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Gornik AE, Jacobson LA, Kalb LG, Pritchard AE. If Opportunity Knocks: Understanding Contextual Factors' Influence on Cognitive Systems. Res Child Adolesc Psychopathol 2024; 52:521-533. [PMID: 37843649 DOI: 10.1007/s10802-023-01134-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
Central to the Research Domain Criteria (RDoC) framework is the idea that RDoC constructs, which vary dimensionally by individual, are heavily influenced by contextual factors. Perhaps chief among these contextual factors is structural opportunity - the quality of resources available to a child as they grow. The aim of this study is to understand the impact of access to opportunity during childhood on three central RDoC cognitive systems constructs: language, visual perception, and attention. These constructs were measured using clinical data from psychological evaluations of youth ages 4-18 years (N = 16,523; Mage = 10.57, 62.3% male, 55.3% White). Structural opportunity was measured using the geocoded Child Opportunity Index 2.0 (COI), a composite score reflecting 29 weighted indicators of access to the types of neighborhood conditions that help children thrive. Findings indicate that, controlling for demographic and socioeconomic factors, greater access to opportunity is associated with significantly stronger cognitive skills across all three constructs. However, opportunity uniquely explains the largest proportion of the variance in language skills (8.4%), compared to 5.8% of the variance in visual processing skills and less than 2% of the variance in attention. Further, a moderating effect of age was found on the relation between COI and language skills, suggesting that the longer children remain exposed to lower levels of opportunity, the lower their language skills tend to be. Understanding how opportunity impacts cognitive development allows clinicians to offer better tailored recommendations to support children with cognitive systems deficits, and will support policy recommendations around access to opportunity.
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Affiliation(s)
- A E Gornik
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L G Kalb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Center for Autism & Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA
| | - A E Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Carnino JM, Salvati LR, Bayly H, Kennedy DG, Mwaura AM, Wilson NR, Levi JR. Appointment Factors Contributing to Children with Speech Disorders Missing Speech and Language Pathology Appointments. Clin Pediatr (Phila) 2024:99228241235440. [PMID: 38439533 DOI: 10.1177/00099228241235440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
This study explores missed pediatric speech and language pathology (SLP) appointments to identify barriers for patients with speech disorders. Data from 839 referrals at Boston Medical Center, including demographics, appointment details, COVID-19 lockdown, and number of items on patient problem lists, were analyzed using chi-square tests and logistic regression. The findings revealed that lockdown status, appointment timing, appointment type (in-person vs telemedicine), referral department (ear, nose, and throat [ENT] vs non-ENT), sex, race, primary language, birthplace, and primary care provider presence had no significant impact on attendance. However, the number of patient-listed problems, prior cancelations, and missed appointments were significant predictors of patients who did not keep appointments. In conclusion, this research emphasizes the patient's problem list and past appointment behavior as critical factors in predicting missed SLP appointments for pediatric speech disorder patients. These insights can guide targeted interventions to improve attendance and enhance SLP engagement.
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Affiliation(s)
- Jonathan M Carnino
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | | | - Henry Bayly
- School of Public Health, Boston University, Boston, MA, USA
| | - Dean G Kennedy
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Amos M Mwaura
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Nicholas R Wilson
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
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Gibbard D, Roulstone S, Kandala Shadrack NI, Morgan L, Harding S, Smith C, Markham C. A randomised controlled trial of the effectiveness of parent-based models of language intervention for 2- to 3-year-old children with speech, language and communication needs (SLCN) in areas of social disadvantage. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38285603 DOI: 10.1111/1460-6984.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. AIMS To compare the impact of standard parent-based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. METHODS AND PROCEDURES A multicentre clustered blind randomised controlled trial was used to compare the effect of parent-based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20-week period. Participants received one of two interventions: (1) Standard Care - indirect group PBI - (PBI) (2) Enhanced Care: indirect group enhanced PBI - (EPBI). Both standardised and non-standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure - Speech & Language Therapy (PAM-SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well-being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. OUTCOMES AND RESULTS One hundred fifty-five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur-Bates Communicative Development Inventories Sentence Length, from pre-intervention to post-intervention and 6 months post-intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval -0.02 to 0.76), although wide variation was found. CONCLUSIONS AND IMPLICATIONS This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS What is already known on the subject Speech, language and communication needs (SLCN) have a knock-on effect on emotional well-being, school readiness, literacy and school attainment, putting children at increased risk of long-term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work? This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes.
