Background/Objectives: Developmental language disorder (DLD) has widespread and persistent consequences for children's development, extending beyond language. Quality of life (QoL) can also be affected, potentially related to difficulties with cognition (e.g., language ability), behaviour (e.g., social-emotional functioning), and/or environmental factors (e.g., multilingualism). This study set out to characterise changes in the QoL of children with DLD and to identify related factors. Methods: Data were collected at 4 and 9 years from children who had attended early language intervention groups before age 4. Parents completed online questionnaires, including the KINDL for QoL. The KINDL measures QoL on six domains: physical well-being, emotional well-being, self-esteem, family well-being, social well-being, and school functioning. Structural Equation Modelling (SEM) was used to assess the relationship between change in QoL and cognitive, behavioural, and environmental factors. Results: At both time points, the QoL of children with DLD was reduced compared to the normative group on all domains except self-esteem and family. Emotional well-being and self-esteem scores were significantly lower at 9 years compared to 4 years. Peer problems and multilingualism emerged as influential factors regarding changes in QoL over time. Conclusions: The QoL of children with DLD is vulnerable between age 4 and 9. Overall, QoL might deteriorate in this period, specifically emotional well-being. Early peer problems and multilingual status influence the changes observed in different aspects of QoL, although these effects should be interpreted with caution.

Tweetalige peuters met een vermoeden van een taalontwikkelingsstoornis (TOS) hebben niet alleen een mogelijk taalleerprobleem, maar worden ook relatief minder vaak blootgesteld aan elk van beide talen. In een promotieonderzoek bestudeerden wij of deze kinderen (drie tot zes jaar) hierdoor extra kwetsbaar zijn in hun taalvaardigheid, beginnende geletterdheid en gedragsontwikkeling. Onze resultaten toonden aan dat tweetalige peuters met TOS moeite hadden met beide talen, terwijl tweetalige peuters zonder TOS in alleen het Nederlands zwakker waren dan eentalige leeftijdsgenoten. Bij de Nederlandse beginnende geletterdheid bleken tweetalige peuters met TOS vooral kwetsbaar in taalspecifieke vaardigheden, zoals rijmen. Er was geen sprake van een verhoogde mate van gedragsproblemen. Zwakke tweetalige fonologische vaardigheden en beperkte groei in het Nederlands taalbegrip vormden risico's voor de beginnende geletterdheid en gedragsontwikkeling bij tweetalige peuters. We bespreken wat deze resultaten betekenen voor het signaleren en ondersteunen van taalproblemen bij tweetalige peuters.

Background Previous research has shown that foundational linguistic skills (i.e., phonological awareness and grammatical ability) indirectly (through arithmetic skills) predict growth from fifth-to sixth-grade geometric and fraction skills. Aims Our study aimed to investigate the linguistic precursors of sixth-grade geometric and fraction skills in children with and without DLD, while examining potential (cognitive) strengths within the DLD group that may partly compensate for learning geometry and fractions, at both the group and individual level. Sample Participants were 46 children with DLD and 122 typically developing peers from 9 to 11 years of age. Methods Classroom and individual measures were administered in both grade 4 and grade 6. Results At the group level, results showed children with DLD to score below their peers on arithmetic, geometric, and fraction skills. Furthermore, indirect effects of phonological awareness and naming speed, via arithmetic skills, on geometric and fraction skills were found to be equally strong for both groups. In addition, similar strengths for both groups were found for nonverbal intelligence, academic vocabulary, and verbal reasoning in directly predicting the scores in geometric and fraction skills. Finally, at the individual level, a strength in verbal reasoning was found to partly compensate the delays in mathematics in children with DLD. Conclusions The educational needs of children with and without DLD in mathematics learning might be more quantitative in nature than that they are qualitative. In addition, identifying individual strengths should be integrated into standardized test batteries and treatment approaches.

