Outcomes from a community speech and language therapy service treatment waiting list: The natural history of 525 children with identified speech and language needs

BACKGROUND

Understanding the natural history of developmental speech and language impairments can support the selection of children whose difficulties are persistent rather than transitory. It can also provide information against which the effectiveness of intervention can be evaluated. However, natural history data are difficult to collect ethically. Furthermore, as soon as an impairment is identified, the behaviour of those around changes, thus creating some level of intervention. Longitudinal cohort studies, where intervention is minimal, or the control arm of randomized trials have provided the best evidence. However, occasional opportunities arise where service waiting lists can provide data about the progress of children who have not received intervention. This natural history study arose within an ethnically diverse, community paediatric speech and language therapy service in the UK where levels of social disadvantage are high.

AIMS

To identify (1) the characteristics of the children who attended initial assessment and were selected for treatment; (2) the differences between children who did and did not attend reassessment; and (3) the factors associated with outcomes.

METHODS & PROCEDURES

A cohort of 545 children were referred and assessed as in need of therapy. Due to resource constraints, intervention was not available for an average of 12 months. Children were invited to attend for a reassessment of need. Initial and follow-up assessments were conducted by experienced clinicians using service guidelines and the Therapy Outcomes Measures Impairment Scale (TOM-I). Descriptive and multivariate regression analyses examined child outcomes for changes in communication impairment, demographic factors and length of wait.

OUTCOMES & RESULTS

At initial assessment, 55% of children presented with severe and profound communication impairments. Children offered appointments at clinics in areas of high social disadvantage were less likely to attend reassessment. By reassessment, 54% of children showed spontaneous improvement (mean TOM-I rating change = 0.58). However, 83% were still judged to require therapy. Approximately 20% of children changed their diagnostic category. Age and impairment severity at initial assessment were the best predictors of continuing requirement for input.

CONCLUSIONS & IMPLICATIONS

Although children do make spontaneous progress post-assessment and without intervention, it is likely that the majority will continue to be assigned case status by a Speech and Language Therapist. However, when evaluating the effectiveness of interventions, clinicians need to factor in the progress that a proportion of the caseload will make spontaneously. Services should be mindful that a lengthy wait may disproportionately impact children who already face health and educational inequalities.

WHAT THIS PAPER ADDS

What is already known on the subject Data from longitudinal cohorts (where intervention has been minimal) and the no treatment control arms of randomized controlled trials have provided the best evidence of the natural progression of speech and language impairments in children. These studies provide a varied rate of resolution and progress depending on the case definitions and measurements used. What this study adds to existing knowledge Uniquely, this study has evaluated the natural history of a large cohort of children who had been waiting for treatment for up to 18 months. Data showed that, over a period of waiting for intervention, the majority of those identified as a case by a Speech and Language Therapist remained a case. Using the TOM, on average children in the cohort made just over half a rating point progress during their waiting period. What are the potential or actual clinical implications of this work? The maintenance of treatment waiting lists is probably an unhelpful service strategy for two reasons: first, the case status of the majority of the children is unlikely to change whilst they await intervention and thus children and their families are subjected to further limbo waiting time; second, the dropout from the waiting list may disproportionately affect children who are offered appointments in clinics where there are higher levels of social disadvantage, thus exacerbating inequalities in the system. Currently, a suggested reasonable outcome of intervention is a 0.5 rating change in one domain of TOMs. Study findings suggest this is insufficiently stringent for a paediatric community clinic caseload. There is a need to evaluate spontaneous improvement which may occur in other TOM domains (i.e., Activity, Participation and Wellbeing) and to agree an appropriate change metric for a community paediatric caseload.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Speech and Language Therapy for Acquired Central Dysgraphia in Neurological Patients: A Systematic Review to Describe and Identify Trainings for Clinical Practice

PURPOSE

Acquired central dysgraphia is a heterogeneous neurological disorder that usually co-occurs with other language disorders. Written language training is relevant to improve everyday skills and as a compensatory strategy to support limited oral communication. A systematic evaluation of existing writing treatments is thus needed.

METHOD

We performed a systematic review of speech and language therapies for acquired dysgraphia in studies of neurological diseases (PROSPERO: CRD42018084221), following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist with a search on several databases for articles written in English and published until August 31, 2021. Only methodological well-designed studies were included. Further assessment of methodological quality was conducted by means of a modified version of the Downs and Black checklist.

RESULTS

Eleven studies of 43 patients in total were included. For each study, we collected data on type of population, type of impairment, experimental design, type of treatment, and measured outcomes. The studies had a medium level of assessed methodological quality. An informative description of treatments and linkages to deficits is reported.

CONCLUSIONS

Although there is a need for further experimental evidence, most treatments showed good applicability and improvement of written skills in patients with dysgraphia. Lexical treatments appear to be more frequently adopted and more flexible in improving dysgraphia and communication, especially when a multimodal approach is used. Finally, the reported description of treatment modalities for dysgraphia in relation to patients' deficits may be important for providing tailored therapies in clinical management.

Access to Speech and Language Services and Service Providers for Children With Speech and Language Disorders

OBJECTIVES

The purposes of this study were to (a) examine children's access to services for their speech and language disorders during their lifetimes; (b) identify any child, disorder, and family characteristics associated with access to services; and (c) describe the speech and language service providers among children who received care.

STUDY DESIGN

Data from the 2012 National Health Interview Survey were used for this retrospective cohort study. Our sample included 491 children (ages 3;0-17;11 [years;months]) with speech disorders and 333 children with language disorders. We measured the receipt of services for speech or language difficulties (main outcome) and the type of professional providing services (secondary outcome). We examined associations between services and child, disorder, and family characteristics.

RESULTS

Approximately 75% of children with speech and language disorders had ever received services for their difficulties. Privately insured children and children with co-occurring conditions were more likely to receive services than their peers who were uninsured (speech: 6.1 [1.7,21.3]; language: 6.6 [1.3,32.9]) and had no co-occurring conditions (speech: 2.1 [1.2,3.9]; language: 2.9 [1.5,5.5]). Speech-language pathologists (SLPs) were the most commonly reported provider of services (speech: 68%, language: 60%) followed by early interventionists.

CONCLUSIONS

Most children with speech and language disorders received services. However, disparities existed by race/ethnicity, health insurance type, co-occurring diagnoses, and disorder duration (speech only). Most children who received services were being provided with care by the experts of speech and language: SLPs. Updated population-based data and implementation studies are needed to document speech and language screening, referral, and access to services.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19799389.

It is time to address language disorders in schizophrenia: A RCT on the efficacy of a novel training targeting the pragmatics of communication (PragmaCom)

INTRODUCTION

Language and communication disruptions in schizophrenia are at the center of a large body of investigation. Yet, the remediation of such disruptions is still in its infancy. Here we targeted what is known to be one of the most damaged language domains in schizophrenia, namely pragmatics, by conducting a pragmatics-centered intervention with a randomized controlled trial design and assessing also durability and generalization. To the best of our knowledge, this is the first study with these characteristics.

METHODS

Inspired by the Gricean account of natural language use, we tailored a novel treatment addressing the pragmatics of communication (PragmaCom) and we tested its efficacy in a sample of individuals with schizophrenia randomized to the experimental group or to an active control group. The primary outcome with respect to the efficacy of the PragmaCom was measured by changes in pragmatic abilities (as evaluated with the global score of the Assessment of Pragmatic Abilities and Cognitive Substrates test) from baseline to 12 weeks and at 3-month follow-up. The secondary outcome was measured by changes in metaphor comprehension, abstract thinking, and global functioning from baseline to 12 weeks and at 3-month follow-up.