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Affiliation(s)
| | - Sue Roulstone
- Faculty of Health & Life Sciences, University of West of England, Bristol, UK
- Bristol Speech & Language Therapy Research Unit, Bristol, UK
| | | | - Lydia Morgan
- Bristol Speech & Language Therapy Research Unit, Bristol, UK
| | - Sam Harding
- Bristol Speech & Language Therapy Research Unit, Bristol, UK
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Leafe N, Pagnamenta E, Taggart L, Donnelly M, Hassiotis A, Titterington J. What works, how and in which contexts when supporting parents to implement intensive speech and language therapy at home for children with speech sound disorder? A protocol for a realist review. BMJ Open 2024; 14:e074272. [PMID: 38184311 PMCID: PMC10773357 DOI: 10.1136/bmjopen-2023-074272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/07/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Speech and language therapists (SLTs) worldwide report challenges with providing recommended, evidence-based intervention intensity for children with speech sound disorder (SSD). Challenges such as service constraints and/or family contexts impact on access to optimal therapy intensity. Existing research indicates that empowering and training parents to deliver intervention at home, alongside SLT support, offers one possible solution to increasing the intensity of intervention children with SSD receive. Digital health could increase accessibility to intensive home practice and help sustain engagement with therapy activities. Further exploration is needed around what makes parent-implemented interventions for children with SSD effective, for who and in which situations. This paper outlines the protocol for a realist review which aims to explore the active ingredients and contextual factors of effective digital parent-led interventions. METHODS AND ANALYSIS A realist review will explore the research question, following six stages. The scope of the review will be determined, and initial programme theories will be developed about what works in digital parent-implemented interventions for SSD, for whom, how, why and in what circumstances. Relevant secondary data, identified through a formal search strategy, will be selected, appraised, analysed and synthesised using realist principles to test and further refine the initial programme theories. This process will develop refined underpinning explanatory theories which capture the interaction between contexts, mechanisms and outcomes of the intervention. An expert steering group will provide insight to inform explanatory theories, searches, and dissemination. ETHICS AND DISSEMINATION Ethical approval is not required for this review. The refined programme theories from the review will inform the next stages of a wider study. A subsequent realist evaluation will test and further refine theories with key stakeholders. Following this, the underpinning programme theory will be used to coproduce a digital tool, to support parents to deliver home intervention alongside SLT support.
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Affiliation(s)
- Naomi Leafe
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Emma Pagnamenta
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Laurence Taggart
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | | | - Angela Hassiotis
- Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, UK
| | - Jill Titterington
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
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Girshovitz I, Amit G, Goldshtein I, Zimmerman DR, Baruch R, Akiva P, Avgil Tsadok M, Sadaka Y. Increased rates of unattained developmental milestones among Israeli children between 2016 and 2020: a national report. Isr J Health Policy Res 2023; 12:38. [PMID: 38129917 PMCID: PMC10740256 DOI: 10.1186/s13584-023-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The early years of children's lives are critical for their healthy development. Although children's growth and development rates may vary, a significant delay during early childhood could indicate a medical or a developmental disorder. Developmental surveillance is used worldwide by healthcare providers in routine encounters, as well as by educators and parents, to elicit concerns about child development. In this work, we used a national dataset of developmental assessments to describe temporal trends of milestone attainment rates and associations between milestone attainment and various sociodemographic factors. METHODS The study included 1,002,700 children ages birth until 6 years with 4,441,689 developmental visits between the years 2016 and 2020. We used the Israeli developmental scale to assess the annual rates of failure to attain language, social and motoric milestones by the entire population, as well as by subgroups stratified by sociodemographic factors. In addition, we evaluated the rates of parental concern for child development and of the nurse's report of development inadequate for age. We used multivariable logistic regression to analyze the impact of different sociodemographic factors on the odds of failure to attain milestones, while controlling for confounding. RESULTS Milestone failure rates progressively increased over the examined years in all developmental domains, and most prominently in the language domain. Conversely, the rates of parental concern for developmental delay remained constant. In multivariable analysis, higher risk of milestone attainment failure was observed in children whose mothers were divorced, unemployed, immigrant, had lower education, of Bedouin origin or were over 40 years old when giving birth. CONCLUSIONS This report describes national trends of child development in the gross motor, fine motor, language, and social domains. A periodic report of these trends should be published to objectively evaluate subgroups in need for intervention, and to assess the effectiveness of intervention programs in attempt to maximize the developmental potential of children in Israel.
