Lexical retrieval difficulties in children: a new approach combining modelling of impairment and intervention to help word-finding

Lead Research Organisation: University College London
Department Name: Developmental Science


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Description The research was based on the premise that our understanding of word finding difficulties (WFD) may be increased by studying how naming skills emerge in typically developing children (Karmiloff-Smith, 1998; Thomas et al., 2009). We tested 100 typically developing (TD) children aged 4 to 8 and 25 children with WFD aged 6 to 8 on core tasks, tapping semantics (word meaning) and phonological (sound) skills. Both groups made predominantly semantic errors (e.g., "tiger" in response to a picture of a lion). Phonologically related errors were rare for TD children and were found only in the children with WFD who performed most poorly on a non-word repetition task. The results suggest different underlying causes of naming difficulties and thus inform our understanding of WFD.

We explored whether word frequency, word length, number of similarly sounding words (phonological neighbours), imageability of the concept depicted, and visual complexity predicted the naming accuracy for the two groups of children. Imageability was the most robust predictor of naming for both groups, demonstrating the important role of sensory features underpinning the mental representations of words acquired in both typical and atypical development.

Findings from the computational modelling suggest that different underlying limitations to simulated representations or processes can produce similar behavioural deficits; but these limitations may respond differentially to intervention. Children with limitations in their language learning mechanisms need work to strengthen word representations - e.g., to improve word meanings or word sounds. This will make it easier to establish better links between these representations. The links are the key components of vocabulary comprehension and production. The modelling suggests that heterogeneous response should be an expected outcome from language intervention.

Twenty children participated in the intervention strand of our study. At a group level, on the primary outcome measure of naming 100 items (25 of which were treated during each intervention) there was a significant difference between 'wait' and 'therapy' groups in change scores after the first phase of intervention. The intervention group showed a significant advantage with a large effect size (Cohen's d 1.1). There was little change on untreated items for either group. These findings represent the first randomised control trial to demonstrate an effect of therapy with children with WFD in mainstream school. The improvement in word finding for treated items (an experimental set and children's personally-chosen words) was obtained following a clinically realistic intervention in terms of approach, intensity and duration. Initial results at the individual level, where each child's response to semantic and phonological therapy was evaluated, demonstrated a differential response. It was not the case that there were simply children who responded to therapy and those who did not. Overall, more children benefited from semantic therapy. However, if a child performed well on semantic tasks, relative to the typically developing children, they were likely to benefit from phonological therapy. The findings thus lend some support to our hypothesis that children with word-finding difficulties will respond best to different interventions, depending on their underlying language profiles.
Exploitation Route Two new tasks created by the grant team may be developed and adapted for use by clinicians, schools and researchers: a) a task of word-picture verification (WPVT) as a measure of the children's knowledge of the items used to assess naming and (b) a picture judgement task (PJs) in which children are asked to make judgments about the semantic relationship between the pictured items.

The initial computational model of lexical development will continue to be modified. A PhD student is currently building a version of the model with increased ecological validity. The findings from the modelling will be disseminated via the Centre for Educational Neuroscience and the US-based Society for Research in Cognitive Development.

The randomised control trial will develop the evidence base for intervention with primary-aged children presenting with WFD. The word webs and therapy protocol used in the project will be made available via the Centre for Speech and Language Intervention Research website. Funding will be sought to further investigate the conversation skills of children with WFD and possible effects of intervention. One key question is whether a mixed phonological-and-semantic therapy will benefit children with different profiles or whether this will dilute the effect of each intervention.
Sectors Education


