Mechanisms of intervention and the interface with clinical practice: the example of word-finding difficulties

Alireza, Hala Hussein (2022) Mechanisms of intervention and the interface with clinical practice: the example of word-finding difficulties. PhD thesis, Birkbeck, University of London.

Abstract

This thesis investigated mechanistic approaches for understanding the effectiveness of interventions for developmental disorders of language and cognition, in order to contribute to narrowing the gap between theories of underlying causes of language deficits and intervention practices. Taking word-finding difficulties as an example language disorder, the project includes three methodological strands: (i) Qualitative: A questionnaire in which clinicians (speech and language therapists) were asked to identify ways in which research about causes of deficits did or did not inform their practice. (ii) Quantitative: secondary data analyses of two datasets collected as part of the WORD project (Best et al., 2015, 2017, 2021). Developmental trajectories were constructed for phonological, semantic, naming and comprehension skills of 20 children with WFD and 100 typically developing children (ages 4 years to 8;7). Regression analyses were used to assess whether phonological or semantic interventions were more effective in the group of children with WFD, and whether the patterns could be predicted from the children’s language profiles. (iii) Computational: The Best et al. (2015) connectionist model of WFD was modified, and new training sets constructed, to run a sequence of simulations investigating optimal conditions for intervention. These tested whether better outcomes were obtained when intervention was targeted at remediating an area of weakness (the naming pathway) or buttressing a child’s strengths (the structure of phonological and semantic representations) (Alireza, Fedor & Thomas, 2017; Thomas, Fedor, Davis, Yang, Alireza, Charman, Masterson & Best, 2019). Remediating weakness immediately accelerated development of the system but along the same atypical trajectory; improving strengths produced long-term increases in final vocabulary size; a combination yielded the best outcome. Overall, the thesis argues that both convergent methodologies, and a dialogue between basic researchers and clinicians, are necessary to narrow the gap between theories of deficit and clinical practice.

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