Measurement accuracy: Enabling human rights for Fijian students with speech difficulties

Translation and validation of the Intelligibility in Context Scale into Sinhala for adolescents in Sri Lanka with cleft lip and palate

The Intelligibility in Context Scale (ICS) is a parent-report screening tool used to measure parents' perceptions of children's functional intelligibility. This tool has been translated into over 60 languages and found to have a good reliability and validity. The purpose of the current study was to translate the ICS into Sinhala (the ICS-SIN), the main language spoken by the Sinhalese people in Sri Lanka, and to validate it with both typically developing (TD) children and children with repaired cleft lip and/or palate (CLP). The translation process followed the forward-backward-forward method. A total of 88 parents of TD children and children with CLP aged 12-15 years old (TD n = 50, CLP n = 38) completed the ICS-SIN questionnaire. Parents of TD and CLP children reported their children's speech as most intelligible to parents and least intelligible to strangers. The ICS-SIN had high internal consistency for both groups (TD α = 0.87, p < 0.05, CLP α = 0.97, p < 0.05). The ICS-SIN total scores and item scores showed significant correlations, indicating a good construct validity. TD participant group's ICS-SIN average mean scores (M = 4.88, SD = 0.29) were significantly higher compared to the CLP ICS-SIN average mean scores (M = 4.64, SD = 0.67) and varied according to gender in both groups, suggesting good discriminant validity. The ICS-SIN has overall good psychometric properties. Therefore, this tool has the potential to be used as a valid parent-rating screening tool for clinical and research purposes in Sri Lanka.

Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys

This study analyses the use of the self-reported Washington Group (WG) question sets as a first stage screening to identify people with clinical impairments, service and assistive product (AP) referral needs using different cut-off levels in four functional domains (vision, hearing, mobility and cognition). Secondary data analysis was undertaken using population-based survey data from five countries, including one national survey (The Gambia) and four regional/district surveys (Cameroon, Chile, India and Turkey). In total 19,951 participants were sampled (range 538–9188 in individual studies). The WG question sets on functioning were completed for all participants alongside clinical impairment assessments/questionnaires. Using the WG “some/worse difficulty” cut-off identified people with mild/worse impairments with variable sensitivity (44–79%) and specificity (73–92%) in three of the domains. At least 64% and 60% of people with mild/worse impairments who required referral for surgical/medical and rehabilitation/AP services, respectively, self-reported “some/worse difficulty”, and much fewer reported “a lot/worse difficulty.” For moderate/worse impairment, both screening cut-offs improved identification of service/AP need, but a smaller proportion of people with need were identified. In conclusion, WG questions could be used as a first-stage screening option to identify people with impairment and referral needs, but only with moderate sensitivity and specificity.

Combining Child Functioning Data with Learning and Support Needs Data to Create Disability-Identification Algorithms in Fiji's Education Management Information System

Disability disaggregation of Fiji’s Education Management Information System (FEMIS) is required to determine eligibility for inclusive education grants. Data from the UNICEF/Washington Group Child Functioning Module (CFM) alone is not accurate enough to identify disabilities for this purpose. This study explores whether combining activity and participation data from the CFM with data on environmental factors specific to learning and support needs (LSN) more accurately identifies children with disabilities. A survey on questions related to children’s LSN (personal assistance, adaptations to learning, or assessment and assistive technology) was administered to teachers within a broader diagnostic accuracy study. Descriptive statistics and correlations were used to analyze relationships between functioning and LSN. While CFM data are useful in distinguishing between disability domains, LSN data are useful in strengthening the accuracy of disability severity data and, crucially, in identifying which children have disability amongst those reported as having some difficulty on the CFM. Combining activity and participation data from the CFM with environmental factors data through algorithms may increase the accuracy of domain-specific disability identification. Amongst children reported as having some difficulty on the CFM, those with disabilities are effectively identified through the addition of LSN data.

Intelligibility in 3-Year-Olds With Cleft Lip and/or Palate Using the Intelligibility in Context Scale: Findings from the Cleft Collective Cohort Study

Objective:

To provide comparison data on the Intelligibility in Context Scale (ICS) for a sample of 3-year-old English-speaking children born with any cleft type.

Design:

Questionnaire data from the Cleft Collective Cohort Study were used. Descriptive and inferential statistics were carried out to determine difference according to children’s cleft type and syndromic status.

Participants:

A total of 412 children born with cleft lip and/or palate whose mothers had completed the ICS when their child was 3 years old.

Main Outcome Measure(s):

Mothers’ rating of their children’s intelligibility using the ICS.