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Affiliation(s)
| | - Guy Amit
- KI Research Institute, Kfar Malal, Israel
| | | | - Deena R Zimmerman
- Department of Maternal and Child Health, Public Health Division, Ministry of Health, Jerusalem, Israel
| | - Ravit Baruch
- Department of Maternal and Child Health, Public Health Division, Ministry of Health, Jerusalem, Israel
| | | | - Meytal Avgil Tsadok
- TIMNA Initiative, Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Yair Sadaka
- KI Research Institute, Kfar Malal, Israel.
- Neuro-Developmental Research Center, Mental Health Institute, Be'er-Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
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Narasimman A, Vagha S, Kashyap AK. Guiding Mothers About Early Detection and Addressing Speech Delay and Disorders Among Children in a Rural Setup. Cureus 2023; 15:e48822. [PMID: 38106793 PMCID: PMC10722243 DOI: 10.7759/cureus.48822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Speech is one of the most important milestones to be achieved by a growing child. The significance of being informed about different pediatric speech abnormalities, especially to mothers, allows them to help their children in cases of irregularities in the maturation in this domain. Aim and objectives The study aimed to assess and educate mothers on the important milestones of speech delay in children and make them address the issue and be aware of various corrective measures to treat the underlying conditions of speech disorders in children. The objectives of the study include understanding the pre-acquired knowledge of the mothers regarding the delay in speech in children, imparting knowledge regarding different speech disorders and their management, spreading awareness on how to seek help for various underlying causes of speech irregularities or delay, and to train the mothers into approaching the challenges in an orderly manner. Methods A study was conducted to guide rural mothers visiting the Obstetrics and Gynecology and Pediatric out-patient departments and Neonatal wards in a rural tertiary care hospital situated in the Sawangi Meghe village of Wardha City, Maharashtra, India, about the detection and treatment of children with disabilities of speech as early as possible. The mothers' knowledge was assessed before and after the study with the help of questionnaires, and basic understandable information on different types, causes, symptomatology, and management of speech delay and disorders among children was explained with the help of group discussions and posters. Results The motive behind this study was to be aware of facts known by the rural mothers, their actions on coming across such presentations by their children, cues that they would pick up, and the need to ask for help at the appropriate time were assessed and elaborated if not known by them. The Relative Learning Gain and Normalized Gain were calculated to be 76.43% and 0.74 (high gain), respectively, and out of the total subjects, 97.16% of mothers voted that this study proved helpful, and six mothers (4.23%) benefited with the intervention and were referred to experts for evaluation of their children. Conclusion Awareness in this field is necessary to manage children's development, especially by their mothers. Knowing the prevalence of knowledge in mothers may build an association with the prevalence of the recognized cases of speech disorders in children. Evaluation at different community levels may be conducted to gauge the need to impart required knowledge about speech disabilities in children to the maternal population. Future research and the impartation of knowledge to caregivers are vital to promote vigilant and systematic action to be taken regarding the proper growth of their children.
