Predicted and observed outcomes in preschool children following speech and language treatment: parent and clinician perspectives

"We were the best people to do the job": Caregivers' reported outcomes of a virtual caregiver-delivered program for autistic preschoolers

Background and aims

Caregiver-delivered programs are a recommended best practice to support young autistic children. While research has extensively explored children's outcomes quantitatively, minimal qualitative research has been conducted to understand caregivers' perspectives of program outcomes for themselves and their children. Hearing directly from caregivers is an important step in ensuring these programs are meeting the needs of those who use them. This study explored caregivers' perceived outcomes following one virtual caregiver-delivered program, The Hanen Centre's More Than Words® (MTW) program.

Methods

This study was a secondary analysis of data from individual interviews conducted with 21 caregivers who had recently participated in a virtual MTW program. A hybrid codebook thematic analysis approach was taken to analyze the interview data. Program outcomes were coded and analyzed within the International Classification Functioning, Disability, and Health (ICF) framework. Additionally, caregivers completed an online survey and rated Likert Scale items about perceived program outcomes, which were analyzed descriptively.

Results

Five themes were identified: (1) caregivers learned new strategies to facilitate their child's development, (2) caregivers developed a new mindset, (3) children gained functional communication skills, (4) caregiver-child relationships improved, and (5) caregivers gained a social and professional support network. These themes fell within four of five ICF framework components (activities, participation, personal factors, and environmental factors). No themes were identified under Body Structures and Functions. Survey results indicated most caregivers reported learning new communication strategies (n = 20, 95%), and identifying new teaching opportunities with their child (n = 21, 100%).

Conclusions

Some reported outcomes, related to Activities and Participation, were consistent with previous reports in the literature on the MTW program. In line with previous research, caregivers learned strategies to support their child's communication development. Contrary to previous quantitative studies, caregivers in this study rarely commented on gains in vocabulary and instead focused on gains in skills that positively impacted their child's ability to engage in meaningful social interaction. Novel outcomes were identified within the Participation, Personal Factors, and Environmental Factors components of the ICF framework.

Implications

Caregivers in this study identified important outcomes for themselves and their child that have not been the focus of prior research, suggesting it is important to integrate their perspectives in the development and evaluation of caregiver-delivered programs. Clinicians should include goals that address outcomes identified as important by caregivers, including those that address children's Participation, and those that target caregivers' Personal and Environmental Factors. Developers of caregiver-delivered programs could integrate identified goals to ensure they are meeting families' needs.

Speech-language pathologists' treatment goals for preschool language disorders: An ICF analysis

PURPOSE

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework to conceptualise clinical services. This study explored how speech-language pathologists (SLPs) conceptualised therapy goals for preschoolers with language difficulties and disorders within the ICF framework.

METHOD

An online survey was distributed to SLPs practising in a publicly funded Preschool Speech and Language program in Ontario, Canada. SLPs rated their familiarity with the ICF framework, and then reported all therapy goals for one child with language difficulty/disorder on their caseload. For each reported goal, SLPs indicated the ICF component(s) they felt the goal addressed. Researchers then independently categorised SLPs' reported goals into the ICF components.

RESULT

Ninety-three SLPs completed the survey, and 81% reported they were at least "somewhat" familiar with the ICF framework. On average, SLPs reported three therapy goals per child, and felt the Activities and Participation components were most frequently targeted (73% and 72% of all reported goals, respectively). Researchers categorised SLPs' reported goals differently, and identified 57% of goals addressing the Activities component, and 21% the Participation component.

CONCLUSION

There is a need to better understand how SLPs and researchers conceptualise the ICF framework, particularly the Participation component.

ICF and perception of functioning according to children/adolescents in follow-up with speech/language disorders

PURPOSE

To characterize changes in the functioning aspects, in the perception of children and adolescents with speech and language disorders under speech-language follow-up, using the ICF.

METHODS

Descriptive, analytical and longitudinal research, with a qualitative and quantitative approach, whose sample consisted of 60 children and adolescents: 30 with speech and language disorders and 30 with typical speech and language development. Data collection was carried out in two moments: beginning of the research and six months later. A semi-structured questionnaire was administered to the participants, and a medical records analysis was performed. From these data, functioning was classified using he ICF categories. The Wilcoxon test and thematic content analysis were used to compare the interviews.

RESULTS

The use of ICF allowed characterizing changes resulting from speech-language follow-up. Participants with speech and language disorders presented a decrease in the magnitude of the qualifiers in the categories: articulation and fluency, social relationships, daily activities, engagement in play, people's attitude barriers, and how to handle stress.

CONCLUSION

The findings show changes in components of Body Functions, Activities and Participation, and the influence of Environmental Factors after speech-language follow-up, in the perception of the studied group, which brings relevant subsidies for a greater understanding of functioning and therapeutic intervention. The use of the ICF enabled the longitudinal analysis in a biopsychosocial approach, contemplating, in addition to biological aspects, the social impact of speech and language disorders in the lives of these children and adolescents.

Activities and participation of children with language disorders in outpatient care according to the ICF

PURPOSE

To identify the main categories of the Activities and Participation component of the International Classification of Functioning, Disability, and Health and to verify the association with age, gender, education, and speech therapy diagnosis in children who are assisted by an oral language clinic.

METHODS

This is an analytical and cross-sectional observational study, carried out with secondary data from 32 medical records of children with the majority male, mean age of 41.03 months, in early childhood education and language disorder associated with other conditions. The main speech-language pathology manifestations were coded according to the pre-selected categories of the Activities and Participation component, and descriptive and bivariate statistical analyzes were performed, and the Fisher's Exact test was used with a significance level of 5%.

RESULTS

The descriptive analysis of the pre-selected categories allowed us to verify a high number of "Not informed" answers, with a higher percentage in vocal expression without speech (d331) performance (93.8%), making decisions (d177) ability (90.6%), problem solving (d175) performance (65.6%) and capacity (87.5%), reception of oral messages (d310) performance (65.6%) and eating (d550) capacity (65.6%). Among the 24 categories selected, 12 jointly contemplated the Qualifiers of Performance and Capacity. There was a statistically significant association between the three categories with sociodemographic data and speech therapy diagnoses.

CONCLUSION

Difficulties were identified in several categories of the Activities and Participation component and statistically significant associations between them and sociodemographic data and speech therapy diagnoses, showing the impacts of oral language disorders on the activities and participation of children assisted in an outpatient speech therapy service.

Language gains in 4-6-year-old children with developmental language disorder and the relation with language profile, severity, multilingualism and non-verbal cognition

BACKGROUND

Early and effective treatment for children with developmental language disorder (DLD) is important. Although a growing body of research shows the effects of interventions at the group level, clinicians observe large individual differences in language growth, and differences in outcomes across language domains. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking.

AIMS

To assess changes in the language domains: expressive morphosyntax; receptive and expressive vocabulary; and comprehension, in children in special needs education for DLD. To explore if differences in language gains between children are related to child characteristics: language profile; severity of the disorder; being raised mono- or multilingually; and cognitive ability.

METHODS & PROCEDURES

We extracted data from school records of 154 children (4-6 years old) in special needs education offering a language and communication-stimulating educational environment, including speech and language therapy. Changes in language were measured by comparing the scores on standardized language tests at the beginning and the end of a school year. Next, we related language change to language profile (receptive-expressive versus expressive-only disorders), severity (initial scores), growing up mono- and multilingually, and children's reported non-verbal IQ scores.

