Oral language comprehension difficulties in school-aged children: a pilot single case study to investigate the efficacy of a combined intervention approach

Background: A significant gap exists in the literature on interventions for young school-aged children with language comprehension difficulties. This is due to the heterogeneous nature of language impairments and the variance that exists in the specificity and degree of impairment between children. Research has highlighted the existence of concomitant working memory deficits and processing limitations in many children with language impairment (CwLI) and the effects that these can have on learning. Recent research has demonstrated the success of a metalinguistic coding approach (Shape Coding) in improving grammar comprehension in older children and adolescents (11-16 years). This has not been replicated with younger children. Compensatory strategies such as comprehension monitoring (Bianco et al 2010) and rehearsal (Gill & Klecan-Aker 2003) have demonstrated effectiveness in addressing the working memory deficits and processing limitations of young CwLI (5-8 years). Objective: This pilot single case study investigated the effectiveness of a combined intervention approach to oral language comprehension to establish (i) the suitability of Shape Coding with a younger child and (ii) the usefulness of metacognitive strategies in alleviating the negative impact placed on comprehension by working memory difficulties and processing limitations. Results: The child accessed four out of ten planned intervention sessions. Though no significant improvement was noted in the child’s oral language comprehension following intervention, this study provides novel insight into the complex profile of a child with language impairment and the impact of this on intervention. Conclusion: This in-depth single case approach debates the appropriateness of these interventions for younger children with diverse language needs and raises questions about the roles of (i) dosage of therapy and (ii) memory/attention difficulties in a child’s responsiveness to intervention.