Description The research from WORD has impacted on a range of users and beneficiaries outside the research community. 1. Direct involvement. Children with word-finding difficulties who took part in the study were introduced to strategies and resources to help support their retrieval of target words, including words relating to the school curriculum and the children's own interests. Project findings, summarised in a child and family friendly format, have been fed-back to parents and schools. The children, families and teachers involved have also received detailed reports about each child's individual response to our research interventions, including recommendations about how to support their word-finding difficulties at home and school in order to enhance their every-day communication. The project raised awareness about word-finding difficulties and ways of supporting children with expressive language needs. Furthermore, researchers, including Student Teachers, Psychologists and Speech and Language Therapists, who worked on the project have benefited individually and directly from participation, using their experience to inform their practice. The post doctoral fellow employed on WORD at Birkbeck College subsequently took up a post in Germany, where she has utilized the connectionist modelling methods acquired during the project. 2. Teaching and Professional Training. Outputs from the research have been built into training for practitioners, including Special Educational Needs Coordinators / Inclusion Managers, Teachers, Educational Psychologists, Speech and Language Therapists and those learning computational modelling skills. Specifically, at UCL Institute of Education results are presented to teachers taking the Masters in Literacy Learning and Literacy Difficulties as part of the module Reading and Spelling Difficulties and to students taking the Educational Psychology Doctorate. In UCL Psychology and Language Sciences the findings have been included in the teaching for BSc Speech Sciences and the MSc in Speech and Language Sciences. Modelling findings on causes of developmental delay have been included in teaching on the MSc Paediatric Neuropsychology at the Institute of Child Health. 3. Projects related to WORD. Investigators have supervised projects with real world implications for different populations related to WORD at a range of levels from BSc to PhD. A wide range of topics have been covered. A) UCL Institute of Education. This first strand has focused on errors in naming and on exploring word-finding in children with literacy difficulties MSc, i) Naming error classification of children with word finding difficulties, ii) Underlying cognitive and linguistic deficits that may cause reading problems in primary school pupils, iii) Are there differences in the naming of children with reading difficulties and those with WFDs?, iv) Analysis of naming errors in children with reading difficulties. The WORD project has been extended to related research with children with dyslexia by a PhD student, a member of the WORD project team, who is investigating naming in children aged 8 to 9 years with literacy difficulties. B) Birkbeck College. The computational strand focused on specifying mechanisms of plasticity that either underlie or restrict opportunities for response to intervention. An MSc project explored WFDs in children with wider learning needs. Two further PhD students are pursuing projects that extend these ideas, one scaling up and increasing the ecological validity of the specific model designed in the WORD project, the other translating the ideas to the sphere of interventions for autism. C) UCL. The intervention strand has focused on exploring word-finding beyond picture naming and developing clinically useful tools. BSc projects have explored changes in children's word-finding in discourse and investigated a semantic picture judgement test - comparing performance of typically developing children and those with word-finding difficulties. The latter won a project prize and the student is now developing a computerised intervention for adults with aphasia. Masters projects have included developing and evaluating a new test of word-learning, four students explored Word-finding behaviours in conversation - patterns in typical development and children with word-finding difficulties. The PI supervised a PhD which entailed developing and evaluating vocabulary interventions in primary age children. 4. Impacts from modeling. A key issue that arose from the computational modelling strand concerned the importance of age-related changes in plasticity for constraining the nature and extent of responses to intervention. This outcome fed into work seeking to translate current neuroscience findings on plasticity to practical issues facing governments in developing countries. Following a request for a target article from the chief educational psychologist at the World Bank, a subsequent paper focusing on informing educational policy using the neuroscience of learning was published in the in-house journal of UNESCO. 5. Conference presentations. The results from different strands of the WORD project were presented at the Child Language Seminar (2013), Centre of Excellence in Cognition and its Disorders (2014), Child Language Symposium (2015) and at the Society for Research in Child Development (2015). These forums included research practitioners and led to follow-up queries from Australia, Europe and the US about WORD and the specifics of the semantic and phonological intervention techniques. 6. Further developments arising from WORD. The methods investigating intervention have been incorporated into further funded research of Professor Masterson that involves using interventions to facilitate vocabulary learning in second language learners. A key objective for WORD has been to build and strengthen links between research and translational outcomes in the improvement of interventions for children with developmental language problems. Professor Thomas has presented on this topic at a meeting of the Royal Society (2014), a workshop on the Learning Sciences in Singapore and a colloquium on cognitive science in Mexico (2015), as well as an international conference on Building Bridges: Mobilising International Interdisciplinary Science to Benefit Societies (2015). The bridge between individual differences and educational outcomes that a cognitive neuroscience perspective provides has led to funding for Thomas focusing on i) evaluating learning and ii) on distinguishing 'neuromyths' from 'neurofacts'. Thomas has also generated a number of publications on the broader issue of understanding the mechanisms of atypical development from a computational perspective and understanding the individual differences factors that influence developmental outcomes. The design and analysis employed in the WORD intervention study led Professor Best to co-author work on optimising design in future case series intervention studies which has received commentary from 11 leaders in this field. 7. Continuing Professional Development (CPD) and Research Centres. The WORD project team are continuing to build on the study in work with practitioners and have presented the findings to the Wider Advisory Group including a young person who grew up with language needs and an Educational Psychologist. At the Institute of Education, under Masterson's supervision, Teachers are carrying out further intervention studies including investigating the effect of the Expressive Writing programme on narrative writing skills of Year seven students and whether teaching focusing on automaticity and fluency makes a difference to reading comprehension. A series of invitations to present the findings to Speech and Language Therapists has resulted in positive feedback about the WORD interventions. For example, at a recent event, all 25 therapists present either 'agreed' or 'strongly agreed' (anonymously) that: i) the talk contributed to their understanding of word-finding difficulties, ii) they learned something that they could apply to their clinical work, iii) they would find the therapy protocol/resources useful. Asked about resulting change in practice, comments included: "As an NQP, plan a more detailed assessment to help tailor the interventions to the source of the child's difficulty. Plan in time to work on child's meta-cognitive awareness of self-cueing strategies" and "Look more closely at each child's profile to target therapy effectively". The translational perspective, and the interactions that it stimulated between the three institutions the WORD project combined, has led to significant further work in this sphere, in the context of the Birkbeck-UCL-Institute of Education Centre for Educational Neuroscience, of which Thomas is the director and the Centre for Speech and Language Intervention Research, directed by Best.
First Year Of Impact 2012
Sector Education,Healthcare
Impact Types Societal

