This study will pilot a newly developed Syntactic-Semantic Visual Configuration Intervention (SSVCI) designed to help Urdu-speaking children with language impairment improve their ability to understand and produce phrases and sentences. The intervention was developed through extensive literature review, expert recommendations, and the structure of the Urdu language to ensure that it is appropriate for children in Pakistan.
Before pilot testing, experts in speech-language pathology and Urdu linguist according to the inclusion criteria reviewed the intervention material to evaluate whether the activities are relevant, culturally appropriate, and representative of the language skills being taught. Feedback from children and caregivers was also be used to in the first phase of need assessment, before the intervention material was finalized.
The pilot study will include 20 children aged 6 to 12 years, including 10 children with language impairment and 10 children with typical language development. Participants will be recruited from selected schools, hospitals, and special education centers in Islamabad. Children with language impairment conditions , with primary diagnosis of autism spectrum disorder, hearing impairment, cerebral palsy, or Down syndrome, provided they meet the study eligibility criteria will be included.
Participants will complete language assessments before taking part in the intervention activities. These assessments will measure language skills such as sentence formation, understanding of spoken language, and narrative abilities. Information collected during the pilot study will help researchers determine whether the intervention materials are clear, practical, culturally appropriate, and suitable for use in a larger clinical trial. Findings from this study will also be used to refine the intervention by identifying activities or items that require modification or removal before final implementation.
Both genders will be included
Children of age range 6-12 years.
Children whose primary Language is Urdu.
Children who have the concept of noun, verbs, adjectives and prepositional concepts.
Children with any co morbid conditions.
Children with Behavioral issues.
Children with attention deficit hyper activity.
Hearing impaired children not using amplifying and assistive devices.
Single group
Syntactic-Semantic Visual Configuration Intervention (SSVCI)
BehavioralThe Syntactic-Semantic Visual Configuration Intervention (SSVCI) is a structured, therapist-delivered language intervention developed specifically for Urdu-speaking children with language impairment. The intervention integrates syntactic and semantic language instruction with a visual configuration system that uses standardized visual cues to facilitate language comprehension and expressive language production. Therapy progresses systematically from foundational language concepts to early grammatical structures, including question forms, descriptive language, location concepts, negation, and plural forms. The intervention is culturally and linguistically tailored to Urdu and is delivered individually by a qualified speech-language pathologist in sixteen 30-minute sessions conducted two to three times per week.
Outcome 1: Change in Narrative Performance (MAIN)
Description: Narrative language performance will be assessed using the Urdu version of the Multilingual Assessment Instrument for Narratives (MAIN). At baseline and post-intervention, each participant will be presented with a standardized six-picture narrative sequence and will be asked to produce the corresponding story. Narrative production will be scored according to the standardized MAIN Urdu scoring criteria, including story structure and structural complexity. Narrative comprehension will be assessed using the standardized MAIN comprehension questions administered following the narrative task. For each participant, the MAIN narrative production score and narrative comprehension score will be calculated according to the instrument's predefined scoring criteria. Higher scores indicate better narrative production and/or comprehension performance. The outcome will be evaluated as the change in MAIN scores from baseline to immediately after completion of the intervention.
Outcome Measure 2 Title: Change in Mean Length of Utterance in Words Derived from the Narrative Language Sam
Description Description: Mean Length of Utterance in words (MLU-w) will be calculated from each participant's recorded narrative language sample obtained during the story-production task at baseline and after completion of the intervention. The participant's narrative will be audio-recorded and transcribed verbatim. The transcript will be segmented into utterances using predefined language-sample segmentation rules. MLU-w will be calculated as: MLU-w = Total number of words produced ÷ Total number of utterances A separate MLU-w value will be calculated for each participant at baseline and post-intervention. The outcome will be the change in MLU-w from baseline to post-intervention, with a higher MLU-w indicating production of longer utterances and greater expressive syntactic complexity.
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