RESULTS

Relative to the control group, at post-test the PragmaCom group showed greater and enduring improvement in global pragmatic skills and in metaphor comprehension. At follow-up, these improvements persisted and the PragmaCom exerted beneficial effects also on functioning.

CONCLUSIONS

Despite the limited sample size, we believe that these findings offer initial yet encouraging evidence of the possibility to improve pragmatic skills with a theoretically grounded approach and to obtain durable and clinically relevant benefits. We argue that it is time that therapeutic efforts embrace communicative dysfunctions in order to improve illness outcome.

Work Setting Effects on Speech-Language Pathology Practice: Implications for Identification of Children With Specific Language Impairment

PURPOSE

Most research on language acquisition and impairments is neutral to work setting; however, work settings (e.g., schools, health care) are expected to differ in alignment with overlaid workplace models (e.g., education, medical). These differences may affect clinical service provision for individuals with specific language impairment (SLI). This article evaluates potential effects of work setting on top-down advocacy initiatives and clinical service provision for children with symptoms of SLI.

METHOD

Speech-language pathologists serving pediatric populations in health care-based (n = 140) and school-based (n = 423) work settings completed a three-part survey: (a) participant demographics, (b) report of case/workload and practice patterns, and (c) clinical vignettes and eligibility belief. Data analysis included descriptives and chi-square tests.

RESULTS

The work setting groups reported differences in eligibility terminology, eligibility criteria, and practice patterns from the point of referral through discharge. The reported differences aligned with overlaid workplace models. As compared to the school-based group, health care-based participants reported fewer eligibility restrictions in the workplace, agreed more often with a belief in less restrictive eligibility criteria, and reported more sensitive clinical decisions when operating under neutral workplace circumstances. Despite these findings, health care-based participants reported a smaller proportion of individuals with language impairment only on their caseload.

DISCUSSION

Work setting variations influence the underidentification of individuals with SLI for speech-language pathology services. Differences in responses by workplace indicate the need for unique and targeted advocacy efforts. Shifting diagnostic terminology and criteria will be insufficient in closing the gap unless advocacy efforts also address speech-language pathologists' workplace realities.

A Pilot Study Comparing Tele-therapy and In-Person Therapy: Perspectives from Parent-Mediated Intervention for Children with Autism Spectrum Disorders

Conclusions about the efficacy of tele-therapy for parent-mediated intervention for children with Autism Spectrum Disorders (ASD) are limited, due to the shortage of direct comparisons between tele-therapy and traditional face-to-face therapy. In this study, we implemented a parent training program, which targeted on language facilitating intervention strategies. Fifteen parents of children with ASD participated in person, and 15 participated via online video conferencing. We measured parents' intervention fidelity and children's initiations, responses, lexical diversity and morphosyntactic complexity. Results indicated significant improvements in parents' fidelity and children's lexical diversity and morphosyntactic complexity. No significant differences were detected between the two therapy delivery groups on any outcome measures. Finally, children's progress on morphosyntactic complexity was significantly correlated with parents' improvement on fidelity.

Remote Microphone System Use in Preschool Children With Autism Spectrum Disorder and Language Disorder in the Classroom: A Pilot Efficacy Study

Purpose The present pilot study aimed to provide estimates of the feasibility and efficacy of a remote microphone (RM) system as an augmentative intervention to improve the functional listening performance of preschool children with autism spectrum disorder (ASD) and language disorder. Method Eight children with ASD and language disorder participated. Efficacy of the RM system was determined by evaluating participants' functional listening performance, as measured by an observational measure in RM-off and RM-on conditions. Responses were evaluated at the individual level using an alternating conditions design. Results Adequate feasibility was demonstrated as all participants were able to complete tasks in the RM-on condition. A subset of participants showed significant improvements in their functional listening performance in the RM-on condition, as demonstrated by visual inspection and effect sizes (nonoverlapping data points and percentage of data points exceeding the mean), indicating that there may be important sources of individual differences in responses to RM use in children with ASD. Conclusion The results of this pilot study provide support for future research on RM systems to target functional listening performance in children with ASD and language disorder.

Understanding the human language processor: Neurobiology's insights into the human brain's semantic processing of information could inform education and therapies for language disorders

Brain imaging and research on bilinguals and patients with speech disorders is helping to unravel semantic processing - the way how the brain interprets and stores sentences and stories.

Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions

Recently, a novel virus has spread worldwide causing the disease called COVID-19. In addition to putting people's lives at risk and causing mortality, various problems have occurred due to the negative effects of the COVID-19 pandemic. Quarantine, social distancing, and the obligation to use protective tools have led to sometimes long term closing of various jobs and services, including rehabilitation services. For instance, the disease has interrupted the provision of Speech-Language Pathology (SLP) services to children due to the need for face-to-face communication between Speech and Language Pathologists (SLPs) and children during the evaluation and treatment processes. Therefore, here, we described the quality of providing SLP services during the COVID-19 pandemic and the negative effects of the disease on the provision of SLP services. In addition, we made an attempt to explain concerns and problems raised by the families, the importance of providing SLP services during the critical period of speech and language development, telepractice services, the roles of speech-language-hearing related scientific associations, and the roles of SLPs during the outbreak of COVID-19.

Children's Active Engagement in Public School Language Therapy Relates to Greater Gains

Purpose The current study examined children's engagement as an active ingredient of language therapy in public schools and considered the potential interplay between engagement and dose on outcomes. Method Participants included 135 children with language impairment receiving business-as-usual therapy from 70 speech-language pathologists. Two videotaped therapy sessions from each participating child were coded for children's level of engagement and time in language-focused therapy (dose). Results Hierarchical linear modeling was used for analyses; children's level of engagement (i.e., active engagement) was significantly, positively related to children's language gain and was not moderated by dose. Conclusion Findings suggest that children's active participation in therapy sessions is a significant component to effective language therapy and underscores the need for further research.

Understanding event-related potentials (ERPs) in clinical and basic language and communication disorders research: a tutorial

BACKGROUND

Event-related potentials (ERPs), which are electrophysiological neural responses time-locked to a stimulus, have become an increasingly common tool in language and communication disorders research. They can provide complementary evidence to behavioural measures as well as unique perspectives on communication disorders. ERPs have the distinct advantage of providing precise information about the timing of neural processes and can be used in cases where it is difficult to obtain responses from participants, such as infants or individuals who are minimally verbal. However, clinicians and clinician-scientists rarely receive training in how to interpret ERP research.

AIMS

To provide information that allows readers to better understand, interpret and evaluate research using ERPs. We focus on research related to communication sciences and disorders and the information that is most relevant to interpreting research articles.

METHOD

We explain what ERPs are and how ERP data are collected, referencing key texts and primary research articles. Potential threats to validity, guidelines for interpreting data, and the pros and cons using of ERPs are discussed. Research in the area of paediatric language disorders is used as a model; common paradigms such as the semantic incongruity N400 and auditory mismatch negativity are used as tangible examples. With this foundation of understanding ERPs, the state of the field in terms of how ERPs are used and the ways they may inform the field are discussed.

