Parent based language intervention for 2-year-old children with specific expressive language delay: a randomised controlled trial

Parents Plus: A Parent-Implemented Intervention for Preschool Children With Developmental Language Disorders

PURPOSE

Parent engagement is a critical component of optimizing services for young children with disabilities, including those with language disorders. Without training, however, many parents may lack the knowledge and skills to effectively facilitate their children's language development during the essential early childhood years. The Parents Plus intervention was designed to support parents, through online training and coaching, in using focused stimulation, an evidence-based strategy for fostering early language development.

METHOD

Thirty-one parents and their children with developmental language disorder participated in a small-scale randomized controlled trial to provide a preliminary test of Parents Plus. Sixteen parent-child dyads completed the Parents Plus intervention, while 15 parent-child dyads were in the control condition.

RESULTS

Findings indicate that Parents Plus shows promise in improving children's vocabulary and morphosyntactic skills. Additionally, Parents Plus emerged as a socially valid approach, with parents reporting that its goals, content, procedures, and outcomes were acceptable.

CONCLUSION

Implications for education and directions for future research are discussed.

'Parents Are the First Tutors of Their Child': Parents' Perception of Responsibility on Practicing Speech-Language Home Program During COVID-19 Lockdown

BACKGROUND AND OBJECTIVES

Some families faced difficulties accessing speech therapy in some areas of Malaysia and/or during the COVID-19 lockdown. Therefore, parent-mediated intervention could be one of the ways to solve this issue, as it has been proven to effectively improve communication skills among children with communication disorders. Hence, a Mandarin parental guidebook comprising a series of language stimulation activities was developed to explore the perception of parents of children with communication disorders, ranging from 3 to 6 years old, regarding the feasibility of (1) conducting speech-language home programs and (2) using a home-based parental guidebook as a tool to deliver a speech-language home program.

DESIGN, SETTING AND PARTICIPANTS

Semistructured interviews were conducted with nine Malaysian parents of child (ren) with communication disorders, who fulfilled the inclusionary criteria. Parents had attempted the speech-language home program by using the guidebook prior to the interview. The participants were subjected to 45-min to 1-h interviews. The interviews were audio- or video-recorded for verbatim transcription. Thematic analysis was used for data interpretation.

RESULTS

Four main themes were identified: (1) 'Golden Period': a guidebook to deliver speech-language home program, (2) perception of the speech-language home program among parents of children with communication disorders, (3) challenges faced by parents when practicing speech-language home program and (4) suggestions for improvements: parent's needs. The themes informed the perspective of parents towards the user experience of the parental guidebook, the feasibility of the speech-language home program and their recommendations. Overall, participants conveyed positive responses on the parental guidebook.

CONCLUSIONS

Malaysian parents face difficulties in accessing speech therapy because of limited numbers of SLTs, geographical barriers, financial constraints, availability of facilities and so forth. Findings could assist SLTs in adopting a family-centred approach in their service delivery, thus increasing the cost-effectiveness of their service delivery.

Evaluating an early social communication intervention for young children with Down syndrome (ASCEND): results from a feasibility randomised control trial

BACKGROUND

This paper reports the results from a feasibility trial of an early parent-delivered social communication intervention for young children with Down syndrome ('ASCEND'). The intervention focuses on developing children's early social communication skills, in particular responding to shared attention. The aim was to inform the feasibility of running a full-scale trial through National Health Service (NHS) Speech and Language Therapy (SaLT) services, to assess whether the intervention is effective in improving language skills before children with Down syndrome start school.

METHODS

This was a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site, comparing the intervention plus standard NHS SaLT provision with standard NHS SaLT alone. We recruited 20 children with Down syndrome aged between 11 and 36 months through 3 NHS SaLT services, 19 of whom were randomised (10 - intervention group, 9 -control group). Pre- and post-intervention and 6-month follow-up assessments included language, social communication skills, adaptive behaviour, quality of life (parents and children), parental anxiety and depression. The intervention was parent delivered with parents having access to SaLT services and the research team during the intervention. Data were collected on recruitment and retention, standard care, treatment fidelity, acceptability of the intervention by the parents and speech and language therapists, feasibility of collecting health economic measures and suitability of the primary outcome measure.

RESULTS

The sample was sufficient for a feasibility study. The intervention (manual, support, materials) was positively received by the participating parents. Speech and language therapists also evaluated the acceptability of the intervention positively. Treatment fidelity which was measured by completion of weekly parent diaries and two adherence phone call was acceptable as 100% of the parent diaries were returned, over 90% of the parental diaries were completed correctly and 100% of adherence phone calls were completed. Retention was acceptable at 84% overall. The preliminary health economic data suggest that this intervention will be low cost. The sample size calculation suggests that 290 participants would need to be recruited, with 228 having a complete data set, for a full RCT.

CONCLUSION

Based on recruitment, retention and treatment fidelity, as well as the acceptability of the intervention to parents and speech and language therapists, a full-scale trial would be feasible in order to assess the effectiveness of the intervention.

TRIAL REGISTRATION

ISRCTN13902755, registered on 25th August 2020, http://www.isrctn.com/ISRCTN13902755.

Effect of online parent training in promoting language development of children with language delay in Hubei province, China

BACKGROUND

Training parents to implement language and communication intervention strategies is an effective approach to promote language development for children with language delay.

AIMS

This study introduces an online parent training program conducted in Hubei province, China, which was designed to help parents of language-delayed children with a diagnosis of autism spectrum disorder (ASD), developmental language disorder (DLD) or global developmental delay (GDD) apply language intervention strategies into daily interactions and promote their children's language development at home.

METHODS & PROCEDURES

The Bethel Hearing and Speaking Training Center Family Training for Early Communication & Language Development (Bethel Family Training Program, BFT) (Bethel HSTC, 2020) was designed to improve the language and communication skills for children with language delay in a naturalistic way. The caregivers (including parents, grandparents and other main caregivers) participated in an 8-h online program, including lectures on milestones in child language development, common misunderstandings of child language development, and three basic family language intervention strategies ('Looking together, playing together, and talking together') incorporating active learning through video analysis and discussion. Tongji Hospital in Hubei then continued with 3 months of online home intervention monitoring to all the caregivers via weekly online Q&As led by BFT certified speech therapists' team. The Gesell Developmental Schedules (GDS) was carried out before the online parent training program and after the 3-month online home intervention monitoring.

OUTCOMES & RESULTS

146 families whose children aged 12-68 months with language delay participated in the online training program. The results of the GDS assessments conducted before and after the program showed that not only did the developmental quotient (DQ) of language improve, but so did the DQ of social behaviour and adaptive behaviour (p < 0.001). There is no between-group difference in the application of three strategies between the ASD group and the DLD or GDD group (p > 0.05). Furthermore, both caregivers' ability to apply 'looking together, playing together, talking together' strategies and the effective interaction time played important roles in improving the child's language abilities.

CONCLUSION & IMPLICATIONS

The online parent training focusing on improving daily interaction with children through speech-language stimulation strategies promoted the development of language skills. It is an economic and practical approach for children with language delay who have limited access to local language intervention programs.

WHAT THIS PAPER ADDS

What is already known on the subject Parent-implemented language intervention is an effective approach at improving children's language development. Telepractice is an appropriate model of service delivery for audiologists and speech-language therapists and may be the primary mode of service delivery or may supplement in-person services. What this paper adds to the existing knowledge This paper explores the effectiveness of an online parent training program and provides new evidence that online training on language support strategies (looking together, playing together, talking together) followed by home intervention monitoring works for Mandarin-speaking children and it is equally effective for children with ASD and non-ASD diagnosis. What are the potential or actual clinical implications of this work? Developmental behavioural paediatricians and speech-language therapists in countries and areas that lack sufficient training resource for every child will have the option to deliver parent training and home intervention monitoring online, which will save time and cost considerably while offering convenience.

Oral language interventions can improve language outcomes in children with neurodevelopmental disorders: A systematic review and meta-analysis

Background

Young people who fail to develop language as expected face significant challenges in all aspects of life. Unfortunately, language disorders are common, either as a distinct condition (e.g., Developmental Language Disorder) or as a part of another neurodevelopmental condition (e.g., autism). Finding ways to attenuate language problems through intervention has the potential to yield great benefits not only for the individual but also for society as a whole.

Objectives

This meta-analytic review examined the effect of oral language interventions for children with neurodevelopmental disorders.

Search Methods

The last electronic search was conducted in April 2022.

