In addition, linguistic mazes can be collected via SLSA. These increase as a child's sentences get longer and their linguistic patterns become more complicated. Children who attempt to create longer, more complicated statements linguistically have a higher linguistic maze rate (Bangert & Finestack, [<reflink idref="bib4" id="ref79">4</reflink>]; Thordardottir et al., [<reflink idref="bib63" id="ref80">63</reflink>]). It is stated that there are three types of linguistic mazes, which are filled pauses, repetitions and revisions (Leadholm & Miller, [<reflink idref="bib42" id="ref81">42</reflink>]).</p> <hd id="AN0176077527-13">Drawing checklist</hd> <p>In this study, Ayla was given a blank piece of A4 paper and crayons and asked to draw at the end of the sessions (Figure 1). The drawing was done as a post‐class activity. After some sessions, Ayla preferred to play with bubbles, toys or games such as <emph>'hide and seek'</emph> or <emph>'the floor is lava'</emph>. At the end of the intervention, there were 19 drawings done by Ayla. Her drawings were analysed via a drawing checklist developed by the researcher (Table 1).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BMP/01mar24/bjsp12496-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjsp12496-fig-0001.jpg" title="1 The picture that Ayla drew before starting the intervention programme.[Colour figure can be viewed at wileyonlinelibrary.com]" /> </p> <p></p> <p>1 TABLE Drawing checklist items without sub‐items.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Items</th><th align="left">Score</th></tr></thead><tbody valign="top"><tr><td align="left">1 Drawings are just scribbles, not deliberate drawings</td><td align="left">Yes</td><td align="left">No</td></tr><tr><td align="left">2 Drawings look like shapes such as circles, squares, etc.</td><td align="left">Yes</td><td align="left">No</td></tr><tr><td align="left">3 Drawings are definitely examples of shapes such as circles, squares, etc.</td><td align="left">Yes</td><td align="left">No</td></tr><tr><td align="left">4 There are human figures (head, body, legs, arms, etc.)</td><td align="left">1 point for every existing sub‐item</td></tr><tr><td align="left">5 There are face details (eyes, nose, mouth, lips, hair, etc.)</td><td align="left">1 point for every existing sub‐item</td></tr><tr><td align="left">6 There are clothes on the bodies (pants, shirts, hat, skirts, etc.)</td><td align="left">1 point for every existing sub‐item</td></tr><tr><td align="left">7 Hand details (fingers, nails, thumb)</td><td align="left">1 point for every existing sub‐item</td></tr><tr><td align="left">8 Themes, stories (house, garden, school, tree, ball, playground, etc.)</td><td align="left">1 point for every existing sub‐item</td></tr><tr><td align="left">9 Colours (one colour or more)</td><td align="left">Yes</td><td align="left">No</td></tr><tr><td align="left">10 Page use (placing figures on the paper in a balanced way)</td><td align="left">Yes</td><td align="left">No</td></tr><tr><td align="left">11 Appropriate figure size</td><td align="left">Yes</td><td align="left">No</td></tr></tbody></table> </ephtml> </p> <p>The drawing checklist was created in line with the opinions of experts, consisting of a psychologist, two child development experts, a pre‐school teacher and an art teacher. While creating the drawing checklist, the items of the Draw a Person Test (Goodenough, [<reflink idref="bib21" id="ref82">21</reflink>]) and the stages of drawing development in children were taken into consideration (Cohn, [<reflink idref="bib15" id="ref83">15</reflink>]).</p> <p>The drawing checklist consists of 11 items (Table 1). In the first three items, it is asked whether the child's drawings are purposeful and whether they form a shape. The fourth item is about human figures in general, with sub‐items dealing with the presence of elements such as head, legs, arms, torso, and so on. The details of the human's head are the focus of the fifth item. The next item is about clothes. The seventh item deals with the hand details. In the eighth item, it is asked whether there is a story in the drawing, whether a symbolic or representative situation. Under this item, it is asked whether there are places such as houses and parks, objects such as armchairs and balls, and elements of nature such as mountains and trees. The ninth item asks about the use of colour. The tenth question asks about the child's use of paper; for example, whether he/she centred the paper in the drawings and whether he/she used the paper proportionally. The eleventh and last question asks whether the house is proportioned appropriately to the person or whether the hand is proportioned appropriately to the head.</p> <p>The items and sub‐items in the drawing checklist are scored with 1 or 0. A drawing can receive a minimum score of zero and a maximum score of 32. The researcher scored all the drawings produced by Ayla with this checklist. Another independent expert scored five randomly selected pictures drawn by Ayla. Inter‐rater reliability was found to be 89%.</p> <p>The 19 drawings by Ayla were assessed in relation to drawing style, age appropriateness, colouring and representations, using the drawing control checklist (Figure 6).