OUTCOMES & RESULTS

Overall, the children showed significant improvements in expressive morphosyntax, expressive vocabulary and language comprehension. Baseline scores and gains were lowest for expressive morphosyntax. Differences in language gains between children with receptive-expressive disorders and expressive-only disorders were not significant. There was more improvement in children with lower initial scores. There were no differences between mono- and multilingual children, except for expressive vocabulary. There was no evidence of a relation between non-verbal IQ scores and language growth.

CONCLUSIONS & IMPLICATIONS

Children with DLD in special needs education showed gains in language performance during one school year. There was, however, little change in morphosyntactic scores, which supports previous studies concluding that poor morphosyntax is a persistent characteristic of DLD. Our results indicate that it is important to include all children with DLD in intervention: children with receptive-expressive and expressive disorders; mono- and multilingual children, and children with high, average and low non-verbal IQ scores. We did not find negative relations between these child factors and changes in language skills.

WHAT THIS PAPER ADDS

What is already known on the subject Intervention studies indicate that intervention can be effective, but not for all children with DLD, and not in all language domains. Longitudinal studies on language development show stable growth patterns in children with DLD at the group level. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking. What this paper adds to existing knowledge In this study, we report on the language gains of a cohort of 154 children with DLD (4-6 years old), in a special education setting for children with language disorders. Our sample includes children with receptive-expressive disorders and expressive-only disorders, and monolingual as well as multilingual children. Our results show that children's language skills improved. The co-normed tests we used revealed that the children had much lower growth in morphosyntax than in the other language domains. Language gains between children with receptive-expressive and expressive-only language disorders did not differ, children with lower initial test scores showed more improvement than children with higher initial scores, multilingual children showed more gains in expressive vocabulary than monolingual children, and there was no effect of non-verbal IQ on change in language scores. What are the potential or actual clinical implications of this work? The results suggest that catching up on language is possible for children with DLD. It is important to include all children with DLD in intervention: mono- and multilingual children; children with receptive-expressive and expressive disorders; and children with high, average and low non-verbal IQ scores. We did not find negative relations between these child factors and changes in language skills. The limited growth in morphosyntax compared with other linguistic areas warrants the attention of both practitioners and researchers, with a particular focus on the implementation of research findings in clinical practice.

Characterizing Communicative Participation in Multilingual Jamaican Preschoolers

PURPOSE

This study characterized communicative participation and related aspects of functional communication for Jamaican Creole (JC)-English-speaking preschoolers with and without functionally defined speech sound disorders (fSSDs). This study included parent reports and direct assessment measures from an existing corpus of baseline data collected prior to the COVID-19 pandemic.

METHOD

The communicative participation of typically developing (TD; n = 226) bilingual JC-English-speaking preschoolers and those with fSSDs (n = 39) was documented using the Focus on the Outcomes of Communication Under Six (FOCUS). Functional speech intelligibility was recorded using the Intelligibility in Context Scale (ICS) in English and JC (ICS-JC). Objective measures of speech production were collected through direct child assessment in both languages and then transcribed and calculated for percent of consonants (PCC), vowels (PVC), and phonemes correct (PPC). Within-group relationships were explored using association testing, and differences between groups were explored through multivariate analyses.

RESULTS

FOCUS scores and ICS and ICS-JC scores were found to be minimally to moderately related for Jamaican preschoolers in the TD group (r = .28-.34, p < .002) and strongly related in the fSSD group (r = .56-.60, p < .002). No relations were observed between the FOCUS scores and PCC/PVC/PPC in either language. There was a statistically significant difference between all FOCUS scores for Jamaican preschoolers in the TD and fSSD groups (p ≤ .002).

CONCLUSIONS

These findings provide additional evidence for using the FOCUS beyond documenting change in communicative participation to support clinical decision-making in planning and developing speech-language interventions. This study also documents an important characterization of JC-English-speaking children with and without fSSDs, offering data on children's abilities that can be used in future comparisons of communicative participation and speech functioning observed during the COVID-19 pandemic and beyond.

A temporal-based therapy for children with inconsistent phonological disorder: A case-series

Deficits in temporal auditory processing, and in particular higher gap detection thresholds have been reported in children with inconsistent phonological disorder (IPD). Here we hypothesized that providing these children with extra time for phoneme identification may in turn enhance their phonological planning abilities for production, and accordingly improve not only consistency but also accuracy of their speech. We designed and tested a new temporal-based therapy, inspired by Core Vocabulary Therapy and called it T-CVT, where we digitally lengthened formant transitions between phonemes of words used for therapy. This allowed to target both temporal auditory processing and word phonological planning. Four preschool Persian native children with IPD received T-CVT for eight weeks. We measured changes in speech consistency (% inconsistency) and accuracy (percentage of consonants correct PCC) to assess the effects of the intervention. Therapy significantly improved both consistency and accuracy of word production in the four children: % inconsistency decreased from 59% on average before therapy to 2% post-T-CVT, and PCC increased from 61% to 92% on average. Consistency and accuracy were furthermore maintained or even still improved at three-month follow-up (2% inconsistency and 99% PCC). Results in a nonword repetition task showed the generalization of these effects to non-treated material: % inconsistency for nonwords decreased from 67% to 10% post-therapy, and PCC increased from 63% to 90%. These preliminary findings support the efficacy of the T-CVT intervention for children with IPD who show temporal auditory processing deficits as reflected by higher gap detection thresholds.

Optimizing Outcomes for Children With Phonological Impairment: A Systematic Search and Review of Outcome and Experience Measures Reported in Intervention Research

PURPOSE

Reporting of outcome and experience measures is critical to our understanding of the effect of intervention for speech sound disorders (SSD) in children. There is currently no agreed-upon set of measures for reporting intervention outcomes and experiences. In this article, we introduce the Speech Outcome Reporting Taxonomy (SORT), a tool designed to assist with the classification of outcome and experience measures. In a systematic search and review using the SORT, we explore the type and frequency of these measures reported in intervention research addressing phonological impairment in children. Given the integral relationship between intervention fidelity and intervention outcomes, reporting of fidelity is also examined.

METHOD

Five literature databases were searched to identify articles written or translated into English published between 1975 and 2020. Using the SORT, outcome and experience measures were extracted and categorized. The number of intervention studies reporting fidelity was determined.

RESULTS

A total of 220 articles met inclusion criteria. The most frequently reported outcome domain was broad generalization measures (n = 142, 64.5%), followed by specific measures of generalization of an intervention target (n = 133, 60.5%). Eleven (5.0%) articles reported measures of the impact of the phonological impairment on children's activity, participation, quality of life, or others. Twenty articles (9.1%) reported on parent, child, or clinician experience or child engagement. Fidelity data were reported for 13.4% of studies of interventions.

CONCLUSIONS

The measurement of intervention outcomes is challenging yet important. No single type of measure was reported across all articles. Through using tailored measures closely related to intervention targets in combination with a universal set of measures of intelligibility, the impact of phonological impairment on children's lives, and the experience of receiving and providing intervention, researchers and clinicians could work together to progress insights and innovations in science and practice for children with SSD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19497803.