Selection Criteria

Intervention studies had to target language skills for children from 2 to 18 years of age with Developmental Language Disorder, autism, intellectual disability, Down syndrome, Fragile X syndrome, and Williams syndrome in randomised controlled trials or quasi-experimental designs. Control groups had to include business-as-usual, waiting list, passive or active conditions. However, we excluded studies in which the active control group received a different type, delivery, or dosage of another language intervention. Eligible interventions implemented explicit and structured activities (i.e., explicit instruction of vocabulary, narrative structure or grammatical rules) and/or implicit and broad activities (i.e., shared book reading, general language stimulation). The intervention studies had to assess language skills in receptive and/or expressive modalities.

Data Collection and Analysis

The search provided 8195 records after deduplication. Records were screened by title and abstract, leading to full-text examinations of 448 records. We performed Correlated and Hierarchical Effects models and ran a retrospective power analysis via simulation. Publication bias was assessed via p-curve and precision-effect estimate.

Main Results

We examined 38 studies, with 46 group comparisons and 108 effects comparing pre-/post-tests and eight studies, with 12 group comparisons and 21 effects at follow-up. The results showed a mean effect size of d = 0.27 at the post-test and d = 0.18 at follow-up. However, there was evidence of publication bias and overestimation of the mean effects. Effects from the meta-analysis were significantly related to these elements: (1) receptive vocabulary and omnibus receptive measures showed smaller effect sizes relative to expressive vocabulary, grammar, expressive and receptive discourse, and omnibus expressive tests; and (2) the length of the intervention, where longer sessions conducted over a longer period of time were more beneficial than brief sessions and short-term interventions. Neither moderators concerning participants' characteristics (children's diagnosis, diagnostic status, age, sex, and non-verbal cognitive ability and severity of language impairment), nor those regarding of the treatment components and implementation of the language interventions (intervention content, setting, delivery agent, session structure of the intervention or total number of sessions) reached significance. The same occurred to indicators of study quality. The risk of bias assessment showed that reporting quality for the studies examined in the review was poor.

Authors’ Conclusions

In sum, the current evidence base is promising but inconclusive. Pre-registration and replication of more robust and adequately powered trials, which include a wider range of diagnostic conditions, together with more long-term follow-up comparisons, are needed to drive evidence-based practice and policy.

Creating the conditions for robust early language development for all: Part two: Evidence informed public health framework for child language in the early years

BACKGROUND

One of the most significant developmental accomplishments is the emergence of language in early childhood. Whilst this process is effortless for most children, others can face significant hurdles. Identifying, in the early years, which children will go on to have developmental language disorder is, however, fraught with several well-documented challenges. In the preceding paper we described and linked new research evidence about factors that influence language development in the early years, noting that exposure to some may be time sensitive and that these influences cluster together and can accumulate over time. We demonstrated that risk profiles were associated with and characterised low language trajectories, and we considered how this information could be integrated into a concept that moves beyond screening at single time points in the early years. We argue that this evidence might be used to build an improved early years framework for language thereby creating a more equitable surveillance system that does not leave children living in less advantageous circumstances behind. Underpinning this thinking was a bioecological framework that incorporates the social, environmental and family factors in the child's ecosystem known to influence language development in the early years.

AIMS

To develop a proposal for the design and implementation of an early language public health framework based on current best evidence METHODS: We synthesised the findings from the companion paper (Reilly & McKean 2023) regarding early language trajectories, inequalities and clustering of risks with key public health concepts, relevant intervention evidence and implementation theories to develop a new framework for language surveillance and preventative interventions in the early years.

MAIN CONTRIBUTION

An evidence informed early language public health framework is presented. Describing in turn (1) essential components; (2) relevant interventions; (3) essential qualities for implementation ((i) probabilistic, (ii) proportionate, (iii) developmental and sustained and (iv) codesigned); (4) system-level structures and (5) processes required to adopt and embed an early language public health framework in an existing Local Government Area's child health surveillance and early prevention-intervention systems.

CONCLUSIONS

Children's language development influences their life chances across the life course and language difficulties are unfairly distributed across society. Current evidence points to the need for whole systems approaches to early child language and enables a blueprint for such a framework to be described.

WHAT THIS PAPER ADDS

What is already known on the subject Early child language development sets the stage for a child's life chances and language difficulties can have profound long-term consequences. Such difficulties are unfairly distributed across society and the reach of preventative services is not universal or equitable.

WHAT THIS STUDY ADDS

Several effective primary and secondary preventative interventions exist but their successful implementation is not straightforward. An early language public health framework of surveillance and intervention is described to provide equitable and effective early interventions to children from 0-4 years. We detail the essential components, interventions and qualities of that framework and describe system-level structures and processes required to adopt and embed an early language public health framework in a given locality. WHAT ARE THE CLINICAL IMPLICATIONS OF THIS WORK?: A whole systems approach to early child language is required and should be co-designed through local collaboration with family, community and children's services stakeholders. A public health speech and language therapist role could catalyse the implementation of such approaches and support continuous improvement.

Evaluating the dose-response relationship of the number of sessions of "It Takes Two to Talk®" in young children with language delay

PURPOSE

To evaluate the dose-response relationship between the number of It Takes Two to Talk® (ITTT) sessions attended and the language outcomes of young children with language delay and their parent's responsivity in a multicultural clinical population.

METHOD

A clinical caseload of 273 early language delayed children (mean age 29.2 months, SD 7.8) and their families participated in parent group workshops and individual coaching sessions of the parent responsivity program ITTT. The children's vocabulary and early syntax, collected using the MacArthur-Bates Communicative Development Inventories and mean length of the three longest utterances respectively, were collated from pre- and post-intervention from pre-existing clinical data. Parental responsivity was evaluated utilising the Parent-Child Interaction checklist at three time points. Multilevel regression was used to determine the relationship between the number of sessions attended and outcomes, while accounting for covariates such as age and language spoken.

RESULT

ITTT dosage did not predict child language outcomes. Rather, vocabulary and early syntax outcomes were predicted by age, pre-scores and parent responsivity at the beginning of treatment. A higher dosage of ITTT did however positively predict parent responsivity, as did speaking only English at home. Socioeconomic status, gender and presence of receptive language difficulties did not contribute significantly to either child or parent outcomes.

CONCLUSION

A lower dosage of the intervention may be considered for parents and children with fewer known risk factors without significant implications.

Feasibility of Family-Centered Workshops for Children Aged 18-36 Months with Language Developmental Delay

BACKGROUND

Family-centered workshops' effects on children with language developmental delay remain unknown. This study assessed the feasibility of workshops for children with language developmental delay.

METHODS

A total of 122 children aged 18-36 months with language developmental delays and their parents participated in six sessions of 2-h family-centered multidisciplinary workshops for 6 weeks. The Mandarin-Chinese Communicative Development Inventory, Peabody Developmental Motor Scale, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Child Health Questionnaire, Pediatric Quality of Life Inventory, Caregiver Strain Index, Impact on Family Scale, PedsQL Family Impact Module, and World Health Organization Quality of Life (QOL) were administered to the children and their parents before and after the workshop.

RESULTS

We found improvement of emotion (P = 0.037), upper extremity and physical function (P = 0.038), and transfer and basic mobility (P = 0.019) in children and parental QOL related to children's conditions (P = 0.049), with no effect on communication ability and QOL in children and family strain and function. We also noted more significant improvement in children with pure developmental language delay than in children with nonpure developmental language delay concerning the success rates (from delayed to normal development) for expressive vocabulary (P < 0.001) and word combination (P = 0.002). Satisfaction levels toward the workshop were high.

CONCLUSIONS

Family-centered workshops improved children's emotions, functional performance, and parental QOL. Although the samples were too small to test different conditions of the developmental delay, the workshops for children with language developmental delays are acceptable and feasible.

Short-term multidisciplinary family-centered workshop for preschool children with global developmental delays

BACKGROUND

Children with developmental delays have a great impact on their families. Educating families on how to interact with their children is an important task. Therefore, we assessed the short-term effectiveness of the workshop for children with global developmental delays.

METHODS

In total, 101 children aged 18-36 months with global developmental delays, all with language delay along with other developmental delays, and their parents participated in six 2-h family-centered workshop sessions for six weeks. Measures were taken before and after the workshop, including the Mandarin-Chinese Communicative Developmental Inventory, Peabody Developmental Motor Scales, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Pediatric Evaluation of Disability Inventory, Pediatric Daily Occupation Scale, Pediatric Quality of Life Inventory (PedsQL), Caregiver Strain Index, and PedsQL-Family Impact Module.

RESULTS

Significant improvements with a small or intermediate effect size in emotions, upper extremity and physical functioning and global functioning, daily occupation performance in sensorimotor, communication, cognitive autonomy, and psychosocial domains, and parental quality of life and family impact were noted with high workshop satisfaction.