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Affiliation(s)
- Akshaya Narasimman
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunita Vagha
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akshat K Kashyap
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Boerma T, Ter Haar S, Ganga R, Wijnen F, Blom E, Wierenga CJ. What risk factors for Developmental Language Disorder can tell us about the neurobiological mechanisms of language development. Neurosci Biobehav Rev 2023; 154:105398. [PMID: 37741516 DOI: 10.1016/j.neubiorev.2023.105398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/03/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
Language is a complex multidimensional cognitive system that is connected to many neurocognitive capacities. The development of language is therefore strongly intertwined with the development of these capacities and their neurobiological substrates. Consequently, language problems, for example those of children with Developmental Language Disorder (DLD), are explained by a variety of etiological pathways and each of these pathways will be associated with specific risk factors. In this review, we attempt to link previously described factors that may interfere with language development to putative underlying neurobiological mechanisms of language development, hoping to uncover openings for future therapeutical approaches or interventions that can help children to optimally develop their language skills.
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Affiliation(s)
- Tessel Boerma
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Sita Ter Haar
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands; Cognitive Neurobiology and Helmholtz Institute, Department of Psychology, Utrecht University/Translational Neuroscience, University Medical Center Utrecht, the Netherlands
| | - Rachida Ganga
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Frank Wijnen
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Elma Blom
- Department of Development and Education of youth in Diverse Societies (DEEDS), Utrecht University, Utrecht, the Netherlands; Department of Language and Culture, The Arctic University of Norway UiT, Tromsø, Norway.
| | - Corette J Wierenga
- Biology Department, Faculty of Science, Utrecht University, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.
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Metwally AM, Aboulghate A, Elshaarawy GA, Abdallah AM, Abdel Raouf ER, El-Din EMS, Khadr Z, El-Saied MM, Elabd MA, Nassar MS, Abouelnaga MW, Ashaat EA, El-Sonbaty MM, Badawy HY, Dewdar EM, Salama SI, Abdelrahman M, Abdelmohsen AM, Eldeeb SE, Naga MM, Elshamy NH, Shaaban FA, ElRifay AS. Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study. BMC Psychiatry 2023; 23:689. [PMID: 37735643 PMCID: PMC10514965 DOI: 10.1186/s12888-023-05171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Child disability has significant implications on their well-being and healthcare systems. AIM This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors. METHODS A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories. RESULTS The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1-1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2-30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5-6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3-5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1-12.1 & AOR = 3.7, 95% CI: 1.7-7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2-10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing. CONCLUSION The study found a high prevalence of disability among Egyptian children aged 1-6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.
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Affiliation(s)
- Ammal M. Metwally
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ahmed Aboulghate
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ghada A. Elshaarawy
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ali M. Abdallah
- Quantitative Methods Department, Aswan University, Aswan, Egypt
| | - Ehab R. Abdel Raouf
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Ebtissam M. Salah El-Din
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Zeinab Khadr
- Department of Statistics, Faculty of Economics and Political Science, Cairo University, Cairo, Egypt
- The Social Research Center, American University in Cairo, Cairo, Egypt
| | - Mostafa M. El-Saied
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Mona A. Elabd
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Maysa S. Nassar
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Marwa W. Abouelnaga
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Engy A. Ashaat
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Mohamed M. El-Sonbaty
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Hala Y. Badawy
- Prevention of Disability General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Eman M. Dewdar
- Prevention of Disability General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Somia I. Salama
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Aida M. Abdelmohsen
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Sherif E. Eldeeb
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Maie M. Naga
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Nada H. Elshamy
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Fatma A. Shaaban
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Amira S. ElRifay
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