</p> <hd id="AN0176077527-15">Procedure</hd> <p>The researcher constructed a neutral setting where the intervention programme was carried out. A small table, two seats, a carpet, a coffee table and open shelves were all provided in the space designated for implementation. Materials included bubbles, crayons, blank pieces of A4 paper, a farm set, a kitchen set, a traffic set, two dolls (a girl and a boy), a doll house, a toy market and supplies. Sequence cards, verb and word cards and concept cards were also included in the setting. The parent who brought Ayla waited in the reception room throughout the implementation, and when the lesson was finished, Ayla called out to her mother or father and ended the lesson. While Ayla painted or played by herself, the researcher recorded the practices in a diary after each lesson. In the final session, the researcher provided the mother and/or father with feedback regarding the activities, Ayla's performance, any problematic behaviours and strategies for dealing with these behaviours.</p> <hd id="AN0176077527-16">Assessment before intervention</hd> <p>At a pre‐determined time and date, in the room where the researcher had prepared and practised, the researcher conducted the initial assessment of Ayla. Following directions, waiting, taking turns, imitating, using gestures and using things in accordance with their function were all noticed during the initial examination. Then, using the TEDIL, CPM and SLSA, cognitive function as well as language and communication abilities were assessed.</p> <p>In the initial assessment, it was noted that Ayla had issues paying attention to what was being said, responding appropriately and speaking in context.</p> <p>Ayla displayed problematic behaviours during the exercise, including not responding to questions, getting up from her desk, and yelling in order to get to the dolls, toys and other items she wanted to play with.</p> <p>Ayla's raw score on CPM was 12 points, meaning that she is intellectually average and is between the 25th and 75th percentiles in her age group (Raven et al., [<reflink idref="bib58" id="ref84">58</reflink>]).</p> <p>Ayla scored 90 points on the verbal language portion of the TEDIL, 101 points on the receptive language sub‐test and 82 points on the expressive language sub‐test. The TEDIL score profile indicates that Ayla's expressive language score is below the age norm, while her verbal language and receptive language scores are within age norms (Güven & Topbaş, [<reflink idref="bib24" id="ref85">24</reflink>]).</p> <p>The examination of the MLU score of 4.52 on the SLSA shows that Ayla is behind her peers by one standard deviation (SD). When vocabulary was assessed, it was found that her NTW score of 147 is lower by one SD than her peers; there is not any statistical difference for the NDW score of 81, according to the SALT database. Ayla's question–response percentage (70.5%) is also lower by one SD than the SALT database. There is not a significant difference in the rate of linguistic mazes (4.5%) between Ayla's results and the SALT database (Acarlar et al., [<reflink idref="bib2" id="ref86">2</reflink>]).</p> <p>It was determined that Ayla's vocabulary was comparable to that of her peers, but she performed less well in expressive language abilities when compared to both the TEDIL and SLSA results before the intervention. Thus, it is clear that Ayla's expressive language abilities should be supported. Ayla should be helped with expanding her vocabulary, improving her expressive vocabulary, retaining words, utilising them in sentences, and employing various word kinds, including conjunctions, adjectives, prepositions and gerunds. The decision was taken to apply enhanced milieu teaching techniques in the natural context to support her language and communication abilities. Additionally, it is intended to offer linguistic assistance through exercises that focus on working memory and theory of mind.</p> <hd id="AN0176077527-17">Intervention sessions</hd> <p>Ayla's intervention programme was implemented in 45‐minute sessions twice a week, with a total number of 72 interventions. In all sessions, the activities were carried out in a similar order. These activities were greetings, playing the game chosen by Ayla from the structured activities, playing the game chosen by Ayla from the natural games to use strategies that support language use in the natural context, and the post‐class activity (Table 2). At the beginning of the session, Ayla sat at the table and was asked how she was and how her day was. Afterwards, the games that could be played were discussed and those chosen by Ayla were listed and played according to that list. When Ayla decided on the game, reinforcement was provided by saying <emph>'good work'</emph> and the intervention session started with the first activity.</p> <p>2 TABLE Examples of activities during the intervention sessions.