Introducing a novel clinical tool to describe child engagement in telehealth speech and language assessments

Purpose: Telehealth may be a solution to access barriers in speech-language pathology. Previous investigations of telehealth assessment have alluded to factors affecting children's engagement, though these factors have not been comprehensively described.Aim: This study aimed to develop a novel clinical tool to describe the factors affecting children's engagement in paediatric telehealth assessments.Method: The Factors Affecting Child Engagement in Telehealth Sessions (FACETS) tool was developed using a mixed methods approach. Iterative analysis was conducted through a qualitative evidence synthesis, followed by the application of the tool to seven children aged between 4;3 and 5;7 years old who participated in a speech and language assessment via telehealth. Descriptive data were obtained regarding engagement on both a child-by-child and task-by-task basis. Reliability of the FACETS was determined via percent agreement and Cohen's kappa between two independent raters.Result: Using a mixed methods design, the FACETS framework was developed and refined. Application of the tool to seven case studies revealed variability in engagement with acceptable inter-rater reliability.Conclusion: The FACETS may be a useful resource for describing the factors that influence children's engagement in telehealth during the assessment. The FACETS requires further testing with clinical populations.

Identifying developmental language disorder (DLD) in multilingual children: A case study tutorial

PURPOSE

A long-standing issue in identifying developmental language disorder (DLD) in multilingual children is differentiating between effects of language experience and genuine impairment when clinicians often lack suitable norm-referenced assessments. In this tutorial we demonstrate, via a case study, that it is feasible to identify DLD in a multilingual child using the CATALISE diagnostic criteria, Language Impairment Testing in Multilingual Settings (LITMUS) assessment tools, and telepractice.

METHOD

This tutorial features a case study of one 6-year-old Urdu-Cantonese multilingual ethnic minority child, and seven age- and grade-matched multilinguals. They were tested via Zoom using Urdu versions of the Multilingual Assessment Instrument for Narratives (LITMUS-MAIN), the Crosslinguistic Lexical Task (LITMUS-CLT), the Crosslinguistic Nonword Repetition Test (LITMUS-CL-NWR), and the Sentence Repetition Task (LITMUS-SRep).

RESULT

The child scored significantly lower in the LITMUS tests compared to her peers in her best/first language of Urdu. Together with the presence of negative functional impact and poor prognostic features, and absence of associated biomedical conditions, the findings suggest this participant could be identified as having DLD using the CATALISE diagnostic criteria.

CONCLUSION

The result demonstrates the promise of this approach to collect reference data and identify DLD in multilingual children. The online LITMUS battery has the potential to support identification of multilingual DLD in any target language.

Reliability and Feasibility of Administering a Child Language Assessment via Telehealth

PURPOSE

Despite the speed with which telehealth use advanced during the COVID-19 pandemic, evidence is needed to support the remote delivery of standardized assessments. This study investigated the reliability and feasibility of administering a standardized language assessment administered in real-world telehealth scenarios compared to in-person administration.

METHOD

A total of 100 children between the ages of 3 and 12 years were administered one of three versions of the Clinical Evaluation of Language Fundamentals (CELF). Children were administered the CELF by the same licensed speech-language pathologists (SLPs) in person and using telehealth, with the order counterbalanced. Means for Core Language standard scores were compared between conditions and among devices. Descriptive statistics summarized the behavior and technology disruptions during administration as well as the results of parent and SLP telehealth perception surveys.

RESULTS

In-person and telehealth mean scores on all three versions of the CELF revealed no systematic differences of one condition under- or overestimating another. The incidence of child behavior disruptions was similar for both test administration conditions. Adaptations compensated for the rare technology disruptions. Despite no significant language score and behavior differences between testing conditions, parents reported they continued to prefer in-person assessments. SLP participants viewed telehealth overall positively but identified conditions in which they continued to prefer in-person delivery.

CONCLUSIONS

This study provides evidence of minimal or no differences in scores and behavioral or technological disruptions between remote and in-person administration of the CELF core language assessments. SLP and parent participants' attitudes toward remote delivery of standardized tests appear to be evolving in a positive direction compared to previous studies.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25292752.

UK paediatric speech and language therapists' perceptions on the use of telehealth in current and future clinical practice: An application of the APEASE criteria

BACKGROUND

Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID-19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face-to-face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real-world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective.

METHODS

An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis.

RESULTS

Four hundred and thirty-eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost-effectiveness compared to face-to-face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance.

CONCLUSIONS

Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow.

WHAT THIS PAPER ADDS

What is already known on this subject The COVID-19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre-COVID-19, evidence for the use of telehealth in this field included small-scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face-to-face delivery. The realities of at-scale clinical practice were not well-represented, and critical elements of service such as cost-effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long-term and future use of telehealth remains unclear. What this paper adds to existing knowledge The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer-term and at-scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face-to-face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work? UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co-ordinated leadership at the local, national and international levels and the development of policy and clinical guidance.

Rapid transition to telepractice across the lifespan in speech-language pathology: Insight from a survey of clinicians in Canada

PURPOSE

This study aims to describe the experiences and needs of Canadian speech-language pathologists (SLPs) who conducted communication assessments via telepractice across the lifespan during the first year (2020) of the COVID-19 pandemic.

METHOD

The present study consisted of an online survey that aimed to capture both quantitative aspects of telepractice-based communication assessment and the qualitative experience of shifting to telepractice. One hundred sixty-eight practicing SLPs across Canada participated in the survey, between September 2020 and January 2021. Quantitative results were analysed using descriptive statistics while open-ended responses were analysed using thematic analysis.

RESULT

SLPs identified challenges and opportunities relating to client and family engagement, access to and knowledge of technology, and the reliability of assessment tools. SLPs also identified a future need for online assessment materials and training, such as materials adapted for different communication needs (e.g. augmentative and alternative communication).

CONCLUSION

The present study contributes to a growing understanding worldwide of potential benefits and challenges related to telepractice, fuelled by the necessary shift in practices in our field during the COVID-19 pandemic. The results provide direction for continuing to build a valid and inclusive approach to telepractice in the future.

The Use of Telepractice to Administer Norm-Referenced Communication and Cognition Assessments in Children With Hearing Loss: A Rapid Review

PURPOSE

Telepractice administration of norm-referenced assessments of communication and cognition is relatively new, and evidence to support this practice for children with hearing loss is limited. This rapid review examines the validity, reliability, feasibility, and common features of telepractice-administered norm-referenced assessments of communication and cognition for children with hearing loss to determine whether results via telepractice-administration are usable.

METHOD

This rapid review was conducted in accordance with the Cochrane Collaboration Rapid Reviews Methods Group recommendations. Rayyan software was used for initial and full-text screening, and the Quality Assessment of Diagnostic Accuracy Studies was used to measure study quality.

RESULTS

Electronic databases searches identified two studies that met the eligibility criteria. The findings of this rapid review provide some evidence to indicate that results of norm-referenced assessments do not differ depending on test administration conditions or hearing group status. Although both studies were of sufficient quality, replicability of these studies is uncertain due to the limited description of telepractice administration procedures. Participants indicated that sound levels provided by inbuilt computer speakers were adequate for them to be able to participate in telepractice assessment.

CONCLUSION

Telepractice administration of the norm-referenced assessments in the included studies may be valid, reliable, and feasible; however, the generalizability of these findings to other norm-referenced assessments is uncertain due to the limited amount of research.

Telehealth assessment of autism in preschoolers using the TELE-ASD-PEDS: A pilot clinical investigation

PURPOSE

Appropriate early intervention is beneficial but dependent on accurate and timely diagnoses. This has been affected by long waiting lists for face-to-face clinical services, in part due to pandemic lockdowns, with telehealth introduced in many services to continue clinical services. This pilot clinical study investigated the feasibility of integrating a specially-designed telepractice autism assessment tool into a tertiary diagnostic service.