CONCLUSION

Short-term family-centered workshop is effective for children with global developmental delays. However, due to the lack of follow-up after the intervention, it should be careful in inferring the developmental gain effect.

IMPACT

The effectiveness of short-term family-centered workshops on children with global developmental delays remains uncertain. Short-term family-centered workshops improved the children's emotions, physical functional performance, and occupational performance in daily life. The short-term family-centered workshop is practical and effective for children with global developmental delays. Further long-term, large-scale, prospective, randomized trials are warranted to confirm these results.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05418933.

A Systematic Review of Interventions for Late Talkers: Intervention Approaches, Elements, and Vocabulary Outcomes

PURPOSE

The aim of this systematic review was to examine the empirical evidence on interventions for late talkers between 18 and 42 months according to type of intervention approach (direct, indirect, and hybrid), reporting of intervention elements, and outcomes for receptive and expressive vocabulary.

METHOD

This review was registered with PROSPERO and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eleven databases were systematically searched with 34 intervention studies involving 1,207 participants meeting criteria. Studies were categorized as using a direct, indirect, or hybrid intervention approach, then examined according to intervention elements, vocabulary outcomes, as well as reported tools and type of score used to evaluate outcomes.

RESULTS

Across 34 studies, nine used a direct intervention approach, 10 an indirect intervention approach, and 14 a hybrid intervention approach. One study compared direct and hybrid intervention approaches. All indirect and hybrid approaches included parent training; direct approaches did not. The type and degree of reporting of other intervention elements, as well as the tools and type of score used to evaluate outcomes, varied within and across approaches. Overall, improvements in expressive vocabulary were reported by 93% of studies, with variable results for the nine studies reporting receptive vocabulary outcomes.

CONCLUSIONS

The direct, indirect, and hybrid intervention approaches were typified by specific intervention elements; however, there was diversity in how other elements comprising the approaches were arranged. When making decisions about which intervention approach to use, clinicians need to be mindful of the differences among approaches, how they discuss those differences with parents, and which approaches and elements might be best suited to individual children and their families.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21291405.

Shared Book Reading Intervention for Parents of Infants and Toddlers

Shared book reading is a well-established vehicle for promoting child language and early development. Yet, existing shared reading interventions have primarily included only children age 3 years and older and high quality dialogic strategies have been less systematically applied for infants and toddlers. To address this gap, we have developed a book-sharing intervention for parents of 12- to 36-month-olds. The current study evaluated acceptability/usability and preliminary efficacy of book-sharing intervention in a randomized controlled trial. Parent-child dyads were randomized to either 8-week book-sharing intervention (n=15) or wait list control (n=15). Parent book-sharing skills were assessed at baseline, post-intervention, and 2-month follow-up. Results indicated parents found the intervention highly acceptable and useful. Parents receiving intervention demonstrated significant improvement in book-sharing strategies compared to controls at post-intervention and 2-month follow-up. The current study provides evidence for the benefit of a brief, low intensity, targeted intervention to enhance parent book-sharing with infants and toddlers.

Evaluating the Acceptability and Social Validity of a Caregiver-Led Technology-Based Menstrual Hygiene Management Intervention for Youth on the Autism Spectrum

OBJECTIVES

Menstrual hygiene management (MHM) is a critical area of daily living skills for neurodiverse menstruators in which few evidence-based interventions exist. This study evaluated the acceptability and social validity of a caregiver-mediated intervention for youth on the autism spectrum utilizing behavior skills training, animated video modeling, task analysis, and telehealth services to improve changing a menstrual pad.

METHODS

The consultant recruited three youth and caregiver dyads to test the intervention and collect acceptability and social validity assessments. Materials varied based on the phase of the study; however, a typical trial required data collection sheets, youth's underwear, a menstrual pad, and, during intervention, the video model and hardware technology. A multiple baseline design across participants and reversal design were used to demonstrate experimental effects. Due to the sensitive nature of the study, independence and accuracy data were collected by caregivers and analyzed later by the consultant through visual analysis.

RESULTS

Overall, youth participants improved their percentage of independent and accurate steps of changing a menstrual pad. Furthermore, caregivers reported moderate to high levels of acceptability of the telehealth service delivery and animated video modeling, as well as the overall MHM training program measured by the Technology Acceptability Model-Fast Form (FF-TAM) and the Behavior Intervention Rating Scale (BIRS), respectively. Youth reported high levels of acceptability of the MHM training program as measured by the Child Intervention Rating Profile (CIRP).

CONCLUSIONS

Results suggest that a technology-based, caregiver-mediated MHM intervention for neurodiverse youth would be considered acceptable and socially valid by caregiver and youth participants.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s41252-022-00261-x.

A systematic review of speech, language and communication interventions for children with Down syndrome from 0 to 6 years

BACKGROUND

Speech and language acquisition can be a challenge for young children with Down syndrome (DS), and while early intervention is important, we do not know what early interventions exist and how effective they may be.

AIMS

To systematically review existing early speech, language and communication interventions for young children with DS from birth up to 6 years, and to investigate their effectiveness in improving speech, language and communication outcomes in children with DS. Other outcomes are changes in parental behaviour and their responsiveness METHODS & PROCEDURES: We conducted a systematic search of relevant electronic databases to identify early intervention studies targeting speech, language and communication outcomes in children with DS published up to May 2020. A total of 11 studies that met the inclusion criteria were synthesized and appraised for quality using the PEDro-P scale. There were a total of 242 children. We identified three types of intervention: communication training and responsive teaching, early stimulation programme, and dialectic-didactic approach.

MAIN CONTRIBUTION

The findings from nine out of the 11 studies reported positive outcomes for children's language and communication up to 18 months following the intervention. All nine studies reported interventions that were co-delivered by parents and clinicians. However, there was also a de-accelerated growth in requesting behaviours in the intervention group reported by one study as well as a case of no improvement for the intervention group. Three studies provided some evidence of improvements to parent outcomes, such as increased parental language input and increased responsiveness. However, there was a moderate to high risk of bias for all studies included.

CONCLUSIONS

The findings from this review suggest that interventions that have high dosage, focus on language and communication training within a naturalistic setting, and are co-delivered by parents and clinicians/researchers may have the potential to provide positive outcomes for children with DS between 0 and 6 years of age. Due to the limited number of studies, limited heterogeneous data and the moderate to high risk of bias across studies, there is an urgent need for higher quality intervention studies in the field to build the evidence base.

WHAT THIS PAPER ADDS

What is already known on the subject Speech and language acquisition is usually delayed in children with DS, yet there are currently no standard interventions for children under 6. A number of research-based interventions exist in the literature, yet it is unknown how effective these are. What this study adds to existing knowledge This is the first systematic review that specifically and exclusively focuses on parent- and non-parent-mediated speech, language and communication interventions for children with DS between 0 and 6 years of age. It complements three existing recent reviews, each of which has a slightly different focus. The previously published reviews have covered only parent-mediated interventions, excluding interventions not mediated by parents, have reviewed interventions including children and adults, without any mention of what early interventions may be like or how effective these may be for young children with DS, have not always assessed risk of bias or have focused specifically on language interventions excluding those focusing on speech articulation or pre-linguistic skills. The findings from the current review suggest that interventions that have high dosage focus on language and communication training within a naturalistic setting and are co-delivered by parents and clinicians/researchers may have the potential to provide positive outcomes for children with Diwn syndrome from 0 to 6. We acknowledge that the current evidence base comes from studies with moderate to high risk of bias, hence our conclusions are not definitive. What are the potential or actual clinical implications of this work? Speech and language therapists will have synthesized information and a quick reference point on what type of interventions exist for children with DS under the age of 6, and evidence of which intervention approaches may be promising in terms of providing positive outcomes. However, it is acknowledged that, due to the limited number of studies and the moderate to high risk of bias inherent in the evidence, there is an urgent need for higher quality intervention studies in the field to build the evidence base.

The ASCEND study: protocol for a feasibility study to evaluate an early social communication intervention for young children with Down syndrome

BACKGROUND

Down syndrome is the most common cause of learning disability, affecting approximately 1 in every 700 babies. Children with Down syndrome have particular difficulties with speech and language. This makes it challenging for them to participate fully in life, access healthcare services and educational opportunities. Improving the language skills of young children with Down syndrome is vital for their future social and emotional well-being and behaviour, and consequently contribution to society. As Down syndrome is detected before or at birth, we can provide support from early on. There are currently no standard interventions for improving the language skills of children with Down syndrome under the age of 36 months. Evidence suggests that early parent-based interventions may be effective in improving language outcomes. In partnership with parents and speech and language therapists, we have co-developed an intervention focusing on early social communication skills and our preliminary work shows that it can lead to better language in children with Down syndrome. Our aim is to carry out a feasibility study which will inform a future pilot/full trial to test whether the intervention is effective in improving language skills before children with Down syndrome start school.

