Exploring Associations between Language and Working Memory Abilities in Children with Specific

311 Pages·2017·3.13 MB·English

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Laura J. Pauls, The University of Western Ontario
Supervisor: Archibald, Lisa M. D., The University of Western Ontario
A thesis submitted in partial fulfillment of the requirements for the Doctor of Philosophy degree
in Health and Rehabilitation Sciences
© Laura J. Pauls 2018
Follow this and additional works at: https://ir.lib.uwo.ca/etd
Part of the Speech Pathology and Audiology Commons
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Pauls, Laura J., "Exploring Associations between Language and Working Memory Abilities in Children with
Specific or Combined Impairments in Language and Working Memory" (2018). Electronic Thesis and
Dissertation Repository. 5360.
https://ir.lib.uwo.ca/etd/5360
This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted
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Abstract
Children with disproportionate deficits in language, known as Specific Language
Impairment (SLI), often demonstrate deficits in nonverbal cognitive abilities, such as
working memory. Such findings have prompted much debate on the association between
language and working memory functioning. The primary aim of this thesis was to
examine the connection between working memory and language abilities among children
with specific or combined impairments in these domains. Study 1 examined the potential
of narrative retell performance to indicate impairment in language or working memory
among 17 children with specific or combined impairment in language or working
memory as well as 9 controls. Quantitative analysis using logistic regression revealed that
language impairment was predicted best by the interaction between mean length of
utterance, percent grammatical utterances, and age, whereas working memory impairment
was best predicted by the interaction between events recalled and subordinate clauses per
utterance. Exploratory qualitative analysis using qualitative descriptors differentiated
narratives of children with and without impairment and revealed clusters of descriptors
that identified contrasting speaking styles. Study 2 tested domain-specific interventions in
language or working memory using a single subject design. Chapter 3 reports the effects
of a narrative-based language intervention for 10 children with language impairment with
or without working memory impairment. Results showed gains on narrative ability for
most participants, and broader linguistic gains for half of the participants. Intervention
effects on related domains (i.e., working memory, reading, math) were evident for some
participants as well. Chapter 4 reports the effects of a working memory training program
for 7 children with working memory impairment with or without language impairment.
Results showed training effects on working memory tasks similar to training tasks for all
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participants. Transfer to language ability was seen for 4 participants, and transfer to
reading or math was evident for 3 participants. Responder analyses for Study 2 showed
associations between intervention effectiveness and baseline cognitive abilities, age,
speaking style, and intervention intensity. Results support the view that working memory
and language are separable but closely related cognitive processes. Responder analyses
highlight the importance of considering heterogeneity among children with impairments
in research and clinical settings.

Keywords
language impairment, working memory impairment, narrative retell, narrative-based
language intervention, working memory training, single subject design, responder
analysis

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Acknowledgements
This research would not have been possible without the support from many people. First I
would like to express my gratitude to my supervisor, Dr. Lisa Archibald, who modeled
exemplary dedication to excellence in her teaching and research. I would also like to
thank the members of my committee, Dr. Elizabeth Skarakis-Doyle and Dr. Julie Theurer,
for their contributions and guidance throughout this process. I am grateful for the many
research assistants, participants, and school staff whose involvement in these studies
enabled me to conduct this research. Thank you also to my office mates and colleagues
for your friendship over the years. And lastly, thank you to my family near and far for all
your support and encouragement along the way.