METHOD

Eighteen boys (2;4-5;1) participated in the study. Assessment was undertaken as per standard practice (parent interview, questionnaires, review of reports), with an additional telepractice assessment, included in place of face-to-face assessment, to provide clinicians with an observation of the children's communication, behaviours, and interests. Ten parents provided feedback via semi-structured interviews.

RESULT

The TELE-ASD-PEDS was a feasible assessment tool in terms of administration, clinical experience, and information gained through the assessment process. Parents reported mostly positive experiences of the TELE-ASD-PEDS and made suggestions for improvements for future use of this tool.

CONCLUSION

It is possible to obtain useful information about a child's autism-specific behaviours using the activities in the TELE-ASD-PEDS. This information can be combined with clinical history from parents using the DSM-5 framework to provide a gold standard assessment for autism.

Tele-Assessment of Oral Personal Narratives in Arabic- and Hebrew-Speaking Children Using the Global TALES Protocol

INTRODUCTION

Tele-assessment (TA) has the potential to enhance access to speech therapy. This preliminary study aimed to investigate the impact of assessment mode (face-to-face [FTF] vs. TA) on the microstructure level and chosen topics of personal narratives produced by Arabic-speaking and Hebrew-speaking school-age children living in Israel. We also investigated whether performance variations, if evident, could be attributed to the children's language/culture.

METHODS

Eighty-nine 10-year-old children, 38 Arabic-speaking and 51 Hebrew-speaking, living in Israel, participated in this study. Forty participants were assigned to a TA group (via Zoom) and 49 to a FTF group. All participants were assessed using the Global TALES protocol, generating six personal narratives each. The narratives were analyzed regarding the following microstructural measures: total number of words, total number of utterances (TNU), number of different words, and mean length of utterance in words (MLU-W). Additionally, each narrative was categorized into a topic according to the Global TALES protocol.

RESULTS

The analysis revealed no significant main effect of assessment mode on any of the microstructure measures. However, a significant interaction effect between language/culture and assessment mode was found for TNU and MLU-W, with a significant main effect for TNU exclusively in the Arabic narratives, with the Arabic-speaking children producing more utterances through FTF compared to TA. Across language/culture groups, there was a significant effect of assessment mode on the chosen topic. Additionally, there were significantly higher scores in the Hebrew compared to the Arabic narratives in all microstructure measures, and language/culture also influenced the chosen topics.

CONCLUSIONS

The results support the feasibility of TA mode for assessing personal narratives in school-aged children, using the Global TALES protocol. However, the results also suggest that TA results may be affected by the language/culture of the narrator. Finally, the findings highlight the potential influence of TA on the chosen topics of personal narratives, perhaps due to a decrease in the quality of communication in TA.

Tele-neuropsychological Assessment of Children and Young People: A Systematic Review

The coronavirus pandemic identified a clinical need for pediatric tele-neuropsychology (TeleNP) assessment. However, due to limited research, clinicians have had little information to develop, adapt, or select reliable pediatric assessments for TeleNP. This preliminary systematic review aimed to examine the feasibility of pediatric TeleNP assessment alongside (1) patient/family acceptability, (2) reliability, and (3) the quality of the literature. Between May 2021 and November 2022, manual searches of PubMed, PsycINFO, and Google Scholar were conducted using terms related to "pediatric" and "tele-neuropsychology." After extracting relevant papers with samples aged 0-22 years, predefined exclusion criteria were applied. Quality assessment was completed using the AXIS appraisal tool (91% rater-agreement). Twenty-one studies were included in the review, with reported qualitative and quantitative data on the feasibility, reliability, and acceptability extracted. Across included studies, TeleNP was completed via telephone/video conference with participants either at home, in a local setting accompanied by an assistant, or in a different room but in the same building as the assessor. Pediatric TeleNP was generally reported to be feasible (e.g., minimal behavioral differences) and acceptable (e.g., positive feedback). Nineteen studies conducted some statistical analyses to assess reliability. Most observed no significant difference between in-person and TeleNP for most cognitive domains (i.e., IQ), with a minority finding variable reliability for some tests (e.g., attention, speech, visuo-spatial). Limited reporting of sex-assigned birth, racialized identity, and ethnicity reduced the quality and generalizability of the literature. To aid clinical interpretations, studies should assess underexamined cognitive domains (e.g., processing speed) with larger, more inclusive samples.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40817-023-00144-6.

Comparison of Voice Therapy Outcomes: Clinic vs Telehealth

BACKGROUND

Voice therapy provides patients with valuable exercises and techniques to optimize vocal behaviors and improve their ability to communicate effectively and efficiently. These sessions were typically held by speech-language pathologists (SLPs) in clinic. During the COVID-19 pandemic, SLPs were provisionally able to provide billable voice therapy services in telehealth format. There is a lack of existing research studies comparing outcomes based on the format of voice therapy.

METHODS

A retrospective chart review was performed on 101 patients who underwent voice therapy at a large academic institution in order to compare outcomes between clinic, telehealth, and mixed voice therapy formats. Demographics, dysphonia etiology, duration of symptoms, number of therapy sessions, and pre- and postvoice therapy scores using reflux symptom index (RSI), voice handicap index (VHI-10), consensus auditory-perceptual evaluation of voice (CAPE-V), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scoring were collected. Statistical comparisons were performed using Fisher's exact test and analysis of covariance.

RESULTS

There were no statistically significant differences in pre- to postvoice therapy RSI, VHI-10, CAPE-V, or GRBAS scores based on format of voice therapy, after adjustment for number of therapy sessions received. There were no differences in these outcomes when comparing voice therapy by etiology of dysphonia.

CONCLUSIONS

Overall, these data support the effectiveness of the telehealth voice therapy format. It is a promising platform for greater patient access to therapy. All formats of voice therapy were effective in improving key measures of voice perception.

Remote First-Language Assessment: Feasibility Study With Vietnamese Bilingual Children and Their Caregivers

PURPOSE

There is a shortage of bilingual speech-language pathologists (SLPs) in the United States. For Vietnamese, less than 1% of SLPs speak the language compared with a Vietnamese American population of > 2.1 million. This study examines the feasibility and social validity of remote child language assessment with the help of a caregiver to address the need for first language assessments among Vietnamese-speaking children.

METHOD

Twenty-one dyads of caregivers and typically developing children (aged 3-6 years) completed two assessment sessions in their first language, Vietnamese, using Zoom videoconferencing. Sessions were counterbalanced between two conditions in which either the clinician or the caregiver was the task administrator. Children's language samples were elicited using narrative tasks. Social validity was also assessed through caregiver and child questionnaires at the end of each session.

RESULTS

There were no significant differences between conditions on language sample measures nor the measures of social validity. Both caregivers and their children felt positively about the sessions. The caregivers' feelings were related to their perception of children's feelings about the sessions. Children's feelings were related to their Vietnamese language proficiency, caregiver-reported language ability, and whether they were born outside of the United States.

CONCLUSIONS

Findings build the evidence base for telepractice as an effective and socially valid service delivery model for bilingual children in the United States. This study supports the potential for caregivers as task administrators in a telepractice setting, making assessment in a child's first language more feasible and accessible. Future investigation is needed to extend results to bilingual populations with disorders.