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Subject</th><th align="left">Cognitive activities</th><th align="left">Language activities</th></tr></thead><tbody valign="top"><tr><td align="left">First‐category activities (used in the first part of the intervention session)</td><td align="left">Structured activities</td><td align="left">Find the pairs</td><td align="left">Sequence the cards</td></tr><tr><td align="left">Puzzle</td><td align="left">Recall the words</td></tr><tr><td align="left">Guess what?</td><td align="left">Guess the feelings</td></tr><tr><td align="left">Remember the actions</td></tr><tr><td align="left">Second‐category activities (used in the second part of the intervention session)</td><td align="left">Milieu teaching (mand‐modelling, expanding)</td><td align="left" /><td align="left">Playing with doll houseFarmBubbles</td></tr><tr><td align="left">Last part of the session</td><td align="left">Ayla could choose between the following relaxing activities: free‐style drawing, hide and seek, 'the floor is lava' game or continuing to play with the doll house</td></tr></tbody></table> </ephtml> </p> <p>The activities can be grouped into two categories. The first category is structured activities which support cognitive abilities, such as working memory, attention and executive functions, and vocabulary, such as teaching new words and verbs. During these structured activities, Ayla had to use cognitive abilities such as estimating, matching and remembering.</p> <p>For example, Ayla's working memory was intensively supported by activities such as finding the pairs among mixed cards, completing a 12‐piece puzzle, and remembering actions on verb cards that were displayed briefly. Ayla's working verbal memory, attention, and recall of words were supported by activities such as sequencing five story cards according to the actions and retelling the story, catching the ball to take a turn, and recalling a word from a previously determined category. Also, guessing the concealed object in the bag and the emotions of the characters in the story that the researcher read helped Ayla's estimation, which is important in theory of mind and in flexible thinking.</p> <p>After the structured activities, the implementation moved on to the second category of activities, which included milieu teaching strategies. In this section, a game was set up by Ayla, with the toys she chose, in her own way. In these games, the researcher used the strategies of mand‐modelling and expanding the language.</p> <p>In these games, which take place in a natural context, the scenario was shaped as Ayla wanted. The researcher sometimes asked for a response by questioning, and became a model when there was no response. If Ayla used the target language structure, she was reinforced instantly; in addition, the researcher was responsive to Ayla's communication initiations. When Ayla started using verbal language, the researcher responded to her by expanding her sentences.</p> <hd id="AN0176077527-18">Assessment during and after the intervention</hd> <p>After Ayla's pre‐intervention assessments were completed, the intervention programme was initiated. In order to follow the development of Ayla's language and communication skills, a spontaneous SLSA was conducted quarterly. Therefore, three more language samples were taken at three months, six months and nine months after the start of the programme, and were analysed with the SALT programme.</p> <p>In order to evaluate Ayla's receptive and expressive language performance, TEDIL was carried out in August 2021 before the programme, and repeated six months during the programme in January 2022 and at the end of the programme in May 2022. Only the TEDIL A form was used in the assessments because of the appropriate duration having elapsed for the retest (Güven & Topbaş, [<reflink idref="bib24" id="ref87">24</reflink>]).</p> <p>The evaluation of Ayla's cognitive performance with CPM before the intervention was repeated after the intervention, to determine possible improvements in Ayla's non‐verbal cognitive performance.</p> <hd id="AN0176077527-19">Parent's and preschool teachers' views</hd> <p>In this study, the opinions of Ayla's mother and pre‐school teacher about Ayla's performance and development were investigated using semi‐structured interviews. Semi‐structured interview questions were prepared by the researcher and sent to three field experts for their opinions. Having obtained these opinions, three questions were selected for use in the semi‐structured interviews, as follows.</p> <p></p> <ulist> <item> Have you noticed any changes in your child's language and communication development when you think about before and after the intervention? If so, what kind of changes have occurred, can you explain by giving examples?</item> <p></p> <item> Have you noticed any changes in your child's behaviour when you think about before and after the intervention? If yes, can you explain the changes with examples?</item> <p></p> <item> What do you think about your communication with your child before and after the study with your child? What has changed, can you give examples?