MAIN CONTRIBUTION

To date, no review has focused on ERPs as they relate to clinical or communication research. The main contribution of this review is that it provides practical information geared toward understanding ERP research.

CONCLUSIONS

ERPs offer insights into neural processes supporting communication and can both complement behaviour and provide information that behavioural measures cannot. We encourage readers to evaluate articles using ERPs critically, effectively pushing the field forward through increased understanding and rigor. What this paper adds ERPs have become more prevalent in research relevant to communication sciences and disorders. In order for clinicians to review and evaluate this research, an understanding of ERPs is needed. This review adds to the field by providing an accessible description of what ERPs are, a description of what ERP components are, and the most relevant commonly used components, as well as how ERP data are recorded and processed. With this foundational understanding of how ERPs work, guidelines for the interpretation of ERP data are given. Though few ERP studies currently have direct implications for clinical practice, we discuss several ways through which ERPs can impact clinical practice in future, by providing information that cannot be obtained by behaviour alone about the aetiology of disorders, and as potential biomarkers of disorder or treatment response.

Selecting and tailoring implementation interventions: a concept mapping approach

BACKGROUND

To improve the uptake of research into practice, knowledge translation frameworks recommend tailoring implementation strategies to address practice barriers. This study reports our experience pairing the Theoretical Domains Framework with information from multiple stakeholder groups to co-develop practice-informed strategies for improving the implementation of an evidence-based outcome measurement tool across a large community health system for preschoolers with communication impairments.

METHODS

Concept mapping was used to identify strategies for improving implementation of the Focus on the Outcomes of Communication Under Six (FOCUS) in Ontario Canada's Preschool Speech and Language Program. This work was done in five stages. First, we interviewed 37 speech-language pathologists (clinicians) who identified 90 unique strategies to resolve practice barriers to FOCUS implementation. Second, clinicians (n = 34), policy-makers (n = 3), and members of the FOCUS research team (n = 6) sorted and rated the strategies by importance and feasibility. Third, stakeholders' sorting data were analyzed to generate a two-dimensional concept map. Based on the rating data from stakeholders, we prioritized a list of strategies that were rated as highly important and highly feasible, and summarized the practice barriers addressed by each of the prioritized strategies. Fourth, we validated these findings with stakeholders via an online survey. Fifth, the mechanisms of action of the prioritized list of strategies were considered based on available evidence from the Theoretical Domains Framework and associated behavior change literature.

RESULTS

Stakeholders categorized the 90 unique implementation strategies into a six-cluster concept map. Based on stakeholders' ratings, a list of 14 implementation strategies were prioritized. These implementation strategies were reported to resolve barriers within the environmental context and resources and beliefs about consequences domains of the Theoretical Domains Framework. All but one of the prioritized strategies have a demonstrated link in resolving existing barriers according to the behavioral change literature.

CONCLUSIONS

Our study contributes to a growing literature that demonstrates the process of tailoring implementation strategies to specific barriers. Practical drawbacks and benefits of using concept mapping as a way to engage stakeholders in implementation research are discussed.

Children with Down syndrome can benefit from language interventions; Results from a systematic review and meta-analysis

Language disorder is a cardinal challenge for children with Down syndrome, and their learning capacity has been debated. The aim of the current study was to conduct a systematic review and meta-analysis of existing language interventions for children with Down syndrome to reveal knowledge about the effects of these interventions and identify any common characteristics specific to effective or ineffective interventions. A systematic search was conducted in databases relevant for education, speech and language therapy, and psychology. Based on a set of predefined inclusion criteria, the hits were screened and coded. Eight studies were synthesised in a systematic review and four in a meta-analysis. The overall effect of the interventions was large (g = 1.01), but significant transfer effects to untrained aspects of language were rarely found. Interventions showing significant effects varied with regards to numerous characteristics including the age of the target group, the intervention approach, the dosage, and the implementer. The common characteristic across the effective interventions was simply the aim of improving language skills in children with Down syndrome. Overall, there was a moderate to high risk of bias across all studies. To conclude, children with Down syndrome have the potential to respond to language intervention. However, more interventions that reach transfer effects are needed to maximise children's language outcomes. Based on the limited number of studies and a moderate to high risk of bias across the studies, there is a great need for more robust intervention studies to ensure that future interventions are informed by high-quality research.

Teaching Preschoolers With Down Syndrome Using Augmentative and Alternative Communication Modeling During Small Group Dialogic Reading

Purpose This study evaluated the effect of aided augmentative and alternative communication modeling (AAC-MOD) on the communication skills of children with Down syndrome (DS) during small group dialogic reading. Method Four children with DS between 3;1 and 5;3 (years;months; M = 4;5) and 5 typically developing peers between 3;5 and 5;9 (M = 4;3) participated. Effects were examined using a multiple probe across behaviors design with 4 children with DS. To simulate typical dialogic reading routines in inclusive classrooms, a strategy called Read, Ask, Answer, Prompt (Binger, Kent-Walsh, Ewing, & Taylor, 2010) was applied during the baseline and intervention sessions. Results A functional relation was demonstrated between (a) AAC-MOD and percentage of correctly identified symbols for 3 participants, (b) AAC-MOD and rate of symbolic communication for 2 participants, and (c) AAC-MOD and number of different words for 2 participants. Increases in number of multiple word combinations occurred for 2 participants. All 4 children maintained their percentage of correctly identified symbols. Increases in rate of symbolic communication did not generalize to thematic play contexts, a distal measure of response generalization. Conclusion AAC-MOD is an effective strategy for teaching target vocabulary and increasing rate of symbolic communication in young children with DS. Supplemental Material https://doi.org/10.23641/asha.10093538.

People with aphasia's perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach

Purpose: To identify which elements of the therapeutic alliance are important to people with aphasia (PWA) attending speech-language pathology post-stroke.Method: A Q methodology design was adopted to explore which elements of the therapeutic alliance were valued by PWA. Statements (n = 453) relevant to the research question were extrapolated from the literature and qualitative interviews. A representative sample of statements (n = 38) was identified from the expansive data set. PWA (n = 23) sorted statements hierarchically according to whether they thought the statement was important or unimportant. Completed Q sorts were analysed using a by-person factor analysis.Result: Analysis yielded a five-factor solution, representing five distinct viewpoints: (1) acknowledge me, help me to understand; (2) respect me, listen to me; (3) challenge me, direct me; (4) understand me, laugh with me; and (5) hear me, encourage me.Conclusion: The findings highlight the need for clinicians to adopt a flexible and idiosyncratic approach to therapeutic alliance construction in order to meet the relational needs of a heterogeneous population. This is the first study to use Q methodology with PWA, demonstrating that Q methodology is an effective and viable method for investigating subjectivity in this population.