Consensus on Terminology for Describing Child Language Interventions: A Delphi Study

Purpose Language intervention for children with language disorder may be effective; however, lack of detailed and consistent terminology for describing language interventions poses barriers for advancement within the field. This study aimed to develop consensus from speech-language pathologists (SLPs) in Australia on a taxonomy with terminology for describing language interventions for school-aged children and investigate SLPs' application of taxonomy terminology when describing child language interventions. Method A taxonomy with terms for describing interventions was developed with reference to contemporary literature and presented to clinicians and researchers with expertise in child language disorders in a three-round Delphi study. We asked Delphi participants to indicate agreement with the taxonomy or propose changes. Application of the taxonomy was investigated by asking participants to use taxonomy terminology to describe interventions presented in two case studies. Results The taxonomy consists of five aspects across which interventions may be described: modality/domain, purpose, delivery, form, and teaching techniques. Consensus on the taxonomy was established in both Round 1 (55 participants) and Round 2 (43 participants), with 100% of SLPs strongly agreeing or agreeing with the overall structure of the taxonomy and at least 87.3% of SLPs strongly agreeing or agreeing with each aspect. In Round 3 (32 participants), consensus was reached on 45/54 taxonomy categories (4/12 of the components) for Case Study 1 and 45/54 taxonomy categories (7/12 of the components) for Case Study 2. Conclusions Consensus on a taxonomy with terminology for describing language interventions represents a significant advancement in the field of child language intervention. Future actions may be needed to facilitate consistent application of taxonomy terms. Supplemental Material https://doi.org/10.23641/asha.16435290.

Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS): A Single-Case Experimental Design Study

Purpose A subset of children with autism spectrum disorder (ASD) has speech sound disorders, including childhood apraxia of speech (CAS). To date, virtually all speech treatment studies consider ASD an exclusionary criterion, resulting in little scientific evidence for treatment of CAS for children who also have ASD. This study proposes and tests a novel approach, Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS), as a theoretically and clinically informed speech treatment option for this population. Method Using a multiple-baseline design within and across participants, three children with co-occurring ASD and CAS received 11-18 treatment sessions. Treatment targets were individually designed and matched with untreated control words. Probes were administered at the start of each session to assess speech production accuracy perceptually. Changes in production accuracy were examined through visual inspection and quantified with effect sizes. Results Findings were mixed, with one child showing significant gains for half of the treated targets at follow-up and two children showing no clear improvement. Conclusions Preliminary evidence suggests potentially positive treatment effects for ACT4CAS when implemented as intended, although treatment intensity and disorder severity likely influence treatment outcome. Replication and comparison of ACT4CAS to other speech treatments is needed. Supplemental Material https://doi.org/10.23641/asha.14110445.

Strengths and challenges of the COSMIN tools in outcome measures appraisal: A case example for speech-language therapy

BACKGROUND

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) is an international initiative that offers standardized and validated tools to guide the appraisal of patient-reported outcome measures in healthcare.

AIMS

To explore the use of a new set of tools from the COSMIN to appraise studies on one outcome measure available to speech and language therapists (SLTs).

METHODS & PROCEDURES

We used the COSMIN tools to appraise seven studies and a user manual that reported the measurement properties of the Focus on the Outcomes of Children Under Six (FOCUS), a validated measure of pre-schoolers' communicative participation that is used in various contexts around the world.

OUTCOMES & RESULTS

Using COSMIN guidelines, the FOCUS was categorized as a 'category A' tool because there was a sufficient level of evidence to support its content validity and internal consistency. According to the COSMIN guidelines, this means that the FOCUS can be recommended for use. The quality of evidence supporting measurement properties of the FOCUS received a rating of 'moderate', meaning users can have moderate confidence in its measurement properties. Since these ratings from the COSMIN tools may be unclear to users of the FOCUS, we have provided more specific recommendations.

CONCLUSIONS & IMPLICATIONS

The COSMIN tools offer detailed standards to support the appraisal of outcome measures available to SLTs. However, several limitations were observed, and recommendations to support the application of the COSMIN tools are provided. What this paper adds What is already known on the subject Collecting outcome data is essential to ensure speech and language therapy is effective. Until the development of COSMIN there was a lack of standards in the way the measurement properties of outcome measure instruments were appraised. What this paper adds to existing knowledge This paper used the FOCUS, a measure of pre-schoolers' communicative participation outcomes in speech and language therapy, as a case example to illustrate the applications of the COSMIN tools. In doing so, the strengths and limitations of the current COSMIN tools in appraising the quality of outcome measure instruments are emphasized. What are the potential or actual clinical implications of this work? The COSMIN tools offer a step-by-step, standardized approach to appraise various measurement properties in outcome instruments. Due to existing limitations of the COSMIN tools, appraisal should provide clear and specific recommendations so users of outcome measures (e.g., SLTs, researchers) can identify the appropriate uses of each instrument.

A Comparative Study of the Communication Profile of Typically Developing Children and Children with Receptive-Expressive Language Disorders: A Parental Perceptive

Background:

Parental concerns pertaining to communication abilities are essential as it does aid in the identification of the children at risk of physical and mental health problems.

Objectives:

The current study followed a cross sectional study design. The study focussed on developing a questionnaire targeting the parental concerns in Typically developing (TD) children and children with Receptive-Expressive Language Disorders (CWRELD) between 3.7 and 6.6 years of age; to administer the developed questionnaire on parents of TD children and CWRELD; and to analyse and compare the concerns faced by parents of TD children and CWRELD across 3.7 and 6.6 years of age.

Methods:

Fifty-one parents of TD children and 51 parents of CWRELD participated in the study. The study was carried out in three phases- Phase I included the development and validation of questionnaire; Phase II included data collection using the developed questionnaire; and Phase III included performing statistical analysis. Descriptive statistics was done to determine the mean and standard deviation (SD) for both the TD and CWRELD groups.

Results:

The results revealed that the concerns exhibited by parents of CWRELD were significantly higher than that of parents of TD children. Chi square results indicated statistically significant findings across all the domains between TD children and CWRELD (p<0.05).

Conclusion:

The developed questionnaire can be used in clinical settings to help track parental concerns which may aid in the early identification of children at risk of various communication disorders. Additionally, this questionnaire may be considered for monitoring parental concerns throughout the course of the intervention program.

Validity of a streamlined version of the Focus on the Outcomes of Communication Under Six: Process and outcome

BACKGROUND

The Focus on the Outcomes of Communication Under Six (FOCUS) is a 50-item outcome measure based on the framework and concepts of World Health Organization's International Classification of Functioning. The FOCUS has been shown to capture participation-level changes associated with speech and language therapy in children 18 to 72 months old and has established validity and reliability. However, there were reasons to try to reduce the measure without losing any of its proven value as a change-detecting instrument.

METHODS

Using data from 18,931 preschool children, we used item response models and a test of redundancy to reduce the original 50-item FOCUS to 34 items. We then assessed the correlations between FOCUS-50 and FOCUS-34 scores on these children.

RESULTS

Findings show that a shortened (34-item) version of FOCUS can be treated as equivalent to the full 50-item version.

CONCLUSION

The correlation between change scores on the two versions is .98. We suggest that in situations where only a total score is of interest, the FOCUS-34 can be used in place of the full FOCUS.

