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The nature of metacognition in speech and language therapy for children with pragmatic language impairment

Gaile, Jacqueline Rose

[Thesis]. Manchester, UK: The University of Manchester; 2015.

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Abstract

Abstract THE UNIVERSITY OF MANCHESTERAbstract of thesis submitted in November 2014 by Jacqueline Gaile for the degree of Master of Philosophy in the Faculty of Medical and Human Sciences. The nature of metacognition in speech and language therapy for children with pragmatic language impairmentMetacognition is thinking about thinking and taking action to ensure success on tasks. Metacognitive knowledge of the person, task and strategy variables in any given cognitive enterprise are monitored and controlled in acts of self-monitoring to make progress. Metacognitive knowledge and skills support self-monitoring and generalisation. Comprehension monitoring is a metacognitive skill and children with developmental language disorders (DLDs) are known to benefit from speech and language therapy (SLT) that includes metacognition, but the nature of metacognition in SLT or how it operates in therapy delivery is unknown. Theories of therapy in SLT typically use theories of impairment to determine therapy goals; intervention studies typically report therapy outcomes. The result is that there are relatively few theories of therapy that can describe the process of therapy in terms of clinical actions in delivery and the interaction in therapy that controls how tasks are delivered. This study aimed to determine the nature of metacognition in therapy from a manualised SLT intervention as delivered within a randomised controlled trial, the Social Communication Intervention Project (SCIP) (Adams et al. 2012a). The current study aimed to examine SCIP therapy in more detail using thematic analysis in order to contribute to a ‘theory of therapy’ and add to the evidence base for practice by providing clarity for practitioners on how SCIP therapy was implemented in the RCT. Video data of therapy sessions collected in the SCIP RCT were purposively sampled to select a representative sample of SCIP participants and therapy content and delivery for analysis (N=8). Existing theory on metacognition as a construct in learning was incorporated into analysis from the beginning. Through cycles of iterative analysis, a preliminary list of key concepts in metacognition was developed into a Metacognitive Coding Framework (MCF). Thematic analysis revealed the presence of metacognition in the content and delivery of SCIP intervention. Metacognition was a feature of how children’s ability to monitor language, pragmatic and social interaction skills in themselves and other people was developed. Error detection was employed to teach problem-solving, that is, metacognitive skills of monitoring and control were an explicit feature of SCIP intervention. SCIP therapy agents were observed to change the task design and delivery to include a particular focus on self-monitoring as a distinct part of the therapy process. A model of the SCIP therapy process has been developed to show the nature of metacognition in SCIP therapy content and delivery.