Mapping practice onto theory: the speech and language practitioner's construction of receptive language impairment

Receptive language impairment (RLI) is one of the most significant indicators of negative sequelae for children with speech and language disorders. Despite this, relatively little is known about the most effective treatments for these children in the primary school period.

To explore the relationship between the reported practice of speech and language practitioners and the underlying rationales for the therapy that they provide.

A phenomenological approach was adopted, drawing on the experiences of speech and language practitioners. Practitioners completed a questionnaire relating to their practice for a single child with receptive language impairment within the 5-11 age range, providing details and rationales for three recent therapy activities. The responses of 56 participants were coded. All the children described experienced marked receptive language impairments, in the main associated with expressive language difficulties and/or social communication problems.

The relative homogeneity of the presenting symptoms in terms of test performance was not reflected in the highly differentiated descriptions of intervention. One of the key determinants of how therapists described their practice was the child's age. As the child develops the therapists appeared to shift from a 'skills acquisition' orientation to a 'meta-cognitive' orientation, that is they move away from teaching specific linguistic behaviours towards teaching children strategies for thinking and using their language. A third of rationales refer to explicit theories but only half of these refer to the work of specific authors. Many of these were theories of practice rather than theories of deficit, and of those that do cite specific theories, no less than 29 different authors were cited many of whom might best be described as translators of existing theories rather than generators of novel theories.

While theories of the deficit dominate the literature they appear to play a relatively small part in the eclectic practice of speech and language therapists. Theories of therapy may develop relatively independent of theories of deficit. While this may not present a problem for the practitioner, whose principal focus is remediation, it may present a problem for the researcher developing intervention efficacy studies, where the theory of the deficit will need to be well-defined in order to describe both the subgroup of children under investigation and the parameters of the deficit to be targeted in intervention.