</item> </ulist> <hd id="AN0176077527-20">Data reliability</hd> <p>Ayla's language samples were acquired by the researcher in the context of conversation during the game. The conversation during the game was audio‐recorded and transcribed by the researcher. Then, it was divided into utterances and morphemes, and error codes were written. The transcripts, which were prepared for analysis, were analysed via the Turkish version of SALT RV18. In order to ensure the reliability of the data, an independent observer listened to 25% of the data and transcribed them, divided the transcription into utterances and morphemes and coded the transcription. The reliability was found to be 92.4% in the translation of the language sample between the researcher and the independent observer. Reliability was found to be 86.2% in separation into utterances and morphemes, and 70.8% in coding.</p> <hd id="AN0176077527-21">RESULTS</hd> <p>The TEDIL results show that Ayla's receptive language score was appropriate for her age before the programme, but her expressive language score and total language score were below the average score of 100. In the second evaluation, it was seen that Ayla's receptive, expressive and total language scores were above average. In the post‐test results, it was clear that Ayla's receptive, expressive and total language scores reached the average (Figure 2).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BMP/01mar24/bjsp12496-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjsp12496-fig-0002.jpg" title="2 Turkish Early Language Test results.[Colour figure can be viewed at wileyonlinelibrary.com]" /> </p> <p></p> <p>The MLU, NTW, NDW, percentage of answering questions, and percentage of mazes obtained from SLSA were used to determine Ayla's language and communication skill performance. Ayla's MLU results were compared against the database of the SALT 18RV programme (Figure 3). Ayla's first language sample was analysed before the intervention programme started. After the start of the programme, three more SLSA were taken at three‐month intervals. The fourth SLSA was taken after the intervention programme. Ayla's MLU value was found to be 4.52 before the programme, indicating that she was one SD below the SALT database. Although the MLU value increased to 4.60 in the language sample analysis performed at the third month, the difference from the SALT database increased to two SDs. Although Ayla's MLU value increased to 4.98 in the examination conducted in the sixth month, the difference between the database was again determined as two SDs. In the last evaluation, Ayla's MLU was 5.81 and there is not any statistical difference between Ayla's MLU and the SALT database. So, it is safe to argue that after the intervention programme, Ayla had caught up with her peers in language development.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BMP/01mar24/bjsp12496-fig-0003.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjsp12496-fig-0003.jpg" title="3 Ayla's mean length of utterance results according to the Systematic Analysis Language Transcriptions database. *1 standard deviation below the database, and **2 standard deviation below the database. MLU, mean length of utterance.[Colour figure can be viewed at wileyonlinelibrary.com]" /> </p> <p></p> <p>When the semantic properties of Ayla's language were investigated and compared with the SALT database, it was found that Ayla's NTW results were one SD below the SALT database (Figure 4). In other words, although Ayla started to use more words and is more talkative than before the intervention, her performance remains behind that of her peers.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BMP/01mar24/bjsp12496-fig-0004.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjsp12496-fig-0004.jpg" title="4 Spontaneous language sample analysis results for vocabulary. The results emphesize with the redbox is above the database. NDW, number of different words; NTW, number of total words.[Colour figure can be viewed at wileyonlinelibrary.com]" /> </p> <p></p> <p>On the other hand, the NDW result, which is a good indicator of vocabulary, had improved after the intervention. When SLSA NDW results were investigated, no statistical differences were found based on the SALT database which was used for the first three assessments. However, the post‐test showed that Ayla's NDW result is higher than those of her peers (Figure 4). In other words, it can be stated that Ayla started to use a greater number of different words after the programme.</p> <p>The percentage of answers to the questions in the examination represents further data about talkativeness and the pragmatic component of language. Ayla's percentage of answers to the questions was one SD below the expected level in the first three assessments. Additionally, in the post‐test, her performance worsened to two SDs below her peers, according to the SALT database (Figure 5).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BMP/01mar24/bjsp12496-fig-0005.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjsp12496-fig-0005.jpg" title="5 Response to questions and linguistic maze percentage. The results emphesize with the redbox is above the database. LinMaze, linguistic maze; RtoQ, Response to questions.