Evaluation of a mechanical hand-support for facilitated communication

A specially designed hand-support device was evaluated to determine its effectiveness in assisting nonspeaking mentally handicapped children transition from facilitated communication (FC) to independent typing. Six autistic individuals (age range: 5 to 31) participated in the main experiment. All six had been reported to be moderately to highly proficient in the use of FC prior to the study. Pre- and posttraining tasks included pointing to pictures, numbers, and letters as well as copying single words by typing on a keyboard or letterboard. After 8 weeks of training, subjects' ability to point or type on all four tasks was assessed in three different conditions: (a) with an experienced facilitator, (b) independently, and (c) with the mechanical hand-support system. Postassessment measures did not reveal any evidence of independent communication with or without the device. An informal extension of the study, in which four of the original six subjects and three additional subjects were included for 4 additional months, also failed to provide evidence of significant communication.

The use of graphic language intervention among young children in Norway

Knowledge about graphic communication intervention and use among young disabled children has been sparse. The present study is based on a thorough search, and provides reliable information about children who are 10 years old or younger who have graphic communication (for example, photographs, drawings, Blissymbols, PIC, traditional orthography) as their main form of communication. The study covers all such children in three Norwegian counties, comprising a population of 1.1 million people. Detailed descriptions of the children, the systems they use, and their educational settings are presented, and implications for the organisation of habilitation services are discussed.

Parent-child interaction therapy and dysfluency: a single-case study

The hypothesis that the modification of parent-child interaction would reduce the dysfluency of a pre-school child was tested in an experimental single-case study. The subject, a four-year-old boy with a moderate to severe stutter, and his parents attended their local clinic for a total of 17 weeks. On each visit, 20-minute play periods with each parent were recorded and measures of fluency taken. No advice was offered in the first six weeks and these measures were used as a baseline for subsequent therapy. Therapy was given over the next six weeks. The parents were advised to make changes in their style of interaction and were asked to practise these at home each day. During the final five weeks, which served as consolidation, the parents continued to practise their skills at home but no new advice was offered. The analysis found no significant trend in the child's dysfluency during the baseline period, a significant improvement during therapy and stabilisation of the lower rate of dysfluencies during the maintenance period.

Word learning in a supported-learning context by preschool children with specific language impairment

Word learning in a supported-learning context is described for 30 preschoolers with SLI and 30 age- and sex-matched children without SLI. Daily production probes assessed number of words learned to criterion, and daily posttests assessed comprehension of the words. Number of words produced to criterion differed between groups; however, the majority of children with SLI performed within the range of the children without SLI. Children typically comprehended words they did not produce to criterion. The relation between vocabulary-test and word-learning findings was not significant (p < .05). Findings for children with SLI indicate that (a) comprehension does not ensure same-word production, (b) word-learning potential cannot be inferred from test scores, and (c) a clinically significant variability in word-learning skills characterizes the disorder.

Successful use of intravenous immunoglobulins in Landau-Kleffner syndrome

A detailed history of a boy with Landau-Kleffner syndrome is presented, demonstrating a close relationship between language functioning and paroxysmal electroencephalogram activity. During a 3-year 6-month follow-up period, three abrupt deteriorations of all language functions occurred: the child became totally noninteractive with his environment within 1 week's time. Two of these deteriorations were reversed with steroid treatment, with an identical recovery phase. Intravenous immunoglobulins had a very dramatic and comparable effect in the third relapse; both language functions and electroencephalogram abnormalities were influenced significantly by the intravenous immunoglobulin treatment.

Parents' beliefs and ideas about children's early speech and language difficulties

This paper reports a qualitative investigation of the ideas and beliefs of parents about their pre-school children's speech and language difficulties. It forms part of a broader study of parental opinions about speech and language difficulties and the speech and language therapy (SLT) intervention they receive. Factors contributing to the development of professional interest in parental views will be reviewed, followed by an outline of the beliefs and ideas expressed by the parents in in-depth interviews. The paper will also discuss parents' views in their wider context and consider implications for SLT practice.

Specialised service to children with specific language impairment in mainstream schools

The following report describes a three year project to develop, implement and evaluate a specialised speech and language therapy (SLT) service to children with specific language impairment (SLI) who attend mainstream schools and nurseries. The report describes how the service was set up and the package of care offered. A range of evaluation measures was designed and implemented and the results of these are discussed. The service aimed to enable key-workers to support children with SLI effectively within the context of the school environment. The results suggest that the package of care offered provided an effective and high quality service as judged by the parents, schools and therapists.