Development and Evaluation of a Virtual Model for Fetal Alcohol Spectrum Disorder (FASD) Assessment and Diagnosis in Children: A Pilot Study

The diagnostic process for fetal alcohol spectrum disorder (FASD) involves a multi-disciplinary team and includes neurodevelopmental, physical, and facial assessments and evidence of prenatal alcohol exposure during the index pregnancy. With the increased use of virtual care in health care due to the pandemic, and desire of clinics to be more efficient when providing timely services, there was a need to develop a virtual diagnostic model for FASD. This study develops a virtual model for the entire FASD assessment and diagnostic process, including individual neurodevelopmental assessments. It proposes a virtual model for assessment and diagnosis of FASD in children and evaluates the functionality of this model with other national and international FASD diagnostic teams and caregivers of children being assessed for FASD.

Barriers and facilitators to paediatric caregivers' participation in virtual speech, language, and hearing services: A scoping review

Purpose

Virtual care-related technologies are transforming the way in which health services are delivered. A growing number of studies support the use of virtual care in the field of audiology and speech-language pathology; however, there remains a need to identify and understand what influences caregiver participation within the care that is virtual and family-focused. This review aimed to identify, synthesize, and summarize the literature around the reported barriers and facilitators to caregiver participation in virtual speech/hearing assessment and/or intervention appointments for their child.

Methods

A scoping review was conducted following the Joanna Briggs Institute manual for evidence synthesis. A search was conducted using six databases including MEDLINE, CINAHL, SCOPUS, ERIC, Nursing and Allied Health, and Web of Science to collect peer-reviewed studies of interest. Data was extracted according to a protocol published on Figshare, outlining a predefined data extraction form and search strategy.

Results

A variety of service delivery models and technology requirements were identified across the 48 included studies. Caregiver participation was found to vary across levels of attendance and involvement according to eight categories: Attitudes, child behavioral considerations, environment, opportunities, provider-family relationship, role in care process, support, and technology.

Conclusions

This review presents a description of the key categories reported to influence caregiver participation in virtual care appointments. Future research is needed to explore how the findings can be used within family-centered care models to provide strategic support benefiting the use and outcomes of virtual care.

Bilingual Mandarin-English preschoolers’ spoken narrative skills and contributing factors: A remote online story-retell study

This study examined the spoken narrative skills of a group of bilingual Mandarin–English speaking 3–6-year-olds (N = 25) in Australia, using a remote online story-retell task. Bilingual preschoolers are an understudied population, especially those who are speaking typologically distinct languages such as Mandarin and English which have fewer structural overlaps compared to language pairs that are typologically closer, reducing cross-linguistic positive transfer. We examined these preschoolers’ spoken narrative skills as measured by macrostructures (the global organization of a story) and microstructures (linguistic structures, e.g., total number of utterances, nouns, verbs, phrases, and modifiers) across and within each language, and how various factors such as age and language experiences contribute to individual variability. The results indicate that our bilingual preschoolers acquired spoken narrative skills similarly across their two languages, i.e., showing similar patterns of productivity for macrostructure and microstructure elements in both of their two languages. While chronological age was positively correlated with macrostructures in both languages (showing developmental effects), there were no significant correlations between measures of language experiences and the measures of spoken narrative skills (no effects for language input/output). The findings suggest that although these preschoolers acquire two typologically diverse languages in different learning environments, Mandarin at home with highly educated parents, and English at preschool, they displayed similar levels of oral narrative skills as far as these macro−/micro-structure measures are concerned. This study provides further evidence for the feasibility of remote online assessment of preschoolers’ narrative skills.

Pediatric language assessments via telehealth: A systematic review

INTRODUCTION

Assessment is crucial in the identification of children with potential delays/disorders and allows speech-language pathologists the opportunity to provide early intervention when indicated. For this reason, inaccessibility to formal assessments can be detrimental to the development and progression of overall communication skills for children with language disorders. The COVID-19 pandemic highlighted the need for increased telehealth services and how the provision of these remote services offers a much-needed alternative to face-to-face services for both clinicians and families.

METHOD

A systematic procedure involving online literature searches in four electronic databases was employed to identify studies for inclusion in this review. Inclusion criteria were as follows: (1) preschool or elementary pediatric participants, and (2) involve the delivery of language-based assessments via telehealth. Additionally, the search was limited to studies written in English, dated 2010 and newer, and published in peer-reviewed journals.

RESULTS

The results of the systematic review showed there was no significant difference between standard scores and behavioral ratings for both face-to-face and telehealth assessments. The studies reviewed determined that telehealth delivery was feasible and presented adequate reliability with high levels of agreement between assessment scores obtained via telehealth and face-to-face.

CONCLUSION

Current research suggests that there is no significant difference between remote and face-to-face assessment administration. Additional research is needed to examine the feasibility and reliability of conducting language-based assessments via telehealth in bilingual children, children younger than four years of age, and in different environments, such as schools or clinics.

Telepractice application for the overt stuttering assessment of children aged 6-15 years old

BACKGROUND

Despite the importance of delivering speech and language therapy services to children who stutter (CWS), there are barriers to accessing speech and language therapy. One way to improve access for those who may otherwise be deprived of speech and language therapy services, including CWS, is through telepractice (TP). However, there is currently no evidence as to the viability of TP stuttering assessments for CWS.

AIM

To investigate the validity and reliability, and acceptability of using a TP application to assess overt stuttering behaviour children aged 6-15 years.

METHODS & PROCEDURE

A total of 30 CWS, aged between 6 and 15 years, were recruited from a speech therapy clinic in King Abdulaziz University Hospital in Riyadh, Saudi Arabia. Children were divided into two testing conditions, either face-to-face (f2f)-led or TP-led testing, and the Stuttering Severity Instrument (SSI-IV) was administered, percentage of syllables stuttered (%SS) was calculated, and severity ratings (SR) assigned, either via f2f or via TP using two laptops with webcams, video conference software and a broadband internet connection. Agreement and reliability of scoring in the two testing conditions were reported in addition to findings from questionnaires exploring children's and their caregivers' perceptions both before and immediately after the TP assessment was carried out.

OUTCOME & RESULTS

A total of 30 sessions were successfully carried out, with results revealing unsatisfactory levels of agreement when applying the Bland and Altman method. However, when discrepancies were found, these were comparable with those from traditional f2f studies. Generally, parents and children exhibited high levels of satisfaction and held a positive view regarding TP pre- and post-assessment.

CONCLUSIONS & IMPLICATIONS

The results of the study suggest that conducting an overt stuttering assessment via TP for 6-15-year-olds CWS is reliable and valid. Although the TP model posed some (mainly technical) challenges for executing the assessment, high levels of satisfaction were recorded by parents and children alike. The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS. These results are preliminary, but they can be seen as a building block for future research in TP assessment studies for CWS.

WHAT THIS PAPER ADDS

What is already known on the subject Stuttering treatment via TP has been proven to be feasible and successful across a variety of treatment programs (e.g., Lidcombe, Camperdown). However, the viability of assessing stuttering via videoconferencing has never been explored in children. What this paper adds to existing knowledge Preliminary support for the assessment of overt stuttering in CWS aged 6-15 years via video conferencing. The results justify larger scale studies of this service delivery method. What are the potential or actual clinical implications of this work? The TP system and equipment chosen in this study has provided a basis for the delivery of TP overt stuttering assessment in a clinical setting, thus addressing the barriers to access that are present for CWS aged 6-15 years.

Therapy services for children and youth living in rural areas of high-income countries: a scoping review

PURPOSE

To identify and describe therapeutic services provided to children and youth with disabilities living in rural areas of mid- and high-income countries and to summarize the benefits, positive outcomes, and challenges related to these services.

