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 a lack of evidence that demonstrates the efficacy of interventions for this population. The Medical Research Council (MRC) recommends that development of interventions should focus on identifying the evidence base and developing theory. This study set out to identify the deficits from the literature, and to develop theory of intervention, using intervention studies and data from focus group discussions with speech and language therapists (SLTs).
A systematic literature review was conducted of the cognitive and linguistic deficits in SRLI. A total of 4,373 citations were identified through a wide search strategy of 11 databases. 37 studies examining a cognitive or linguistic deficit in children with SRLI emerged. The majority of the studies included in the review examined factors related to information processing, identifying deficits particularly for short term and working memory. There was mixed evidence for the presence of auditory processing difficulties, and weak evidence for temporal processing difficulties. Grammar and word learning were identified as areas of particular difficulty for this population. However, a number of issues were identified with the validity of studies in the area.
Following the systematic review, intervention literature for children with SRLI was explored. It was found that that there weak link between intervention studies and the range of deficit studies identified in the SLR, emphasising the need for new primary research.
Three focus groups with expert SLTs (n= 16) were conducted, followed by a workshop with therapists (n= 23) with a broader range of speech and language therapy experience. Participants were asked to discuss interventions they employ in relation to the deficits identified in the systematic review, and to describe the theoretical underpinnings for these interventions.
Thematic analysis revealed core therapy techniques as well as common approaches for selecting targets across groups. Common approaches for selecting targets included consultation with teachers or teaching assistants, developmental order, functionality, priority areas, national curriculum vs. core concepts and severity of difficulty. Core therapy techniques included active pre-teaching, child enjoyment, feedback, hierarchical, making connections, multi-sensory, practice and tailoring to child.
Thematic analysis revealed a range of impairment based interventions. However, a number of interventions appeared to be assistive in nature; that is, they focused on maximising the child’s existing skill sets. A model of interventions for SRLI will be presented which summarises the findings, incorporating SLT targets for SLI as well as the different foci of intervention.
The findings were used to explore possible mechanisms of change for interventions in SRLI. Difficulties with clarifying mechanisms of change in SRLI were identified. Without a clear perspective on how change is brought about, it is difficult to design evaluations that are sufficiently sensitive to detect changes. Routes forward for clarifying mechanisms of change will be discussed. This work demonstrates the value in utlising the MRC guidance in the development and evaluation of interventions.