Collaborative working with specific speech & language disorder in mainstream education

Children with specific speech and language disorders are part of a special needs population whose educational and therapeutic needs have been provided for in a variety of settings over the last fifty years. Changes have been implemented in response to a range of legislation. This has also had implications for the delivery and type of provision of the children's education and therapy. The National Health Service and local education authorities (LEAs) have had to respond to legislation and continue to provide for the full range of specific speech and language disorders. This paper will outline how therapeutic input has had to adapt to the changing educational context. Changes in delivery have necessitated a redefinement of roles and adjustments in collaborative working.

Modelling the consultation process in a secondary referral unit for children

This paper overviews a detailed study of a consultation service for children with severe and/or intractable speech and language difficulties. The Speech Therapy Clinical Unit at the University of Central England in Birmingham (UCE) offered multidisciplinary, in-depth assessment of such children to speech and language therapists, parents and other professions involved in their management. Documentary materials generated by the service were analysed using Grounded Theory to develop a model of the process of assessment and consultation employed in the Unit. The implications of this model for clinical education and practice are discussed.

Innovation and partnership: the voluntary sector contribution

I CAN building on its long experience of integrating education and speech and language therapy in its specialist speech and language schools, has pioneered a variety of new approaches to collaborative working for the benefit of children. This paper describes three examples of relatively new services: Specialist nurseries; Teach Speech: a pilot project for primary aged children using videoconferencing; and Secondary School Language Resources within mainstream schools. Studies to evaluate the effectiveness of some of the services are also reported. All three types of service described demonstrate effective collaboration between at least two of the following three sectors: voluntary, statutory and private. The potential and benefits of this collaboration are highlighted.

A treatment protocol for young children at risk for severe expressive output disorders

The proposed protocol is intended for use with young children who are at risk for severe expressive output disorders in the presence of typically developing receptive, play, and cognitive abilities. It is specifically designed for children who exhibit avoidance of verbal interaction and poor imitative skills. The approach follows a normal progression of sound and syllable structure development and is sequenced so that targets emerge into conversational speech as soon as possible.

Learning disabilities existing concomitantly with communication disorder

This article describes the characteristics of language disorders that occur with learning disabilities. In this context, formal and naturalistic language, including specific standardized test batteries and curriculum-based language assessment, portfolio assessment, and others, are discussed. In addition, service delivery models and interventions that focus on the enhancement of semantic, syntactic, and pragmatic development are presented. Finally, future directions for research in the area of learning disabilities and secondary language disorders are suggested. Intervention strategies, including supportive scaffolding, whole language, and collaborative consultation, are reviewed; and implications for language assessment, intervention, and future research are discussed.

Effects of lexical intervention on the phonology of late talkers

The purpose of this investigation is to determine whether a focused stimulation intervention focusing on lexical training has indirect, secondary effects on children's phonological abilities. Twenty-five toddlers with expressive vocabulary delays and their mothers were randomly assigned to intervention and control groups. The children were between 23 and 33 months of age at entry into the study and were at the single-word stage of language development. Parents of late talkers in the experimental group were trained to employ frequent, highly concentrated presentations of target words without requiring responses. Two measures of phonological diversity (i.e., syllable structure level and consonant inventory) and one measure of accuracy of production (i.e., percent consonants correct) were measured prior to and following intervention within the context of mother-child interactions. The toddlers who received intervention made treatment gains in two areas of phonological ability. They used a greater variety of complex syllable shapes and expanded their speech sound inventories to include more consonant sounds in both initial and final position. In contrast, there were no effects of language treatment on the accuracy of correct production when compared to the adult phonological system.

The influence of peer models on the play scripts of children with specific language impairment

This investigation included two phases of inquiry that examined the effects of peer modeling upon the play scripts of children with specific language impairment (SLI). The first study employed a pretest-posttest control group design involving two groups of children with SLI (10 who participated in the experimental treatment and 10 controls) and a group of peer models (10 children with normal language development). The treatment involved dyadic play sessions in which children with SLI were paired with a normal language peer model. Significant differences were found between the play script reports of the experimental (SLI-E) and control groups (SLI-C) of children with specific language impairment. The second study, utilizing single-case methodology, involved 6 children with SLI who participated in the control group of Study 1, plus 2 peer models. Play dyads consisted of either two children with SLI or one child with SLI and a normal language peer. Results of this study provided support for the contention that play interactions with normal language peers facilitates increases in the play-script reports of children with SLI.