This paper reports upon an evaluation of a school-based screening program aimed at detecting psychological problems1 in 495 deaf and hard of hearing (DHH) students. The first aim of the study was to evaluate the actual implementation of this program. Furthermore, the prevalence of internalizing and externalizing problems in a subset of 277 DHH students was analysed and subsequently how these problems vary as a function of age, gender, context, and negative life circumstances (NLCs). The results show higher prevalence rates of psychological problems compared to typical hearing peers, but lower than in previous studies. More problems were observed in the context of school than at home. No age or gender differences were found, but significantly more internalizing problems in DHH adolescents than externalizing problems. Prevalence of psychological problems among DHH students without NLCs were significantly lower than among students with one or more NLCs. The results shows a screening program to identify psychological problems in special schools can be successfully implemented. Such programs will help to identify psychological problems at an early stage and provide care for DHH children and adolescents with psychological problems.

Children with developmental language disorder (DLD) often have emotion recognition difficulties. Constructivist theories postulate that language, possibly via inner speech, helps categorise ambiguous behaviours into distinct emotion categories. The relationship between inner speech and emotion recognition may depend upon an abstract and precise word meaning structure. The present study examined how blocking inner speech affects emotion recognition in children with and without DLD, and how these effects relate to word meaning structure. Twenty-three fifth and sixth grade children with DLD, 45 vocabulary controls, and 52 grade controls sorted facial expressions by emotion under two conditions: articulatory suppression (reciting irrelevant verbal material) and motor suppression (foot tapping). Only vocabulary controls showed impaired emotion recognition under articulatory suppression, but not motor suppression. These effects were independent of word meaning structure. We tentatively conclude that unlike vocabulary controls, but similar to grade controls, children with DLD do not rely on inner speech for emotion recognition.

BACKGROUND:The implicit learning deficit hypothesis claims that impaired implicit learning underlies deficits in social-communicative abilities associated with developmental language disorder (DLD). However, previous research testing this hypothesis revealed inconsistent results and largely used process-impure sequential learning tasks. AIMS:This study further tested the hypothesis using a novel process-pure implicit associative learning task. METHODS AND PROCEDURES:The performance of 9- to 13-year-old children with (N = 60) and without DLD (typically developing, TD, N = 52) on a contingency learning task (CLT) was compared. The task entailed the incidental learning of the contingency between simultaneously presented figure-colour combinations. Also, the association of CLT performance with three aspects of social-communicative abilities was assessed: facial emotion recognition ability, social responsiveness and language abilities. OUTCOMES AND RESULTS:Compared to the TD group, the DLD group performed equally on the CLT but showed worse performance on the measures of emotion recognition and social abilities. In neither group was CLT performance significantly related to any of the three social-communicative abilities. CONCLUSIONS AND IMPLICATIONS:These results do not support the implicit learning deficit hypothesis. The demonstrated intact implicit learning ability suggests the potential of using interventions to improve social-communicative abilities in children with DLD that are based on incidental or implicit learning rather than on intentional or explicit learning. WHAT THIS PAPER ADDS:What is already known on the subject Individuals with developmental language disorder (DLD) not only have linguistic problems but also impaired abilities in social and emotional domains. According to the implicit learning deficit hypothesis, these impairments are largely due to a compromised ability to incidentally or implicitly learn regularities of stimuli or events occurring in daily life. However, research examining this hypothesis has yielded mixed results. What this paper adds to existing knowledge This study contributes to the discussion about the presence or absence of a domain-general implicit learning deficit in individuals with DLD, and corresponding potential clinical implications. For this, in addition to measures of language, emotion recognition and social abilities, a novel incidental learning task was used that was held to provide a more process-pure measure of incidental and implicit learning compared to previous research. The collective results do not support the claim of a domain-general implicit learning deficit underlying the social-communicative and -emotional problems in DLD. What are the potential or actual clinical implications of this work? Current interventions to improve language, social and emotional abilities in children with DLD are largely based on relatively effortful strategies involving explicit instruction and feedback. The present evidence of intact incidental and implicit learning abilities supports the examination of possible novel interventions that are based on relatively effortless implicit learning strategies, which may be more in line with how these abilities are acquired in daily life.