Use of the International Classification of Functioning, Disability and Health in Speech-Language-Hearing Therapy: an integrative literature review

ABSTRACT Purpose: to carry out an integrative review of literature regarding the use of the ICF in Speech-Language-Hearing Therapy. Methods: a search was conducted on both national and international databases, for articles published between 2008 and 2018, considering the following descriptors in Portuguese, English and Spanish: “International Classification of Functioning, Disability and Health”, “Speech-Language-Hearing”, and “Speech Therapy”. Duplicated articles, as well as those introducing new ICF-based protocols and studies whose theme didn’t refer exclusively to speech-language-hearing practices were excluded. Results: 36 articles were found, 9 of which met the inclusion criteria. The articles were categorized according to speech-language-hearing subareas (most belonging to the subarea of language), and to types of study (most being case studies). Conclusion: studies point out that the ICF can contribute to the development of unique therapy projects in a broader approach to health in the speech-language-hearing clinic. However, it has been perceived the need for more researches on the theme with applicability to the other fields of knowledge in speech-language-hearing sciences.

Parental experiences and perceptions related to childhood apraxia of speech: Focus on functional implications

PURPOSE

The purpose of this study was to examine the functional implications of childhood apraxia of speech (CAS) as experienced by children and their parents.

METHOD

Using a mixed qualitative/quantitative design, 40 parents responded to two Likert-scale questionnaires and four phenomenological questions about their personal experiences and their perceptions of their children's (ages 3-16 years) experiences of living with CAS.

RESULT

Quantitative data indicated that although parents reported concern about their children's speech production as expected, they also expressed that CAS affected their children's every day activities and social interactions. Four key themes emerged from the parents' qualitative responses (1) concerns about their children's intelligibility, (2) challenges with peer relationships, (3) reliance on parent to be the child's "voice" and (4) emotional responses such as frustration.

CONCLUSION

Parents' perceptions of the functional implications of CAS focussed on their children's peer interactions, their own need to be the voice for their children, and the broader functional impact of CAS on their children in daily activities. These functional implications of CAS may play a role in supporting the clinical management of those with CAS by implementing peer-related activities, functional social situations and parent education/support during intervention.

Quality of life in children with developmental language disorder

BACKGROUND

Developmental language disorder (DLD) is common in children, but little is known about its association with quality of life (QoL) in middle childhood. QoL is a complex construct, aligning with an individual's sense of well-being and is related to functional limitations associated with DLD. Biopsychosocial models of disability account for both the extent and functional limitations of the impairment; however, the DLD literature rarely reports on both aspects. Studies are required that detail QoL in children with and without DLD.

AIMS

To investigate the association between DLD, identified at 4 years and persisting at 7 years, and QoL over 4, 7 and 9 years; to compare QoL for children whose DLD was mild to moderate and severe at 7 years; and to investigate how variables known to impact on language development (e.g., maternal vocabulary), as well as social-emotional behaviours at 4 and 7 years contribute to QoL at 9 years.

METHODS & PROCEDURES

The analyses included 872 children who participated in the 4-, 7- and 9-year data collection of the Early Language in Victoria Study (ELVS). We compared the parent-reported QoL profiles at 4, 7 and 9 years for children with and without DLD, and those with mild to moderate and severe DLD using the Pediatric Quality of Life Inventory (PedsQL). We conducted regression analyses to estimate how child, family and environmental factors predicted QoL at 9 years, including social-emotional behaviours measured using the Strengths & Difficulties Questionnaire (SDQ) at 4 and 7 years.

OUTCOME & RESULTS

Children with DLD (n = 70) had lower parent-reported QoL at 9 years than typically developing children (n = 802), with mean scores of 74.9 and 83.9 respectively. There was no evidence of differences in QoL between those with severe (n = 14) or mild to moderate (n = 56) DLD. In contrast to their peers, children with DLD had a profile of declining QoL between 4 and 9 years. For all children, language skills at 7 years predicted QoL at 9 years. For children with DLD, emotional symptoms and peer problems at 4 years plus SDQ Total Difficulties at 7 years were predictive of lower QoL at 9 years.

CONCLUSIONS & IMPLICATIONS

Children with DLD had a lower QoL than their typical peers at 9 years and, contrary to previous studies, differences in QoL were not observed with DLD severity. Co-occurring social-emotional problems appear to play an important role in contributing to the lower QoL experienced by children with DLD. Consideration of associated functional limitations is required to support the communication and social development of all young children with DLD.

Factors Contributing to Preschoolers' Communicative Participation Outcomes: Findings From a Population-Based Longitudinal Cohort Study in Ontario, Canada

PURPOSE

The aim of this study was to identify predictors of communicative participation outcomes for a large cohort of preschoolers with speech and language impairments.

METHOD

A secondary analysis of longitudinal program evaluation data from Ontario, Canada's Preschool Speech and Language Program was done. Data available for 46,872 children 18-67 months of age (M = 41.76 months, SD = 11.92; 68% boys, 32% girls) were previously used to predict children's communicative participation skill development in 5 levels of function. Demographic and intervention-based variables were added to the models to identify new predictors of growth.

RESULTS

Three demographic and 3 intervention-based variables were statistically significant predictors of children's communicative participation outcomes. Clinically significant predictors included participation in an early learning environment, receipt of speech-language interventions, and the amount of time spent in intervention. These variables impacted predicted outcomes differently, depending on a child's level of communicative function.

CONCLUSIONS

This population-based study of preschoolers with speech and language impairments identified predictors of growth in communicative participation skills-an outcome important and meaningful to families but not often explored. A broad picture emerged of factors that may influence the development of communicative participation skills and may be used to predict outcomes for preschoolers. Given the large sample size, these robust findings may be used to predict outcomes outside the Preschool Speech and Language Program as well.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6024422.

Developmental Trajectory of Language From 2 to 13 Years in Children Born Very Preterm

OBJECTIVES

The objective of this study was to describe language functioning at 13 years of age and examine its developmental trajectory from 2 to 13 years of age in children born very preterm (VP) compared with term controls.

METHODS

Two hundred and twenty-four children born VP (<30 weeks' gestation) and 77 term controls had language skills assessed by using performance-based and/or parent-report measures at 2, 5, 7, and 13 years of age. Regression models were used to compare verbal memory, grammar, semantics, and pragmatic skills between the VP and term groups at 13 years of age. Linear mixed effects regression models were used to assess language trajectories from 2 to 13 years of age.

RESULTS

Compared with term controls, children born VP had poorer functioning across all components of language (mean group differences ranged from -0.5 SD to -1 SD; all P < .05) at 13 years of age. At each follow-up age, the VP group displayed poorer language functioning than the term controls, with the groups exhibiting similar developmental trajectories (slope difference = -0.01 SD per year; P = .55).

CONCLUSIONS

Children born VP continue to display language difficulties compared with term controls at 13 years of age, with no evidence of developmental "catch-up." Given the functional implications associated with language deficits, early language-based interventions should be considered for children born VP.