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Table of Contents
Abstract .............................................................................................................................. i
Acknowledgements .......................................................................................................... iii
Table of Contents ............................................................................................................. iv
List of Tables .................................................................................................................... x
List of Figures ................................................................................................................. xii
List of Appendices ......................................................................................................... xiii
Chapter 1 Introduction .................................................................................................. 1
Specific language impairment .................................................................................... 2
Definition, prevalence, and diagnostic criteria ................................................... 2
Characteristics of SLI ......................................................................................... 4
Lexical abilities ............................................................................................ 4
Grammatical abilities ................................................................................... 5
Fluency ........................................................................................................ 5
Discourse ..................................................................................................... 7
Nonverbal abilities ....................................................................................... 9
Heterogeneity ............................................................................................. 10
Working memory ..................................................................................................... 10
Phonological loop ............................................................................................. 11
Visuospatial sketchpad ..................................................................................... 12
Central executive .............................................................................................. 13
Episodic buffer .................................................................................................. 14
Working memory and SLI ....................................................................................... 14
Verbal short term memory ................................................................................ 14
Verbal working memory ................................................................................... 15
Visuospatial short term memory ....................................................................... 17
Visuospatial working memory .......................................................................... 18
Theories of SLI ........................................................................................................ 19
SLI as a phonological deficit ............................................................................ 19
SLI as a short term memory deficit .................................................................. 20
Linguistic theories of SLI ................................................................................. 20
iv
Domain-general accounts of SLI ...................................................................... 22
Testing theories of SLI ............................................................................................. 24
Epidemiological approach ................................................................................ 24
Intervention studies ........................................................................................... 25
Methodological considerations ................................................................................ 26
Narrative sampling ............................................................................................ 26
Single subject design ........................................................................................ 28
Language intervention ...................................................................................... 31
Working memory intervention .......................................................................... 32
Overall objective ...................................................................................................... 33
References ................................................................................................................ 35
Chapter 2 Linguistic and cognitive processes contributing to narrative retell ........... 63
Introduction .............................................................................................................. 63
Language impairment and narrative assessment .............................................. 64
Working memory and narrative assessment ..................................................... 65
Performance indicators of narrative retell ........................................................ 67
Productivity ................................................................................................ 68
Grammaticality .......................................................................................... 69
Fluency ...................................................................................................... 70
Trade-off effects ............................................................................................... 73
Study purpose ................................................................................................... 74
Methods ................................................................................................................... 75
Participants ........................................................................................................ 75
Procedure .......................................................................................................... 79
Quantitative scoring ................................................................................... 80
Quantitative analysis .................................................................................. 82
Qualitative analysis .................................................................................... 84
Results ...................................................................................................................... 86
Predicting impairment status ............................................................................ 86
Preliminary analysis ................................................................................... 86
Predicting language impairment ................................................................ 88
v
Predicting working memory impairment ................................................... 93
Qualitative descriptions of narrative samples ................................................... 97
Discussion .............................................................................................................. 104
Differentiating impairment based on narrative retell performance ................ 105
Lessons from qualitative analysis ................................................................... 109
Simplifiers and Risk Takers ..................................................................... 110
Study limitations ............................................................................................. 112
Clinical implications ....................................................................................... 113
Conclusion ...................................................................................................... 114
References .............................................................................................................. 115
Chapter 3 Narrative-based language intervention for children with specific language
impairment with or without working memory impairment ..................... 125
Introduction ............................................................................................................ 125
Childhood discourse genres ............................................................................ 126
Narrative macrostructure and microstructure ................................................. 127
Cognitive demands of narrative retell ...................................................... 129
Children with SLI ........................................................................................... 129
Narrative ability ....................................................................................... 130
Syntax ...................................................................................................... 131
Narrative-based language intervention (NBLI) .............................................. 131
NBLI for children with language impairment ................................................ 135
Narrative language and related domains ......................................................... 140
Methodological considerations ....................................................................... 142
Study purpose ................................................................................................. 144
Methods ................................................................................................................. 144
Participants ...................................................................................................... 144
Procedures ....................................................................................................... 147
Study timeline .......................................................................................... 147
Intervention ..................................................................................................... 149
Initial goal selection ................................................................................. 149
Intervention materials .............................................................................. 150
vi
Intervention procedure .................................................................................... 150
Treatment fidelity ........................................................................................... 154
Outcome measures .......................................................................................... 155
Probe measures ........................................................................................ 155
Assessment battery .................................................................................. 158
Analysis .......................................................................................................... 161
Results .................................................................................................................... 165
Probe measures ............................................................................................... 165
Narrative retell and standardized measures .................................................... 173
Overall results ................................................................................................. 178
Responder analysis ......................................................................................... 179
Responders, simplifiers, and Risk Takers ....................................................... 183
Discussion .............................................................................................................. 184
Conclusion ...................................................................................................... 190
References .............................................................................................................. 192
Appendices ............................................................................................................. 208
Chapter 4 Cognitive and linguistic effects of working memory training in children
with specific working memory impairment or language and working
memory impairment ................................................................................. 220
Introduction ............................................................................................................ 220
Working memory ............................................................................................ 221
Working memory and language ............................................................... 222
Working memory and academic abilities ................................................ 223
Working memory impairment ........................................................................ 224
Working memory training .............................................................................. 226
Evidence base for working memory training .................................................. 227
Near transfer ............................................................................................ 227
Far transfer ............................................................................................... 228
Study purpose ................................................................................................. 231
Methods ................................................................................................................. 232
Participants ...................................................................................................... 232
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General procedure ........................................................................................... 234
Intervention materials ..................................................................................... 234
Intervention procedure .................................................................................... 234
Study timeline and outcome measures ............................................................ 236
Analysis .......................................................................................................... 237
Treatment fidelity ........................................................................................... 238
Results .................................................................................................................... 239
Treatment fidelity ........................................................................................... 239
Probe measures ............................................................................................... 240
Standardized measures .................................................................................... 248
Overall results ................................................................................................. 250
Responder analysis ......................................................................................... 251
Responders, Simplifiers, and Risk Takers ...................................................... 254
Discussion .............................................................................................................. 255
Conclusion ...................................................................................................... 260
References .............................................................................................................. 262
Chapter 5 General discussion ................................................................................... 270
Working memory and language ability in narrative retell ..................................... 270
Summary of results ......................................................................................... 272
Implications of findings .................................................................................. 273
Narrative-based language intervention .................................................................. 275
Summary of results ......................................................................................... 276
Implications of findings .................................................................................. 278
Working memory training ...................................................................................... 280
Summary of results ......................................................................................... 281
Implications of findings .................................................................................. 282
General discussion ................................................................................................. 283
Theoretical implications: Working memory and language ............................. 283
Clinical implications ....................................................................................... 284
Heterogeneity ........................................................................................... 284
Far transfer ............................................................................................... 285
viii
Research implications: Responder analyses ................................................... 286
Conclusions ............................................................................................................ 286
References .............................................................................................................. 288
Appendix A: Ethics approval ........................................................................................ 294
Appendix B: Curriculum Vitae ..................................................................................... 295

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