A population-based study of communicative participation in preschool children with speech-language impairments

Health-Related Quality of Life and Behavioral Difficulties in Greek Preschool Children with Developmental Language Disorder

Developmental language disorder (DLD) has a great impact on language skills as well as on a wide range of functioning areas, such as social and school functioning. In the present study, we aim to explore the Health-Related Quality of Life (HRQoL) of preschool children with DLD, compared to children with no language difficulties, using a self and proxy report method. A total of 230 parents of preschool children with DLD and 146 parents of children without language difficulties completed the Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Generic Core Module and the Strengths and Difficulties Questionnaire (SDQ). Additionally, 71 children with DLD and 55 peers without DLD completed the self-reported PedsQLTM module. The parents of kindergarten children (5-6 years old) with DLD reported that their kids experience worse social and school functioning compared to the control group. In addition, the children with DLD self-reported lower physical and social functioning. The parents of children with DLD reported that their children experience higher hyperactivity/inattention problems than the parents of the control group. Kindergarten children with DLD have a poorer HRQoL compared to their peers, as perceived by themselves and their parents. Moreover, children with DLD present with higher hyperactivity and inattention symptoms. Health professionals working with children who have DLD need to consider not only the language difficulties but also the children's wellbeing and symptoms of hyperactivity and inattention.

Engaging clinical end users in the development of an outcome measurement protocol for paediatric communicative health systems

PURPOSE

To develop a conceptual framework of the factors likely to influence clinicians' use of a new participation-focused outcome measurement protocol in a large paediatric speech-language pathology program.

METHOD

A convenience sample of 27 end users (clinicians, managers) were recruited from Ontario, Canada's Preschool Speech and Language Program. Participants engaged in one virtual concept mapping session in groups of five to six during which they learned about the new protocol, and generated statements in response to a prompt asking them to identify factors that would influence their use of the protocol. Following all sessions, participants asynchronously sorted and rated all statements, and data were analysed using multidimensional scaling and hierarchical cluster analyses.

RESULT

Six themes were identified: (1) response from families; (2) use of resources; (3) feasibility and clinical utility; (4) relevance and value-added for clinicians; (5) streamlining policies and guidelines; and (6) delivery, administration, and modification of tool. Response from families, feasibility and clinical utility, and use of resources received the highest importance ratings.

CONCLUSION

Concept mapping methodology was used to engage clinicians and managers to identify the barriers to a new implementation protocol for outcome measurement. Results will support future research and implementation efforts.

A systematic scoping review on contextual factors associated with communicative participation among children with developmental language disorder

BACKGROUND

Variations in communicative participation of children with developmental language disorder (DLD) cannot be wholly explained by their language difficulties alone and may be influenced by contextual factors. Contextual factors may support or hinder communicative participation in children, which makes their identification clinically relevant.

AIMS

To investigate which contextual (environmental and personal) factors in early childhood are protective, risk or neutral factors for communicative participation among school-aged children with DLD, and to identify possible gaps in knowledge about this subject.

METHODS & PROCEDURES

A scoping review was conducted based on a systematic search of studies published from January 2007 to March 2022 in Pubmed, Embase (without MEDLINE), CINAHL and PsycINFO. In total, 8802 studies were reviewed using predefined eligibility criteria, of which 32 studies were included for data extraction and critically appraised using the Critical Appraisal Skills Programme (2021) tools.

MAIN CONTRIBUTION

The methodological quality of included studies was adequate to strong. Personal protective factors identified are being a preschool girl, reaching school age and being prosocial, while personal risk factors are becoming a teenager or adolescent, having low socio-cognitive skills and experiencing comorbid mobility impairment or behavioural problems. Gender after the preschool years and non-verbal abilities were not found to be of influence, and the role of socio-emotional skills is inconclusive. Receiving therapy is an environmental protective factor, while the association between socio-economical family characteristics with communicative participation is inconclusive.

CONCLUSIONS & IMPLICATIONS

Limited research has been conducted on which risk and protective factors present in early childhood are associated with later communicative participation of children with DLD. The influence of co-occurring health conditions, social background variables, individual psychological assets, interpersonal relationships and attitudes of other people represent knowledge gaps. In addition, knowledge about the comparative effectiveness of different types of interventions and service delivery models, and the impact of administrative control, organizational mechanisms and standards established by governments on children's communicative participation is lacking. More longitudinal research is needed focusing on the identification of relevant personal and environmental factors and the interactions between them in relation to communicative participation outcomes.

WHAT THIS PAPER ADDS

What is already known on this subject Children with DLD experience varying degrees of communicative participation restrictions. Insight into contextual factors that influence communicative participation can help to identify children at risk and inform family and child-centred therapy. Systematic research on contextual factors that facilitate or hinder communicative participation in children with DLD is currently lacking. What this paper adds to existing knowledge Knowledge of protective factors can guide the development of interventions for children and young people with DLD that boost resilience and facilitate communicative participation, while insight into the risk factors can help professionals identify the most vulnerable children and develop interventions that can lift or neutralize barriers present in the life of these children. Specific groups potentially at risk are young boys, children with co-morbid mobility impairment, children with conduct problems, and children reaching adolescence. In contrast, potentially protective factors are reaching school age and being prosocial. In addition, the development of socio-cognitive skills may be beneficial for the communicative participation of children with DLD. What are the potential or actual clinical implications of this work? To support communicative participation, it is important that professionals who work with children with DLD understand which groups are at risk for communicative participation restrictions, and which factors can foster resilience. In the absence of evidence-based instruments for the systematic assessment of personal and environmental factors, consulting parents and children on the contextual factors that they perceive as important remains critical.

