Metacognition in speech and language therapy for children with pragmatic language impairment: Implications for a theory of therapy

摘要

Background: Metacognition is a significant component of complex interventions for children who have developmental language disorders. Research into how metacognition operates in the content or process of therapy delivery is limited. Identification and description of proposed active therapy components, such as metacognition, may contribute to our understanding of how to deliver complex communication interventions in an optimal manner. Aims: To analyse aspects of metacognition during therapy derived from a manualised speech and language intervention (the Social Communication Intervention Programme or SCIP) as delivered within a randomised controlled trial for children who have Social Communication Disorder (SCD); and to examine the dynamic process of delivering therapy.Methods and procedures: A purposive sample of eight filmed therapy sessions from five SCIP treatment condition participants (aged between 5;11 and 10;3) was selected and transcribed. Filmed sessions represented a variety of communication profiles and SCIP therapy content. Starting from existing theory on metacognition, cycles of iterative analysis were performed using a mixed inductive-deductive analysis based on the Framework Method. A preliminary list of metacognitive content embedded in the intervention was developed into a Metacognitive Coding Framework (MCF). A thematic analysis of the identified metacognitive content of the intervention was then carried out across the whole sample. Outcomes and results: Thematic analysis revealed the presence of metacognition in the content and delivery of SCIP intervention. Four main themes of metacognitive person, task and strategy knowledge and monitoring/control were identified. Metacognition was a feature of how children’s ability to monitor language, pragmatic and social interaction skills in themselves and other people was developed. A model of the SCIP therapy process was developed to show the dynamic nature of metacognition in SCIP therapy content and delivery. Task design and delivery methods were found to play a particular role in adjusting the metacognitive content of the therapy activities. Conclusions and implications: This study makes explicit the metacognitive content and delivery within a complex developmental communication intervention. The model of management of metacognitive content presented here provides an explanation of how the skilled speech and language therapist manipulates task demands, person knowledge and therapy methods towards the therapy goal. This model is discussed with respect to theory on metacognition, the practitioner’s theory of therapy and implications for practical strategies in metacognitive therapy. The process of making the tacit knowledge of the therapist explicit can contribute to the implementation of complex evidence based interventions.