Interventions for children with Developmental Language Disorder that target oral pragmatic language: A systematic review and narrative synthesis of the Hows and Whys in single-case design studies: A SYSTEMATIC REVIEW AND NARRATIVE SYNTHESIS OF THE HOWS AND WHYS IN SINGLE-CASE DESIGN STUDIES

This study presents a review of interventions targeting the oral pragmatic language abilities of children with developmental language disorder (DLD), as well as an overview of the ingredients and teaching techniques used to provide changes, determine the setting and dosage, test the efficacy of the intervention, and measure the quality of the studies. The review adheres to regulations outlined in the PRISMA guidelines for systematic reviews. Seven electronic databases were searched using appropriate search terms. Only single-case studies (AB, ABA, interrupted time series, alternating treatment, multiple baseline designs, and non-experimental case designs) were included. All included papers were published between 2006 and 2020. The age range of participants was 3 to 18 years and included participants who were either formally diagnosed with DLD or met the criteria for language disorder. Studies where oral pragmatic language was measured as an outcome variable were included and appraised using Risk of Bias Assessment tool for Non-randomised Studies (RoBANS). Eleven studies were included in the final analysis: these studies reported on interventions in the domain of pragmatic language for children with DLD aged 3 to 9 years. Seven of the interventions targeted conversational skills, while the remaining four targeted narrative skills. All studies used prompting or modelling techniques to enhance pragmatic abilities selected for change such as initiation, response, turn-taking, topic management, adaption to listener knowledge, and the ability to build sequences. Several of the children in the studies improved their pragmatic skills after undergoing the intervention, however individual differences were noted. All interventions were carried out in the children’s schools and varied in terms of duration. The quality of the studies included was medium. Due to the diversity observed among the studies regarding oral pragmatic outcome measures that were used to evaluate changes, as well as the ingredients and teaching techniques used, it was difficult to draw precise conclusions about recommendations for practitioners based on the included studies. Although several interventions reported moderate changes in conversational and narrative skills, as well as good social validity, the findings are considered weak because of the lack of ecological validity.