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.
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.