Policy & public services

Description Dissertation supervision at UCL Institute of Education
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Improved skills of students to carry out research into wordfinding difficulties
Description PhD supervision at UCL Institute of Education
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact The student has developed skills in assessing wordfinding difficulties in children, including in children with literacy difficulties.
Description Speech and Language Therapy for children with word-finding difficulties
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Researchers presented a series of workshops to teams of Speech and Language Therapists employed in Health/Education working with school age children with word-finding difficulties and covering a total of over 250 primary schools in and around London. Feedback indicated participants all agreed the sessions would influence their clinical work with this population and that they had an increased understanding of word-finding difficulties and appropriate intervention.
Description Teaching on the Professional Doctorate in Educational Psychology at UCL Institute of Education
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Improved understanding of wordfinding difficulties in children among trainee Educational Psychologists
Description Teaching within the module Reading and Spelling Difficulties at UCL Institute of Education
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact Teachers, special education advisers and psychologists who undertake the module have increased knowledge about wordfinding difficulties in children
Description UNESCO transformational research paper, identifying principles for enhancing adult learning with particular reference to adult literacy and motor skill learning in the developing world as a means to escape poverty.
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
URL http://link.springer.com/article/10.1007/s11159-014-9412-6/fulltext.html
Description Australian Research Council - Centre for Excellence in Cognition and its Disorders (CCD) Cross Programme Support Grant
Amount $18,037 (AUD)
Organisation Macquarie University 
Sector Academic/University
Country Australia
Start 08/2017 
End 09/2018
Description CCD Cross Program Support
Amount $39,000 (AUD)
Organisation Australian Research Council 
Department ARC Centre of Excellence in Cognition and its Disorders
Sector Academic/University
Country Australia
Start 01/2015 
End 12/2015
Description Research Project Grant
Amount £182,086 (GBP)
Funding ID RPG-2013-180 
Organisation The Leverhulme Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2013 
End 03/2017
Title New assessment tools for detailed evaluation of children's word-finding and related skills: Word Picture Verification, Picture Judgement and Conversation Tasks 
Description Word-Picture Verification Task: This was developed using the pictures from our core naming task (Funnell et al., 2006; Druks and Masterson, 2000). It involved presenting one picture at a time on a laptop computer together with a pre-recorded spoken word. On one occasion the picture was presented with the matching word and on another the picture was presented with a semantically related word. The child was asked to decide if the spoken word corresponded to the picture or not. Responses were scored correct only if the child accepted the correct name and, on a separate occasion, rejected the semantically related word. Reaction times were also recorded. Picture judgement task: In this task, three pictures depicting objects were presented - a target together with two pictures underneath. One of the two pictures presented in the lower part of the screen had an associative semantic relationship to the target, the second came from the same semantic category as the first (e.g., tie presented with associate shirt and distracter shorts). Sixty-nine pictures depicting items from the Funnell et al. (2006) and Druks and Masterson (2000) picture sets were selected. The child was asked to choose which of the two items in the lower part of the screen fitted best with the item at the top. Accuracy and reaction times were recorded. Conversation task: A structured protocol was developed, which reliably elicits a conversation sample from both typically-developing and children with word-finding difficulties. This involves using standard starter questions as well as a hierarchy of verbal and non-verbal prompts. Conversation samples were video-recorded and transcribed, then analysed using a system based on the Profile of Word Errors and Retrieval in Speech (POWERS; Herbert et al., 2013). This tool, originally designed for use on the conversations of adults with communication impairment, was modified for use with children in our study. 
Type Of Material Physiological assessment or outcome measure 
Provided To Others? No  