METHODS

This is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site comparing the intervention (plus standard NHS speech and language therapy) with no intervention (standard NHS speech and language therapy only). We aim to recruit between 25 and 30 children with Down syndrome aged between 11 and 36 months. Sites are defined by the geographical boundaries of three National Health Service (NHS) Trusts. Recruitment is from NHS Speech and Language Therapist caseloads within the 3 Trusts, and self-referral. In the intervention arm, parents/guardians will receive brief training on the parent-based intervention and a manual to follow with their child for 10 weeks. The children's language and early communication skills and family health outcomes will be assessed by a blinded assessor at baseline, post-intervention and 6 month follow-up. Questionnaire and semi-structured interviews will explore the acceptability of the intervention to parents and SLTs.

DISCUSSION

The feasibility study's outcomes will determine whether it would be viable to progress to a full-trial and whether adjustments need to made to the procedures, data collection methods, intervention delivery and the intensity of support needed. We want to assess whether our early intervention can be delivered and rolled out through NHS Speech and Language Therapy (SLT) Services. We anticipate that NHS SLT Services will need to make ongoing changes due to the COVID-19 pandemic, so it is likely that we will need to make adjustments for the definitive trial. We will also calculate descriptive statistics of the language outcome measure which we will use for any future sample size calculation.

TRIAL REGISTRATION

ISRCTN13902755. Registered on 25 August 2020. http://www.isrctn.com/ISRCTN13902755.

Validity and feasibility of a predictive language screening tool in 2-year-old children in primary pediatric care

OBJECTIVE

To assess the predictive validity and feasibility of the newly developed language screening tool, SPES-2 (Sprachentwicklungsscreening), for 2-year-old children in pediatric primary care.

METHODS

A prospective cohort study recruited 2,044 non-selected German-speaking children undergoing a regular well-baby check-up at the age of 2 years. Thirty primary care pediatricians spread over urban and rural areas screened the children using a short parent-reported questionnaire and direct assessment of word comprehension. To validate the screening tool, language skills were assessed using a standardized language screening tool in the complete sample 1 year later. Data of a random sample of 621 children were analyzed. Feasibility of the screening tool was evaluated using questionnaires completed by the participating pediatricians.

RESULTS

The new screening tool, SPES-2, demonstrated good diagnostic accuracy with AUC (Area under the Roc Curve) of 0.885, a sensitivity of 0.74, and specificity of 0.86, using a parent-reported questionnaire (expressive vocabulary, two-word combinations, parental concerns) as stage 1, followed by a stage 2 direct assessment of word comprehension by the pediatrician. The second stage was restricted to children who failed the parental screening. The screening identified children with high, moderate, and low risk of significant language deficits (SLD) at the age of 3 years, permitting tailored follow-up assessment and parental counseling. Practicality and acceptability of the screening were mostly rated as high. Pediatricians regarded the availability of follow-up diagnostic services and parent guidance as most important for a general implementation of the new instrument.

CONCLUSION

The language screening tool, SPES-2, was valid for the identification of significant language deficits 1 year later, and considered as feasible within primary pediatric care.

Identifying Language Disorder Within a Migration Context: Development and Performance of a Pre-school Screening Tool for Children With German as a Second Language

BACKGROUND

There is a lack of accurate and practicable instruments for identifying language disorders in multilingual children in pre-school settings.

OBJECTIVE

To develop a language screening instrument for pre-school children who are growing up with German as their second language.

DESIGN

After the development and initial validation of a language screening tool, the new instrument (LOGiK-S) was administered to three cohorts of children (2014, 2015, 2017) with a non-German first language attending a variety of public pre-schools in Upper Austria. The screening instrument measures expressive and receptive grammatical skills in German. The final validation study included the results for 270 children for the screening measure and reference tests. A combination of a standardized comprehensive language test of grammatical skills developed for children acquiring German as a second language and a test of expressive vocabulary with the use of specific cutoffs for second language learners was applied as the gold standard for identifying language disorders.

RESULTS

The LOGiK-S screening of expressive grammar demonstrated excellent accuracy (AUC.953). The screening subscale of receptive grammar did not improve the prediction of language disorders. Using an optimized cutoff yielded a fail rate of 17%, excellent sensitivity (0.940), and specificity (0.936). Time economy and acceptance of the screening by children and screeners were mostly rated as high.

CONCLUSION

The LOGiK-S language screening instrument assessing expressive German grammar development using bilingual norms is a valid and feasible instrument for the identification of language disorders in second language learners of German at the pre-school age.

Benefits of Parent Training in the Rehabilitation of Deaf or Hard of Hearing Children of Hearing Parents: A Systematic Review

The present study is a systematic review on the effectiveness of Parent Training (PT) and coaching in deaf and hard of hearing (DHH) rehabilitation programs which reviews and synthesizes the existing body of evidence to assess the benefits of these programs in enhancing parents' sensitivity, responsivity and promoting language development in DHH children during the first years after HA fitting or CI activation. Five published studies met the Population, Intervention, Comparison and Outcomes (PICO) inclusion criteria and were eligible to be included, but heterogeneity in terms of the study design, interventions and outcomes did not allow for performing a meta-analysis. All included studies shared the view that a parent's learning is a circular (rather than frontal) process, and the results appear promising in terms of enhancing parents' responsiveness and promoting DHH child language development. Nevertheless, the available evidence was judged to not be robust enough due to limitations in the studies' designs. Further high-quality evidence is needed to evaluate the true degree of clinical value and the cost effectiveness of PT programs aimed at increasing parents' responsiveness to their DHH children.

Language Screening in 3-Year-Olds: Development and Validation of a Feasible and Effective Instrument for Pediatric Primary Care

Objective: The study was aimed at evaluating the validity and feasibility of SPES-3 (Sprachentwicklungsscreening), a language screening in 3-year-old children within the constraints of regular preventive medical check-ups. Methods: A four-component screening measure including parental reports on the child's expressive vocabulary and grammar based on the MacArthur Communicative Development Inventory and pediatrician-administered standardized assessments of noun plurals and sentence comprehension was used in a sample of 2,044 consecutively seen children in 30 pediatric offices. One-hundred forty-four children (70 who failed and 74 who passed the screener) comprised the validation sample and also underwent follow-up gold standard assessment. To avoid verification and spectrum bias multiple imputation of missing diagnosis for children who did not undergo gold standard assessment was used. Independent diagnoses by two experts blinded to the screening results were considered gold standard for diagnosing language disorder. Screening accuracy of each of the four subscales was analyzed using receiver operator characteristic (ROC) curves. Feasibility was assessed by use of a questionnaire completed by the pediatricians. Results: The two parental screening subscales demonstrated excellent accuracy with area under the curve (AUC) scores of 0.910 and 0.908 whereas AUC scores were significantly lower for the subscales directly administered by the pediatricians (0.816 and 0.705). A composite score based on both parental screening scales (AUC = 0.946) outperformed single subscales. A cut off of 41.69 on a T-scale resulted in about 20% positive screens and showed good sensitivity (0.878) and specificity (0.876). Practicability, acceptability and sustainability of the screening measure were mostly rated as high. Conclusion: The parent-reported subscales of the SPES-3 language screener are a promising screening tool for use in primary pediatric care settings.

The Effects of a Parent-Implemented Language Intervention on Late-Talkers' Expressive Skills: The Mediational Role of Parental Speech Contingency and Dialogic Reading Abilities

Several qualitative and quantitative features of parental speech input support children’s language development and may play a critical role in improving such process in late talkers. Parent-implemented interventions targeting late-talkers have been developed to promote children’s language outcomes by enhancing their linguistic environment, i.e., parental speech input. This study investigated the effect of a parent-implemented intervention in increasing late talkers’ expressive skills through modifications in structural and functional features of parental speech input. Forty-six thirty-one-month-old late talkers differing in their birth condition (either low-risk preterm or full-term) participated in the study with a parent; 24 parent-child dyads received a parent-implemented intervention centered on dialogic reading and focused stimulation techniques, whereas the other 22 dyads constituted the control group. At pre- and post-intervention, dyads took part in a parent-child shared book-reading session and both parental and child’s speech measures were collected and examined. Results showed that the intervention positively affected parents’ use of responses and expansions of children’s verbal initiatives, as well as the parental amount of talking over reading, whereas no structural features of parental input resulted modified. Mediation analyses pointed out that the intervention indirectly enhanced late-talkers’ use of verbal types and tokens through changes in parental use of expansions and amount of talking over reading. As birth status was entered as a covariate in the analysis, these findings can be extended to children with different gestational age. We conclude that the parent-implemented intervention was effective in supporting late-talkers’ gains in language development as a cascade result of the improvements in parental contingency and dialogic reading abilities. These promising findings suggest to examine not only children and parental outcomes but also the intervention mechanisms promoting changes in late-talkers’ language development as a clearer view on such process can inform the development of feasible, ecological and effective programs.