BACKGROUND:It is well-established that children and adolescents with developmental language disorder (DLD) have social-emotional difficulties. This is reflected in their behaviour, for instance, by (social) withdrawal, hyperactivity or difficulty with peer relations. Children with DLD are also known to have poorer quality of life (QoL). This is likely to be related to social-emotional difficulties, for both concern similar developmental domains but from a different point of view. Findings on the social-emotional abilities, QoL and predictors thereof in children with DLD are inconsistent across studies. AIMS:This review investigates how social-emotional functioning (SEF) and QoL develop from childhood into early adulthood in children with DLD. These developments are then compared and predictors are identified. METHODS & PROCEDURES:A systematic review of 128 articles, conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in January 2024, yielded 34 articles for inclusion after qualitative assessment. Clinical populations were labelled differently (e.g., DLD, specific language impairment (SLI), language impairment (LI)) but adhered to inclusion criteria for language disorder (LD). The majority of the articles focused on SEF (n = 30 articles), while the remaining examined QoL (n = 4 articles). MAIN CONTRIBUTION:This is the first review to simultaneously investigate SEF and QoL in children with LD. No single developmental pattern was found for SEF: a range of possible developmental trajectories exists. Interestingly, prosocial skills generally appear to improve over time, whereas children also experience increasing problems with peer relations. Few studies employed a longitudinal design regarding QoL, but those that did suggest that children with LD are likely to have poorer and declining QoL, at least between the ages of 4 and 9. The sole study examining SEF and QoL in the same sample found a predictive relationship between early SEF and later QoL. Linguistic abilities were predictive in less than half of the studies on SEF development and had little impact on QoL development. Findings on other predictors were inconsistent. CONCLUSIONS:Despite their interrelatedness, SEF and QoL do not necessarily develop similarly in children with LD. Only one study examined SEF and QoL in the same children and found contrasting developmental trends. This could imply that SEF and QoL are not as intertwined as presumed. It also remains unclear what best predicts change over time in these two dimensions. More research is necessary to further examine the relationship between SEF and QoL, as well as to identify potential predictors. WHAT THIS PAPER ADDS:What is already known on the subject Children with LD are more likely than their peers without LD to have lower SEF and poorer QoL. However, the development of these domains across childhood and adolescence remains unclear. The relationship between SEF and QoL is equally under-researched. What this paper adds to the existing knowledge This is the first review on those with LD that takes a longitudinal perspective on both SEF and QoL and looks at their relationship. It highlights that longitudinal research is valuable and necessary, specifically for QoL, where studies are scarce. Only one study examined SEF and QoL in the same group of children and found a predictive relationship between (aspects of) SEF and later QoL. What are the potential or actual clinical implications of this work? This study highlights the relevance of longitudinal research when aiming to comprehend development, particularly in heterogeneous populations such as language disorders (LD). Clinicians are advised to address social-emotional problems alongside language to potentially increase SEF and QoL. Future research should investigate SEF and QoL simultaneously to substantiate the preliminary evidence for this relationship between SEF and QoL. Additionally, future studies consider support and multilingualism as potential predictors of this development in children with LD.

It has been proposed that an implicit learning deficit explains the difficulties with grammar commonly observed in children with Developmental Language Disorder (DLD). The present study further investigates this link in two ways. Firstly, we investigate whether kindergartners with DLD have more difficulties with preposition understanding and production as compared to their typically developing peers because they have not (yet) learned to weigh implicit structural information (word order) over more explicit semantic information (noun animacy; Study 1). Secondly, we investigate whether kindergartners with DLD learn to comprehend and produce locative prepositions from an implicit learning context (Study 2). In Study 1 we observed that Dutch kindergartners with DLD (n = 32) made more errors in preposition comprehension (picture-matching task) and preposition production (semi-spontaneous production task) as compared to their typically developing peers (n = 30). We have no evidence that these differences can be explained by a difference in cue weighing or implicit learning ability (serial reaction time task). In Study 2 we observed that the storytelling context led to an increase in preposition production in children with DLD, but we found no evidence that it also led to a better understanding and more semantically accurate productions of the prepositions. We conclude that Dutch kindergartners with DLD have difficulties with locative prepositions but cannot conclude that differences in cue-weighing or implicit learning play a role herein.

