DEVELOPING THE TOOLS TO THRIVE: PSYCHOSOCIAL AND BEHAVIOURAL SUPPORT FOR FAMILIES OF CHILDREN WITH DEVELOPMENTAL LANGUAGE DISORDER.

: Developing the tools to thrive: Developmental Language Disorder

Abstract

Background: Developmental language disorder (DLD) is characterised by lifelong difficulties with receptive and/or expressive language and is estimated to impact 7% of children. Children with DLD are also recognised to experience an increased rate of psychosocial difficulties than their typically developing peers; for example, more anxiety, bullying victimisation, emotional dysregulation, hyperactivity, social isolation and lower self-esteem (all evidenced in Chapter 1). Traditional psychosocial support however often includes ‘talking therapies’, which is harder for children with DLD to engage with.

Aims: This thesis aimed to first understand the need for psychosocial support for children with DLD, before developing and piloting a novel intervention designed specifically for children with DLD.

Methods & Results: The five studies in this thesis were structured around the person-based approach to intervention development. First, a systematic review was conducted of the evidence-base for parent-led psychosocial interventions of children with neurodevelopmental disorders (NDDs; Chapter 2). As such, the ‘active components’ most used in existing effective interventions were identified amongst children who share similar psychosocial
difficulties to children with DLD: ‘parent and child emotion management’, ‘parent-child interaction training’ and ‘parent behavioural training’. Concurrently, a qualitative study explored the priorities for psychosocial intervention
from parents of children with DLD, and adults with DLD reflecting on their childhood (Chapter 3). This qualitative study then fed into a mixed-methods, case-control study looking to quantify its findings in a larger DLD sample, when compared to typically developing children (Chapter 4). Overall, results emphasised the need for support managing the internalising symptoms of children with DLD, particularly anxiety and emotion dysregulation (Chapters 3-4). Novel findings also suggested that intolerance of uncertainty and insistence on sameness contributed to the children’s internalising symptoms, where parent coping mechanisms and behaviour did not (Chapters 3 and 4). As such, no ‘parent behavioural
training’ was included in the current intervention. In Chapter 5, a co-production study used qualitative feedback from parents of DLD (the target service-users) and healthcare professionals (who have experience delivering interventions to children with DLD), to finalise the content and design of the novel intervention, PLUTO (Parent-Led-individUalised Treatment Online). Results indicated the importance of visual, non-linguistic activities for the children, a reduction in the time required to complete the intervention (i.e. no longer than 45 minutes a week), and the simplification of more complex, cognitive tasks. Finally, an interrupted-time-series design was then used to pilot PLUTO amongst 10 families of children with DLD, aged 6-11 years old (Chapter 6). Both qualitative and quantitative data were analysed at a case-series level, to provide an indication of the feasibility and effectiveness of PLUTO in improving the psychosocial skills of the children
and the wellbeing of the parents. Results indicated that PLUTO was a feasible option for eight out of the ten families enrolled in PLUTO, helping to reduce the emotional symptoms of five of the children and four of the adults that successfully engaged in PLUTO. Qualitative analysis also indicated an increase in emotional communication within the family, improvement in child self-esteem and parent’s understanding of their child.

Conclusions: The findings of this thesis extend the literature by prioritising qualitative insight from parents of children with DLD and adults with DLD. In doing so, findings have implications for the treatment and advocacy of children with DLD. Firstly, there is evidence that children with DLD require psychosocial intervention that is tailored to their needs. There is also evidence that the PLUTO intervention is a feasible option for parents of children with DLD, that helps improve their children’s psychosocial skills. Importantly, findings suggest more support and guidance is required for parents of children with DLD at the point of diagnosis, and more research is required into ‘intolerance of uncertainty’ and ‘insistence on sameness’ amongst children with DLD. Finally, more research is required to understand the implementation options of the PLUTO intervention.

Date of Award	27 Mar 2024
Original language	English
Awarding Institution	University of Bath
Supervisor	Michelle St Clair (Supervisor), Charlotte Dack (Supervisor) & Rachael Bedford (Supervisor)