[Colour figure can be viewed at wileyonlinelibrary.com]" /> </p> <p></p> <p>In this study, Ayla's percentage of mazes before, during and after the programme were examined and it was observed that there was a regular increase. The incidence of mazes peaked especially in the third period, and after the programme, as Ayla started to use more complex sentences when compared with peers (Figure 5).</p> <p>According to Ayla's mother and pre‐school teacher, she started to express herself with more complex sentences. Ayla's pre‐school teacher stated that the frequency of problem behaviours also decreased and her interaction with peers was more positive. Ayla's mother also said that Ayla was both more patient and more successful at focusing on work and conversations.</p> <p>Another finding of the study was obtained from Ayla's drawings. It was stated that Ayla used only one colour in the pictures she drew freely before the programme, drew similar figures, and the situation she represented could not be understood by the adults. On the other hand, human figures called 'tadpoles' were drawn by Ayla from around the age of three years. In drawings made after the programme, Ayla used more than one colour and more than one figure, and a specific situation is represented in the pictures which can be understood by an adult. Additionally, drawing checklist results show the development of Ayla's drawings (Figure 6). For instance, Ayla's first drawing (Figure 1) scored 13 points on the list, while her last drawing scored 21 points (Figure 7). In relation to the picture in Figure 7, Ayla said that she drew a picture representing her going to school with her parents on a rainy day with black clouds. In the mother and child figures in the same drawing, it can be seen that the 'tadpole' drawing has been replaced by human figures where the head and arms are attached to the body. Additionally, using more than one colour, and using circles, squares and triangle shapes for the house, bus, clouds, windows and door, contributed to the drawing's score of 21 points.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BMP/01mar24/bjsp12496-fig-0006.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjsp12496-fig-0006.jpg" title="6 Ayla's drawings and assessment results.[Colour figure can be viewed at wileyonlinelibrary.com]" /> </p> <p></p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BMP/01mar24/bjsp12496-fig-0007.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjsp12496-fig-0007.jpg" title="7 One of Ayla's drawings after intervention.[Colour figure can be viewed at wileyonlinelibrary.com]" /> </p> <p></p> <p>Finally, the intervention programme also improved Ayla's non‐verbal cognitive performance. Ayla's CPM raw score was 12 points and was between the 25th and 75th percentiles in her age group (Raven et al., [<reflink idref="bib58" id="ref88">58</reflink>]) before the intervention programme. After the intervention, Ayla's raw score was 18 and she had risen to the 90th percentile in her age group (Raven et al., [<reflink idref="bib58" id="ref89">58</reflink>]).</p> <hd id="AN0176077527-28">DISCUSSION</hd> <p>One of the most popular ways to express oneself is through language, which is also one of the qualities that define humanity. However, language is not the only means of self‐expression. Like language, drawing is also a means of expression. This study aimed to investigate the impact of a programme in which various techniques based on structured and naturalistic approaches were employed with a child with DD, with the goal of improving the child's performance in non‐verbal cognitive abilities, language and communication skills and investigating effects on drawing abilities. CPM was employed in this study to assess Ayla's non‐verbal cognitive performance, TEDIL and SLSA to assess her language and communication abilities, and drawing checklist to assess her drawing abilities. According to the evaluation results, Ayla's language and communication abilities improved. According to the TEDIL, Ayla's expressive language score and total language score were lower than those of her peers prior to the intervention programme, but her receptive language score was comparable to those of her peers. It was determined that Ayla, whose receptive language score was appropriate for her age before the intervention, reached levels comparable to her peers in all TEDIL points, according to the re‐evaluation conducted six months after the intervention programme began. According to the results of the TEDIL, Ayla maintained her growth in language and communication abilities in the final examination conducted after the intervention programme. After the intervention, it was seen that Ayla's receptive language, expressive language and total language scores persisted on average for nine months. According to these findings, it can be concluded that language and communication support techniques based on two separate approaches are successful in enhancing language and communication skills. Similar results were reported by Biller et al. ([<reflink idref="bib8" id="ref90">8</reflink>]), who employed both natural teaching methodologies and voice production techniques in their case studies with only one participant. They supported the generation of speech sounds with physical modelling and visual cues in speech production methods, which are more structured techniques, while using the strategies of environmental arrangement, modelling and mand‐modelling from milieu teaching strategies.