Speech-language Pathologists' Services for Children with Co-occurring Language and Executive Function Deficits

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There is a well-documented association between developmental language disorder (DLD) and executive function (EF) deficits. These co-occurring deficits pose risks to students’ short- and long-term academic and social outcomes. In the United States, school-based speech-language pathologists (SLPs) are tasked to ensure that students with DLD are able to achieve academic success, and though EF generally lies within their scope of practice, it remains unclear the extent to which SLPs are equipped to address these deficits. This dissertation consists of three related studies, the sum of which shall provide insight into the SLPs’ services. The first of these studies, Chapter 2, offers a systematic literature review of the evidence supporting intervention for children with co-occurring deficits, as well as a synthesis of the guidance for SLPs addressing EF deficits in their services. I found a dearth of empirical studies for interventions targeting this population, though a relative abundance of practitioner papers provides a foundation of best practices for direct and indirect services. Chapter 3 presents the second study, an exploratory latent profile analysis of 167 Kindergarteners’ receptive language, expressive language, and working memory (WM), as well as follow-up analyses of variance which examine children’s average behavior ratings by profile. I identified a suitably-fitted three-profile model of language and WM, and I found that low-performing children, on average, were rated lower in social competence. Finally, Chapter 4 contains a mixed-methods analysis of school-based SLPs’ interventions for children with EF deficits. Following an explanatory sequential design, I first surveyed 350 SLPs, then followed up with eight interviews designed to explain and contextualize the survey results. I found that most SLPs support EF deficits through indirect services or embedded strategies, though fewer provide direct intervention. However, direct intervention is feasible, and SLPs’ knowledge and confidence about EFs influence their service provision. Overall, the findings of this dissertation support the notion that SLPs can be active and involved service providers, addressing EF deficits that are abundant in children with DLD, and which may otherwise hinder students’ education. However, to optimize these services, the field of SLP requires further empirical intervention research and improved SLP preparation to ensure that SLPs can meet all the needs of students with co-occurring deficits.