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Pearson's EBP Briefs: Comparing the Effects of Working Memory-Based Interventions for Children with Language Impairment

Pearson's EBP Briefs: Comparing the Effects of Working Memory-Based Interventions for Children with Language Impairment
Kelly Farquharson, PhD, CCC-SLP, Chelsea E. Franzluebbers, MA, CCC-SLP
July 26, 2016

Structured Abstract

Clinical Question: Do working memory–based interventions improve language, reading, and/or working memory skills in school-aged children with language impairment?

Method: Literature review of evidence-based practice (EBP) intervention comparisons

Sources: Google Scholar, ASHA journals database, Academic OneFile, Academic Search Complete, and ERIC 

Search Terms: working memory intervention, language impairment

Number of Studies Included: 4

Primary Results: All four studies indicated that children with language impairment made improvements after memory-based interventions, although the improvements may not have been to language skills. Two separate studies reported generalization to untrained areas, namely word reading and expressive language. One study indicated that phonological awareness treatment in addition to language intervention may improve recall-based skills in children with language impairment. One study explored memory-based strategies that may be fruitful for children with language impairment. 

Conclusions: There appear to be direct benefits from targeting working memory skills for children with language impairment. Incorporating phonological awareness and memory strategies into language-based interventions may improve working memory deficits in children with language impairment.

Clinical Scenario

Katie is a school-based speech-language pathologist (SLP) in an elementary school that serves students in kindergarten through grade 6. She has a large and diverse caseload of children with speech and language impairments, although she predominantly works with children who have language impairment (LI) in the absence of other intellectual disabilities. Katie has noticed that many of these children struggle with reading processes, particularly in the area of decoding and comprehension. One child in particular, Marissa, has not been making progress in therapy, despite Katie’s use of various language-based approaches. Marissa is in third grade and has received speech-language services for LI since kindergarten. Marissa’s parents report that homework time is painful for everyone involved. Her teacher reports that Marissa has difficulty answering questions when she is called upon and appears frustrated during independent reading time. Specifically, she has a hard time decoding unknown words and also has difficulty answering comprehension-based questions. The classroom teacher has started to question whether Marissa’s reading comprehension is limited by problems decoding text, understanding the text while reading, or recalling text information after reading. In this way, Marissa is behind many of her peers who are performing well in reading. In therapy sessions, Marissa performs poorly with sequencing, word recall, phonological awareness, following multi-step directions, and sometimes word finding. Although she believes that Marissa’s primary deficit is language-based, Katie wonders if there is a working memory component to Marissa’s LI.

Katie examines the research literature and finds that many children with LI have working memory deficits (Cain, Oakhill, & Bryant, 2004), and, conversely, that many children with working memory impairment have deficits in language (Archibald, Joanisse, & Edmunds, 2011). This discovery leads Katie to explore whether there are effective working memory–based interventions for children with LI and if there are specific techniques that she can incorporate into her therapy sessions with Marissa and other children on her caseload with similar memory concerns. She thus searches for research articles that examine working memory–based interventions for children with LI with potential impacts on language, reading, and/or working memory outcomes. 


In the absence of intellectual disabilities, such as autism and Down syndrome, children with LI characteristically struggle with the processing and production of spoken language. Some of the specific areas in which many of these children have difficulty are word finding, narrative retell and understanding, receptive and expressive vocabulary, grammatical understanding and expression, phonological processing, and working memory. Regarding the latter, working memory is a limited capacity space that is used for the temporary storage of phonological or visual information before it is erased or stored in long-term memory. Cumulative evidence suggests that children with LI have difficulty with working memory tasks (e.g., Boudreau & Constanza-Smith, 2011; Edwards, Beckman, & Munson, 2004; Gathercole & Baddeley, 1990). Some specific examples of working memory tasks include following multiple-step directions, repeating nonwords, counting forward or backward by a set incremental amount (e.g., ± 3), transcribing a series of recently heard sentences verbatim, and following the actions of multiple characters over the course of a story (Boudreau & Constanza-Smith, 2011). Working memory has been found to be crucial for vocabulary and reading acquisition (Baddeley, Gathercole, & Papagno, 1998; Gathercole & Baddeley, 1990) as well as phonological awareness (Oakhill & Kyle, 2000; Schuele & Boudreau, 2008). Working memory may be involved with reading comprehension tasks such as making inferences, recalling details within a passage, and understanding new vocabulary. Thus, if a child has a working memory deficit (in addition to LI or in isolation), it is likely that the child may exhibit weakness in reading comprehension abilities.

kelly farquharson

Kelly Farquharson, PhD, CCC-SLP

Kelly Farquharson, PhD, CCC-SLP is an SLP and an associate professor and director of the Children Literacy and Speech Sound Lab at Florida State University.  Her research interests include school-aged children with phonological and language disorders, the effect of those disorders on the acquisition of literacy skills, and the cognitive, environmental, and academic factors that contribute to phonological and language disorders.  Prior to pursuing a research degree, she was a school-based SLP in Pennsylvania.  

Chelsea E. Franzluebbers, MA, CCC-SLP

Chelsea Franzluebbers is a speech-language pathologist at Columbus Public Schools and Wiggles and Giggles Therapy for Kids in Nebraska.  Her clinical interests include working with the pediatric population, focusing on children with concurrent speech and language disorders, phonological disorders, and complex communication needs. 

Related Courses

20Q: Dynamics of School-Based Speech and Language Therapy Variables
Presented by Kelly Farquharson, PhD, CCC-SLP, Anne Reed, MS, CCC-SLP
Course: #10002Level: Advanced1 Hour
This course reviews dynamics of speech and language therapy variables such as session frequency, intervention intensity, and dosage, and how these are impacted by different service delivery models. It discusses how therapy outcomes are related to therapy quality, IEP goals, and SLP-level variables such as job satisfaction and caseload size.

What Do We Know About Dosage in School-Based Speech Sound Therapy Sessions?
Presented by Kelly Farquharson, PhD, CCC-SLP
Course: #9619Level: Intermediate1 Hour
Dose is defined as the number of teaching episodes/opportunities in one therapy session and has been reported as an “active ingredient” that yields change. This course discusses research on why dosage matters in speech sound therapy, factors that influence what’s possible in school-based sessions, and the results of a recent investigation into both.

Connections Between Speech Sound Production and Literacy Skills
Presented by Kelly Farquharson, PhD, CCC-SLP
Course: #8920Level: Intermediate1 Hour
This course reviews the phonological relations between speech sound production and literacy skills such as word decoding and spelling. The overlap between speech sound disorders and reading impairments, such as dyslexia, are highlighted.

Incorporating Phonological Awareness and Orthography into Speech Sound Treatment
Presented by Kelly Farquharson, PhD, CCC-SLP
Course: #9213Level: Intermediate1 Hour
One way to help improve the literacy outcomes for children with speech sound disorders is to focus on code-based skills within speech sound treatment sessions. This course will provide detailed and explicit examples of how SLPs might consider incorporating phonological awareness and orthography into treatment sessions for children with speech sound disorders.

Facilitating First Verbs through Shared Book Reading
Presented by Susan Hendler Lederer, PhD, CCC-SLP
Course: #9735Level: Introductory1 Hour
This course discusses early verb acquisition, choosing first verb targets, and a variety of strategies to facilitate verb learning using children’s picture books as a therapy context.

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