The Effectiveness of Classroom Vocabulary Intervention for Adolescents With Language Disorder

Purpose Phonological-semantic intervention has been shown to be effective in enhancing the vocabulary skills of children with language disorder in small-group or individual settings. Less is known about vocabulary interventions for adolescents with language disorder in whole-class models of delivery. The current study investigated the effectiveness of phonological-semantic vocabulary intervention for adolescents with language disorder, delivered by secondary school teachers within science lessons. Method Seventy-eight adolescents with language disorder, aged 11-14 years, were taught science curriculum words by teachers in class, under 2 conditions: (a) 10 words taught through usual teaching practice and (b) 10 matched words taught using an experimental intervention known as Word Discovery, which embedded phonological-semantic activities into the teaching of the syllabus. Ten similar control words received no intervention. Word knowledge was assessed pre-intervention, postintervention, and follow-up. Results At pre-intervention, measures of depth of word knowledge and expressive word use did not differ between usual teaching practice and experimental words. At postintervention, depth of knowledge of experimental words was significantly greater than that of usual teaching practice words. This significant advantage was not maintained at follow-up, although depth of knowledge for experimental words remained significantly higher at follow-up than at pre-intervention. At postintervention, expressive use of experimental words was significantly greater than that of usual teaching practice words, and this significant difference was maintained at follow-up. There was no change in students' depth of knowledge or expressive use of no-intervention words over time, confirming that the findings were not due to maturity or practice effects. Conclusion The experimental intervention was more effective than usual teaching practice in increasing the word knowledge of participants. Clinical and teaching implications include the importance of intervening during the adolescent years, with classroom vocabulary intervention being a viable option for collaborative teacher and speech and language therapy/pathology practice.

Speech-Language Disorders in 22q11.2 Deletion Syndrome: Best Practices for Diagnosis and Management

Purpose Speech and language disorders are hallmark features of 22q11.2 deletion syndrome (22qDS). Learning disabilities, cognitive deficits, palate abnormalities, velopharyngeal dysfunction, behavioral differences, and various medical and psychiatric conditions are also major features of this syndrome. The goal of this document is to summarize the state of the art of current clinical and scientific knowledge regarding 22qDS for speech-language pathologists (SLPs) and provide recommendations for clinical management. Method Best practices for management of individuals with 22qDS were developed by consensus of an expert international group of SLPs and researchers with expertise in 22qDS. These care recommendations are based on the authors' research, clinical experience, and literature review. Results This document describes the features of 22qDS as well as evaluation procedures, treatment protocols, and associated management recommendations for SLPs for the often complex communication disorders present in this population. Conclusion Early diagnosis and appropriate management of speech-language disorders in 22qDS is essential to optimize outcomes and to minimize the long-term effects of communication impairments. Knowledge of this diagnosis also allows anticipatory care and guidance regarding associated features for families, health care, and educational professionals.

Early Language Interventions for Young Dual Language Learners: A Scoping Review

Purpose The aim of this article was to provide a systematic scoping review of the literature describing early language interventions for young children who are dual language learners, including children with early language deficits. Method The search conducted yielded a total of 27 sources describing 70 language strategies or procedures for dual language learners from 9 months of age to 3 years 11 months of age. The majority of sources were recommended practices (n = 12) followed by descriptive studies (n = 7). There were a total of 6 intervention studies and 5 research review studies. Results Strategies were collated and categorized into 5 major types: general approach, caregiver based, interaction based, language strategies, and early literacy strategies. Conclusion A preliminary evidence map was created to chart each strategy and sources that included the strategy and to indicate the highest strength of recommendation observed across sources. A discussion of compelling and promising strategies is presented.

Evidence-Based Interventions for Learners Who Are Deaf and/or Multilingual: A Systematic Quality Review

Purpose Many educators and speech-language pathologists have difficulty providing effective interventions to the growing population of d/Deaf and hard-of-hearing (DHH) learners who use more than 1 language. The purpose of this review article was to identify evidence-based interventions for speech, language, and literacy used with DHH multilingual learners (DMLs), monolingual DHH learners, and hearing bilingual learners without hearing loss. Interventions used with these groups can inform the practice of professionals providing services to DMLs. Method This review article considered speech, language, and literacy interventions used with DHH and hearing bilingual learners from birth to 21 years of age. The following electronic databases were searched: Academic Search Complete/EBSCO (CINAHL, Education, ERIC), Linguistics & Language Behavior Abstracts, PsycINFO, and PubMed. Data describing article, participant, methodological, and intervention variables were extracted from studies. The methodological quality of studies was examined using the Council for Exceptional Children's (2014) standards for evidence-based practice in special education. Results A total of 144 studies were reviewed, describing over 9,370 learners aged 1.8-22.0 years. Two studies investigated DMLs, 76 investigated DHH learners, and 67 investigated hearing bilingual learners. A total of 146 different interventions were examined. Most studies reported positive effects. Only 17 studies met all quality indicators specified by the Council for Exceptional Children (2014): 7 examined DHH learners, and 10 examined hearing bilingual learners. There was insufficient evidence for any intervention to be considered an evidence-based intervention, although 6 could potentially contribute to evidence-based practice. Conclusions No evidence-based interventions for DMLs were identified. A small number of interventions examined in high-quality studies of DHH and hearing bilingual learners were identified, which may be appropriate for use with DMLs following further investigation. Supplemental Material https://doi.org/10.23641/asha.9108386.

The feasibility and appropriateness of a peer-to-peer, play-based intervention for improving pragmatic language in children with autism spectrum disorder

Purpose: This study trialled a play-based, peer-to-peer intervention with children with autism spectrum disorder (ASD) to identify suitable instruments for measuring changes in pragmatic language following the intervention, and evaluate preliminary effectiveness. It also aimed to investigate the appropriateness of the intervention for participants. Method: Ten children with ASD, their typically developing peers, and parents participated. The Pragmatics Observational Measure (POM), Social Emotional Evaluation (SEE) and Profiling Elements of Prosody in Speech Communication (PEPS-C) measured the participant's social communication skills before, after, and 2-months following the intervention. Parent interviews were conducted two months after the intervention and responses were analysed using a thematic approach. Result: Children demonstrated gains in pragmatic language on the POM (χ²(3) = 11.160, p = 0.011) and related higher-level language on the SEE (χ²(2) = 6.686, p = 0.035). The PEPS-C did not produce any significant results. Parent interview responses indicated the intervention was appropriate for the children and families involved. Conclusion: The intervention warrants further investigation of effectiveness with a more robust research design. Consideration should be given to using observational measures of pragmatic language away from the clinic environment to evaluate generalisation, and future development of the intervention might consider variations in playmates and group size.

Improving storytelling and vocabulary in secondary school students with language disorder: a randomized controlled trial

BACKGROUND

Although language and communication difficulties are common in secondary school students, there has been limited research into the efficacy of interventions for adolescents with language and communication difficulties.

AIMS

To investigate the efficacy of teaching assistant (TA)-delivered narrative and vocabulary interventions to mainstream secondary school-aged students with language disorder.

METHODS & PROCEDURES

A randomized controlled trial (RCT) of a language and communication intervention was used to evaluate the efficacy of vocabulary and narrative interventions to improve the vocabulary and narrative performance of adolescents (mean age = 12.8 years) with language disorder. The language and communication programmes (narrative, vocabulary and combined narrative and vocabulary) were delivered by TAs in the classroom, three times per week, for 45-60 min each, over 6 weeks, totalling 18 sessions. Standardized and intervention-specific measures were used as outcomes.

OUTCOMES & RESULTS

Twenty-one schools with 358 eligible participants were recruited. The three intervention groups showed significant improvements (d = .296) on a narrative latent variable defined by a standardized narrative assessment (the Expression, Reception and Recall of Narrative Instrument-ERRNI), but there were no significant improvements on an overall vocabulary latent variable compared with the waiting control group. Differential effects were found on some non-standardized intervention-specific measures with the narrative group making significantly more progress on narrative tasks compared with the waiting control group, the vocabulary group showing the same pattern on specific vocabulary tasks, and the combined narrative and vocabulary group making significantly more progress on some of the intervention-specific narrative, and all the intervention-specific vocabulary outcomes compared with the waiting control group.