Using the International Classification of Functioning, Disability and Health Framework to Achieve Interprofessional Functional Outcomes for Young Children: A Speech-Language Pathology Perspective

The International Classification of Functioning, Disability and Health (ICF) framework is an excellent tool to facilitate the writing of functional goals for children who exhibit communication disorders and other developmental problems that require services from professionals in multiple therapeutic areas. The holistic view of children provides each professional with an approach that integrates how one's specific health conditions and contextual factors influence a child's functioning and participation in daily activities. This allows the interprofessional team to view the child as a person, recognizing how one need influences another within his or her environment.

The human right to communicate and our need to listen: Learning from people with a history of childhood communication disorder

PURPOSE

In 2013, the Australian Government Senate formed a committee for inquiry and report into the prevalence of speech, language, and communication disorders and speech pathology services in Australia. Submissions were sought from individuals and organisations. In this paper, submissions made by individuals with a history of childhood communication disorder were examined to explore their life experiences and the impact on their lives when the right to communicate could not be enacted.

METHOD

There were 305 submissions to the Australian Government Senate Committee Inquiry, of which 288 were publically accessible. In this study, the submissions (n = 17) from children or adults with a history of communication disorder (including speech, language and stuttering), who provided personal accounts of their experiences, were analysed using an interpretative phenomenological approach.

RESULT

Four themes emerged relating to: personal identity, life with communication disorder, the importance of help, and how life would be different without a communication disorder.

CONCLUSIONS

This paper gives voice to children and adults with communication disorder. In listening to these voices, the impact of communication disorder on the right to communicate and on other human rights can be heard, and the need for a response is clear. However, the challenge is to determine how the voices of these individuals, and others like them, can be enabled to exert real influence on practice and policy so communication disorder will no longer be a barrier to attainment of their human rights.

Families' perception of children / adolescents with language impairment through the International Classification of Functioning, Disability, and Health (ICF-CY)

Purpose

To investigate the perception of family members regarding linguistic conditions and social participation of children and adolescents with speech and language impairments using the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY).

Methods

Quali-quantitative approach research, in which a survey of medical records of 24 children/adolescents undergoing speech-language therapy and interviews with their family members was conducted. A descriptive analysis of the participants' profiles was performed, followed by a categorization of responses using the ICF-CY.

Results

All family members mentioned various aspects of speech/language categorized by the ICF-CY. Initially, they approached it as an organic issue, categorized under the component of Body Functions and Structures. Most reported different repercussions of the speech-language impairments on the domains, such as dealing with stress and speaking, qualified from mild to severe. Participants reported Environmental Factors categorized as facilitators in the immediate family's attitudes and as barriers in the social attitudes.

Conclusion

These findings, according to the use of the ICF-CY, demonstrate that the children/adolescents' speech-language impairments, from the families' perception, are primarily understood in the body dimension. However, guided by a broader approach to health, the findings in the Activities and Participation and Environmental Factors demonstrate a broader understanding of the participants of the speech-language impairments. The results corroborate the importance of using the ICF-CY as a health care analysis tool, by incorporating functionality and participation aspects and providing subsidies for the construction of unique therapeutic projects in a broader approach to the health of the group studied.

Validity of the Communication Function Classification System for use with preschool children with communication disorders

AIM

To evaluate construct and predictive validity of the Communication Function Classification System (CFCS) for use with preschool children with a range of speech and language disorders.

METHOD

Seventy-seven preschool children with speech and language disorders (50 males, 27 females; mean 2y 7mo, standard deviation [SD] 1y) participated in this cohort study. Preschool children had speech and language, language-only, or speech-only disorders. Together with parent input, speech-language pathologists (SLPs) completed the CFCS at time 1. Parents and SLPs then independently completed a validated change-detecting functional communication outcome measure, the Focus on the outcomes of Communication Under Six (FOCUS), three times: at assessment (time 1), at the start of treatment (time 2), and at the end of treatment (time 3).

RESULTS

There was a significant negative correlation between CFCS classifications and FOCUS scores at all three measurement points for the ratings by both parents and SLPs (correlations ranged from -0.60 to -0.76). As expected, no correlations between CFCS classifications and FOCUS change scores were statistically significant.

INTERPRETATION

This study provides evidence of construct and predictive validity of the CFCS, demonstrating its value as a discriminative tool for use with preschool children with a range of speech and language disorders.

Current Methods of Evaluating Speech-Language Outcomes for Preschoolers With Communication Disorders: A Scoping Review Using the ICF-CY

PURPOSE

The purpose of this scoping review was to identify current measures used to evaluate speech-language outcomes for preschoolers with communication disorders within the framework of the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY; World Health Organization, 2007).

METHOD

The review involved 5 phases outlined by Arksey and O'Malley (2005) and further developed by Levac, Colquhoun, and O'Brien (2010): (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results. The ICF-CY was used to frame the measures included.

RESULTS

A total of 214 relevant peer-reviewed publications were included in the review. Most publications used measures to evaluate changes in outcomes for Activities (65%), followed by measures evaluating changes in Body Functions (20%), and finally measures evaluating changes at the level of Participation (15%). There has been a slight increase in the evaluation of Participation-based outcomes in the past 4 years (2012-2015).

CONCLUSION

The review revealed a dearth of measures in the pediatric speech-language literature that address Participation-based outcomes. The authors strongly advocate for the use of Participation-based outcome measures to detect meaningful change in the lives of children and families.

Klassifikation von Sprachentwicklungsstörungen

Zusammenfassung. Sprache ist ein wichtiger Bestandteil unserer Kultur und ermöglicht den Austausch von Gedanken und Gefühlen sowie die Aneignung von Wissen. Defizite in den sprachlichen Fähigkeiten können sich auf verschiedenen linguistischen Ebenen äußern, was in der Diagnostik von Sprachentwicklungsstörungen berücksichtigt werden sollte. Es folgt ein Überblick zur Symptomatik und zur Untergliederung von Sprachentwicklungsstörungen in den psychiatrischen Klassifikationssystemen DSM-5 und ICD-10. Zusätzlich wird ein Ausblick auf die ICD-11 (Beta-Entwurf) gegeben. Die diagnostischen Klassifikationssysteme werden der Interdisziplinären S2k-Leitlinie gegenübergestellt. Keines der dargestellten Systeme berücksichtigt die einzelnen linguistischen Ebenen der Sprache, wie es in der S2k-Leitlinie gefordert wird. Zudem bestehen deutliche Unterschiede in den Diagnosekriterien. In der Praxis führt dies zu erheblichen Schwierigkeiten in der differenzierten Erfassung von Sprachdefiziten. Die zuverlässige Abklärung einer Sprachentwicklungsstörung erfordert eine umfassende berufsübergreifende Diagnostik. Dafür ist eine eindeutige interdisziplinäre Klassifikation notwendig.