METHODS

This scoping review involved a systematic search of four academic electronic databases: MEDLINE, EMBASE, CINAHL, and Psych INFO, using a combination of subject headings and keywords related to (1) child disabilities; (2) rehabilitation: occupational therapists, speech-language pathologists, physiotherapists, audiologists, and recreation therapists; (3) multidisciplinary care team; (4) rural areas. Charting involved an iterative process whereby the full text articles meeting the inclusion criteria were abstracted using the charting form by two independent reviewers.

RESULTS

Thirty-seven articles from seven high-income countries were included in the analysis. Twenty-seven articles reported on in-person services, and 19 on telepractice (nine evaluated in-person and telepractice). In person services included outreach programs and specialized on-site programs. Positive outcomes and challenges of in person and telepractice services in rural areas are described.

CONCLUSIONS

Findings of this review highlight the need for further research on service delivery models offered in rural areas of upper middle and high-income countries, especially those focusing specifically on the rural communities, with a clear description of services. IMPLICATIONS FOR REHABILITATIONThis scoping review helps to advance the understanding of how therapy services are offered in rural areas of high-income countries.Telepractice was found to enhance ease of access to services for families living in rural areas.The findings of this review suggest that telepractice may be an effective means of providing therapy services to children and youth with disabilities living in rural areas of high-income countries, pending families' access to technology.

Reliability of Scoring Telehealth Speech Sound Assessments Administered in Real-World Scenarios

PURPOSE

COVID-19 caused a worldwide conversion from in-person therapy to telehealth; however, limited evidence to support the efficacy of remotely delivering standardized tests puts the future of widespread telehealth use at risk. The aim of this study is to investigate the reliability of scoring a speech sound assessment administered in real-world scenarios including two examples of telehealth technology.

METHOD

A total of thirty-nine 3- to 8-year-olds were administered the Goldman-Fristoe Test of Articulation-Third Edition. Licensed speech-language pathologists (SLPs) concurrently scored children's responses in person and in two telehealth conditions considered typical and enhanced. Mean standard scores and interrater reliability results were compared among the three conditions. Descriptive statistics were used to summarize the frequency of technology and behavior disruptions during administration and the results of an SLP telehealth perception survey.

RESULTS

All scoring conditions were found to be highly correlated, with mean differences revealing no systematic differences of one condition over- or underestimating another. Although response agreement was high (85%-87%), final sounds in words or sounds that are difficult to observe tended to attenuate reliability. Neither child nor technology disruptions affected SLPs' ability to score responses. Despite no significant differences between conditions on scoring reliability, SLP participants reported they continued to prefer in-person over a telehealth speech sound assessment.

CONCLUSIONS

This study supports the provision of a pediatric speech sound assessment using consumer-grade equipment, as in-person, typical telehealth, and enhanced telehealth scoring conditions produced similar results. However, SLP participants' skeptical attitudes toward remote delivery of standardized tests reveal an ongoing barrier to widespread telehealth use.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19593367.

Online Administration of the Test of Narrative Language-Second Edition: Psychometrics and Considerations for Remote Assessment

PURPOSE

Our aim was to evaluate the psychometric properties of the online administered format of the Test of Narrative Language-Second Edition (TNL-2; Gillam & Pearson, 2017), given the importance of assessing children's narrative ability and considerable absence of psychometric studies of spoken language assessments administered online.

METHOD

The TNL-2 was administered to 357 school-age children at risk for language and literacy difficulties as part of a randomized controlled trial, across three annual cohorts, at three time points (pretest, posttest, and 5-month follow-up). Cohort 3 students were tested using an online format at posttest and at follow-up. We compared the Cronbach's alpha internal consistency reliability of the TNL-2 online testing scores with in-person scores from TNL-2 normative data and Cohort 3 in-person testing at pretest, and interrater reliability for Cohort 3 across test points. In addition, we examined measurement invariance across test occasions and the criterion validity of the TNL-2, the latter based on its correlations with narrative sample measures (Mean Length of Utterance in words and the Monitoring Indicators of Scholarly Language rubric).

RESULTS

Internal consistency reliability, interrater reliability, and measurement invariance analyses of the online and in-person administration of the TNL-2 yielded similar outcomes. The criterion validity of the TNL-2 was found to be good.

CONCLUSIONS

TNL-2 psychometric properties from online administration were generally in the good range and were not significantly different from in-person testing. When administered online using standardized procedures, the TNL-2 is valid and reliable for use in assessing narrative language proficiency in school-age children at risk for language and learning difficulties.

Evaluating the Equivalence of Telepractice and Traditional Administration of the Test of Integrated Language and Literacy Skills

PURPOSE

This study evaluated the equivalence of the Test of Integrated Language and Literacy Skills (TILLS) when administrated via telepractice (Tele-TILLS) and face-to-face methods.

METHOD

Participants were 51 children and adolescents in three age bands, ages 6-7 years (n = 9), 8-11 years (n = 21), and 12-18 years (n = 21). Data were gathered by 25 volunteer examiners who assessed the same participants twice within a 2- to 4-week period, using Tele-TILLS and traditional methods in randomly selected, counterbalanced order.

RESULTS

Evaluation of identification equivalence showed 96% agreement between methods (49 of 51 decisions), with 39 agreements of no disorder, 10 agreements of yes disorder, and two disagreements (yes disorder for Tele-TILLS and no disorder for traditional). Partial correlations, controlled for test order, showed moderate to high agreement between all composite and subtest scores, except Nonword Repetition. Scoring by examiners and the first author showed high interrater agreement. No differences between Nonword Repetition scores were found for students who wore headsets (n = 12), whereas differences were found for those who did not (n = 34).

CONCLUSIONS

This study provided preliminary evidence that Tele-TILLS results can be equivalent to traditional TILLS, supporting its validity for identifying language/literacy disorder and interpreting profiles. The small, highly homogeneous sample with well-educated parents limits generalizability to the broader population. Caution is warranted when testing 6- to 7-year-old students for whom Nonword Repetition is part of the Identification Core score. Suggestions are provided for optimizing technological setup, preparing facilitators, and making minor modifications in subtest administration.

Can You See My Screen? Virtual Assessment in Speech and Language

PURPOSE

This introduction presents the LSHSS Forum: Can You See My Screen? Virtual Assessment in Speech and Language. The goals of the forum are to document reliability and validity of assessment results conducted virtually, identify characteristics of measures that are suitable for online assessment, and provide clinical and research guidance for interpreting diagnostic results obtained in virtual settings.

METHOD

In this introduction, we provide an overview of the research completed by nine teams, who submitted research articles and notes on a variety of topics pertinent to the theme of telehealth assessments. Of these, seven teams investigated the validity and reliability of 14 different assessment tools, while two teams described training and experience issues.

CONCLUSION

The nine studies presented in this forum will provide speech-language pathologists with insight into a range of issues regarding telehealth assessment, including the breadth of suitable assessment tools; practical strategies for assessing children with a diverse range of ages, languages, skills, and abilities; and the unexpected challenges and opportunities of conducting clinical work and research during a global pandemic.

Is Bilingual Receptive Vocabulary Assessment via Telepractice Comparable to Face-to-Face?

PURPOSE

This study investigated the effect of delivery method (face-to-face or telepractice), time, home language, and language ability on bilingual children's receptive vocabulary scores in Spanish and English.

METHOD

Participants included bilingual children with (n = 32) and without (n = 57) developmental language disorders (DLD) that were assessed at 2 time points about 1 year apart. All children participated in face-to-face assessment at Time 1. At Time 2, 41 children were assessed face-to-face and 48 children were assessed using telepractice.

RESULTS

Delivery method was not a significant predictor of receptive scores in either Spanish or English. Spanish and English receptive vocabulary increased over time in both children with and without DLD. Children with DLD had lower receptive vocabulary raw scores than children with typical development. Children who spoke English-only at home had significantly higher English receptive scores than children who spoke Spanish-only or both Spanish and English at home.