CONCLUSIONS & IMPLICATIONS

It is possible to improve narrative but not vocabulary skills, as assessed by standardized measures, in secondary school students with a relatively brief group TA-delivered intervention. There were differential effects for both narrative and vocabulary with intervention-specific measures. Future work is required to explore whether more intensive and longer lasting interventions would be more effective and to identify which students in this age group are most likely to benefit from such interventions.

Speech, language and swallowing impairments in functional neurological disorder: a scoping review

BACKGROUND

Functional neurological disorder (FND) is common across healthcare settings. The Diagnostic and Statistical Manual of Mental Disorders states that speech and swallowing symptoms can be present in FND. Despite this, there is a dearth of guidelines for speech and language therapists (SLTs) for this client group.

AIMS

To address the following question in order to identify gaps for further research: What is known about speech, language and swallowing symptoms in patients with FND?

METHODS & PROCEDURES

A scoping review was conducted. Six healthcare databases were searched for relevant literature: CINAHL PLUS, MEDLINE, ProQuest Nursing and Allied Health Professionals, Science Citation Index, Scopus, and PsychINFO. The following symptoms were excluded from the review: dysphonia, globus pharyngeus, dysfluency, foreign accent syndrome and oesophageal dysphagia.

MAIN CONTRIBUTION

A total of 63 papers were included in the final review; they ranged in date from 1953 to 2018. Case studies were the most frequent research method (n = 23, 37%). 'Psychogenic' was the term used most frequently (n = 24, 38%), followed by 'functional' (n = 21, 33%). Speech symptoms were reported most frequently (n = 41, 65%), followed by language impairments (n = 35, 56%) and dysphagia (n = 13, 21%). Only 11 publications comment on the involvement of SLTs. Eight papers report direct speech and language therapy input; however, none studied the effectiveness of speech and language therapy.

CONCLUSIONS & IMPLICATIONS

Speech, language and swallowing symptoms do occur in patients with FND, yet it is a highly under-researched area. Further research is required to create a set of positive diagnostic criteria, gather accurate data on numbers of patients with FND and speech, language or swallowing symptoms, and to evaluate the effectiveness of direct speech and language therapy involvement.

How Mixed-Effects Modeling Can Advance Our Understanding of Learning and Memory and Improve Clinical and Educational Practice

Purpose A key goal of researchers, clinicians, and educators within the fields of speech, language, and hearing sciences is to support the learning and memory of others. To do so, they consider factors relevant to the individual, the material to be learned, and the training strategy that can maximize learning and retention. Statistical methods typically used within these fields are inadequate for identifying the complex relationships between these factors and are ill equipped to account for variability across individuals when identifying these relationships. Specifically, traditional statistical methods are often inadequate for answering questions about special populations because samples drawn from these populations are usually small, highly variable, and skewed in distribution. Mixed-effects modeling provides advantages over traditional statistical techniques to answer complex questions while taking into account these common characteristics of special populations. Method and Results Through 2 examples, I illustrate advantages of mixed-effects modeling in answering questions about learning and memory and in supporting better translation of research to practice. I also demonstrate key similarities and differences between analysis of variance, regression analyses, and mixed-effects modeling. Finally, I explain 3 additional advantages of using mixed-effects modeling to understand the processes of learning and memory: the means to account for missing data, assess the contribution of variations in delay intervals, and model nonlinear relationships between factors. Conclusions Through mixed-effects modeling, researchers can disseminate accurate information about learning and memory to clinicians and educators. In turn, through enhanced statistical literacy, clinicians and educators can apply research findings to practice with confidence. Overall, mixed-effects modeling is a powerful tool to improve the outcomes of the individuals that researchers and practitioners serve within the fields of speech, language, and hearing sciences.

Standardizing test scores for a target population: The LMS method illustrated using language measures from the SCALES project

BACKGROUND

Centile curves and standard scores are common in epidemiological research. However, standardised norms and centile growth curves for language disorder that reflect the entire UK local school population do not exist.

METHODS

Scores on six language indices assessing receptive and expressive functioning of children were obtained from the SCALES population survey. Monolingual English speaking participants were aged between five and nine years. Children who attended special schools at study intake, or who were learning English as an additional language were excluded. We constructed language norms using the LMS method of standardisation which allows for skewed measurements. We made use of probability weights that were produced from a two-step logistic model. Distributions of estimated standard scores from an intensively assessed sub-population and from the full population were contrasted to demonstrate the role of weights.

RESULTS

Non-overlapping centile curves and standardised scores at each age were obtained for the six language indices. The use of weights was essential at retrieving the target distribution of the scores. An online calculator that estimates standardised scores for the measures was constructed and made freely available.

CONCLUSIONS

The findings highlight the usefulness and flexibility of the LMS method at dealing with the standardisation of linguistic and educational measures that are sufficiently continuous. The paper adds to the existing literature by providing population norms for a number of language tests that were calculated from the same group of individuals.

Distributional Cues to Language Learning in Children With Intellectual Disabilities

Purpose

In typical development, distributional cues-patterns in input-are related to language acquisition processes. Statistical and implicit learning refer to the utilization of such cues. In children with intellectual disability, much less is known about the extent to which distributional cues are harnessed in mechanisms of language learning.

Method

This tutorial presents what is known about the process of language learning in children with language impairments associated with different sources of intellectual disability: Williams syndrome, autism spectrum disorder, Down syndrome, and fragile X syndrome.

Results

A broad view is taken on distributional cues relevant to language learning, including statistical learning (e.g., transitional probabilities) and other patterns that support lexical acquisition (e.g., sensitivities to sound patterns, cross-situational word learning) or relate to syntactic development (e.g., nonadjacent dependencies).

Conclusions

Critical gaps in the literature are highlighted. Research in this area is especially limited for Down syndrome and fragile X syndrome. Future directions for taking learning theories into account in interventions for children with intellectual disability are discussed, with a focus on the importance of language input.

[The place of the native language in speech therapy]

A high number of children consulting a speech therapist for a language disorder have in common the direct or indirect experience of migration and therefore find themselves in a context of plurilingualism. A dedicated group, called Mélimémo, has been set up for children in such situations. It enables their linguistic and cultural diversity to be integrated into the speech therapy.

Vocabulary intervention for adolescents with language disorder: a systematic review

BACKGROUND

Language disorder and associated vocabulary difficulties can persist into adolescence, and can impact on long-term life outcomes. Previous reviews have shown that a variety of intervention techniques can successfully enhance students' vocabulary skills; however, none has investigated vocabulary intervention specifically for adolescents with language disorder.

AIMS

To carry out a systematic review of the literature on vocabulary interventions for adolescents with language disorder.

METHODS & PROCEDURES

A systematic search of 14 databases and other sources yielded 1320 studies, of which 13 met inclusion criteria. Inclusion criteria were: intervention effectiveness studies with a focus on enhancing oral receptive and/or expressive vocabulary skills in the study's aims; participants in the age range 11;0-16;11 with receptive and/or expressive language difficulties of any aetiology.