Children with developmental language disorder (DLD) experience problems in language comprehension and/or production. In particular, storytelling or narrative ability is often impaired, as this type of discourse involves all domains of language. These problems may lead to a lower quality of social interaction and mental health. Moreover, problems in oral narrative ability during early development have a negative effect on later literacy. However, telling a story involves more than language alone. Executive functioning is thought to play an important part in stimulating narrative ability, as linguistic utterances need to be planned in a temporal and causal order, and switching is needed between multiple characters and events in the story. Research has shown that children with DLD experience problems with executive functioning, independent of their language ability. Thus, the difficulties in storytelling may be caused by both impaired language and executive functioning, as both domains follow hierarchical developmental paths during the early childhood years. In this review, we discuss three components of narrative ability (comprehension, production of macrostructure and production of microstructure) and how they may be interconnected to the three core components of executive functioning (working memory, switching and inhibition) and attention. This review shows that updating and monitoring information in working memory plays an important part in all three components of narrative ability, across multiple studies. This result may give direction in the development of narrative assessment and intervention, and urge further research to disentangle the interplay between language and executive control in DLD.

Background and aims Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD. Methods Participants were five children with DLD aged 9–12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories. Results For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions. Conclusions By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD. Implications The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.

Methods to effectively improve socio-emotional functioning by adolescents with developmental language disorders (DLD) are scarce. Current methods to improve socio-emotional functioning in adolescents with other neurobiological disorders seem less suitable, as these methods are highly language based. This study therefore examined the feasibility of the virtual reality (VR) training for socio-emotional skills: ‘InterAction’. The aims of the present study were to (1) examine whether interactive VR is a feasible training method for adolescents with DLD; (2) investigate adolescents’ appreciation of the VR training; (3) examine whether the virtual reality training facilitates the participants’ sense of presence during social practice situations in an interactive digital world; and (4) explore whether adolescents socio-emotional skills improved during the six-session training. A sample of nine adolescents (13–16 years) with DLD reported on their presence in VR contexts and their appreciation toward the VR training. They also completed weekly self-reports on their socio-emotional functioning. Results indicated that ‘InterAction’ was a feasible method to practice socio-emotional functioning with adolescents with DLD. Adolescents highly appreciated the VR training. In addition, adolescents rated the sense of presence as high in the VR training. The individual trajectories showed that improvements in the trained skills varied both between and within participants. The results were also not uniform between the specific skills trained. The findings suggest that interactive virtual reality training may be a promising tool for improving socio-emotional functioning in adolescents with DLD. Future studies should examine the positive indications of this study in a larger sample.

In this study, we investigated first- (L1) and second-language (L2) vocabulary and phonology, and selective attention, as precursors of L2 early literacy in bilingual kindergartners with and without Developmental Language Disorder (DLD). We compared typically developing (TD) and DLD bilinguals with TD/DLD monolinguals ( n = 157, M AGE = 3;8), and examined how TD/DLD bilinguals ' precursor abilities predicted L2 phonological awareness, rapid automatized naming (RAN), and letter knowledge. The precursor variables were assessed during preschool, including L1/L2 Dutch and L1 Turkish/Polish. Two years later, we assessed L2 Dutch early literacy. The results showed that at preschool, DLD bilinguals scored lower than the other groups on L1 vocabulary and L1 - L2 phonology. By kindergarten, bilingual and DLD groups had poorer Dutch rhyme and RAN than monolingual and TD groups, respectively. Combined L1 - L2 phonological skills predicted phonological awareness and RAN among TD/DLD bilinguals. We conclude that poorer L1 - L2 phonology in DLD bilingual preschoolers poses a risk for their L2 early literacy at kindergarten.

BACKGROUND:It is unclear how speech production, selective attention, and phonological working memory are related to first- (L1) and second-language (L2) vocabularies in bilingual preschoolers with Developmental Language Disorder (DLD).AIMS:To study individual variation in vocabularies in DLD bilingual preschoolers by (1) comparing them to typically developing (TD) bilingual, and TD and DLD monolingual peers; (2) differentially predicting L2 vocabulary; and (3) identifying and characterizing bilinguals' L1/L2 vocabulary profiles.METHODS:We measured the selective attention, working memory, and L1 Turkish/Polish (where applicable) and L1/L2 Dutch speech and vocabulary abilities of 31 DLD bilingual, 37 TD bilingual, and 61 DLD and 54 TD Dutch monolingual three-to-five year-olds.RESULTS:DLD bilinguals scored lower than TD bilinguals and TD/DLD monolinguals on all measures, except L2 vocabulary, where all bilinguals underperformed all monolinguals. Selective attention predicted Dutch vocabulary across groups. Three bilingual vocabulary profiles emerged: DLD bilinguals were less likely to be L1 dominant, TD/DLD bilinguals with better attention more often had a Balanced high L1/L2 profile, while those with poorer selective attention and L1 speech tended to be L2 dominant.CONCLUSIONS:These findings highlight the roles of L1 speech and selective attention, rather than L2 speech and working memory, in understanding bilingual vocabulary variation among DLD preschoolers.