CONCLUSIONS

Face-to-face and telepractice assessments seem to be comparable methods for the assessments of Spanish and English receptive skills. Spanish and English receptive skills increased over time in children with and without DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17912297.

From a Distance: Comparison of In-Person and Virtual Assessments With Adult-Child Dyads From Linguistically Diverse Backgrounds

PURPOSE

Our proof-of-concept study tested the feasibility of virtual testing using child assessments that were originally validated for in-person testing only.

METHOD

Ten adult-child dyads were assigned to complete both in-person and virtual tests of language, cognition, and narratives. Child participants fell between the ages of 4 and 8 years; adult participants were speech-language clinicians or researchers with experience in administering child assessments. Half of child participants were Spanish-English bilinguals, and half were monolingual English speakers.

RESULTS

Results showed similar performance across in-person and virtual modalities on all assessments. Recommendations for adapting, administering, and scoring virtual measures with linguistically diverse children are discussed.

CONCLUSIONS

Although additional research on virtual assessment is needed, our results open opportunities for appropriate remote assessment, particularly for bilingual children, who may not have in-person access to speech-language pathology services.

Tele-Assessments in Rural and Remote Schools – Perspectives of Support Teachers

Tele-assessments may enable specialist evaluation of students in schools and their progress following intervention. The aim of this project was to evaluate the feasibility of using videoconferencing technology to assess students with reading difficulties in the school setting and obtain the perspectives of teachers supporting the students during the assessment. Teachers ( n = 57) of 71 primary school age students participated in the study. Teachers provided feedback on the tele-assessment by completing questionnaires about students’ behaviours and the quality of the technology and assessment process. Randomly selected teachers ( n = 24) were invited to participate in a semi-structured interview to provide qualitative feedback. Tele-assessments were completed in 93.4% of the sample. Support teachers reported satisfaction with the audio and visual quality as well as the assessment process. The majority of students completed the tele-assessment with good compliance, engagement and attention. Feedback from support teachers also reflected the strengths of tele-assessments, such as better access to service, cost saving and convenience. Barriers to tele-assessments included technical difficulties, assessment limitations and equipment issues at schools. Tele-assessment is a feasible method of objectively measuring outcomes of students following an intervention. Tele-assessment at school is largely accepted by teachers who supported students in this study. Feedback obtained from this research may be used to offer guidance on undertaking tele-assessments with students in the school setting.

Zoom, Zoom, Baby! Assessing Mother-Infant Interaction During the Still Face Paradigm and Infant Language Development via a Virtual Visit Procedure

The COVID-19 pandemic has necessitated innovations in data collection protocols, including use of virtual or remote visits. Although developmental scientists used virtual visits prior to COVID-19, validation of virtual assessments of infant socioemotional and language development are lacking. We aimed to fill this gap by validating a virtual visit protocol that assesses mother and infant behavior during the Still Face Paradigm (SFP) and infant receptive and expressive communication using the Bayley-III Screening Test. Validation was accomplished through comparisons of data (i.e., proportions of missing data for a given task; observed infant and maternal behaviors) collected during in-person laboratory visits and virtual visits conducted via Zoom. Of the 119 mother-infant dyads who participated, 73 participated in lab visits only, 13 participated in virtual visits only, and 33 dyads participated in a combination of lab and virtual visits across four time points (3, 6, 9, and 12 months). Maternal perspectives of, and preferences for, virtual visits were also assessed. Proportions of missing data were higher during virtual visits, particularly for assessments of infant receptive communication. Nonetheless, comparisons of virtual and laboratory visits within a given time point (3, 6, or 9 months) indicated that mothers and infants showed similar proportions of facial expressions, vocalizations and directions of gaze during the SFP and infants showed similar and expected patterns of behavioral change across SFP episodes. Infants also demonstrated comparable expressive and receptive communicative abilities across virtual and laboratory assessments. Maternal reports of ease and preference for virtual visits varied by infant age, with mothers of 12-month-old infants reporting, on average, less ease of virtual visits and a preference for in-person visits. Results are discussed in terms of feasibility and validity of virtual visits for assessing infant socioemotional and language development, and broader advantages and disadvantages of virtual visits are also considered.

Evolution of Telehealth Technology, Evaluations, and Therapy: Effects of the COVID-19 Pandemic on Pediatric Speech-Language Pathology Services

PURPOSE

Telehealth services experienced exponential growth during the COVID-19 pandemic. This survey examined the resulting evolution in the technology, connectivity, implementation of services, and attitudes of pediatric speech-language pathology clinicians using synchronous videoconferencing.

METHOD

The Telehealth Services: Pediatric Provider Survey participants were 259 speech-language clinicians in a variety of employment settings from across the country and abroad. Analyses identified telehealth barriers eliminated and those that persisted during the pandemic, advantages, and disadvantages of remote delivery of evaluation and treatment services, the most common telehealth technology used by clinicians and their clients to access care, and clinicians' predictions about the optimization and future of telehealth.

RESULTS

Elimination of regulatory and insurance hurdles allowed children from varying socioeconomic backgrounds living in rural, suburban, and urban areas access to telehealth. Telehealth technology shifted from computers with external hardware and specialized software to commercially available equipment, such as handheld portable devices with built-in audiovisual components and publicly available videoconferencing platforms. However, connectivity of these devices continued to be problematic, and lack of technology prevented some children from accessing care. Judgments about the appropriateness and effectiveness of evaluations and treatments varied based on the age and communication disorder of a child. Although some participants expressed uncertainty about the effectiveness of telehealth compared with in-person care, telehealth was widely recognized as a viable delivery method.

CONCLUSIONS

Although clinicians reported many advantages of telehealth, some barriers identified reported prior to COVID-19 still persist. Clinicians anticipate that new developments have the potential to continue improving telehealth service delivery, bolstering the viability of telehealth long after the COVID-19 pandemic is gone.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.16959361.

Conducting oral and written language adapted tele-assessments with early elementary-age children with autism spectrum disorder

BACKGROUND AND AIMS

Due to the COVID-19 pandemic, tele-health has gained popularity for both providing services and delivering assessments to children with disabilities. In this manuscript, we discuss the process of collecting standardized oral language, reading, and writing tele-assessment data with early elementary children with autism spectrum disorder (ASD) and offer preliminary findings related to child and parent engagement and technology issues.

METHODS

The data presented are from pretest assessments during an efficacy study examining the electronic delivery of a listening comprehension intervention for children with ASD. Pretest sessions included a battery of standardized language, reading, and writing assessments, conducted over Zoom. The authors operationalized and developed a behavioral codebook of three overarching behavioral categories (parent involvement, child disengagement, and technology issues). Researchers coded videos offline to record frequencies of indicated behaviors across participants and assessment subtests.

RESULTS

Involvement from parents accounted for the highest number of codes. Children showed some disengagement during assessment sessions. Technology issues were minimal. Behavioral categories appeared overall limited but varied across participants and assessments.

CONCLUSIONS

Parent involvement behaviors made up approximately two-thirds of the coded behaviors. Child disengagement behaviors made up approximately one-fourth of the coded behaviors, and these behaviors occurred more frequently across many different participants (with lower frequencies but greater coverage across children). Technology problems specific to responding to assessment items were relatively uncommon.

IMPLICATIONS

Clear guidelines including assessment preparation, modification of directions, and guidelines for parents who remain present are among the implications discussed. We also provide practical implications for continued successful adapted tele-assessments for children with ASD.