MAIN CONTRIBUTION

There was a high degree of diversity between studies. Types of intervention included: semantic intervention (four studies); comparison of phonological versus semantic intervention (two); and combined phonological-semantic intervention (seven). The strongest evidence for effectiveness was found with a combined phonological-semantic approach. The evidence suggested a potential for all models of delivery to be helpful (individual, small group and whole class).

CONCLUSIONS & IMPLICATIONS

Tentative evidence is emerging for the effectiveness of a phonological-semantic approach in enhancing the vocabulary skills of adolescents who have language disorder. Future research needs to refine and develop the methodologies used in this diverse group of studies in order to replicate their findings and to build consensus.

Predicting Response to Treatment in a Tier 2 Supplemental Vocabulary Intervention

PURPOSE

To effectively implement a response to intervention approach, there is a need for timely and specific information about student learning in response to treatment to ensure that treatment decisions are appropriate. This exploratory study examined responsivity to a supplemental, Tier 2 vocabulary intervention delivered to preschool children with limited language abilities.

METHOD

A secondary analysis of a cluster-randomized trial of a supplemental vocabulary intervention was conducted. Responsivity (e.g., adequate learning) to the intervention was examined, and learning in the 1st few weeks of intervention was evaluated as a possible predictor of response to intervention.

RESULTS

Using a criterion of learning of 20% of target vocabulary, nearly one third of participants were identified as poor responders. A 1st unit benchmark was identified that maximized the sensitivity to identification of children who were likely to respond to the intervention.

CONCLUSIONS

Even for generally effective interventions, there is likely to be a substantial proportion of children who are not responsive. Learning in the 1st few weeks of intervention may be a useful indicator of appropriate response to treatment and could inform instructional decisions.

The Frequency and Nature of Communication Between School-Based Speech-Language Pathologists and Caregivers of Children With Language Impairment

PURPOSE

The present study investigates the extent to which school-based speech-language pathologists (SLPs) communicate with the caregivers of children with language impairment and the factors that are significantly associated with frequent communication. In addition, this study investigates the extent to which frequent SLP-caregiver communication is associated with change in language and literacy abilities of children.

METHOD

To address the study aims, weekly communication logs from 73 SLPs, serving 3-5 children with language impairment in grades K-2, were collected for a complete academic year. Logs detailed the frequency and nature of SLP-caregiver communication. Information regarding children's age, language ability, and socioeconomic status were gathered at study onset; additionally, SLPs completed a questionnaire about their work experience and current work conditions (e.g., caseload size and job satisfaction). Finally, children were administered grammar, vocabulary, and early literacy assessments at the beginning and end of the academic year.

RESULTS

Descriptive results indicate that (a) the most common type of communication was via homework, (b) children's socioeconomic status was related to communication frequency, and (c) increased SLP-caregiver communication related to increased grammar gains over the academic year.

CONCLUSION

These results suggest that SLP-caregiver communication may be important for children's language outcomes; further studies exploring ways to support these communicative efforts are warranted.

Intellectual Disability and Language Disorder

Intellectual disability (ID) and language disorders are neurodevelopmental conditions arising in early childhood. Child psychiatrists are likely to encounter children with ID and language disorders because both are strongly associated with challenging behaviors and mental disorder. Because early intervention is associated with optimal outcomes, child psychiatrists must be aware of their signs and symptoms, particularly as related to delays in cognitive and adaptive function. Optimal management of both ID and language disorders requires a multidisciplinary, team-based, and family centered approach. Child psychiatrists play an important role on this team, given their expertise with contextualizing and treating challenging behaviors.

Cross-linguistic transfer effects after phonologically based cognate therapy in a case of multilingual specific language impairment (SLI)

BACKGROUND

Clinicians globally recognize as exceptionally challenging the development of effective intervention practices for bi- or multilingual children with specific language impairment (SLI). Therapy in both or all of an impaired child's languages is rarely possible. An alternative is to develop treatment protocols that facilitate the transfer of therapy effects from a treated language to an untreated language.

AIMS

To explore whether cognates, words that share meaning and phonological features across languages, could be used to boost lexical retrieval in the context of multilingual SLI. This is dependent on exploiting the phonological information in the one, trained language as a mechanism for (phonological) language transfer to the other, untrained languages.

METHODS & PROCEDURES

The participant is an 8.5-year-old girl diagnosed with SLI who showed a severe naming deficit in her three spoken languages (Bulgarian, English and Greek). She received training on cognates (n = 20) using a picture-based naming task in English only, three times a week, over a 4-week period for 20 min each time. Phonological-based naming therapy was carried out using form-based strategies.

OUTCOMES & RESULTS

There was a significant improvement during therapy and immediately after intervention on cognate performance in English which was maintained 1 month after intervention. Cognate production in Bulgarian and Greek also improved during all stages of the intervention. Improvement in the non-treated languages was slightly more than half of the improvement recorded in English. The findings reflected some degree of cross-linguistic transfer effects.

CONCLUSIONS & IMPLICATIONS

Cross-linguistic transfer effects were evident during therapy and after therapy had finished and the effects were maintained 1 month post-treatment. Both the native language (Bulgarian) and the dominant language (Greek) benefitted equally from the treatment of cognates in English. Generalization to non-treatment words was evident, predominantly for English. The results suggest that cognates can indeed be used successfully as a WFD intervention strategy for multilingual children with SLI with lasting effects.

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.

Prior History of Feeding-Swallowing Difficulties in Children With Language Impairment

PURPOSE

This study updated and extended our previous investigation (Malas et al., 2015) of feeding-swallowing difficulties and concerns (FSCs) in children with language impairments (LI) by using more stringent inclusion criteria and targeting children earlier in the care delivery pathway.

METHOD

Retrospective analyses were performed on the clinical files of 29 children (average age: 60 months, SD = 9.0) diagnosed as having LI using standardized testing, nonstandardized testing and final speech-language pathologist judgment. The files of children born prematurely or with a history of anatomical, structural, neurodevelopmental, cognitive, sensory, motor, or speech disorders were excluded. Literature-based indicators were used to determine the prevalence of difficulties in sucking, food transition, food selectivity, and salivary control. Values were compared with the general population estimate of Lindberg et al. (1992).

RESULTS

A significantly higher percentage of histories of FSCs (48%) were found in the files of children with LI when compared with the population estimate (χ2 = 13.741, df = 1, p < .001). Difficulties in food transition (31%) and food selectivity (14%) were the most frequent. Data confirm and extend our previous findings and suggest that a previous history of FSCs may characterize children with LI early in their care delivery pathway.

A Clinical Evaluation of the Competing Sources of Input Hypothesis

PURPOSE

Our purpose was to test the competing sources of input (CSI) hypothesis by evaluating an intervention based on its principles. This hypothesis proposes that children's use of main verbs without tense is the result of their treating certain sentence types in the input (e.g., Wasshe laughing?) as models for declaratives (e.g., She laughing).

METHOD

Twenty preschoolers with specific language impairment were randomly assigned to receive either a CSI-based intervention or a more traditional intervention that lacked the novel CSI features. The auxiliary is and the third-person singular suffix -s were directly treated over a 16-week period. Past tense -ed was monitored as a control.

RESULTS

The CSI-based group exhibited greater improvements in use of is than did the traditional group (d = 1.31), providing strong support for the CSI hypothesis. There were no significant between-groups differences in the production of the third-person singular suffix -s or the control (-ed), however.