A cochlear implant (CI) is a prosthesis that allows people with severe to profound hearing loss to understand speech in quiet settings. However, listening to music presents a challenge to most CI users; they often do not enjoy music or avoid it altogether. The Musi-CI training course was developed for CI users with the goal of reducing music aversion and improving music enjoyment. A consortium was established consisting of a professional musician with CI, CI rehabilitation professionals and researchers. Participatory action research (PAR) was applied to develop and evaluate the training experiences, collaborating with 37 CI users during three cycles of eight training sessions, each held over a period of 3 months. Input and feedback were collected after each training session using questionnaires, observations and focus group interviews. Almost all participants (86%) completed the training. After completing the training a large majority of participants reported increased music appreciation, increased social participation in musical settings and a positive impact on general auditory perception. The resulting Musi-CI training programme focuses on music listening skills, self-efficacy, and self-motivation. It consists of exercises intended to strengthen attention and working memory, to improve beat and rhythm perception (with online rhythm exercises) and exercises to distinguish timbre of instruments and emotion in music. A Melody Game was developed to improve pitch and melodic contour discrimination.

In the present study, we investigated Dutch language and behavior progress in monolingual and bilingual preschoolers with developmental language disorders (DLD). All were enrolled in an early intervention program targeting language and communication in interaction. Following a pretest-posttest design, 100 monolingual chil-dren (MAGE symbolscript 3;5) and 50 bilingual children (MAGE symbolscript 3;6) were tested on receptive and expressive vocabulary, language comprehension, and sentence production in Dutch as L1 versus L2. Pedagogical therapists rated chil-dren's internalizing and externalizing behavioral problems before and after the intervention. Results showed that monolingual and bilingual children improved their Dutch language abilities during the intervention, with no in-crease in behavioral problems. Bilingual children obtained lower Dutch language scores than monolingual peers. There was no evidence for differences in behavior problems between the groups. Furthermore, for both groups, better receptive vocabulary abilities, less progress in expressive vocabulary, and greater progress in language comprehension and sentence production during the intervention were related to fewer internalizing behaviors after the intervention. We conclude that strengthening Dutch language development during the intervention may also prevent the occurrence of internalizing behavioral problems in both monolingual and bilingual children with DLD.

We tested if the newly designed ToMotion task reflects a single construct and if the atypical groups differ in their performance compared to typically developing peers. Furthermore, we were interested if ToMotion maps a developmental sequence in a Theory of Mind (ToM) performance as exemplified by increasing difficulty of the questions asked in every item. The sample consisted of 13 adolescents that have been diagnosed with a developmental language disorder (DLD) and 14 adolescents that are deaf or hard of hearing (DHH). All of these adolescents were in special schools for secondary vocational education. The control group existed of 34 typical developing adolescents (TD) who were in regular intermediate vocational education, ranging from level 2 to 4. The ToMotion, available in a spoken Dutch version and in a version in Sign Language of the Netherlands (SLN), was used to map ToM abilities. An attempt has been made to fill the gap of missing studies of ToM in adolescents by developing a new measuring instrument. In conclusion, assessing ToM with the ToMotion results in a picture that DHH adolescents score lower than TD peers. However, their scores are as consistent as those of the TD peers. The picture of DLD adolescents is the reverse. They show no differences in ToM scores, but seem to be somewhat more inconsistent compared to TD peers. We provide a discussion on those results and its implications for future research. What this paper adds? The current study introduces a new visual Theory of Mind (ToM) task, ToMotion, designed specifically to assess ToM in adolescents in an ecologically valid way and adapted to the needs of adolescents with language and communication difficulties.