A Parent-Implemented Language Intervention for Late Talkers: An Exploratory Study on Low-Risk Preterm and Full-Term Children

Parent-implemented language interventions have been used for children with expressive language delays, but no study has yet been carried out using this intervention for low-risk preterm children. The current study examined the effect of a parent-implemented dialogic book reading intervention, determining also whether the intervention differently impacted low-risk preterm and full-term children. Fifty 31-month-old late talkers with their parents participated; 27 late talkers constituted the intervention group, and 23 constituted the control group. The overall results indicated that more children in the intervention group showed partial or full recovery of their lexical expressive delay and acquired the ability to produce complete sentences relative to the control group. Concerning full-term late talkers, those in the intervention group showed a higher daily growth rate of total words, nouns, function words, and complete sentences, and more children began to produce complete sentences relative to those in the control group. Concerning low-risk preterm late talkers, children in the intervention group increased their ability to produce complete sentences more than those in the control group. We conclude that a parent-focused intervention may be an effective, ecological, and cost-effective program for improving expressive lexical and syntactic skills of full-term and low-risk preterm late talkers, calling for further studies in late talkers with biological vulnerabilities.

A meta-analysis on the effectiveness of intervention in children with primary speech and language delays/disorders: Focusing on China and the United States

The purpose of this meta-analysis was to investigate the immediate and long-term effects of intervention for children with primary speech and language delays/disorders and to explore whether some characteristics of interventions, specifics of the study and research participants moderate the magnitude of the effectiveness of interventions. Using the random effect model, we pooled the effect size and conducted a publication bias evaluation, a moderating effect analysis in CMA 2.0. Results of a random effects model analysis demonstrated a moderate immediate effect (g = 0.70), whereas the long-term efficacy was small (g = 0.23). Additionally, type of measure, language of intervention, parental involvement, intervention content and study quality, as well as the duration of intervention, significantly moderated the effect size of intervention effectiveness.

Intervención logopédica naturalista con familias de hablantes tardíos: efectos en el lenguaje infantil y en los intercambios adultos

El objetivo del presente artículo es valorar la eficacia de un programa de intervención logopédica de corte naturalista. Fueron seleccionadas 16 familias monolingües españolas con hijos/as hablantes tardíos/as de entre 24 y 29 meses de edad, y, posteriormente, asignadas a dos condiciones experimentales (intervención y control). Las familias pertenecientes al grupo de intervención se beneficiaron de un programa logopédico de intervención naturalista en el que las rutinas familiares se utilizaron para estimular el desarrollo comunicativo y lingüístico de los/as niños/as y para desarrollar estilos conversacionales ajustados a su nivel de comunicación y lenguaje. Con las familias del grupo control se empleó la estrategia “wait and see” (esperar y ver). Pasados cuatro meses de intervención naturalista, los resultados informaron de que las familias del grupo de intervención usaban más conductas ajustadas y sus hijos presentaban un vocabulario más extenso y producían más combinaciones de palabras frente al grupo control.

Randomised Controlled Trial Evaluating Active versus Passive Waiting for Speech-Language Pathology

INTRODUCTION

High demand for speech-language pathology means children sometimes wait over 12 months for services, missing out on timely support. Waiting can be a time of stress, concern, and powerlessness for caregivers. Provision of information via a website may support families and encourage active waiting.

OBJECTIVE

The aim of this study was to compare children's speech, intelligibility, language, and literacy outcomes, and caregivers' satisfaction and empowerment in active versus passive waiting conditions.

METHODS

Ninety-seven preschool-aged children referred to a community health speech-language pathology service in Australia were screened for eligibility. Eligible children (n =42) with speech/language difficulties were randomly allocated to: (a) active waiting (provision of a purpose-built website; n = 20), or (b) passive waiting (control group; n = 22). Pre- and post-assessments (after 6 months on a waiting list) were completed with children and caregivers by a speech-language pathologist blinded to group allocations.

RESULTS

Intention to treat (n =36) and per-protocol analyses (n =30) were conducted to measure group differences in child and caregiver outcomes at post-assessment using one-way ANCOVA, controlling for baseline scores. There were no statistically significant differences between groups for children's speech, intelligibility, language, and literacy, or caregivers' empowerment and satisfaction. Children in both groups made minimal gains over 6 months.

CONCLUSIONS

Provision of an active waiting website did not lead to statistically significant change in child or caregiver outcomes, and children in both groups made little progress over a 6-month period. Early speech-language pathology intervention delivered with appropriate dosage is needed to optimise children's outcomes. Until timely and effective speech-language pathology intervention can be provided for all who need it, provision of early assessments may be beneficial. There remains a need for effective ways to support children and families on waiting lists.

Expectations and experiences of parents taking part in parent-child interaction programmes to promote child language: a qualitative interview study

BACKGROUND

Parent-child interaction therapies are commonly used by speech and language therapists (SLTs) when providing services to young children with language learning difficulties. However, the way parents react to the demands of such interventions is clearly important, especially for those from socially disadvantaged backgrounds. Parents play a central role in the therapy process so to ensure parent engagement, and to maximize intervention effectiveness, parents' views must be considered.

AIMS

To explore the expectations and experiences of parents from socially disadvantaged backgrounds who had taken part in a parent-child interaction programme aimed at promoting language development in 2-3 year olds with language difficulties.

METHODS & PROCEDURES

The sample included parents who had a child aged 2-3 years and had attended a parent-child interaction programme to promote their child's language development. Parents were eligible to take part if they were living in the 30% most deprived areas in a city in the North of England that constituted the study site. Ten parents participated in a qualitative semi-structured face-to-face interview in the home. Framework analysis was used to analyse the interview transcripts.

OUTCOMES & RESULTS

Parents' expectations before taking part in parent-child interaction interventions contribute to how they may engage throughout the intervention process. Barriers include parents' uncertainty about the nature of the intervention and differing attitudes regarding intervention approaches and strategies. Facilitators during the intervention process include gaining support from other parents, reassurance from the SLT regarding their child's language development, and their own ability to support their child's language learning, as well as increased confidence in how they support their child's development.

CONCLUSIONS & IMPLICATIONS

Parents respond very differently to parent-child interaction intervention for children with language difficulties, depending on their expectations and attitudes towards intervention. Thus, it is critical that these different perspectives are understood by practitioners before intervention commences to ensure successful engagement. What this paper adds What is already known on this subject Parent-child interaction interventions are widely used to promote child language development. Parents play a central role in the therapy process of such interventions, so to maximize effectiveness, parents must be appropriately 'engaged' in that intervention. This involves attending, fully participating and having appropriate attitudinal and/or emotional involvement. The reciprocal nature of engagement means that parents are more likely to become engaged in intervention over time when they are supported by their SLT. What this paper adds to existing knowledge Parental expectations about the intervention process vary considerably and often need to be negotiated before the start of intervention. Reassurance and supporting positive attitudes to co-working with their SLT may be particularly important for families living with social disadvantage. Supporting parent engagement in parent-child interaction programmes can contribute to the parents' capability to continue implementing language-promoting strategies outside the intervention context and beyond the end of therapy. What are the potential or actual clinical implications of this work? Parents have different expectations regarding programme involvement. Therefore, having a two-way, open dialogue between parents and SLTs from the beginning is clearly important, not only as a way of sharing information but also to build on parents' understanding of what the intervention will involve and trust that the SLT will be able to deliver the intervention in collaboration with the parent. SLTs can enhance parent engagement by supporting parents to feel confident and providing reassurance in terms of their child's development and how they can support their child's language learning.

Preliminary evaluation of a low-intensity parent training program on speech-language stimulation for children with language delay

AIM

The study assessed the outcome of a low-intensity parent training program for improving parent's language input to children with language delay.

METHOD

Nine parents and their children aged between 12 months to 24 months, exhibiting delay in language development, participated in a brief training program over three sessions. Training comprised of inputs on speech-language development, play development and speech-language stimulation strategies, supported by a manual. Effect of the training program on parent's language behaviour was evaluated through observations of parent-child interaction recorded before training and six-weeks and 10-weeks post training. Measures including, different functions served by verbalizations of parents and their nonverbal affective behaviours, were analysed.

