Understanding differing outcomes from semantic and phonological interventions with children with word-finding difficulties: A group and case series study.

Developmental Language Disorder occurs in up to 10% of children and many of these children have difficulty retrieving words in their receptive vocabulary. Such word-finding difficulties (WFD) can impact social development and educational outcomes. This research aims to develop the evidence-base for supporting children with WFD and inform the design and analysis of intervention studies. We included 20 children (age 6 to 8) with WFD each of whom participated in two interventions one targeting semantic attributes and the other phonological attributes of target words. The interventions, employing word-webs, were carefully constructed to facilitate direct comparison of outcome which was analysed at both group and case-series level. The study used a robust crossover design with pre-intervention baseline, between-intervention wash-out and post-intervention follow-up testing. We incorporated: matching of item sets on individual performance at baseline, independent randomisation of order of intervention and items to condition, blinding of assessor, evaluation of fidelity and control items. The interventions were clinically feasible, with weekly sessions over six weeks. Intervention improved children's word-finding abilities with statistically significant change only during treatment phases of the study and not over baseline, wash-out or follow-up phases. For the group the semantic intervention resulted in a gain of almost twice as many items as the phonological intervention, a significant difference. However, children differed in their response to intervention. Importantly, case-series analysis revealed outcomes predictable on the basis of children's theoretically driven language profiles. Taking account of individual profiles in determining choice of intervention would enable more children to benefit. The study provides new evidence to inform and refine clinical practice with this population. Future studies should be designed such that results can be analysed at both group and case series levels to extend theoretical understanding and optimise use of appropriate interventions.

Intervention for children with word-finding difficulties: a parallel group randomised control trial.

PURPOSE: The study investigated the outcome of a word-web intervention for children diagnosed with word-finding difficulties (WFDs). METHOD: Twenty children age 6-8 years with WFDs confirmed by a discrepancy between comprehension and production on the Test of Word Finding-2, were randomly assigned to intervention (n = 11) and waiting control (n = 9) groups. The intervention group had six sessions of intervention which used word-webs and targeted children's meta-cognitive awareness and word-retrieval. RESULT: On the treated experimental set (n = 25 items) the intervention group gained on average four times as many items as the waiting control group (d = 2.30). There were also gains on personally chosen items for the intervention group. There was little change on untreated items for either group. CONCLUSION: The study is the first randomised control trial to demonstrate an effect of word-finding therapy with children with language difficulties in mainstream school. The improvement in word-finding for treated items was obtained following a clinically realistic intervention in terms of approach, intensity and duration.

Receptive vocabulary and semantic knowledge in children with SLI and children with Down syndrome.

Receptive vocabulary and associated semantic knowledge were compared within and between groups of children with specific language impairment (SLI), children with Down syndrome (DS), and typically developing children. To overcome the potential confounding effects of speech or language difficulties on verbal tests of semantic knowledge, a novel task was devised based on picture-based semantic association tests used to assess adult patients with semantic dementia. Receptive vocabulary, measured by word-picture matching, of children with SLI was weak relative to chronological age and to nonverbal mental age but their semantic knowledge, probed across the same lexical items, did not differ significantly from that of vocabulary-matched typically developing children. By contrast, although receptive vocabulary of children with DS was a relative strength compared to nonverbal cognitive abilities (p < .0001), DS was associated with a significant deficit in semantic knowledge (p < .0001) indicative of dissociation between word-picture matching vocabulary and depth of semantic knowledge. Overall, these data challenge the integrity of semantic-conceptual development in DS and imply that contemporary theories of semantic cognition should also seek to incorporate evidence from atypical conceptual development.