Konstruktion eines Sprachstandserhebungsverfahrens für Kinder im Alter zwischen 3 und 5 Jahren

Zusammenfassung. Umschriebene Entwicklungsstörungen des Sprechens und der Sprache gehören zu den häufigsten Entwicklungsstörungen und beeinträchtigen die psychosoziale, kognitive und schulische Entwicklung eines Kindes. Insbesondere im Vorschulalter gewinnt die Diagnostik sprachlicher Kompetenzen zunehmend an Bedeutung. Die Anforderungen an eine valide Diagnostik gestalten sich vor dem Hintergrund der Heterogenität der Symptomatik und der Abhängigkeit vom Alter der Kinder entsprechend komplex. Vor diesem Hintergrund wurde der Sprachstandserhebungstest für Kinder im Alter zwischen 3 und 5 Jahren (SET 3 – 5) entwickelt, der eine umfassende Beurteilung sprachlicher Kompetenzen ermöglicht. Es werden die Ergebnisse der Konstruktionsstichprobe des Verfahrens berichtet. Hierfür wurden 316 Kinder im Alter von 3;0 bis 5;11 Jahren mit dem SET 3 – 5 überprüft. Die Aufgabenanalyse zeigt gute Itemschwierigkeiten und Itemtrennschärfen im mittleren bis hohen Bereich. Die internen Konsistenzen (Cronbachs Alpha) sind ebenfalls als zufriedenstellend bis gut zu bewerten.

Communicative participation changes in pre-school children receiving augmentative and alternative communication intervention

PURPOSE

This paper reports changes in communicative participation skills-systematically measured and described-in an empirical observational case series of eight children receiving augmentative and alternative communication (AAC) interventions.

METHOD

The eight children (seven boys, one girl), ranging from 1 year 4 months to 4 years 11 months (mean = 2.8 years; SD = 1.32 years) received varied AAC interventions (i.e. sign language, assistive technology, PECS), averaging 15 hours of treatment over a 12-month period. Parents completed an outcome measure (FOCUS) three times: at the start, mid-point (6 months) and end of the intervention period (after 12 months). They also completed the ASQ-SE at the start and end of intervention.

RESULT

FOCUS scores increased over the treatment interval, indicating improvement in real-world communication skills as observed by their parents. The ASQ-SE items that pertained to communication also improved, while the items that did not correspond to communication did not. This divergence suggests that the communicative participation improvements resulted from treatment rather than general developmental gains. The largest improvements were noted in receptive language/listening, pragmatics and social/play skills. Improvements in intelligibility were also measured for several children.

CONCLUSION

These results suggest that AAC intervention facilitated improvements in communicative participation skills in pre-school children.

Life habits of school-aged children with specific language impairment as perceived by their parents and by school professionals

PURPOSE

Describe social participation of a group of children with specific language impairment.

METHOD

26 parents of children with specific language impairment (SLI) aged from 5 to 13 years and 11 school professionals participated in the study. Data collection was performed with the adapted version for children aged from 5 to 13 years old of the Assessment of Life Habits (Fougeyrollas et al., 2001). The questionnaire encompasses 196 life habits, grouped in 12 dimensions: nutrition, fitness, personal care, communication, housing, mobility, responsibilities, interpersonal relationships, community life, education, work and recreation (Fougeyrollas, 2010).

RESULTS

According to their parents and school professionals, children in this study carried out without difficulty life habits related to housing and mobility. However, they experienced difficulty with life habits related to interpersonal relationships, recreation and responsibilities, in addition to communication and education.

CONCLUSIONS

Children with SLI are perceived by their parents and school professionals as having reduced social participation in many aspects of their daily life. Social participation should be considered as a major outcome when offering services in school to these children. This study proposes specific ways to help children with SLI.

A Bioecological framework to evaluate communicative participation outcomes for preschoolers receiving speech-language therapy interventions in Ontario, Canada

BACKGROUND

The Preschool Speech and Language Program (PSLP) in Ontario, Canada, is a publically funded intervention service for children from birth to 5 years with communication disorders. It has begun a population-level programme evaluation of children's communicative participation outcomes following therapy. Data are currently being collected for all children who access this service--over 50,000 children each year.

AIMS

To understand and evaluate how therapeutic interventions in speech-language therapy impact the everyday lives of children and families by applying a theoretical framework.

MAIN CONTRIBUTION

This discussion paper critically examines how the Bioecological Model of Development can be applied to the study of communicative participation outcomes following speech and language therapy. This model will be used in future analyses of communicative participation outcomes data in Ontario's PSLP. The strengths and challenges of this approach are reviewed.

Impact of occupational, physical, and speech and language therapy in preschoolers with hyperactive/inattentive symptoms: A naturalistic 2-year follow-up study

OBJECTIVE

Impact of speech and language therapy (ST) and occupational/physical therapy (OT/PT) on language and motor skills was examined in hyperactive/inattentive children.

METHODS

Preschoolers were divided into those receiving and not receiving ST or OT/PT.

RESULTS

Children receiving ST showed no gains in language functioning relative to those not receiving ST. OT/PT yielded similar results for motor functions. Hours of a service did not predict improvement. However, children who received ST showed improvement in social skills.

DISCUSSION

The apparent lack of benefit suggests the need for further investigation into efficacy of these treatments in hyperactive/inattentive preschool children.

Construct validity of the FOCUS© (Focus on the Outcomes of Communication Under Six): a communicative participation outcome measure for preschool children

OBJECTIVE

The aim of this study was to establish the construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS©). This measure is reflective of concepts in the International Classification of Functioning Disability and Health--Children and Youth framework. It was developed to capture 'real-world' changes (e.g. communicative participation) in preschoolers' communication following speech-language intervention.

METHOD

A pre-post design was used. Fifty-two parents of 3- to 6-year-old preschoolers attending speech-language therapy were included as participants. Speech-language therapists provided individual and/or group intervention to preschoolers. Intervention targeted: articulation/phonology, voice/resonance, expressive/receptive language, play, and use of augmentative devices. Construct validity for communicative participation was assessed using pre-intervention and post-intervention parent interviews using the FOCUS© and the communication and socialization domains of the Vineland Adaptive Behavior Scales-II (VABS-II).

RESULTS

Significant associations were found between the FOCUS©, measuring communicative participation, and the VABS-II domains for: (i) pre-intervention scores in communication (r = 0.53, P < 0.001; 95% CI 0.30-0.70) and socialization (r = 0.67, P < 0.001; 95% CI 0.48-0.80); (ii) change scores over-time in communication (r = 0.45, P < 0.001; 95% CI 0.201-0.65) and socialization (r = 0.39, P = 0.002; 95% CI 0.13-0.60); and (iii) scores at post-intervention for communication (r = 0.53, P < 0.001; 95% CI 0.30-0.70) and for socialization (r = 0.37, P = 0.003; 95% CI 0.11-0.50).

CONCLUSIONS

The study provided evidence on construct validity of the FOCUS© for evaluating real-world changes in communication. We believe that the FOCUS© is a useful measure of communicative participation.

Measuring communicative participation using the FOCUS©: Focus on the Outcomes of Communication Under Six

BACKGROUND

The FOCUS© is a new outcome tool for use by both parents and clinicians that measures changes in the communicative participation skills of preschool children. Changes in communicative participation skills as measured by the FOCUS were compared across three groups of children: those with speech impairments only (SI), those with language impairments only (LI) and those with both speech and language impairments (S/LI).

METHODS

Participating families (n = 112, 75 male children) were recruited through 13 Canadian organizations. Children ranged from 10 months to 6 years 0 months (mean = 2.11 years; SD = 1.18 years) and attended speech-language intervention. Parents completed the FOCUS at the start and end of treatment. There were 23 children in the SI group, 62 children in the LI group and 27 children in the S/LI group. The average amount of the children's therapy varied from 7 to 10 h.

