Intervention Goals Targeting Working Memory

To support children with Developmental Language Disorder (DLD), intervention must occur on two levels: classroom-based strategies that help reduce cognitive load and make instruction more accessible, and individual goals that target the underlying skills contributing to these difficulties, such as working memory (WM), phonological processing, and metacognition. This post brings together evidence-based recommendations for educators and speech-language pathologists (SLPs), outlining practical classroom supports as well as targeted therapy goals.

Non-empirical articles offer guidance to SLPs, however the current literature is modest and has inconsistent effects (Senter et al., 2022). Although literature does exist to offer global approaches to WM intervention, it's important to note the substantial within-child variability with improvements to cognitive skills when targeting vocabulary, morphosyntax, and auditory comprehension. Therefore, client-specific goals based on assessment information is key to effective intervention.

Classroom Intervention

Analyzing the classroom demands will help learn about areas where the child is asked to store more taxing amounts of information (Boudreau & Costanza-Smith, 2011). Most classroom-based instruction is explicit learning which utilizes executive attention, WM, and logical reasoning which place more demands on children with DLD (Baron & Arbel, 2022). Therefore, part of intervention includes working with educators to modify classroom environments and add supports. Discourse within the classroom may present as a difficulty for children with DLD, especially with WM deficits.

• Repetition: Children with DLD learn a new word after hearing it approximately 36x compared to 12-24x in typically developing children (Pham & Archibald, 2020). Therefore, educators should be encouraged to model focused productions of the target form many times and 'chunk' information within summaries.

• Response environments: During group work or class discussion, the student can be the first or second contributor so they don't have to remember previous responses and shift their points based off that information (Pham & Archibald, 2020). Furthermore, reducing the rate of instruction itself can also elicit better learning for this population.

• Multiple means of learning: Children will solidify learning when presented with information in different ways (e.g., verbally, visually, kinesthetically) because they are processed by unique networks of the brain and therefore decrease concentration and overload of one area (Pham & Archibald, 2020). Furthermore, visual supports can reduce the amount of information a child must maintain in memory to complete a task (Boudreau & Costanza-Smith, 2011).

  • Verbal supports: redundant instruction, mental imagery, advance notice of transitions (Senter et al., 2022).

  • Visual supports: gesturing towards materials needed for task, writing instructions on the board, posters with easily accessible information (e.g., high frequency words, multiplication table), graphic organizers to enhance vocabulary and reading comprehension. Visual aids can also help executive functions such as schedules, timers, calendars, and checklists.

• Kinesthetic supports: providing objects for manipulation (e.g., stackable blocks) has been shown to enhance reading and math comprehension.

• Breaking down tasks: Children with WM deficits are likely to do better if the task is broken into smaller parts because it reduces the amount of information they need to process at one time (Boudreau & Costanza-Smith, 2011). It is also important for children to understand the end goal of the task, therefore it would be helpful for educators to show the target end product.

• Pre-teaching: Pre-teaching key concepts ensures background knowledge and long-term memory is activated therefore reducing the demands of retrieval.

Client-Specific Goals

Based off of evidence from (Boudreau & Costanza-Smith, 2011; Pham & Archibald, 2020) if not cited.

Improve Working Memory?

Some SLPs and WM-specific programs work to tax a student's WM during tasks that may be used for assessment such as digit span, nonword repetition, odd one out tasks. Some evidence shows that repeated, challenging practice in a meaningful context may improve executive function skills, although transfer effects are generally narrow (Senter et al., 2022). There is caution against solely using WM training due to the lack of generalizability. Instead, most literature encourages considering the bidirectional association between language and WM (Senter et al., 2022).

Improve Phonological Memory

• Improve ability to perceive and produce novel phonological sequences to assist in phonological encoding efficiency.

• Explicitly train phonics skills to improve segmentation of unfamiliar words, and therefore help ability to spell, repeat, and read words.

Increase Automaticity of Skills

Through repeated practice of skills, children will overlean and therefore the task will become automatic which decreases WM resources.

• Repeat & distribute practice in areas of need for the child (e.g., math, story writing, story retelling, time concepts, etc).

• Address vocabulary and syntactic structure such as explicitly teaching conditional clauses (if/then), temporal terms (before/after), math concepts (more/than). Use sentence frames when writing in classroom activities as needed.

Sentence Starters (Schmitt, 2024).

• Ensure schema is set for classroom experiences such as structural organization of textbooks or steps required to complete a particular activity (e.g., science lab) to support consistency.

Improve Metacognitive & Strategy Use

Metacognitive skills are important for compensating for WM deficits (Boudreau & Costanza-Smith, 2011). When children are aware of difficulties and strategies, they use them more efficiently. It's important to explicitly teach time management, complex planning, self-regulation, pacing, and temporal reasoning because they are critical for managing routines, homework, and transitions within school contexts (Ward & Jacobsen, 2014). When teaching strategies, it's also important to also teach the student contect- where, when, why, and how to use them (Senter et al., 2022).

• Teach rehearsal strategies, first aloud then 'in their head'.*

• Improve task analysis by identifying current goal of task and steps needed to reach it.

• Teach visualization strategies (e.g., mind mapping) to help with multi-task directions.*

• Improve study and organizational skills especially for older children.

  • Connect new information with well-learned information to make it more meaningful.

  • Self-testing through 'free recall': students read text, set it aside, then spend time freely recalling and writing down what you now.

• Address self-esteem as many individuals with DLD experience lower self-esteem and this can impact task confidence (Senter et al., 2022).

*Rehearsal and visualization strategies improve memory in children with language impairments compared to traditional therapy alone, and such effects are seen at 8-month follow up (Senter et al., 2022).

References

Baron, L. S., & Arbel, Y. (2022). An Implicit–Explicit Framework for Intervention Methods in Developmental Language Disorder. American Journal of Speech-Language Pathology, 31(4), 1557–1573. https://doi.org/10.1044/2022_ajslp-21-00172

Boudreau, D., & Costanza-Smith, A. (2011). Assessment and Treatment of Working Memory Deficits in School-Age Children: The Role of the Speech-Language Pathologist. Language, Speech & Hearing Services in Schools, 42(2), 152–166. https://web-s-ebscohost-com.proxy1.lib.uwo.ca/ehost/pdfviewer/pdfviewer?vid=0&sid=6042988f-2152-4c44-9798-285dbbe3f07e%40redis

Pham, T., & Archibald, L. (2020). Avoiding Working Memory Overload in Students with LDs. LD@School - Ensuring the success of all students with learning disabilities. https://www.ldatschool.ca/working-memory-overload/

Schmitt, A. (2024). Sentence Starters: The secret to helping students compose sentences that make sense and form paragraphs that are organized. Colorfully Enthused. https://colorfullyenthused.org/sentence-starters-the-secret-to-helping-students-compose-sentences-that-make-sense-and-form-paragraphs-that-are-organized/

Ward, S., & Jacobsen, K. (2014). Executive Function Situational Awareness Observation tool. Perspectives on School-Based Issues, 15(4), 164–173. https://doi.org/10.1044/sbi15.4.164