</p> <p>Ayla's MLU scores and maze ratio exhibit linear growth when SLSA results are considered. It is said that the complexity of the language and the increase in the number of words in the sentences are related to the rise in MLU and linguistic mazes (Bangert & Finestack, [<reflink idref="bib4" id="ref91">4</reflink>]; Thordardottir et al., [<reflink idref="bib63" id="ref92">63</reflink>]). Therefore, based on these findings, we can say that Ayla became more proficient in the use of the language's morphemes and grammar since the programme, which suggests that Ayla's expressive language skills have improved as a result of the intervention. According to the SALT database, Ayla may have actually closed the gap with her peers in terms of MLU by the end of the nine‐month programme. As compared to the pre‐programme, Ayla's NDW and NTW results also increased. Examination of the measurement data for Ayla's expressive vocabulary reveals that her NTW shows an overall rise, with occasional falls, whereas her NDW exhibits a linear increase. These findings show that, alongside an increase in the overall quantity of words used by Ayla, her use of terms was steadily growing and contained more variation. In other words, Ayla used more words in expressive language, but what is more intriguing is that she was able to employ a wider variety of phrases.</p> <p>In terms of language and communication abilities, it can be stated that a modest rise was observed in the proportion of responses to the questions that reveal information about the pragmatic component of the language. Although Ayla's findings were higher than pre‐test in some metrics, more reliable data are required to reach a firm conclusion. These findings indicate that Ayla's pragmatic abilities were not improved by the intervention programme to the predicted degree. The lack of separate research to generalise these abilities for Ayla could be the cause of these outcomes. The percentage of Ayla's correct responses did not rise satisfactorily, and the fact that the NTW increased but the NDW did not demonstrate a parallel improvement may allow the following observation: it is stated that children with DDs have learned helplessness and low motivation (Johnson, [<reflink idref="bib31" id="ref93">31</reflink>]). Thus, the fact that Ayla appears to have sufficient different words in her mental vocabulary but answers with so few can be interpreted as Ayla demonstrating low motivation to use verbal language and a learned helplessness from the past.</p> <p>The CPM results show that Ayla's non‐verbal cognitive performance improved as well. This may be explained by Ayla's improved working memory and attention performance. Similarly, Bereiter and Scardamalia ([<reflink idref="bib6" id="ref94">6</reflink>]) argued that in non‐verbal intelligence performance, attention and working memory have considerable effects. A snowball effect can be another explanation for the CPM results of Ayla. She may have been motivated, and therefore more focused on producing her real performance, in the test questions. Therefore, it is safe to state that both Ayla's CPM response accuracy and expressive vocabulary improved.</p> <p>The improvement in Ayla's drawing abilities can be considered one of the study's more intriguing outcomes. Ayla utilised more figures and colours in her drawings following the programme, according to an analysis of the drawings she created before and after it. It was also noted that she progressed from depicting 'tadpoles' to human characters with bodies in her drawings. The 'tadpole' figures in Ayla's earliest drawings have led to the assumption that she learned to draw when she was about three years old (Goodman, [<reflink idref="bib22" id="ref95">22</reflink>]; Jolley, [<reflink idref="bib32" id="ref96">32</reflink>]). Her use of bodies of human figures in her most recent works suggests that her level of drawing ability corresponds to her age (Goodman, [<reflink idref="bib22" id="ref97">22</reflink>]; Jolley, [<reflink idref="bib32" id="ref98">32</reflink>]). It is reported that children progress from scribbling to controlled scribbling and from non‐representational images to compositions that are representative (Coates & Coates, [<reflink idref="bib14" id="ref99">14</reflink>]; Goodman, [<reflink idref="bib22" id="ref100">22</reflink>]; Jolley, [<reflink idref="bib32" id="ref101">32</reflink>]). Therefore, it may be that Ayla's early drawings lacked representation and, if that was the case, adults would not be able to understand them. At the conclusion of the programme, adults could analyse the picture, since the figures in the picture could be matched to an event. In other words, Ayla's language and communication skills as well as her drawing abilities were favourably impacted by an intervention programme that promoted working memory and language skills and employed two separate methodologies. The intervention programme's