RESULTS AND DISCUSSION

Parents' verbalizations increased significantly from baseline to the two follow-up sessions. Proportion of comments, suggestions and reflections on the child's productions increased with a concurrent decrease in the use of direct commands and questions, from baseline to post training at 10-weeks. Parents reported regular use of the manual during and after the training sessions. Post training, they identified play-based activities and provided opportunities for interactions in daily routines. Changes in the child's communication skills were also reported.

CONCLUSION

A low-intensity training program for parents, supported by a manual focusing on developmentally appropriate play and speech-language stimulation, resulted in increased verbal interaction and changes in language input to children.

SLTs' conceptions about their own and parents' roles during intervention with preschool children

BACKGROUND

Current research investigating collaboration between parents and speech and language therapists (SLTs) indicates that the SLT role is characterized by therapist-led practice. Co-working with parents of children with speech and language difficulties is less frequently described. In order to embrace co-working during intervention, the SLT role may need to be reframed, focusing on acquiring skills in the role of coach as well as the role of planning intervention and treating children.

AIMS

To report (1) SLTs' conceptions about their own roles during intervention for pre-school children with speech and language difficulties; and (2) SLTs' conceptions of parents' roles during intervention.

METHODS & PROCEDURES

A qualitative study used individual, semi-structured interviews with 12 SLTs working with pre-school children. Open-ended questions investigated SLTs' expectation of parents, experience of working with families, and the SLTs' conception of their roles during assessment, intervention and decision-making. Thematic network analysis was used to identify basic, organizational and global themes.

RESULTS & OUTCOMES

SLTs had three conceptions about their own role during intervention: treating, planning and coaching. The roles of treating and planning were clearly formulated, but the conception of their role as coach was more implicit in their discourse. SLTs' conception of parents' roles focused on parents as implementers of activities and only occasionally as change agents.

CONCLUSIONS & IMPLICATIONS

Collaboration that reflects co-working may necessitate changes in the conception about the role for both SLTs and parents. SLTs and parents may need to negotiate roles, with parents assuming learner and adaptor roles and SLTs adopting a coaching role to activate greater involvement of parents. Applying conceptual change theory offers new possibilities for understanding and enabling changes in SLTs' conception of roles, potentially initiating a deeper understanding of how to achieve co-working during speech and language intervention.

Association of Parent Training With Child Language Development: A Systematic Review and Meta-analysis

IMPORTANCE

Training parents to implement strategies to support child language development is crucial to support long-term outcomes, given that as many as 2 of 5 children younger than 5 years have difficulty learning language.

OBJECTIVE

To examine the association between parent training and language and communication outcomes in young children.

DATA SOURCES

Searches of ERIC, Academic Search Complete, PsycINFO, and PsycARTICLES were conducted on August 11, 2014; August 18, 2016; January 23, 2018; and October 30, 2018.

STUDY SELECTION

Studies included in this review and meta-analysis were randomized or nonrandomized clinical trials that evaluated a language intervention that included parent training with children with a mean age of less than 6 years. Studies were excluded if the parent was not the primary implementer of the intervention, the study included fewer than 10 participants, or the study did not report outcomes related to language or communication.

DATA EXTRACTION AND SYNTHESIS

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included.

MAIN OUTCOMES AND MEASURES

Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment.

RESULTS

This meta-analysis included 59 randomized clinical trials and 17 nonrandomized clinical trials including 5848 total participants (36.4 female [20.8%]; mean [SD] age, 3.5 [3.9] years). The intervention approach in 63 studies was a naturalistic teaching approach, and 16 studies used a primarily dialogic reading approach. There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean [SE] Hedges g, -0.33 [0.06]; P < .001). The association between parent training and parent use of language support strategies was large (mean [SE] Hedges g, 0.55 [0.11], P < .001). Children with developmental language disorder had the largest social communication outcomes (mean [SE] Hedges g, 0.37 [0.17]); large and significant associations were observed for receptive (mean [SE] Hedges g, 0.92 [0.30]) and expressive language (mean [SE] Hedges g, 0.83 [0.20]). Children at risk for language impairments had moderate effect sizes across receptive language (mean [SE] Hedges g, 0.28 [0.15]) and engagement outcomes (mean [SE] Hedges g, 0.36 [0.17]).

CONCLUSIONS AND RELEVANCE

The findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention.

Parent-implemented early language intervention programme for late talkers: parental communicative behaviour change and child language outcomes at 3 and 4 years of age

BACKGROUND

Late language emergence is a risk indicator for developmental language disorder. Parent-implemented early language intervention programmes (parent programmes) have been shown to have positive effects on children's receptive and expressive language skills. However, long-term effectiveness has rarely been studied. Additionally, little is known about which strategies parents learn to use after participating in parent programmes and whether this affects their child's language development.

AIMS

To evaluate medium- and long-term effectiveness (1 and 2 years after inclusion) of a low-dosage parent programme in a sample of late talkers (LTs) with an expressive language delay. Specifically, we investigated which strategies the parents learned to use in interaction with their child and which strategies were associated with child language growth over time.

METHODS & PROCEDURES

This quasi-experimental study with a longitudinal design included 24-month-old LTs. After the pre-test, parents of children in the intervention group received a parent programme (n = 30), while parents of children in the comparison group received care as usual (n = 30). Children's language development was assessed using standardized language tests at pre-test and two follow-up tests at 36 and 48 months of age. Change in parental communicative behaviour was measured by a parent-child interaction observation measure, at pre-test and follow-up at 36 months of age.

OUTCOMES & RESULTS

At 36 months old, children in the parent programme group showed a significantly higher growth in expressive vocabulary than children in the comparison group. However, differences between the groups were not seen in the long-term, at the 48-month follow-up. In contrast to parents in the comparison group, parents in the parent programme group changed their communicative behaviour positively in two domains: Interaction and Pressure on the child. However, no changes in the domains of Language Stimulation and Responsiveness were observed. Children's growth in expressive vocabulary and expressive syntax was associated with a decrease in the domain of Pressure.

CONCLUSIONS & IMPLICATIONS

At 4 years of age, the majority of children in both groups achieved expressive vocabulary scores within the normal range. However, the mean score for expressive syntax in both groups remained below that of their peers, and 29% of the children still had expressive language scores below the mean range. Ongoing monitoring of LTs' language development is necessary in order to make decisions regarding the timing and nature of intervention.

Prediction of the outcome of children who had a language delay at age 2 when they are aged 4: Still a challenge

PURPOSE

This study investigated the role that variables related to children and their environment play in the prediction of outcomes at 4 years of age for children with a language delay at 2 years.

METHOD

A longitudinal study was undertaken where 64 children (45 boys, 19 girls; mean age = 53.3 months; SD = 4.4) with language delay at age 2 years were re-evaluated at age 4 years. Three developmental trajectories were analysed.

RESULT

The early stages of grammar, as estimated by mean length of utterance at 3.5 years, are an important prognosis factor of subsequent language impairment (LI). Children who are exposed to several risk factors simultaneously are more likely to have a language delay (LD) or a LI, but the profile of LD children is more akin to that of the typically developing (TD) children. Children with LI tend to have profiles with a greater number of risk factors.

CONCLUSION

The results of this study encourage different intervention approaches depending on the child's language profile at 2 years, due to differing language prognosis. The results also point to the need to assess the child's environment. Future studies with large diverse population samples may give more precise information on potential risk factors and their cumulative effect.

Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders

BACKGROUND

Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facial expression (or a combination of these), making their communication difficult to understand. Parents may be offered training to help recognise and interpret their child's signals and to stimulate their children's development of new communication skills.

OBJECTIVES

To assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual or clinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have non-progressive motor disorders.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. We also searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies.

SELECTION CRITERIA

We included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication intervention with no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders up to five years of age.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and their mothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected their gestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or three home visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took place at an intervention centre in Canada and the other in South Korea.Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending or therapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated one study at high risk of attrition bias, and both studies at low risk of reporting bias.There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children's initiation of conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became more responsive to their children's communication, but there were no differences in the extent to which they controlled conversation by directing their children. Missing data meant that we were unable to evaluate the effects of training on children's frequency of communication, frequency of spoken language in conversation, speech production, or receptive or expressive language development. There were no effects on maternal stress. We found no reports of the effects of parent training on children's use of individual communication skills, such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports of mothers' satisfaction with treatment, its acceptability or their compliance with it.

AUTHORS' CONCLUSIONS

There is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples and high risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lack of detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication. Some speech and language therapists currently provide communication training for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures, coupled with detailed reporting of children's baseline skills, is needed to test whether communication training for parents can help them to promote the communication development of their young children with movement disorders.