Results:

The average ICS score for the total sample was 3.75 ( sometimes-usually intelligible; standard deviation [SD] = 0.76, 95% CIs = 3.68-3.83) of a possible score of 5 ( always intelligible). Children’s speech was reported to be most intelligible to their mothers (mean = 4.33, SD = 0.61, 95% CIs = 4.27-4.39) and least intelligible to strangers (mean = 3.36, SD = 1.00, 95% CIs = 3.26-3.45). There was strong evidence ( P < .001) for a difference in intelligibility between children with cleft lip only (n = 104, mean = 4.13, SD = 0.62, 95% CIs = 4.01-4.25) and children with any form of cleft palate (n = 308, mean = 3.63, SD = 0.76, 95% CIs = 3.52-3.71). Children born with cleft palate with or without cleft lip and an identified syndrome were rated as less intelligible (n = 63, mean = 3.28, SD = 0.85, 95% CIs = 3.06-3.49) compared to children who did not have a syndrome (n = 245, mean = 3.72, SD = 0.71, 95% CIs = 3.63-3.81).

Conclusions:

These results provide preliminary comparative data for clinical services using the outcome measures recommended by the International Consortium for Health Outcomes Measurement.

The UNICEF/Washington Group Child Functioning Module-Accuracy, Inter-Rater Reliability and Cut-Off Level for Disability Disaggregation of Fiji's Education Management Information System

This paper explores the validity (sensitivity and specificity) of different cut-off levels of the UNICEF/Washington Group Child Functioning Module (CFM) and the inter-rater reliability between teachers and parents as proxy respondents, for disaggregating Fiji's education management information system (EMIS) by disability. The method used was a cross-sectional diagnostic accuracy study comparing CFM items to standard clinical assessments for 472 primary school aged students in Fiji. Whilst previous domain-specific results showed "good" to "excellent" accuracy of the CFM domains seeing, hearing, walking and speaking, newer analysis shows only "fair" to "poor" accuracy of the cognitive domains (learning, remembering and focusing attention) and "fair" of the overall CFM (area under the Receiver Operating Characteristic curve: 0.763 parent responses, 0.786 teacher responses). Severe impairments are reported relatively evenly across CFM response categories "some difficulty", "a lot of difficulty" and "cannot do at all". Most moderate impairments are reported as "some difficulty". The CFM provides a core component of data required for disaggregating Fiji's EMIS by disability. However, choice of cut-off level and mixture of impairment severity reported across response categories are challenges. The CFM alone is not accurate enough to determine funding eligibility. For identifying children with disabilities, the CFM should be part of a broader data collection including learning and support needs data and undertaking eligibility verification visits.

Impact of communication partner familiarity and speech accuracy on parents' ratings of their child for the Intelligibility in Context Scale: Dutch

PURPOSE

The aim of this study was to examine the role of familiarity of a communication partner on Dutch parents' perception of their child's intelligibility, for children with typically-developing speech (TD) or speech sound disorder (SSD).

METHOD

Participants were 67 Dutch-speaking children (48-84 months), 48 with TD and 19 with SSD. Item scores on the parent-rated Intelligibility in Context Scale: Dutch (ICS-NL) were compared between groups and related to naive listeners' ratings of children's intelligibility (IR), and a measure of speech accuracy (i.e. percentage of consonants correct-adjusted, PCC-A).

RESULT

Statistical analysis yielded a significant Group by Familiarity interaction on the ICS-NL. Parents rated the intelligibility of their child with SSD as higher with more familiar communication partners than less familiar, more so than parents of children with TD. In the SSD group, IR was more strongly correlated with ICS-NL item scores for less familiar partners. PCC-A was only correlated with ICS-NL item 7 (strangers).

CONCLUSION

Parents perceive their children as more intelligible with people in close relationships, likely due to their higher familiarity with the child's speech. Children's relationships should be considered with respect to communicative participation. PCC-A may be a less reliable predictor of participation in family and community life.

Communication rights: Fundamental human rights for all

The right to communicate includes the right to "freedom of opinion and expression" and rights and freedoms "without distinction of … language". The 70th anniversary of the Universal Declaration of Human Rights is a time to celebrate and reflect on communication as a human right, particularly with respect to Article 19 and its relationship to national and international conventions, declarations, policies and practices. This review profiles articles from the special issue of International Journal of Speech-Language Pathology (volume 20, issue 1) addressing communication rights from four perspectives: (1) communication rights of all people; (2) communication rights of people with communication disabilities; (3) communication rights of children and (4) communication rights relating to language. Divergent perspectives from across the globe are considered. First-hand accounts of people whose right to communicate is compromised/upheld are included and perspectives are provided from people with expertise and advocacy roles in speech-language pathology, audiology, linguistics, education, media, literature and law, including members of the International Communication Project. Three steps are outlined to support communication rights: acknowledge people - adjust the communication style - take time to listen. Future advocacy for communication rights could be informed by replicating processes used to generate the Yogyakarta Principles.