Tele-assessment of cognitive functions in children: a systematic review

Cognitive Tele-Assessment approach (CTA) has been widely used in adults for clinical, research, and screening purposes. In the last decades, it has been considered a useful tool for evaluating child development in both clinical and educational settings and new instruments for CTA in children have been developed. In comparison to In Person Assessment (IPA), CTA can have several advantages, such as increasing accessibility, cutting waiting lists, reducing time and travel costs, and assisting with infection control by minimizing face-to-face contact in times of pandemic. Nevertheless, several issues related to the feasibility and reliability of using CTA to evaluate cognitive development are still open. The present systematic review has a twofold aim: 1. to describe the cognitive functions that are most frequently measured by CTA in children, the procedures used, and the characteristics of the samples investigated; 2. to investigate the agreement between CTA and IPA scores in children.In the present systematic review, 23 studies using CTA in children, with typical or atypical development, have been selected and analyzed. Results support the similarities in performance scores between IPA and CTA and good compliance by children and their families in participating in CTA. Nonetheless, most studies suggest that several methodological precautions must be taken to manage technical and procedural characteristics that may represent challenges for CTA of children. Suggestions for a correct use of CTA, factors affecting the validity of the results and directions for future research are discussed.

Clinician experiences using standardised language assessments via telehealth

Purpose: Telehealth is rapidly becoming an essential part of speech-language pathologists' core business, and yet the experiences and opinions of community-based therapists in using telehealth remain relatively unknown. This paper describes a recent study in which speech-language pathologists were provided with access to a formal language assessment within a telehealth platform and asked to provide feedback about their experiences.Method: Twenty-seven speech-language pathologists in paediatric practice were recruited via callouts on social media, community contacts and professional networks. The participants were provided access to a telehealth platform with a built-in formal language assessment and asked to use the assessment with their own caseload as clinically indicated and provide feedback after each assessment. Questionnaire data was collected via an online survey system and contained questions about each assessment including the most enjoyable and most difficult aspects of the assessment and their overall experience of the platform.Result: More than 100 assessments were completed during the 3-month trial, with clinicians reporting that on most occasions, video and audio quality was adequate or more than adequate, and that interactions with their child clients were effective. Qualitative data indicated that technical difficulties were a drawback to the assessments, but that ease of use of the assessment, the added functionality of using the assessment within the telehealth platform and factors including general benefits of telehealth, particularly that of being able to continue to provide services when face-to-face work was not possible were seen as positive elements.Conclusion: This study adds clinicians' voices to the research into telehealth, indicating that the assessment within the telehealth platform was generally easy to use, and provided an unexpected depth of insight and connection for clinicians and their clients. Future research may consider the voices of other stakeholders in telehealth interactions, including parents and child clients.

Barriers and facilitators: Clinicians' opinions and experiences of telehealth before and after their use of a telehealth platform for child language assessment

BACKGROUND

Despite emerging evidence of validity and reliability, speech and language therapists' (SLT) uptake of telehealth has been limited and barriers remain to the effective and confident use of this service model. The COVID-19 pandemic has caused significant disruption to essential health services, including speech and language therapy assessment and intervention, meaning that telehealth must now be considered as part of the suite of service delivery options for all clinicians.

AIMS

To explore the perceived barriers and facilitators of telehealth among community paediatric SLTs before and after their use of a telehealth platform with an embedded standardised assessment tool.

METHODS & PROCEDURES

Mixed-methods questionnaires were developed for this study and completed by SLTs before and after the 3-month trial of the telehealth platform. A total of 38 SLTs completed the pre-trial questionnaire and training in the use of telehealth platform (Coviu), including instruction in using a standardised, norm referenced language test as an integrated tool within the Coviu platform. A total of 27 SLTs went on to use the telehealth platform, and 25 of these completed the post-trial questionnaire on which subsequent qualitative and quantitative analysis was completed.

OUTCOMES & RESULTS

Prior to using the platform, perceived barriers included technology issues, limited clinician experience and concerns around parent acceptance of the service. Potential facilitators included access to appropriate platforms, tools and resources as well as increased clinician confidence with telehealth. Following the trial, barriers to telehealth use continued to include technology barriers, particularly internet stability, and client issues, including suitability for telehealth services. Facilitators for future telehealth use included access to appropriate platforms for telehealth, stable and appropriate internet connectivity, and more extensive telehealth resources for both assessment and intervention for this mode of service delivery.

CONCLUSIONS & IMPLICATIONS

This study provides insights into the perceptions of the barriers and facilitating factors for telehealth use among community-based SLTs. This information will be useful in developing strategies to promote uptake and effective and confident use of telehealth as a mode of service delivery beyond the pandemic.

WHAT THIS PAPER ADDS

What is already known on the subject Research about telehealth has shown that it is a reliable and valid way of delivering speech pathology services, yet many clinicians have been wary of its use and uptake of telehealth prior to COVID-19 had been limited. We wanted to know what SLTs thought about using telehealth before and after participating in a 3-month trial of a telehealth platform with an embedded formal language assessment. What this study adds to existing knowledge This study indicates that technology issues including internet stability are a barrier to effective telehealth services, but that appropriate telehealth platforms, resources and experience are facilitators of uptake and successful use of telehealth. What are the potential or actual clinical implications of this work? This information will be useful in developing strategies to promote uptake and effective and confident use of telehealth as a mode of service delivery for children during and beyond the pandemic, including those isolated by geographical or transport barriers.

Preschool Executive Functioning and Child Behavior: Association with Learning Prerequisites?

Preschool age is a golden period for the emergence of executive functions (EFs) that, in turn, predict learning and adaptive behavior throughout all life. The study was aimed to identify which EFs measures significantly explained the learning prerequisites and the mediation role of self-regulatory and executive behavior recorded in structured or free settings. One hundred and twenty-seven preschoolers were remotely assessed by standardized tests of response inhibition, working memory, control of interference, and cognitive flexibility. Teachers provided a global measure of learning prerequisites by an observational questionnaire. Self-regulatory behavior during the assessment was evaluated by a rating scale filled by the examiners. Executive function behavior in daily life was measured by a questionnaire filled by parents. Accuracy in tasks of response inhibition and working memory explained about 48% of the variability in learning prerequisites while response speed and accuracy in the control of interference and in cognitive flexibility were not significant. EFs also had indirect effects, mediated by the child’s self-regulatory behavior evaluated during the assessment but not in daily life. The results are interpreted with respect to the contribution of the main EF components to school readiness and the mediation of the child behavior as measured in structure contexts.

Crosslinguistic Influence (CLI) of Lexical Breadth and Depth in the Vocabulary of Bilingual Kindergarten Children - A Bilingual Intervention Study

Introduction: Research in recent years has explored the vocabulary size (lexical breadth) of bilingual children, but less is known about the richness of bilingual word knowledge (lexical depth), and about how knowledge of words in the two languages interact. This study explores how bilingual narrative intervention with vocabulary instruction in each language may modulate crosslinguistic influence (CLI) between the languages of bilingual kindergarten children, focusing on CLI of lexical knowledge, and which factors modulate performance. Methods: Forty-one typically developing English-Hebrew bilingual children (M = 64.63 months) participated. A bilingual adaptation of Story Champs narrative intervention program (Spencer and Petersen, 2012) was used to deliver vocabulary instruction in separate blocks of home language (HL) and school language (SL) sessions. Different intervention words were targeted in each language, but the children were tested on all target words in both languages. Lexical knowledge was assessed with a definition task four times throughout the study: prior to intervention, after each intervention block, and 4-6 weeks later. Learner characteristics (chronological age, age of onset of bilingualism and length of exposure) and proficiency in each language (standardized tests, familiarity with the vocabulary introduced in the intervention at baseline) were examined as possible modulators of performance. Results: Children showed growth in lexical breadth and depth in their HL/English after HL intervention and in lexical breadth in the SL/Hebrew following SL intervention, with CLI for semantic depth observed via a qualitative analysis, but not quantitatively. Better HL/English performance was correlated with later AoB (and shorter SL exposure) and higher HL language proficiency scores. Children with higher HL/English proficiency responded better to the SL/Hebrew intervention, gaining more than those with lower English proficiency. Children with SL/Hebrew vocabulary dominance at the outset of the study also gained more from the HL/English intervention. No correlations were found between learner characteristics and SL performance. Discussion: The current study indicates that bilingual narrative intervention with vocabulary instruction may be efficacious for improving the lexical breadth and depth of bilingual kindergarten children. It suggests that CLI may enhance bilingual children's language learning success, and points to the importance of strengthening both languages of bilingual children.