CONCLUSIONS

The group differences in the effects on the 2 treated morphemes may be due to differences in their distribution in interrogatives and declaratives (e.g., Ishe hiding/Heishiding vs. Doeshe hide/He hides). Refinements in the intervention could address this issue and lead to more general effects across morphemes.

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.

Management of developmental speech and language disorders. Part 2: acquired conditions

Many children who present with these acquired impairments of communication have a clear preceding event such as an acquired brain injury from a road traffic accident. Children often respond differently in this situation to adult presentations. They may have a period of mutism when the prognosis might look poor and yet they subsequently make rapid progress and recover speech. They have greater potential for neural plasticity and language recovery, although they often have persisting difficulties in oral and written language. Alternatively, there may be a presentation with a paroxysmal event such as a seizure or a period of depressed consciousness, and the unusual behaviour that may accompany dysphasia and dysarthria may be misinterpreted in the child, whereas for the adult with the more common 'stroke-like' presentation, it would be immediately considered. Rarely the aphasia/dysphasia may itself be the paroxysmal event where actually recognising that the child's disrupted communication is the basis of any observed behaviours can be the greater challenge.

[Neuropsychological study in patients with Parkinson's disease: the effects of deep brain stimulation]

INTRODUCTION

Parkinson's disease (PD) is a disorder whose clinical manifestations are observed in the motor and neuropsychological domain and have an impact on the patient's quality of life. Several scientific studies evidence the effectiveness of deep brain stimulation as treatment for the motor symptoms, but further research is required on the neuropsychological symptoms.

AIM

To analyse the existence of significant differences in neuropsychological processes, such as attention, memory, language, visuoperception and the executive functions in patients with PD prior to and following deep brain stimulation.

PATIENTS AND METHODS

Our sample consisted of 20 patients of both sexes, aged 50-70 years, with PD, who were treated by healthcare service providers in Medellin. These subjects were administered the Continuous Performance Test and the Trail Making Test in order to assess attention, the Rey Complex Figure and Ardila memory tests to evaluate memory, the Boston and verbal fluency tests to assess language, the Rey Complex Figure Copy test for visuoperception, and the Wisconsin Card Sorting Test to appraise the executive functions.

RESULTS

There are significant differences between the scores before and after deep brain stimulation in patients with PD on attention and memory.

CONCLUSIONS

Knowledge of these findings is relevant for the neuropsychological therapy of patients with PD.

Religion, Spirituality and Speech-Language Pathology: A Viewpoint for Ensuring Patient-Centred Holistic Care

This paper presents a viewpoint concerning the largely neglected clinical relevance of spirituality and religious belief in speech-language pathology (SLP) assessments, interventions and outcomes across the lifespan. An overview of the refereed SLP literature is presented with regard to religion and spirituality. It was found that while there is increasing research with regard to spirituality, health and well-being, there is very little specific to SLP. What is available and clinically relevant, generally relates to holistic care and/or cultural and linguistic diversity. Amidst the health care literature, however, there is a growing number of recommended instruments (for religious/spiritual screening) sensitive to intercultural and interfaith issues that are currently available to medical, nursing, allied health and chaplaincy practitioners. These instruments can also be of value to SLPs to ensure holistic assessments and interventions. It would seem timely for SLPs (and other allied health practitioners) to consider including spiritual screenings/assessments as part of their clinical practice so as to ensure appropriate holistic care. This would also mean undertaking research and including relevant education within tertiary institutions and professional development programs.

Making sense of it: a brief programme to improve reading comprehension in adolescents with language impairments in main stream school

BACKGROUND

Children with language impairment show academic outcomes that are consistently poorer than those of their typically developing peers. A contributor to this is difficulty with reading comprehension. Although these difficulties are reported to continue well into adolescence, this population is generally underserved with regard to therapy. The efficacy of interventions for reading comprehension is well established in the research literature, but whether the same effects are achievable within a reasonable time reflecting available resources in real-life circumstances is less clear.

AIMS

Efficacy trials may significantly overestimate how strong an effect will be when the treatment is used under more natural conditions and within local constraints. The aim was to discover whether a short classroom intervention would be effective in improving reading comprehension in adolescents with the heterogeneous profiles of general or specific learning disabilities, additional diagnoses and behavioural and socio-emotional problems found in mainstream schools today.

METHOD & PROCEDURES

Twenty-eight adolescents with heterogeneous language and reading profiles were recruited from a mainstream school. The intervention programme comprised eight sessions of instruction in multiple reading comprehension strategies, held over 4 weeks. Experiment 1 had 10 participants. Experiment 2 had 18 participants who underwent the same programme, plus the addition of a session dedicated to decoding skills. Efficacy was evaluated within a pre- and post-study design, with baseline and post-therapy measures taken using the York Assessment of Reading for Comprehension (YARC).

OUTCOMES & RESULTS

Both experiments showed a significant group difference pre/post-intervention, with similar large effect sizes. Experiment 2 also showed a significant group difference in decoding ability pre and post the single intervention session.

CONCLUSIONS & IMPLICATIONS

This short intervention programme proved effective in a population with heterogeneous profiles, and fitted well with delivery in a mainstream school setting. It showed significant gains can be attained for this client group with relatively few resources.

Language difficulties and criminal justice: the need for earlier identification

BACKGROUND

At least 60% of young people in the UK who are accessing youth justice services present with speech, language and communication difficulties which are largely unrecognized. The contributing reasons for this are discussed, suggesting that early language difficulty is a risk factor for other problems such as literacy difficulties and educational failure that may increasingly put the young person at risk of offending. Opportunities for identification and remediation of language difficulties before young people reach youth justice services are also outlined.

AIMS

To examine language skills in a sample of children in a secure children's home aged 11-17 years.

METHODS & PROCEDURES

A sample of 118 males were routinely assessed on four Comprehensive Evaluation of Language Fundamentals (CELF) subtests and the British Picture Vocabulary Scale (BPVS).

OUTCOMES & RESULTS

Around 30% of the participants presented with language difficulties scoring 1.5 SD (standard deviation) below the mean on the assessments. Despite them entering the home because their vulnerability was recognized, only two participants had a previous record of language difficulties. A total of 20% of the participants had a diagnosis of mental illness, 50% had a history of drug abuse and 31% had looked-after status prior to entry to the home.

CONCLUSIONS & IMPLICATIONS

Children experiencing educational or emotional difficulties need to be routinely assessed for speech, language and communication difficulties. More population-based approaches to supporting the development of oral language skills in children and young people are also supported.

A Randomized Controlled Trial of Two Syntactic Treatment Procedures With Cantonese-Speaking, School-Age Children With Language Disorders

PURPOSE

In this study, we aimed to evaluate the efficacy of sentence-combining (SC) and narrative-based (NAR) intervention approaches to syntax intervention using a randomized-controlled-trial design.

METHOD

Fifty-two Cantonese-speaking, school-age children with language impairment were assigned randomly to either the SC or the NAR treatment arm. Seven children did not receive treatment as assigned. Intervention in both arms targeted the same complex syntactical structures. The SC group focused on sentence combination training, whereas the NAR group made use of narratives in which the target structures were embedded. Pretest and posttest performances measured using a standardized language assessment were subjected to analyses of covariance mixed-effect-model analyses of variance.