Clinical feasibility, utility, and usability of the Profile of Preschool Communication: A pilot test in community settings

AIM

. This study aimed to pilot test, assess usability and utility of, and identify barriers to implementation for the Profile of Preschool Communication (PPC) - a new data collection tool designed to support outcome monitoring in preschool speech-language programs and practice-based research.

METHODS

. This pilot study was conducted with three sites in the Ontario Preschool Speech and Language (PSL) program. Twenty-three speech-language pathologists used the PPC for all outcome monitoring assessments for 2-3-months and provided feedback about their experience using it in practice. Then, 18 of the 23 speech-language pathologists completed online surveys to rate usability and utility, and report their perceived implementation barriers and facilitators.

RESULTS

. Speech-language pathologists reported difficulties completing some sections of the PPC, most notably obtaining data related to maternal education and family history of mental health concerns. Usability and utility were generally rated favorably with some items rated as neutral. Barriers to implementation included the paper format, completion time, requirement to ask personal questions, and the perception by some that data were useful for outcome monitoring but not practice. Facilitators included ease of use, an improvement over the existing tool, and the collection of data to support service planning.

CONCLUSIONS

. The PPC shows potential as an outcome monitoring data collection tool in preschool speech-language pathology programs. Findings will be of interest to researchers engaged in practice-based research and those interested in engaging end users to develop clinically meaningful tools.

Assessing communicative participation in preschool children with the Focus on the Outcomes of Communication Under Six: a scoping review

AIM

To describe uses of the Focus on the Outcomes of Communication Under Six (FOCUS) in research with children with and without various communication disorders since its publication in 2010.

METHOD

Six databases were searched for the term 'Focus on the Outcomes of Communication Under Six'. With additional searches we ascertained 70 articles, of which 25 met inclusion criteria for full review and data extraction.

RESULTS

The FOCUS has been used in research across multiple countries, purposes, populations, contexts, and versions. Evaluative studies have described: the development of children's communicative participation skills and factors that impact the development of communicative participation; the impact of specific interventions on communicative participation; how FOCUS captures change relative to measures of impairment; and how FOCUS performs when used at different intervals. Adaptations have included: use of the FOCUS as a descriptive or discriminative tool; use with children outside the validated age range; use of select items; and use with typically developing children.

INTERPRETATION

The FOCUS is used worldwide in research and practice, and much has been learned about children's communicative participation. Future research is needed to explore the relationship between children's impairments and their communicative participation, develop a FOCUS App, and develop and validate a FOCUS for school-age children.

A Multidisciplinary Delphi Consensus Study of Communicative Participation in Young Children With Language Disorders

Purpose Our aim was to develop consensus on the definition and operationalization of communicative participation (CP) in 2- to 8-year-old children with language disorders (LDs). A clear definition and operationalization can facilitate the discussion about children's communication problems in daily life between parents and professionals. Method In an online Delphi study, anonymized thoughts and opinions were collected on the definition and operationalization of CP in young children with LD. The 47 Delphi panel members were Dutch parents, young adults with LDs, teachers and assistants, speech-language pathologists, clinical linguists, and clinical researchers. Thematic content analysis was used to develop a concept definition and items operationalizing CP. The Delphi panel rated the suitability of concept definitions using a 7-point Likert scale. Concept definitions were revised with feedback from the Delphi panel until consensus was achieved. The Delphi panel rated items on how well they operationalize CP, using the same Likert scale. Results The majority (79%) of the Delphi panel indicated that the essence of CP was captured by the definition: "CP is understanding and being understood in a social context, by applying verbal and non-verbal communication skills." In addition, 33 behavioral items were developed. Conclusion This study resulted in strong consensus on the definition of CP between Dutch parents and professionals. Items were developed that can inform speech-language pathologists on the type of questions to ask a child's parents or teacher when discussing CP. Further research is needed on how the items can best be used in clinical practice.

Establishing consensus among community clinicians on how to categorize and define preschoolers' speech and language impairments at assessment

PURPOSE

To achieve consensus amongst speech-language pathologists (SLPs) on the categories and definitions of preschoolers' communication impairments.

METHODS

In Phase 1, impairments were identified, categorized, and defined based on an evidence review. In Phase 2, a four-round Modified Delphi study was completed with SLPs (N = 38). SLPs reviewed three documents that categorized and defined preschoolers': (1) broadly focused impairments, (2) language disorder sub-categories, and (3) speech sound disorder sub-categories; rated whether categories captured all preschoolers with communication impairments and definitions were clear (consensus = 90% agreement across all documents); and made suggestions for improvement. Documents were revised between rounds based on SLPs' responses, literature review, and consultation with experts.

RESULTS

In Round 1, 90% agreement was reached only for the language disorder sub-categories document. In Round 2, no consensus was reached for the Speech Sound Disorder sub-categories document. In Round 3, consensus was reached for all three documents, but a fourth round was run to incorporate newly updated terminology. In Round 4, consensus was reached for updated terminology presented in the language disorders document.

CONCLUSIONS

Clinical and research expertise are integrated throughout the final documents, resulting in consensus terminology for preschoolers' communication impairments. Findings can support consistent terminology for preschoolers with communication impairments amongst SLPs. In research, documents will be used in a developing data collection tool that will undergo reliability testing prior to use in large scale studies related to children's communication. This study demonstrates the value of engaging in practice-based research.

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.