Efficacy, Model of delivery, Intensity and Targets of Pragmatic Interventions for Children with Developmental Language Disorder: A Systematic Review

Background
It is widely acknowledged that children with developmental language disorder (DLD) predominantly have difficulties in the areas of grammar and vocabulary, with preserved pragmatic skills. Consequently, few studies focus on the pragmatic skills of children with DLD, and there is a distinct lack of studies examining the effectiveness of pragmatic interventions.

Aims
To carry out a systematic review of the literature on pragmatic interventions for children with DLD.

Methods & Procedures
This systematic review was registered with PROSPERO (ID = CRD42017067239). A systematic search in seven databases yielded 1031 papers, of which 11 met our inclusion criteria. The included papers focused on interventions for children with DLD (mean = 3–18 years), enhancing oral language pragmatic skills, published between January 2006 and May 2020, and were based on a group-study design such as randomized control trial or pre-post-testing. Study participants were monolingual speakers. The quality of papers was appraised using the Cochrane Risk of bias tool for randomized controlled trials.

Outcomes & Results
There was a high degree of variability between the included intervention studies, especially regarding intensity, intervention targets and outcomes. The evidence suggested that pragmatic intervention is feasible for all models of delivery (individual, small and large group) and that interventions for pragmatic language are mostly focused on encouragement of conversation and narrative skills observed through parent–child interaction or shared book-reading activities.

Conclusions & Implications
This study highlights the importance of promoting and explicitly teaching pragmatic skills to children with DLD in structured interventions. A narrative synthesis of the included studies revealed that in addition to direct intervention, indirect intervention can also contribute to improving oral pragmatic skills of children with DLD.

What this paper adds
What is already known on the subject?
An increasing number of studies have shown that difficulties in acquiring pragmatic language is not only present in children with autism.

What this study adds to existing knowledge?
Interventions for pragmatic language in children with DLD are mostly focused on encouragement of conversation and narrative skills, very often through parent–child interaction or shared book-reading activities. Interventions that target language pragmatic are feasible for all models of delivery (individual, small and large group).

What are the potential or actual clinical implications of this work?
The efficacy of the existing studies varies, and it is difficult to give recommendations regarding the intensity and duration of the specific intervention. In addition to offering pragmatic intervention directly from a specialist, pragmatic interventions can also be carried out indirectly if the intervention is under the continuous supervision of a specialist.