An exploration of evidence of deficits and theories of therapy for specific-receptive language impairment in children

Abstract

Children with specific receptive language impairments (SRLI) have been found to be vulnerable to negative outcomes later in life, in terms of mental health, behaviour and literacy. Currently there is little evidence of the efficacy of speech and language therapy in this area, and a dearth of studies that have investigated interventions for receptive language. Following recommended steps from the Medical Research Council’s guidance for the development of complex interventions, this research focuses on identifying and developing evidence and theory for interventions for SRLI. Evidence of deficit was first explored in a systematic literature review (SLR), examining the nature of the cognitive and linguistic deficits in children with SRLI. Grammar and word learning were identified as areas of particular difficulty for this population. Deficits in information processing, in particular short term and working memory, were also identified as playing a role in these children’s impairments. However, a number of issues were identified with the validity of studies in the area.Theories of therapy were examined in relation to the areas of deficit identified in the SLR through examination of existing intervention studies for children with SRLI, and exploring expert speech and language therapists (SLTs) views in focus groups. Three focus groups with 16 expert SLTs were conducted, followed by a larger group with 23 SLTs who had a range of experience. The groups explored intervention approaches for SRLI, in relation to the deficits identified in the SLR, as well as their rationales for these interventions. It was found that SLTs did not often refer to explicit theories underpinning their intervention for SRLI and had difficulty describing processes of change. However, thematic analysis revealed core therapy components, as well as common approaches for selecting targets across groups. Responses also indicated that the interventions SLTs describe often focus on children’s participation and functioning rather than impairment. The findings of the research are used to present a model of interventions for SRLI. The findings are also drawn upon to examine possible mechanisms of change in interventions for children with SRLI