primary goals were to support language, communication and cognitive abilities. Drawing abilities were not supported by a separate application. Despite this, Ayla's ability to communicate and express herself verbally and via drawing grew concurrently. In this situation, it may be claimed that as cognitive ability grows, so do vocabulary and grammatical skills, and concurrently, so do representational drawing skills. These results may be consistent with the findings of Panesi and Morra's ([<reflink idref="bib53" id="ref102">53</reflink>]) study, which claims that executive functions and especially working memory skills are strongly related to drawing skills. In other words, Ayla's language and communication abilities improved because of her improved executive function abilities; at the same time her drawing skills improved too.</p> <p>It is important to conduct comparative and experimental investigations of a larger sample in order to have a much more detailed understanding of the topic. Ayla's representational performance in both language and drawing skills may have improved due to the fact that executive functions and memory capacity are important for both language and drawing skills.</p> <p>Given that this is a single‐subject case study, its results cannot be generalised. However, it is apparent that the intervention programme used in the study improved Ayla's language and communication skills. This study could pave the way for future research that sheds light on the relationship between language and drawing development. Alternatively, it can be viewed as a minor but significant result in terms of revealing the positive effects of executive function development on language and drawing development. In order to clarify the relationship between language, drawing and working memory, there is a need for future studies involving a greater number of participants conducted with control groups, and for longitudinal studies.</p> <hd id="AN0176077527-29">FUNDING INFORMATION</hd> <p>There is no funding to disclose.</p> <hd id="AN0176077527-30">CONFLICT OF INTEREST STATEMENT</hd> <p>The author declare no conflict of interest.</p> <hd id="AN0176077527-31">DATA AVAILABILITY STATEMENT</hd> <p>The data can be shared in accordance with the author's decision.</p> <hd id="AN0176077527-32">ETHICS STATEMENT</hd> <p>In this single‐subject case study, the consent form was signed by the participant's parents. 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  Data: Language and Drawing Development after a Combined Intervention: A Single-Subject Case Study
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  Label: Abstract
  Group: Ab
  Data: Language and drawing each have their own sets of symbols that they use to convey messages. It is still unclear whether the development of these two expression mechanisms is similar or distinct. There are various approaches to supporting language and communication skills, including structured and naturalistic methods. The goal of this in-depth case study is to find out how a combined intervention affects the language and drawing abilities of a three-year-old girl with developmental delay. Structured implementations and milieu teaching strategies were used in the same session, but not simultaneously. The participant's language and communication skills improved at the end of the programme. Interestingly, even though there was no drawing-related goal, her drawings evolved too. Even though this is a single-subject case study, it suggests that if a child's cognitive and language skills develop, his/her drawing skills do as well.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1416969
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1416969
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/1467-8578.12496
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 35
    Subjects:
      – SubjectFull: Freehand Drawing
        Type: general
      – SubjectFull: Language Skills
        Type: general
      – SubjectFull: Communication Skills
        Type: general
      – SubjectFull: Skill Development
        Type: general
      – SubjectFull: Reading Writing Relationship
        Type: general
      – SubjectFull: Females
        Type: general
      – SubjectFull: Young Children
        Type: general
      – SubjectFull: Developmental Delays
        Type: general
      – SubjectFull: Teaching Methods
        Type: general
      – SubjectFull: Program Implementation
        Type: general
      – SubjectFull: Art Education
        Type: general
      – SubjectFull: Individual Characteristics
        Type: general
      – SubjectFull: Communication Research
        Type: general
    Titles:
      – TitleFull: Language and Drawing Development after a Combined Intervention: A Single-Subject Case Study
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Ceyhun Servi
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 0952-3383
            – Type: issn-electronic
              Value: 1467-8578
          Numbering:
            – Type: volume
              Value: 51
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: British Journal of Special Education
              Type: main
ResultId 1