Towards development of guidelines for virtual administration of paediatric standardized language and literacy assessments: Considerations for clinicians and researchers

OBJECTIVES

Previous virtual care literature within the field of speech-language pathology has primarily focused on validating the virtual use of intervention programmes. There are fewer articles addressing the validity of conducting virtual assessments, particularly standardized assessment of oral language and literacy abilities in children. In addition, there is a lack of practical, useful recommendations available to support clinicians and researchers on how to conduct these assessment measures virtually. Given the recent rapid rise in virtual care and research as a result of the Coronavirus-19 pandemic, clinicians and researchers require guidance on best practices for virtual administration of these tools imminently. This article seeks to fill this gap in the literature by providing such recommendations.

METHODS

We (a) completed a narrative review of the extant literature, and (b) conducted semi-structured interviews with a group of 12 clinicians, students and researchers who had administered standardized language and literacy assessments with a variety of monolingual and multilingual school-aged children, with and without speech and language difficulties, in clinical and research settings. Six themes: candidacy for virtual assessment, communication and collaboration with caregivers, technology and equipment, virtual administration, ethics, consent and confidentiality, and considerations for bilingual populations were identified as a result of these two processes and were used to develop a set of recommendations to guide the use of standardized assessments in a virtual setting. In line with the Guidelines International Network, these recommendations were rated by group members, and reviewed by external stakeholders. A quasi-Delphi consensus procedure was used to reach agreement on ratings for recommendations.

RESULTS

We have developed and outlined several recommendations for clinicians and researchers to guide their use of standardized language and literacy assessments in virtual care, across six key themes.

CONCLUSIONS

This article is one of the first to share practical recommendations for virtual assessment in the domain of oral language and literacy assessment for clinicians and researchers. We hope the current recommendations will facilitate future clinical research in this area, and as the body of research in this field grows, this article will act as a basis for the development of formal Clinical Practice Guidelines.

The Bilingual Home Language Boost Through the Lens of the COVID-19 Pandemic

Usage-based accounts of language acquisition suggest that bilingual language proficiency is dynamic and susceptible to changes in language use. The COVID-19 pandemic led to unprecedented modifications in the language learning environment of developing bilinguals. Drawing on this unique opportunity, we analyzed existing data of two matched groups of Mandarin-English bilingual children (ages 4 to 8 years, n = 38), one tested before (pre-COVID group) and the other during (COVID group) the pandemic. The dataset comprises responses to a language environment questionnaire, and scores on a sentence comprehension task and a sentence recall task in the bilinguals’ two languages. Questionnaire data revealed a richer Mandarin language environment for children in the COVID group compared to peers in the pre-COVID group. On both comprehension and production tasks, the two groups performed comparably in English but the COVID group showed better performance in Mandarin than the pre-COVID group. Within the pre-COVID group, English was stronger than Mandarin in both comprehension and production. Within the COVID group, the two languages were balanced in comprehension and Mandarin was stronger than English in production. Moreover, language use variables were correlated with production performance in both languages. These patterns illustrate the intimate relationships between language use and bilingual language proficiency through the lens of COVID-19 induced language environment modification.

End users' rating of a mHealth app prototype for paediatric speech pathology clinical assessment

Background

Previous studies reported the efficacy of the implementation of information technology in clinical evaluation. No research has addressed the development of mobile applications for the clinical evaluation and diagnosis of paediatric language disorders.

Purpose

This study aims to investigate the usability of a clinical assessment mobile application (app) prototype, the “Paediatric Arabic Language Test” (PALT), to diagnose language disorders among paediatric patients.

Methods

Using the Lewis Computer Software Usability Questionnaire (CSUQ) and a 5-point Likert Scale, data was collected and scored on the usability of the app prototype developed on two mobile platforms- iPhone and iPad- across a general operating system, iOS. A sample of 77 potential end-users rated the usability of the app prototype that they used between 2017 and 2019.

Results

The average CSUQ rating for the app prototype was 75.68 and 53.2% strongly agreed that the information and its organization was clear and easy to understand; 75% of the end users were very satisfied (p < 0.0001). Out of the total items, 68% of studied items on the scale loaded on factor 1 even after subjecting the scale to three standardization methods.

Conclusion

The prototype design was judged to be usable. Users reported an effective user interface that allows effective operation. Differences in the factor loading may be explained by cultural factors, type of task and field context.

Remote Assessment of Verbal Memory in Youth With Cochlear Implants During the COVID-19 Pandemic

Purpose Youth with cochlear implants (CIs) are at risk for delays in verbal short-term memory (STM)/working memory (WM), which adversely affect language, neurocognitive, and behavioral outcomes. Assessment of verbal STM/WM is critical for identifying and addressing these delays, but standard assessment procedures require face-to-face (FTF) administration. The purpose of this study was to determine the feasibility and validity of remote testing methods (teleassessment) of verbal STM/WM in youth with CIs as a method of addressing COVID-19-related restrictions on FTF test administration. Method Tests of verbal STM/WM for nonwords, digit spans, letter-number sequences, sentences, and stories were individually administered by speech-language pathologists over a teleassessment platform to 28 youth (aged 9-22 years) with CIs and 36 same-aged normal-hearing peers. Examiners, parents, and participants completed quality and satisfaction ratings with the teleassessment procedure. Teleassessment scores were compared to results of tests obtained at FTF visits an average of 1.6 years earlier. Results Quality and satisfaction ratings for teleassessment were high and in almost all cases did not differ between the CI and normal-hearing samples. Youth with CIs scored lower than normal-hearing peers on measures of verbal STM/WM, and scores for digit span and letter-number sequencing did not differbetween teleassessment and FTF methods. Correlations across teleassessment and FTF visits were strong for digit span, letter-number sequencing, and sentence memory, but were more modest for nonword repetition. Conclusion With some caveats, teleassessment of verbal STM/WM was feasible and valid for youth with CIs.

Taking Language Samples Home: Feasibility, Reliability, and Validity of Child Language Samples Conducted Remotely With Video Chat Versus In-Person

Purpose There has been increased interest in using telepractice for involving more diverse children in research and clinical services, as well as when in-person assessment is challenging, such as during COVID-19. Little is known, however, about the feasibility, reliability, and validity of language samples when conducted via telepractice. Method Child language samples from parent-child play were recorded either in person in the laboratory or via video chat at home, using parents' preferred commercially available software on their own device. Samples were transcribed and analyzed using Systematic Analysis of Language Transcripts software. Analyses compared measures between-subjects for 46 dyads who completed video chat language samples versus 16 who completed in-person samples; within-subjects analyses were conducted for a subset of 13 dyads who completed both types. Groups did not differ significantly on child age, sex, or socioeconomic status. Results The number of usable samples and percent of utterances with intelligible audio signal did not differ significantly for in-person versus video chat language samples. Child speech and language characteristics (including mean length of utterance, type-token ratio, number of different words, grammatical errors/omissions, and child speech intelligibility) did not differ significantly between in-person and video chat methods. This was the case for between-group analyses and within-child comparisons. Furthermore, transcription reliability (conducted on a subset of samples) was high and did not differ between in-person and video chat methods. Conclusions This study demonstrates that child language samples collected via video chat are largely comparable to in-person samples in terms of key speech and language measures. Best practices for maximizing data quality for using video chat language samples are provided.