Impact The development of these new research tools has allowed us to place the children's word-finding skills in the context of their wider language abilities, as well providing new insight into how difficulties with word retrieval may affect a child's everyday communication. Conversation skills are closely linked with social and emotional development and capturing performance in this area aligns with the World Health Organisation's ICF requirement to consider communication as it occurs in everyday life - at the level of Activity and Participation, as well as Impairment. There has been interest from researchers and practitioners in these outcome measures and we plan to investigate their clinical applicability in further research. 
Title Data for 102 typically developing children and 24 children with wordfinding difficulties 
Description The database includes data relating to naming performance for 102 children aged four to eight years with typically developing language (TD) and 24 children with word finding difficulty (WFD) aged six to eight years. The file contains scores for four core tasks 1) picture naming as a measure of children's ability to retrieve and produce words in response to a picture, 2) word-picture verification as a measure of the children's knowledge of the concept in each picture, 3) picture judgement as a measure of associative semantics, 4) nonword repetition to explore the children's phonological abilities. Scores in background assessments are also included: simple and choice reaction time, non-verbal ability and receptive vocabulary. 
Type Of Material Database/Collection of data 
Year Produced 2015 
Provided To Others? Yes  
Impact The database has been used as to plot the performance of children with wordfinding difficulties in the same tasks, and for computational modelling of the trajectory of typical naming development. It is currently being employed for computational modelling of the effects of different types of intervention for wordfinding difficulties 
Title The Associator Model of Lexical Development 
Description The Associator is the first developmental computational model of lexical retrieval from the Computational strand of the WORD project. This is implemented in Matlab, which is potentially portable to other machines. 
Type Of Material Computer model/algorithm 
Year Produced 2012 
Provided To Others? Yes  
Impact Technical proceedings paper: Fedor, A., Best, W., Masterson, J. and Thomas, M. S. C. (2013). Towards identifying principles for clinical intervention in developmental language disorders from a neurocomputational perspective. DNL Tech report 2013-1. A number of results from this pilot model have been made publicly available via YouTube (e.g., https://www.youtube.com/watch?v=WIrr0Jr6kfo&list=UU4wgfMbR9b5tUc4XfobxJlQ). A paper has been submitted, applying our model of lexical development to simulating two case studies of 7-year-old children with developmental word-finding difficulties across four core behavioural tasks. Developmental models were created which captured the deficits of each child. In order to predict the effects of intervention, we exposed the computational models to simulated behavioural interventions of two types, either targeting the improvement of phonological (sound) or semantic (meaning) knowledge. The model was then evaluated by testing these predictions against the actual results from an intervention study carried out with the two children. For one child it was predicted that the phonological intervention would be effective and the semantic intervention would not. This was borne out in the behavioural study. For the second child, it was predicted that both the phonological and semantic interventions would be effective; the behavioural study found an effect of semantic but not phonological intervention. Through an explicit computational simulation, we therefore employed intervention data to evaluate our theoretical understanding of the processes underlying acquisition of lexical items for production and how they may vary in children with developmental language disorders. The model is still in development, so making the final version publicly available remains a future goal. 
URL http://www.psyc.bbk.ac.uk/research/DNL/techreport/Fedor_DNLTechreport2013-1.pdf
Description Partnership with the Language and Communication Service 
Organisation Camden Language and Communication Service (CLCS)
Country United Kingdom 
Sector Public 
PI Contribution Members of our project team have contributed to the Continuing Professional Development of local service providers by sharing research findings related to word-finding and word-learning.
Collaborator Contribution The Health Trust's Language and Communication Service has supported an NIHR Clinical Doctoral Fellowship application for a member of our project team. The head of the service has agreed to act as Lead Clinical Host for a proposal to carry out a PhD on Children's Conversation Therapy.
Impact The NIHR shortlisted our Fellowship proposal which was not successful at final interview stage. The proposal is being re-formulated to apply for funding. The partnership will support the new application. The applicant was successful in applying for an ESRC studentship and is carrying out a PhD in this field from 2018.
Start Year 2011
Description Centre for Educational Neuroscience Workshop 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Talk sparked questions and discussion afterwards from the audience of teachers and educational psychologists.