Accuracy of a Screening Tool for Early Identification of Language Impairment

PURPOSE

A screening tool called the VTO Language Screening Instrument (VTO-LSI) was developed to enable more uniform and earlier detection of language impairment. This report, consisting of 2 retrospective studies, focuses on the effects of using the VTO-LSI compared to regular detection procedures.

METHOD

Study 1 retrospectively compared VTO-LSI with regular detection procedures. Outcome measure was the detection rate of language impairment among 24-month-old children. Data were retrieved from medical records of children attending a youth health care center. Study 2 retrospectively compared the effects of VTO-LSI and regular detection procedures on the age at referral for diagnostic investigations and the influence of sex. Data were retrieved from medical records from the speech and hearing center and analyzed with multivariate analysis of variance.

RESULTS

With the VTO-LSI, significantly more cases with language impairment were identified compared with the regular detection procedure (2.4% vs. 0.4%). In regions where the VTO-LSI was used, girls were almost 2 years younger, and boys were 1 year younger when referred to diagnostic investigations than in regions with regular detection procedures.

CONCLUSION

The VTO-LSI was more effective than regular detection procedures.

One-Year Language Outcomes in Toddlers With Language Delays: An RCT Follow-up

OBJECTIVES

The current study is a 1-year follow-up analysis of data from a randomized controlled trial of Enhanced Milieu Teaching (EMT) for toddlers with language delays. Outcomes and predictors of child language and parent intervention implementation were examined 6 and 12 months after the end of the intervention.

METHODS

Toddlers with language delays were recruited from the community, and 97 toddlers and parents were randomly assigned to receive usual community treatments or a 3-month EMT intervention with parent training. Multiple regression analyses were used to estimate the differences between groups at the 6- and 12-month follow-up periods. A subgroup of participants with receptive and expressive language delays was used in a post hoc moderator analysis of treatment outcomes.

RESULTS

Children in the treatment arm did not differ from children in the control arm at 6- and 12-month follow-ups. However, post hoc analyses revealed that children with receptive-expressive language delays were persistently delayed relative to normative performance throughout the follow-up period.

CONCLUSIONS

The immediate effects of the brief delivery of EMT were not sustained over the 1-year follow-up period. However, the short-term intervention may not have been sufficient for children with receptive-expressive delays to develop typical language abilities, suggesting they may need more intensive early intervention. Although this intervention may not be necessary for all children with primary language delays, future research should determine the extent to which children with receptive-expressive delays may benefit from more intensive intervention.

Parent-implemented home therapy programmes for speech and language: a systematic review

BACKGROUND

Parent-delivered home programmes are frequently used to remediate speech and language difficulties in young children. However, the evidence base for this service delivery model is limited.

AIMS

The aim of this systematic review is to investigate the effectiveness of parent-implemented home programmes in facilitating the development of children's speech and language skills, and to evaluate the cost-effectiveness and feasibility of this service delivery method.

METHODS & PROCEDURES

A systematic search of the PsycINFO, CINAHL and ERIC databases was conducted. Quality appraisal of individual studies was conducted. Findings from each of the studies were then integrated to report on outcomes for the child, the parent and the service.

OUTCOMES & RESULTS

There is preliminary evidence that home programmes can lead to growth in a child's speech and language skills and are more effective than no intervention, provided the home programmes are used with high dosage rates and direct parent training.

CONCLUSIONS & IMPLICATIONS

Home programmes are a potentially useful service delivery model, but caution should be exercised when considering their use to address broader service delivery challenges. Further high-level evidence is needed across all facets of this service delivery model.

Parent-child interaction in motor speech therapy

PURPOSE

This study measures the reliability and sensitivity of a modified Parent-Child Interaction Observation scale (PCIOs) used to monitor the quality of parent-child interaction. The scale is part of a home-training program employed with direct motor speech intervention for children with speech sound disorders.

METHOD

Eighty-four preschool age children with speech sound disorders were provided either high- (2×/week/10 weeks) or low-intensity (1×/week/10 weeks) motor speech intervention. Clinicians completed the PCIOs at the beginning, middle, and end of treatment. Inter-rater reliability (Kappa scores) was determined by an independent speech-language pathologist who assessed videotaped sessions at the midpoint of the treatment block. Intervention sensitivity of the scale was evaluated using a Friedman test for each item and then followed up with Wilcoxon pairwise comparisons where appropriate.

RESULTS

We obtained fair-to-good inter-rater reliability (Kappa = 0.33-0.64) for the PCIOs using only video-based scoring. Child-related items were more strongly influenced by differences in treatment intensity than parent-related items, where a greater number of sessions positively influenced parent learning of treatment skills and child behaviors.

CONCLUSION

The adapted PCIOs is reliable and sensitive to monitor the quality of parent-child interactions in a 10-week block of motor speech intervention with adjunct home therapy. Implications for rehabilitation Parent-centered therapy is considered a cost effective method of speech and language service delivery. However, parent-centered models may be difficult to implement for treatments such as developmental motor speech interventions that require a high degree of skill and training. For children with speech sound disorders and motor speech difficulties, a translated and adapted version of the parent-child observation scale was found to be sufficiently reliable and sensitive to assess changes in the quality of the parent-child interactions during intervention. In developmental motor speech interventions, high-intensity treatment (2×/week/10 weeks) facilitates greater changes in the parent-child interactions than low intensity treatment (1×/week/10 weeks). On one hand, parents may need to attend more than five sessions with the clinician to learn how to observe and address their child's speech difficulties. On the other hand, children with speech sound disorders may need more than 10 sessions to adapt to structured play settings even when activities and therapy materials are age-appropriate.

Inequalities in the provision of paediatric speech and language therapy services across London boroughs

BACKGROUND

The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest.

AIMS

To examine the provision of paediatric speech and language services across London boroughs and to relate provision to the level of deprivation of the boroughs.

METHODS & PROCEDURES

Information on the employment of paediatric speech and language therapists was obtained from London boroughs by freedom-of-information requests. The relationship between the number of therapists and the index of multiple deprivation for the borough was examined.

OUTCOMES & RESULTS

Twenty-nine of 32 boroughs responded. A positive relationship between provision and need was obtained, suggesting that the inverse-care law does not apply. However, large inequalities of provision were found particularly among the more socially deprived boroughs. In some instances boroughs had five times as many therapists per child as other boroughs.

CONCLUSIONS & IMPLICATIONS

The data reveal that large differences in speech and language therapy provision exist across boroughs. The reasons for these inequalities are unclear, but the lack of comparative information across boroughs is likely to be unhelpful in planning equitable services. The use of freedom of information in assessing health inequalities is stressed and its future availability is desirable.

Direct and Indirect Effects of Behavioral Parent Training on Infant Language Production

Given the strong association between early behavior problems and language impairment, we examined the effect of a brief home-based adaptation of Parent-child Interaction Therapy on infant language production. Sixty infants (55% male; mean age 13.47±1.31 months) were recruited at a large urban primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the home-based parenting intervention or standard pediatric primary care. The observed number of infant total (i.e., token) and different (i.e., type) utterances spoken during an observation of an infant-led play and a parent-report measure of infant externalizing behavior problems were examined at pre- and post-intervention and at 3- and 6-month follow-ups. Infants receiving the intervention demonstrated a significantly higher number of observed different and total utterances at the 6-month follow-up compared to infants in standard care. Furthermore, there was an indirect effect of the intervention on infant language production, such that the intervention led to decreases in infant externalizing behavior problems from pre- to post-intervention, which, in turn, led to increases in infant different utterances at the 3- and 6-month follow-ups and total utterances at the 6-month follow-up. Results provide initial evidence for the effect of this brief and home-based intervention on infant language production, including the indirect effect of the intervention on infant language through improvements in infant behavior, highlighting the importance of targeting behavior problems in early intervention.

Management of developmental speech and language disorders: Part 1

The identification of developmental problems in a child's acquisition of speech, language and/or communication is a core activity in child surveillance. These are common difficulties with up to 15% of toddlers being 'late talkers' and 7% of children entering school with persisting impairments of their language development. These delays can confer disadvantages in the long term, adversely affecting language, cognition, academic attainment, behaviour and mental health. All children presenting with significant speech and language delay should be investigated with a comprehensive hearing assessment and be considered for speech and language therapy assessment. Socioeconomic adversity correlates with delayed language development. Clinical assessment should confirm that the presentation is definitely not acquired (see part 2) and will also guide whether the difficulty is primary, in which there are often familial patterns, or secondary, from a very wide range of aetiologies. Symptoms may be salient, such as the regression of communication in <3-year-olds which 'flags up' autism spectrum disorder. Further investigation will be informed from this clinical assessment, for example, genetic investigation for sex aneuploidies in enduring primary difficulties. Management of the speech and language difficulty itself is the realm of the speech and language therapist, who has an ever-increasing evidence-based choice of interventions. This should take place within a multidisciplinary team, particularly for children with more severe conditions who may benefit from individualised parental and educational supports.

Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study

Background

The Child Talk study aimed to develop an evidence-based framework to support the decision-making of speech and language therapists (SLTs) as they design and plan interventions appropriate to the needs of individual children with primary speech and language impairments and their families. The need for early identification and effective intervention for these children continues to be a government policy priority because of the link between children’s early speech and language skills and their broader well-being and outcomes in later life. The first phase of Child Talk sought to map and describe current SLT practice for these children; identify and summarise the existing research evidence relating to practice; and investigate the perspectives of parents, early years practitioners, preschool children and ‘underserved’ communities on speech and language therapy. The second phase of Child Talk focused on the development of a toolkit – assessment tools, outcome measures and a data set – to support future service and economic evaluations of the framework.

Methods

Child Talk adopted a mixed-methods design. Quantitative methods included surveys and investigated the prevalence and patterns of intervention usage; qualitative data collection methods included focus groups, interviews and reflection to investigate participants’ perspectives and understandings of interventions. Data analysis methods included descriptive and inferential statistics, thematic and content analysis and framework analysis. Participants were recruited nationally through six NHS sites, professional bodies, parent groups and advertising. Participants included SLTs (n = 677), parents (n = 84), preschool children (n = 24), early years practitioners (n = 31) and ‘underserved’ communities (n = 52).

Key findings

Speech and language therapy interventions were characterised in terms of nine themes, viewed as comprehensive and inclusive by practitioners. Relevant assessments, interventions and outcome domains were identified for the nine themes. Areas of tacit knowledge and underspecified processes contributed to variability in the detail of the framework. Systematic reviews identified 58 relevant and robust studies (from 55,271 papers retrieved from the initial literature search). The number of studies relevant to each theme varied from 1 to 33. Observational data on preschool children’s perspectives on speech and language therapy interventions revealed the dynamic nature of their interaction with different activities and people within therapy sessions. Parents’ experiences of speech and language therapy were generally positive although some reported that the rationale for therapy was not always clear. Parental perspectives in underserved communities suggested that, although parents were confident about how to support children’s language development, they were less informed about the nature of language impairments and the function of speech and language therapy. The availability of information regarding resources directed towards speech and language therapy services was poor. In particular, services lacked both a culture of collecting outcome data routinely and measures of professional input and costs associated with their activities.

Conclusion

A descriptive framework of SLT practice has been developed to support the discussions between therapists and families when making decisions regarding the selection of interventions and outcome measures. Further research is needed to address gaps in the intervention framework and evaluate its effectiveness and cost-effectiveness in improving outcomes for preschool children with primary speech and language impairments.

Study registration

This study is registered as PROSPERO CRD42013006369.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Hearing impairment and language delay in infants: Diagnostics and genetics

This overview study provides information on important phoniatric and audiological aspects of early childhood hearing and language development with the aim of presenting diagnostic and therapeutic approaches. The article first addresses the universal newborn hearing screening that has been implemented in Germany for all infants since January 2009. The process of newborn hearing screening from the maternity ward to confirmation diagnostics is presented in accordance with a decision by the Federal Joint Committee (G-BA). The second topic is pediatric audiology diagnostics. Following confirmation of a permanent early childhood hearing disorder, the search for the cause plays an important role. Hereditary hearing disorders and intrauterine cytomegalovirus (CMV) infection, probably the most common cause of an acquired hearing disorder, are discussed and compared with the most common temporary hearing disorder, otitis media with effusion, which in some cases is severe enough to be relevant for hearing and language development and therefore requires treatment. The third topic covered in this article is speech and language development in the first 3 years of life, which is known today to be crucial for later language development and learning to read and write. There is a short overview and introduction to modern terminology, followed by the abnormalities and diagnostics of early speech and language development. Only some aspects of early hearing and language development are addressed here. Important areas such as the indication for a cochlear implant in the first year of life or because of unilateral deafness are not included due to their complexity.

Effects of the teach-model-coach-review instructional approach on caregiver use of language support strategies and children's expressive language skills

PURPOSE

In this study, the authors examined the effects of the Teach-Model-Coach-Review instructional approach on caregivers' use of four enhanced milieu teaching (EMT) language support strategies and on their children's use of expressive language.

METHOD

Four caregiver-child dyads participated in a single-subject, multiple-baseline study. Children were between 24 and 42 months of age and had language impairment. Interventionists used the Teach-Model-Coach-Review instructional approach to teach caregivers to use matched turns, expansions, time delays, and milieu teaching prompts during 24 individualized clinic sessions. Caregiver use of each EMT language support strategy and child use of communication targets were the dependent variables.

RESULTS

The caregivers demonstrated increases in their use of each EMT language support strategy after instruction. Generalization and maintenance of strategy use to the home was limited, indicating that teaching across routines is necessary to achieve maximal outcomes. All children demonstrated gains in their use of communication targets and in their performance on norm-referenced measures of language.

CONCLUSION

The results indicate that the Teach-Model-Coach-Review instructional approach resulted in increased use of EMT language support strategies by caregivers. Caregiver use of these strategies was associated with positive changes in child language skills.

Telepractice for pediatric Dysphagia: a case study

A closed-ended intensive pediatric swallowing telepractice program was developed and piloted in one pediatric patient with Opitz BBB/G and Asperger's Syndromes, oropharyngeal dysphagia and aerophagia. The present study is a case report. Outcome variables included behavioral, swallowing and quality of life variables, and were assessed at baseline and at the end of the four-week program. Selective variables were also assessed at a follow-up family interview four weeks post program completion. Over the four-week intervention period, the patient demonstrated substantial improvements in: oral acceptance of eating-related objects and a variety of foods (behavioral variable), timing of voluntary saliva swallows and aerophagia levels (swallowing variables) and quality of life. Follow-up interview analysis showed that most skills were retained or improved one-month post intervention. This intensive telepractice program proved to be feasible and effective for this pediatric patient with dysphagia.

Characterizing early detection of language difficulties in children born preterm

BACKGROUND

The optimal age for assessing language difficulties in premature children remains unclear.

AIMS

To determine the most predictive and earliest screening tool for later language difficulties on children born preterm.

STUDY DESIGN

A prospective population-based study in the Loire Infant Follow-up Team LIFT SUBJECTS: All children born <35weeks of gestation between 2003 and 2005 were assessed at corrected ages by four screening tools: the Ages & Stages Questionnaire (ASQ) communication scale at 18 and 24months, the language items of Brunet Lezine test at 24months, and the "Epreuves de Repérage des Troubles du Langage" (ERTL) at 4years.

OUTCOME MEASURES

After 5years, the kindergarten teacher evaluated the vocabulary, grammar and pronunciation capacities of the child in comparison with the classroom performances.

RESULTS

Among 1957 infants enrolled at discharge, 947 were assessed by their teacher with 12.2% (n=116) of language difficulties. Full data at all time points were available for 426 infants. The area under curve of the receiver operator characteristic curve obtained for the ASQ communication scale at 18months was significantly lower (0.65±0.09) than that obtained at 24months (0.77±0.08) and the languages items of Brunet Lezine test at 24months (0.77±0.08), and the ERTL at 4years (0.76±0.09). The optimal cut-off value for ASQ communication at 24months is ≤45 [sensitivity of 0.79 (95%CI: 0.70-0.86); specificity of 0.63 (95%CI: 0.59-0.66)].

CONCLUSIONS

The Ages & Stages Questionnaire communication scale at 24 corrected months appears as an acceptable test at an early time point to identify preterm children at risk of later language difficulties.

Role of maternal gesture use in speech use by children with fragile X syndrome

PURPOSE

The purpose of this study was to investigate how maternal gesture relates to speech production by children with fragile X syndrome (FXS).

METHOD

Participants were 27 young children with FXS (23 boys, 4 girls) and their mothers. Videotaped home observations were conducted between the ages of 25 and 37 months (toddler period) and again between the ages of 60 and 71 months (child period). The videos were later coded for types of maternal utterances and maternal gestures that preceded child speech productions. Children were also assessed with the Mullen Scales of Early Learning at both ages.

RESULTS

Maternal gesture use in the toddler period was positively related to expressive language scores at both age periods and was related to receptive language scores in the child period. Maternal proximal pointing, in comparison to other gestures, evoked more speech responses from children during the mother-child interactions, particularly when combined with wh-questions.

CONCLUSION

This study adds to the growing body of research on the importance of contextual variables, such as maternal gestures, in child language development. Parental gesture use may be an easily added ingredient to parent-focused early language intervention programs.