Pilot Evaluation of the Developed Syntactic-Semantic Visual Configuration Intervention for Children With Language Impairment

Language impairment affects a child's ability to understand and use spoken language, particularly the development of phrases and sentences. Urdu-speaking children with conditions like autism, hearing impairment , down syndrome and cerebral palsy , often experience difficulties with syntactic and semantic language skills; however, there is currently no standardized, culturally appropriate intervention developed specifically for the Urdu language. The Syntactic-Semantic Visual Configuration Intervention (SSVCI) was developed to address this gap by providing a structured, visually supported language intervention based on the linguistic characteristics of Urdu.

The intervention was developed through a systematic review of evidence and literature on language intervention approaches, followed by the identification of foundational syntactic and semantic domains relevant to Urdu-speaking children. Intervention materials were designed , with reference to different domains using visual configuration cues to facilitate language comprehension and expression. Before pilot implementation, the content underwent expert review to evaluate its relevance, representativeness, technical quality, and cultural appropriateness. Feedback from SLPs and Urdu linguistic experts and representatives of the target population was incorporated to refine the intervention materials.

The purpose of this pilot study is to evaluate the feasibility, acceptability, and preliminary clinical utility of the SSVCI in Urdu-speaking children with language impairment. The study will also determine whether the intervention procedures, session structure, assessment methods, and treatment materials are suitable for implementation in a larger clinical trial.

All enrolled participants will receive the SSVCI. This pilot study uses a single-group, quasi-experimental pretest-posttest design, and no control group or randomization will be used during this phase.

Participants will complete baseline language assessments before beginning the intervention. Following baseline assessment, participants will receive 16 individual therapy sessions, delivered by a qualified speech-language pathologist two to three times per week, with each session lasting approximately 30 minutes.

The intervention is organized into progressive stages. The initial sessions focus on baseline assessment of language abilities. The second stage introduces children to the visual configuration system and its symbolic cues that support comprehension and production of language. Therapy activities target foundational syntactic and semantic concepts, including understanding and answering questions . The final stage targets early grammatical structures, , through structured visual supports and functional language activities designed to promote phrase and sentence development.

Participant progress will be monitored throughout the intervention using standardized probe activities and language assessments administered before and after treatment. Measures of participant engagement, treatment adherence, intervention delivery, and language performance will also be collected to evaluate the practicality and acceptability of the intervention.

The findings of this pilot study will be used to refine the intervention protocol, improve treatment materials and procedures, and establish the feasibility of conducting a future randomized controlled trial to evaluate the effectiveness of the Syntactic-Semantic Visual Configuration Intervention in Urdu-speaking children with language impairment.

Inclusion criteria

• 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 who are unable to join them to form phrases and sentences.
• Diagnosed cases of ASD, hearing impairments, Cerebral Palsy and Down syndrome.

Exclusion criteria

• 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.
• Children with impaired vision.
• Children not able to perform on ICW level 1 and blank level