RESULTS

The FOCUS captures changes in communicative participation for children with a range of communication disorder types and severities. All three groups of children made clinically important improvements according to their FOCUS scores (MCID ≥ 16 points). The FOCUS captured improvements in intelligibility, independent communication, play and socialization.

CONCLUSIONS

The FOCUS measured positive changes in communicative participation skills for all three groups of children after 7-10 h of speech-language therapy. An outcome measure that targets only specific speech and language skills would miss many of the important social function changes associated with speech-language treatment.

Treating Children Ages 3–6 Who Have Speech Sound Disorder: A Survey

Purpose

In a national survey, speech-language pathologists (SLPs) were asked about service delivery and interventions they use with children ages 3–6 who have speech sound disorder (SSD).

Method

The survey was e-mailed to 2,084 SLPs who worked in pre-elementary settings across the United States. Of these, 24% completed part or all of the survey, with 18% completing the entire survey.

Results

SLPs reported that they provided children ages 3–6 who had SSD with 30 or 60 min of treatment time weekly, regardless of group or individual setting. More SLPs indicated that they used traditional intervention than other types of intervention. However, many SLPs also reported using aspects of phonological interventions and providing phonological awareness training. Fewer SLPs indicated that they used nonspeech oral motor exercises than in a previous survey (Lof & Watson, 2008). Recently graduated SLPs were no more familiar with recent advances in phonological intervention than were their more experienced colleagues.

Discussion

This study confirms previous findings (Mullen & Schooling, 2010) about the amount of service provided to children ages 3–6 who have SSD. Issues related to the use of traditional and phonological intervention with children who have phonological disorder are discussed, along with concerns related to evidence-based practice and research needs.

Validation of the Focus on the Outcomes of Communication under Six outcome measure

AIM

The aim of this study was to establish the construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS(©) ),a tool designed to measure changes in communication skills in preschool children.

METHOD

Participating families' children (n=97; 68 males, 29 females; mean age 2y 8mo; SD 1.04y, range 10mo-4y 11mo) were recruited through eight Canadian organizations. The children were on a waiting list for speech and language intervention. Parents completed the Ages and Stages Questionnaire - Social/Emotional (ASQ-SE) and the FOCUS three times: at assessment and at the start and end of treatment. A second sample (n=28; 16 males 12 females) was recruited from another organization to correlate the FOCUS scores with speech, intelligibility and language measures. Second sample participants ranged in age from 3 years 1 month to 4 years 9 months (mean 3y 11mo; SD 0.41y). At the start and end of treatment, children were videotaped to obtain speech and language samples. Parents and speech-language pathologists (SLPs) independently completed the FOCUS tool. SLPs who were blind to the pre/post order of the videotapes analysed the samples.

RESULTS

The FOCUS measured significantly more change (p<0.01) during treatment than during the waiting list period. It demonstrated both convergent and discriminant validity against the ASQ-SE. The FOCUS change corresponded to change measured by a combination of clinical speech and language measures (κ=0.31, p<0.05).

CONCLUSION

The FOCUS shows strong construct validity as a change-detecting instrument.

Code Sets for Everyday Life Situations of Children Aged 0–6: Sleeping, Mealtimes and Play — A Study Based on the International Classification of Functioning, Disability and Health for Children and Youth

Introduction:

The complexity of the Child and Youth version of the International Classification of Functioning, Disability and Health, the ICF-CY, is a challenge for occupational therapists and other professionals in clinical work. Code sets including only essential categories help to make it more user-friendly. Thus far, code sets have been developed to reflect functioning for children in different developmental periods. However, there are no code sets that support screening of participation in everyday life situations and can be used across diagnoses. This exploratory study is the first attempt to develop code sets for preschoolers' (age 0–6 years) everyday life situations.

Method:

Using sequential Delphi processes with expert panels consisting of 35 professionals in five interdisciplinary early intervention teams and six parents of children, the study identified content in three code sets: Sleeping, Mealtimes and Play.

Results:

A limited number of relevant categories were identified for three code sets: Sleeping (12), Mealtimes (21) and Play (30). Findings suggested a professional focus on Environmental factors compared with a parental focus on Body functions.

Conclusion:

It is important to consider the opinions of all involved when developing code sets to provide a common framework for screening of children's everyday functioning.

The association between expressive grammar intervention and social and emergent literacy outcomes for preschoolers with SLI

PURPOSE

To determine whether (a) expressive grammar intervention facilitated social and emergent literacy outcomes better than no intervention and (b) expressive grammar gains and/or initial expressive grammar level predicted social and emergent literacy outcomes.

METHOD

This investigation was a follow-up to a recently published study exploring the impact of grammatical language intervention on expressive grammar outcomes for preschoolers with specific language impairment (SLI). Twenty-two 3- to 5-year-old preschoolers received ten 20-minute intervention sessions addressing primary deficits in grammatical morphology. Participants' social and emergent literacy skills were not targeted. Twelve children awaiting intervention, chosen from the same selection pool as intervention participants, served as controls. Blind assessments of social and emergent literacy outcomes were completed at preintervention, immediately postintervention, and 3 months postintervention.

RESULTS

Only intervention participants experienced significant gains in social and emergent literacy outcomes and maintained these gains for 3 months postintervention. Expressive grammar gains was the only single significant predictor of these outcomes.

CONCLUSIONS

Expressive grammar intervention was associated with broad impacts on social and emergent literacy outcomes that were maintained beyond the intervention period. Gains in expressive grammar predicted these outcomes. Social and emergent literacy skills were positively affected for preschoolers with SLI during a grammatical language intervention program.

Changing practice: implications of the World Report on Disability for responding to communication disability in under-served populations

The World Report on Disability provides a major challenge to the conceptualization and delivery of services for people with communication disabilities around the world. Many people, in both Majority and Minority World countries, receive limited or no support in relation to their communication disability. In this paper the prevalence of communication disability across the world (and the challenges to obtaining these data) are discussed, particularly in relation to disability more broadly. Populations that are under-served by speech-language pathology services in both Majority and Minority World countries are described. The paper describes organizational change theory and the potential it has, together with a biopsychosocial model of disability, to assist in understanding and influencing development of relevant services for people with communication disabilities (PWCD), particularly those who are under-served. Aspects of, and influences on, service delivery for PWCD are described. The need for novel ways of conceptualizing development of services, including population-based approaches, is highlighted. Finally, the challenges and opportunities for PWCD and for speech-language pathologists which arise from the nine recommendations of the World Report on Disability are considered and readers are encouraged to consider new and novel ways of developing equitable services for people with communication disabilities, in both majority and minority world settings.

Paediatric speech-language pathology service delivery: an exploratory survey of Australian parents

Consideration of client values and preferences for service delivery is integral to engaging with the evidence-based practice triangle (E(3)BP), but as yet such preferences are under-researched. This exploratory study canvassed paediatric speech-language pathology services around Australia through an online survey of parents and compared reported service delivery to preferences, satisfaction, and external research evidence on recommended service delivery. Respondents were 154 parents with 192 children, living across a range of Australian locations and socio-economic status areas. Children had a range of speech and language disorders. A quarter of children waited over 6 months to receive initial assessment. Reported session type, frequency, and length were incongruent with both research recommendations and parents' wishes. Sixty per cent of parents were happy or very happy with their experiences, while 27% were unhappy. Qualitative responses revealed concerns such as; a lack of available, frequent, or local services, long waiting times, cut-off ages for eligibility, discharge processes, and an inability to afford private services. These findings challenge the profession to actively engage with E(3)BP including; being cognisant of evidence-based service delivery literature, keeping clients informed of service delivery policies, individualizing services, and exploring alternative service delivery methods.