Implementation factors are neglected in research investigating telehealth delivery of allied health services to rural children: A scoping review

INTRODUCTION

Rural children are likely to benefit from the telehealth delivery of multidisciplinary allied healthcare. This study aimed to (a) identify the scope of literature describing the telehealth delivery of allied health services to children living in rural areas and (b) understand the extent to which implementation - that is, specific activities designed to put telehealth into practice - has been investigated in such literature.

METHODS

Systematic scoping review methodology was used to locate studies in which telehealth delivered allied health services to children aged 0-12 who lived rurally (January 1998-January 2018). Two reviewers screened the studies, extracted data and appraised quality with Critical Skills Appraisal Programme checklists. Databases searched were PubMed, MEDLINE, CINAHL, PsycINFO, ERIC and Cochrane Library.

RESULTS

Data were extracted from 23 papers (two randomised controlled trials, one pseudorandomised controlled trial, one non-randomised experimental trial, two interrupted time series without parallel control groups, 10 case series and seven studies of diagnostic yield). Most were level III (n = 4) or IV (n = 17) when classified according to National Health and Medical Research Council guidelines. One study met all Critical Skills Appraisal Programme quality criteria. Allied healthcare interventions were aimed at improving functioning in communication (n = 10), behaviour and socio-emotional domains (n = 8) and identifying hearing concerns (n = 5). Many studies (n = 12) identified implementation facilitators, largely training and equipment. Only one study referred to an explicit framework for telehealth implementation (user-centred design).

DISCUSSION

Future research should target occupational therapy, physiotherapy, dietetics and social work, and determine the implementation factors and models likely to create successful telehealth services for this population.

Telehealth and autism: Are telehealth language assessments reliable and feasible for children with autism?

BACKGROUND

Access to timely and appropriate speech-language pathology (SLP) services is a significant challenge for many families. Telehealth has been used successfully to treat a range of communication disorders in children and adults. Research examining the use of telehealth for children with autism has focused largely on diagnosis, parent-implemented interventions, and behavioural interventions involving interactions between clinicians and parents. There is, however, very limited research into the use of telehealth directly to assess or intervene with children with autism. This paper reports the outcomes of a study of telehealth language assessments with primary school-aged children with autism.

AIMS

To evaluate the reliability and feasibility of telehealth language assessments for school-aged children with autism.

METHODS & PROCEDURES

The language skills of 13 children with autism aged 9-12 who attended mainstream schools or support classes were assessed using the Clinical Evaluation of Language Fundamentals-4th Edition. An SLP delivered and scored four subtests of the assessment via telehealth from a remote location. A second SLP at the same location as the child co-scored the online subtests to provide a measure of reliability and delivered the remaining subtests. The local SLP completed checklists in both conditions to provide observations regarding behaviour. Parent feedback was elicited via survey.

OUTCOMES & RESULTS

There was strong interrater reliability between the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.919 to 0.990 across the subtests and Core Language Score) and good agreement between clinicians on all measures. Analysis using the Wilcoxon Signed Rank test indicated no significant differences in children's behaviour between the telehealth and face-to-face conditions, although variation between individuals was observed. Parents provided generally positive feedback about the use of telehealth for the assessments.

CONCLUSIONS & IMPLICATIONS

The findings of this study provide preliminary support the use of telehealth assessments of school-aged children with autism. Comparison of telehealth and face-to-face assessment scores showed high agreement and correlation, and while the children showed individual differences in their behaviour during the telehealth sessions, there was no clear difference between the conditions at the group level. The findings suggest that telehealth may present a reliable and feasible approach to the assessment of language for children with autism in some circumstances as a primary or adjunct service model, while acknowledging that individual differences among these children may be important to consider when planning both assessment and intervention via telehealth.

Agreement between telehealth and face-to-face assessment of intellectual ability in children with specific learning disorder

Introduction

Access to cognitive assessments for children living remotely is limited. Telehealth represents a potential cost- and time-effective solution. A pilot study was conducted to determine the feasibility of telehealth to assess cognitive function in children with learning difficulties.

Methods

Thirty-three children (median age = 9 years 11 months), recruited from the New South Wales (NSW) Centre for Effective Reading, underwent assessment of intellectual ability. Comparisons were made between the intellectual ability index scores obtained by a psychologist sitting face-to-face with the children and another psychologist via telehealth using a web-based platform, Coviu.

Results

The telehealth administration method yielded comparable results to the face-to-face method. Correlation analyses showed high associations between the testing methodologies on the intellectual ability indices (correlation coefficient range = 0.981–0.997).

Discussion

Findings indicate that telehealth may be an alternative to face-to-face cognitive assessment. Future work in a broader range of cognitive tests and wider range of clinical populations is warranted.

Telehealth and autism: A systematic search and review of the literature

PURPOSE

Research interest in telehealth and autism spectrum disorder (ASD) has grown. There is a need to review the literature to allow speech-language pathologists (SLPs) and other service providers to consider applicability to their settings. The aim of this review was to examine the nature and outcomes of studies examining telehealth assessment and/or intervention in ASD.

METHOD

A systematic search of the literature was undertaken, with 14 studies meeting inclusion criteria. The authors extracted information from each included article, including participant characteristics, technology used, measures and reported outcomes. Quality review of articles was undertaken.

RESULT

The 284 participants with ASD across the 14 included studies ranged in age from 19 months to adulthood. The quality of the studies varied. A range of services were provided via telehealth, including diagnostic assessments, early intervention and language therapy. Results suggested that services delivered via telehealth were equivalent to services delivered face to face, and superior to comparison groups without telehealth sessions.

CONCLUSION

The findings suggest there may be a range of benefits in using telehealth with individuals with ASD, their families, and teachers. Further research, however, is required particularly regarding the use of telehealth directly with children with ASD for assessment and intervention.

Using physical objects with young children in 'face-to-face' and telehealth speech and language therapy

PURPOSE

Speech language therapists increasingly are using telehealth to enhance the accessibility of their services. It is unclear, however, how play-based therapy for children can be delivered via telehealth. In particular, modalities such as videoconferencing do not enable physical engagement between therapists and clients. The aim of our reported study was to understand how physical objects such as toys are used in similar and different ways across videoconferenced and "face-to-face" (hereafter, "in-person") therapy.

METHODS

We used conversation analytic methods to compare video-recorded therapy sessions for children delivered across in-person and telehealth settings. Utilising a broader corpus of materials, our analysis focused on four client-therapist dyads: two using videoconferencing, and two who met in-person.

RESULTS

Both videoconferencing and in-person sessions enabled routine affordances and challenges for delivering therapy. Within in-person therapy, therapists made access to objects contingent upon the client producing some target expression. This contingency usually was achieved by restricting physical access to these objects. Restricting access to a toy was not necessary in videoconferenced therapy; therapists instead used techniques to promote engagement.

CONCLUSIONS

When delivering play-based therapy via telehealth, our study demonstrates how practitioners adapt the intervention to suit the particular medium of its delivery. Implications for Rehabilitation Telehealth enhances equitable access for those who cannot physically access rehabilitation services. Telehealth modalities can create practical challenges, however, when delivering interventions such as play-based therapy. Practitioners should intentionally adapt telehealth interventions to suit the particular telehealth modality they are using.