PURPOSE:This study investigated the roles of cross-language transfer of first language (L1) and attentional control in second-language (L2) speech perception and production of sequential bilinguals, taking phonological overlap into account.METHOD:Twenty-five monolingual Dutch-speaking and 25 sequential bilingual Turkish-Dutch-speaking 3- and 4-year-olds were tested using picture identification tasks for speech perception in L1 Turkish and L2 Dutch, single-word tasks for speech production in L1 and L2, and a visual search task for attentional control. Phonological overlap was manipulated by dividing the speech tasks into subsets of phonemes that were either shared or unshared between languages.RESULTS:In Dutch speech perception and production, monolingual children obtained higher accuracies than bilingual peers. Bilinguals showed equal performance in L1 and L2 perception but scored higher on L1 than on L2 production. For speech perception of shared phonemes, linear regression analyses revealed no direct effects of attention and L1 on L2. For speech production of shared phonemes, attention and L1 directly affected L2. When exploring unshared phonemes, direct effects of attentional control on L2 were demonstrated not only for speech production but also for speech perception.CONCLUSIONS:The roles of attentional control and cross-language transfer on L2 speech are different for shared and unshared phonemes. Whereas L2 speech production of shared phonemes is also supported by cross-language transfer of L1, L2 speech perception and production of unshared phonemes benefit from attentional control only. This underscores the clinical importance of considering phonological overlap and supporting attentional control when assisting young sequential bilinguals' L2 development.

Adolescents with Developmental Language Disorders (DLD) have more difficulties in social emotional functioning than their typically developing peers (TD), such as shyness and anxiety in social situations, fewer peer relations, greater risk of victimization, social isolation and depression. In addition, they are more likely to report higher levels of hyperactivity and conduct problems. These problems derive from a complex interplay between difficulties in language, social communication, underlying cognitive deficits in Theory of Mind (ToM), Executive Functioning (EF) and self-directed speech (SDS). The aim of this mini review is to provide an overview of studies examining the effectiveness of interventions targeting the factors underlying social emotional functioning of school-aged children and adolescents with DLD. We found that studies dedicated to social emotional functioning in school-aged children and adolescents with DLD were relatively scarce. Based on this overview, we give suggestions to improve social emotional functioning in adolescents with DLD. We propose that intervention programs should target the social, linguistic and cognitive functions underlying social emotional functioning and create opportunities to practice these skills in daily, real-life situations with peers.

Joint attention is important for children's language development. We report two meta-analyses that demonstrate that the congruency in hearing status between parent and child affects the establishment and maintenance of joint attention. Dyads consisting of hearing parents and children with hearing loss, achieve fewer and briefer moments of joint attention in comparison to dyads of hearing parents and hearing children and dyads of deaf parents and deaf children. The theoretical and practical implications of these differences are discussed and placed in the context of two narrative syntheses. The first one focusing on parental strategies used to achieve and maintain moments of joint attention and the second one on the relation between joint attention and spoken language proficiency. We also expect that this review may serve as the start of quest towards a more detailed description (taxonomy) and operationalization of joint attention in the context of hearing loss.

Drama therapy is applied to children and adolescents with psychosocial problems. Drama therapy is an experimental form of treatment which methodologically uses drama and theatre processes to achieve psychological growth. Although in clinical practice, drama therapy has been applied successfully, little is known about how and why drama therapy contributes to a decrease in psychosocial problems. A systematic narrative review was performed to obtain more insight into this issue. Eight databases were systematically searched. Ten out of 3742 studies were included, of which there were four random controlled trails, three non-controlled trials, and three pre-and post-test design studies. We identified the results, drama therapeutic means, attitude, and mechanism of change. Positive effects were found on overall psychosocial problems, internalizing and externalizing problems, social functioning, coping and regulation processes, social identity, and cognitive development. An adaptive approach was mentioned as the therapeutic attitude. The means established contribute to a dramatic reality, which triggers the mechanisms of change. These are processes that arise during treatment and which facilitate therapeutic change. We found ten supposed mechanisms of change to be frequently used in all studies. No direct relations were found between the results, drama therapeutic attitude, means, and mechanisms of change.