RESULTS

Children in both treatment arms demonstrated significant growth after 4 months of intervention. The main effect between treatment arms and time was not significant after controlling the pretest performance, suggesting that both treatment approaches showed similar effects. The main effect of time was significant.

CONCLUSIONS

This study provided evidence to support language intervention in the school years in Cantonese-speaking children. However, neither approach was shown to be more efficacious than the other. Future researchers could examine the effects of a longer treatment period and include functional outcome measures.

Stability of Language and Literacy Profiles of Children With Language Impairment in the Public Schools

PURPOSE

The present study focused on the identification and stability of language and literacy profiles of primary school children receiving school-based language therapy over the course of one academic year.

METHOD

Participants included 272 early elementary school-age children (144 boys, 128 girls) who had been clinically identified as having a language impairment. A latent profile analysis was used to identify distinct profiles on the basis of a battery of language and literacy assessments in the fall and spring of the academic year.

RESULTS

Four profiles were identified in both fall and spring that could be best described as representing high, average, and low overall abilities. Two average groups were identified that differentiated according to phonological awareness abilities. Children's profile membership was variable from fall to spring with nearly 60% of children shifting into a higher profile. The results of t tests comparing children who shifted into higher profiles from those who remained stable in profile membership revealed group differences regarding language severity, socio-economic status, and proportion of therapy sessions received in the classroom.

CONCLUSION

These results provide further evidence regarding the heterogeneity of children with language impairment served in the public schools, indicating that differences may be best conceptualized along a continuum of severity.

New graduates' perceptions of preparedness to provide speech-language therapy services in general and dysphagia services in particular

BACKGROUND

Upon graduation, newly qualified speech-language therapists are expected to provide services independently. This study describes new graduates' perceptions of their preparedness to provide services across the scope of the profession and explores associations between perceptions of dysphagia theory and clinical learning curricula with preparedness for adult and paediatric dysphagia service delivery.

METHODS

New graduates of six South African universities were recruited to participate in a survey by completing an electronic questionnaire exploring their perceptions of the dysphagia curricula and their preparedness to practise across the scope of the profession of speech-language therapy.

RESULTS

Eighty graduates participated in the study yielding a response rate of 63.49%. Participants perceived themselves to be well prepared in some areas (e.g. child language: 100%; articulation and phonology: 97.26%), but less prepared in other areas (e.g. adult dysphagia: 50.70%; paediatric dysarthria: 46.58%; paediatric dysphagia: 38.36%) and most unprepared to provide services requiring sign language (23.61%) and African languages (20.55%). There was a significant relationship between perceptions of adequate theory and clinical learning opportunities with assessment and management of dysphagia and perceptions of preparedness to provide dysphagia services.

CONCLUSION

There is a need for review of existing curricula and consideration of developing a standard speech-language therapy curriculum across universities, particularly in service provision to a multilingual population, and in both the theory and clinical learning of the assessment and management of adult and paediatric dysphagia, to better equip graduates for practice.

Language dysfunction

PURPOSE OF REVIEW

Language is a complex brain function requiring a number of cognitive processes and is commonly affected by both focal brain lesions and neurodegenerative disorders. This article reviews the neuroanatomic basis of language, assessment techniques of language function, and disorders affecting language.

RECENT FINDINGS

Recent functional imaging studies of language suggest that the classic connectionist models of language function may be incomplete. These studies and those analyzing how the primary progressive aphasias (PPAs) affect language function suggest that language processing is completed through large-scale distributed networks. The use of structured, standardized techniques allows for the diagnosis of focal brain lesions affecting language function as well as neurodegenerative and psychogenic causes of language dysfunction.

SUMMARY

By employing an accurate, neuroanatomically grounded language assessment technique, the neurologist can reach the correct diagnosis and implement the optimal management plan for patients with language disorders. Neurologists should also be aware of new information regarding the neural basis of language function as our understanding of the complex cognitive process of language continues to evolve.

Communication Disorders and Use of Intervention Services Among Children Aged 3-17 Years: United States, 2012

Nearly 8% of children aged 3-17 years had a communication disorder during the past 12 months. • Children aged 3-6 years, boys, and non-Hispanic black children were more likely than other children to have had any communication disorder. • Approximately 55% of children aged 3-17 years who had any communication disorder received an intervention service during the past 12 months. • Among those with any communication disorder, younger children, boys, and non-Hispanic white children were more likely than other children to receive an intervention service for their disorder.

What's on Your Mind? Conversation Topics Chosen by People With Degenerative Cognitive-Linguistic Disorders for Communication Boards

PURPOSE

Conversational topics chosen by a group of adults with degenerative cognitive-linguistic disorders for personalized communication board development were examined. The patient-generated themes commonly selected are presented to guide treatment planning and communication board development.

METHOD

Communication boards were created for 109 adults as part of a larger research project. One autobiographical topic that each participant would enjoy discussing multiple times was represented on each communication board with 16 pictures and word labels. For this review, topics were collapsed into general themes through a consensus process and examined by gender and age.

RESULTS

Sixty unique conversational topics were identified from 109 participants and collapsed into 9 general themes: Hobbies, Family, Travel, Work, Home/Places I've Lived, Sports/Fitness, Religion, Animals, and World War II. Age and gender produced variations in themes chosen, though no significance in rank orders was found across groups.

CONCLUSIONS

Topics selected by adults with degenerative cognitive-linguistic disorders for communication boards resemble common conversational adult themes and do not center around basic needs or medical issues. Differences in gender and age for topic selection tend to be based on traditional roles. These general themes should be used when creating personalized communication boards for those who benefit from conversational aids.

Monolingual or bilingual intervention for primary language impairment? A randomized control trial

PURPOSE

This study investigated the clinical effectiveness of monolingual versus bilingual language intervention, the latter involving speech-language pathologist-parent collaboration. The study focuses on methods that are currently being recommended and that are feasible within current clinical contexts.

METHOD

Bilingual children with primary language impairment who speak a minority language as their home language and French as their second (n=29, mean age=5 years) were randomly assigned to monolingual treatment, bilingual treatment, and no-treatment (delayed-treatment) conditions. Sixteen sessions of individual language intervention were offered, targeting vocabulary and syntactic skills in French only or bilingually, through parent collaboration during the clinical sessions. Language evaluations were conducted before and after treatment by blinded examiners; these evaluations targeted French as well as the home languages. An additional evaluation was conducted 2 months after completion of treatment to assess maintenance of gains. Both monolingual and bilingual treatment followed a focused stimulation approach.

RESULTS

Results in French showed a significant treatment effect for vocabulary but no difference between treatment conditions. Gains were made in syntax, but these gains could not be attributed to treatment given that treatment groups did not improve more than the control group. Home language probes did not suggest that the therapy had resulted in gains in the home language.

CONCLUSIONS

The intervention used in this study is in line with current recommendations of major speech-language pathology organizations. However, the findings indicate that the bilingual treatment created through collaboration with parents was not effective in creating a sufficiently intense bilingual context to make it significantly different from the monolingual treatment. Further studies are needed to assess the gains associated with clinical modifications made for bilingual children and to search for effective ways to accommodate their unique needs.

Call for studies in implementation science: improving reading comprehension in school-age children

PURPOSE

In this article, the Editor of Language, Speech, and Hearing Services in Schools makes the case for more studies in implementation science in order to improve the reading comprehension of school-age children, particularly those with specific language impairment and nonspecific language impairment.