Increased both researchers' and delegates' understanding of the challenges of undertaking research within an educational neuroscience framework.
Year(s) Of Engagement Activity 2014
URL http://www.educationalneuroscience.org.uk/current-projects/
Description Child Language Seminar Presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talk sparked questions and discussion afterwards

After the 2013 talk, speech and language therapists and professionals from related disciplines requested updates about the results of our study which we then presented at the 2015 Symposium.
Year(s) Of Engagement Activity 2013,2015
URL http://www.psych-sci.manchester.ac.uk/aboutus/events/cls2013/
Description Continuing Professional Development Presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact 10 speech and language therapists, specialising in services to schools, attended a talk given by members of the project team on the nature of word-finding difficulties and plans for the intervention stage of the study. The talk sparked questions and discussion about clinical practice. Feedback from the clinicians also fed into the design of research therapy sessions.

Impact assessment:
90% of participants agreed that they had learned something new.
All agreed that they would like to find out more about the subjects discussed indicating that the event acted as a catalyst for further engagement.
70% of participants agreed that they would be confident in further discussion with colleagues leading to diffusion of knowledge about word-finding and word-learning.
Year(s) Of Engagement Activity 2011
Description Invited 'expert' article on word-finding for Bulletin of Royal College of Speech and Language Therapists 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The article summarised word-finding interventions for adults and children in the Royal College of Speech and Language Therapists Bulletin. This resulted in follow-up questions about the intervention stemming from the funded research and an invitation to present to the mainstream schools Clinical Excellence Network.
Year(s) Of Engagement Activity 2018
Description Talk to primary school teachers (London) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact 20 Members of teaching staff attended this talk about 'Identifying and supporting children with word-finding difficulties'.

As a result of this talk, we received further referrals to our project as part of our ongoing recruitment of children with word-finding difficulties.
Year(s) Of Engagement Activity 2012
Description Wider Advisory Group presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Participants in your research and patient groups
Results and Impact The presentation resulted in detailed discussion and further questions about wordfinding difficulties afterwards

After the presentation the professionals (teachers, educational psychologists) and parents stated commitment to further participation in the research.
Year(s) Of Engagement Activity 2013
Description Word-learning and word-finding teaching sessions 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Students reported increased understanding of word-finding difficulties and improved confidence in working with children who experience these.

After the sessions, students produced their own therapy plans for case studies of children discussed during the workshop.
They posted questions and comments in a virtual learning environment to demonstrate their engagement with the subjects covered during the teaching session. Six students selected related research projects.
Year(s) Of Engagement Activity 2013,2014,2015,2016,2018