Improving outcomes of preschool language delay in the community: protocol for the Language for Learning randomised controlled trial

Background

Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.

Methods/Design

A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4^th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.

Discussion

A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.

Trial registration

Current Controlled Trials ISRCTN03981121.

Participation and environmental aspects in education and the ICF and the ICF-CY: findings from a systematic literature review

BACKGROUND

This paper presents findings from a systematic review of the literature related to participation and the ICF/ICF-CY in educational research.

OBJECTIVES

To analyse how and investigate the application of participation in educational research. Specifically, how participation is related to the environmental dimensions availability, accessibility, affordability, accommodability and acceptability.

METHODS

A systematic literature review using database keyword searches and refinement protocols using inclusion and exclusion criteria at abstract, full-text and extraction.

RESULTS

Four hundred and twenty-one initial works were found. Twenty-three met the inclusion criteria. Availability and accommodations are the most investigated dimensions. Operationalization of participation is not always consistent with definitions used.

CONCLUSION

Research is developing a holistic approach to investigating participation as, although all papers reference at least one environmental dimension, only four of the 11 empirical works reviewed present a fully balanced approach when theorizing and operationalizing participation; hopefully this balanced approach will continue and influence educational policy and school practice.

A nationally representative study of the association between communication impairment at 4-5 years and children's life activities at 7-9 years

PURPOSE

To examine the longitudinal association between communication impairment (primary or secondary diagnosis) and children's Activities and Participation (International Classification of Functioning, Disability and Health--Children and Youth [ICF-CY]; World Health Organization [WHO], 2007).

METHOD

Participants were 4,329 children in the Longitudinal Study of Australian Children (LSAC; Australian Institute of Family Studies [AIFS], 2009): 1,041 (24.0%) of these children were identified with communication impairment at 4-5 years of age, and 3,288 (76.0%) of these children were not identified with a communication impairment. At age 7-9 years, Activities and Participation (WHO, 2007) outcomes across 5 ICF-CY domains were provided by (a) teachers (Academic Rating Scales [National Center for Education Statistics (NCES), 2002], Approach to Learning Scale [Gresham & Elliott, 1990], School Progress Scale (AIFS, 2009), Strengths and Difficulties Questionnaire [SDQ; Goodman, 1997], and Student-Teacher Relationship Scale [Pianta, 2001]); (b) parents (School-Age Inventory of Temperament [McClowry, 1995] and SDQ); (c) children (Marsh Self-Description Questionnaire-III [Marsh, 1992], School Liking [Ladd & Price, 1987], and Bullying [Kochenderfer & Ladd, 1997]); and (d) child assessment (Peabody Picture Vocabulary Test--III: Adapted; Rothman, 2003).

RESULTS

Children identified with communication impairment at age 4-5 years performed significantly poorer at age 7-9 years on all outcomes. Parents and teachers reported slower progression in reading, writing, and overall school achievement than peers. Children reported more bullying, poorer peer relationships, and less enjoyment of school than did their peers. Analyses of covariance tests confirmed significant associations between communication impairment and outcomes, over and above the effects of sex, age, Indigenous status, and socioeconomic status.

CONCLUSION

Consideration of the breadth and longevity of Activities and Participation outcomes reveals the potential extent and severity of communication impairment and directs future research and practice.

Exploring the relationship of family goals and scores on standardized measures in children with cerebral palsy, using the ICF-CY

AIM

To explore the relationships of family selected goals and scores on standardized measures using the ICF-CY as a classification system.

METHODS

Goal attainment scaling (GAS)-goals (n = 110) of 22 children, 11 girls, 1-6 years, bilateral or unilateral cerebral palsy, GMFCS I-IV and MACS I-IV were linked to the ICF-CY. The children had participated in goal-directed therapy during 12 weeks. GAS-goals, baseline assessments and change scores from PEDI and GMFM-66 were used to explore the relationships.

RESULTS

All GAS-goals were classified in the Activity and Participation domain within ICF-CY. The number of GAS-goals correlated to baseline scores in PEDI and GMFM-66. The change scores in PEDI and GMFM-66 correlated to goal attainment in the Mobility and the Self-Care chapter.

CONCLUSIONS

The family goals were reflected in standardized measures. The combined use of standardized and individual measures offers a possibility to explore the focus in therapy and the impact in children with cerebral palsy.

Evidence-Based Practice for Children With Speech Sound Disorders: Part 2 Application to Clinical Practice

Purpose

This article provides both a tutorial and a clinical example of how speech-language pathologists (SLPs) can conduct evidence-based practice (EBP) when working with children with speech sound disorders (SSDs). It is a companion paper to the narrative review of 134 intervention studies for children who have an SSD (Baker & McLeod, 2011).

Method

A seven-step EBP decision-making process is presented for managing SSDs in children (drawing on the work of Dollaghan, 2007, and Gillam & Gillam, 2006). We describe how SLPs can integrate externally published evidence with evidence from clinical practice as well as client factors, values, and preferences, to make clinical decisions. An organized EBP network is described as a clinical example of the application of the EBP decision-making process.

Results

Compared with a matched and national sample, SLPs in the EBP network were more likely to read relevant articles and tended to have more confidence in research evidence and in their own ability to select intervention targets based on published research.

Conclusion

SLPs need to use their clinical expertise to integrate research findings with the constraints and complexities of everyday clinical practice and client factors, values, and preferences in their management of SSDs in children.

The impact of speech impairment in early childhood: investigating parents' and speech-language pathologists' perspectives using the ICF-CY

PURPOSE

To explore the application of the Activities and Participation component of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY, World Health Organization, 2007) as a framework for investigating the perceived impact of speech impairment in childhood.

METHOD

A 32-item questionnaire based on six ICF-CY domains was distributed to (a) a national sample of speech-language pathologists (SLPs; n=205), and (b) parents (n=86) of preschool children identified with speech impairment.

RESULTS

Factor analysis of the SLP data revealed six coherent factors with moderate-high internal reliability: Verbal communication (e.g., Conversation, Speaking), Advanced learning (e.g., Learning to read/write), Interpersonal interactions (e.g., Relating with strangers, Informal social relationships), Basic learning (e.g., Copying, Rehearsing), Applied learning and general tasks (e.g., Focussing attention, Handling stress), and Non-verbal communication. The first five factors were also confirmed by the parent data. Both SLPs and parents rated the first two factors, Verbal communication and Interpersonal interactions, as the most difficult activities for children with speech impairment.

CONCLUSION

The ICF-CY Activities and Participation component is a useful framework for considering the breadth of activities that may be impacted by speech impairment in childhood.

LEARNING OUTCOMES

(1) Discuss the potential use of the ICF-CY in speech-language pathology; (2) Describe the breadth of activities that may be difficult for children as a result of speech impairment; and (3) Recognize that SLPs and parents may have different perspectives regarding the impact of speech impairment on children's activities and participation.