Two models of grammar facilitation in children with language impairments: phase 2

Fey, Cleave, Long and Hughes (1993) demonstrated the effectiveness of two 5-month interventions for preschoolers with problems in expressive grammar. This article reports the results of an additional 5-month intervention phase for 18 of the original participants. Results indicated that although participants improved during Phase 2, improvements generally were not as strong as those noted for Phase 1. Gains were larger and more consistent for children who received the relatively costly clinician-administered approach than for those who received a less expensive parent-administered intervention. The parent intervention was successful in helping parents to use sentence recasts, and especially so for parents of children at relatively early stages of grammatical development, Finally, children who were dismissed after a highly successful treatment Phase 1 generally exhibited no gains over the no-treatment Phase 2.

Bilingualism and specific language impairment in children attending language units

Bilingual children were found to form a distinct subgroup within a large cohort of children with specific language-impairment (SLI) attending language units across England. They differed from the cohort as a whole, and from a language-matched monolingual 'control' group, on measures including language profile on entry to the unit, performance on standardised tests, emotional-behavioural state and probable future educational placement. This paper sets out the nature of these differences in more detail, and suggests some possible explanations for them.

A comparison of three approaches to delivering a speech and language therapy service to people with learning disabilities

This research aimed to compare three different approaches to delivering a speech and language therapy service to people with learning disabilities, in order to make recommendations for future service delivery. The three approaches all involved working with key communication partners in the environment. They were: (i) working directly on a one-to-one basis with the person and partner; (ii) working indirectly by providing teaching for partners; and (iii) a combination of these two approaches. A teaching course called 'Talkabout' was used. Talkabout aims for staff to reach a recognised level of knowledge and competence in communication skills, thus facilitating the communication skills of their service users. The results indicated that whilst communication changed in all three approaches, overall changes were greater in the combination approach. Only the combination approach demonstrated statistically significant differences following intervention, in terms of staff initiations, service user responses, and their use of additional modalities.

Adults with language-learning disabilities: new challenges and changing perspectives

As children and adolescents mature into adult life, their language-learning disabilities continue. Consequently, the view that language-learning disabilities are limited to the school years must be changed. This article reviews our understanding of adults with language-learning disabilities. Ecological and context-specific perspectives are presented to provide a framework for understanding the chronic and persistent nature of these disabilities across the lifespan. Descriptors of language-learning disorders in adults are provided that focus the clinician on observable behaviors to guide the process of assessment and intervention planning.

Systemic concepts in speech-language treatment

While systemic concepts are well known in many professions, a systemic paradigm is relatively new to most speech-language pathologists. Five systems concepts that apply to current practices in speech-language pathology are described and illustrated. The concepts relate to the influences of context or environment, relationships, family structure, isomorphism, and the attribution of meaning.

Right cerebral hemisphere damage: incidence of language problems

While dysphasia is rare after right cerebral hemisphere damage (RHD), there is now a body of evidence to suggest that language and communication problems can occur. This paper reports the findings of a pilot study that estimated the incidence of non-dysphasic language and communication problems following RHD. Eleven subjects completed language assessments within 2 weeks of onset and again 3 months later. The results show that language impairment can follow a unilateral RHD for 50% of the sample, and that there are marked difficulties for 20%. Furthermore these problems do not resolve spontaneously over a 3 month period. The case for speech and language therapy intervention for this patient group is discussed.

Treatment of attention deficit hyperactivity disorder: a multi-modal model for schools

Treatment of ADHD in schools has received comparatively little attention, even though children spend more time in school than in most other structured environments and have their most consistent, extensive contact with a variety of trained professionals there. Because schools could play a strategic role in treating ADHD children, a multi-modal treatment model for children with ADHD in school settings is presented, and logistic factors likely to increase its effective implementation are reviewed. Then, a functional approach to the assessment and treatment of ADHD that focuses on identifying individual-specific deficiencies and environmental factors that may prevent these children from performing appropriate behavior is discussed.

Attaining, sustaining, and focusing attention: intervention for children with ADHD

An alternative intervention approach for children with ADHD, a "situational-discourse-semantic model," is described. This approach examines the interactions between environmental factors and a student with ADHD and determines the roles of these factors in the establishment of a student's "deficit." Once this is accomplished, selected factors can be manipulated to increase the student's ability to attain the attention needed for academic tasks, to sustain such attention during academic tasks, and then to focus attention on key task elements so that a more effective environment for learning and communication is achieved. The application of the model's principles is illustrated through case study descriptions of therapy interactions with a young boy with ADHD.