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Hamza FS, Unicomb R, Hewat S. Consensus on an assessment protocol for children with speech sound disorders in Sri Lanka. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1610-1629. [PMID: 37132224 DOI: 10.1111/1460-6984.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Speech sound disorders (SSDs) are the most common form of communication disorders in children. SSD have an impact on children's abilities to make themselves understood to their listeners and can influence a child's social and emotional well-being as well as their academic achievements. Therefore, it is important to identify children with an SSD early, in order to provide appropriate intervention. A wealth of information on best practice in the assessment of children with SSD is available in countries where the speech and language therapy profession is well established. In Sri Lanka, there is a paucity of research evidence supporting assessment practices that are culturally and linguistically appropriate in SSDs. Therefore, clinicians rely on informal assessment methods. There is a need to understand more about how clinicians in Sri Lanka assess this caseload in order to get general agreement regarding comprehensive and consistent procedures for assessment of paediatric SSD in Sri Lanka. This would support speech and language therapists' (SLTs') clinical decision-making in relation to choice of appropriate goals and intervention for this caseload. AIM To develop and gain consensus on an assessment protocol for Sri Lankan children with SSD that is culturally appropriate and based on existing research. METHOD A modified Delphi method was utilised to gather data from clinicians currently working in Sri Lanka. The research involved three rounds of data collection, exploring current assessment practices in Sri Lanka, ranking these in order of priority and establishing consensus on a proposed assessment protocol. The proposed assessment protocol was based on the results of the first and second rounds as well as previously published best practice guidelines. OUTCOME AND RESULTS The proposed assessment protocol achieved consensus in relation to content, format and cultural appropriateness. SLTs affirmed the usefulness of the protocol within the Sri Lankan context. Further research is required to assess the feasibility and effectiveness of this protocol in practice. CONCLUSIONS & IMPLICATIONS The assessment protocol supports practicing SLTs with a general guide to assessing children with suspected SSDs in Sri Lanka. The application of this protocol built upon consensus enables clinicians to improve their individual practice patterns based on best practice recommendations in the literature and the evidence on culturally and linguistically appropriate practices. This study has identified the need for further research in this area, including the development of culturally and linguistically specific assessment tools that would complement the use of this protocol. WHAT THIS PAPER ADDS What is already known on the subject The assessment of children with speech sound disorders (SSDs) requires a comprehensive and holistic approach due to their heterogeneous nature. Although there is evidence to support the assessment of paediatric SSDs in many countries where the profession of speech and language therapy is established, there is limited evidence to support the assessment of children with SSDs in Sri Lanka. What this study adds This study provides information about current assessment practices in Sri Lanka and consensus on a proposed culturally appropriate protocol for the assessment of children with SSDs in this country. What are the clinical implications of this work? The proposed assessment protocol provides speech and language therapists in Sri Lanka with a guide for assessment of paediatric SSDs to support more consistent practice in this area. Future evaluation of this preliminary protocol is required; however, the methodology used in this research could be applied to the development of assessment protocols for other range of practice areas in this country.
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Affiliation(s)
- Fathima Shimla Hamza
- The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
- Colombo South Teaching Hospital, Kalubowila-Dehiwela, Sri Lanka
| | - Rachael Unicomb
- The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Sally Hewat
- The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
- OST Therapy, Shenzhen, China
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10
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Gallagher AL, Murphy R, Fitzgerald J, Murphy CA, Law J. Exploring the acceptability, feasibility, and appropriateness of a communication-friendly classroom tool for use in Irish schools: A qualitative inquiry. PLoS One 2023; 18:e0287471. [PMID: 37347731 PMCID: PMC10286983 DOI: 10.1371/journal.pone.0287471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Ten percent of the school-aged population have speech, language, and communication needs (SLCN) that impact access to the curriculum. Successful implementation of classroom-based SLCN interventions can reduce barriers to learning, thereby improving educational outcomes for this vulnerable population. The challenges of implementing innovations in educational settings are well-documented, yet limited studies have addressed such considerations when developing, and piloting universal level SLCN interventions for use in Irish schools. METHODS A qualitative exploratory study was undertaken to establish the acceptability, feasibility, and appropriateness of a universal level SLCN intervention. An advisory panel of teachers (n = 8) and children with SLCN (n = 2) were engaged as co-researchers in the study. The Communication Supporting Classrooms Observation Tool, developed as part of the Better Communication Project in the UK, was trialled across a diverse sample of school settings (n = 5). Semi-structured interviews were conducted with school practitioners and school leaders, and a deductive content analysis was undertaken using the domains of the Consolidation Framework for Implementation Research. DISCUSSION The observation tool was viewed as acceptable with suggested additions. Integrating use of the tool within existing data-informed, school self-evaluation processes aimed at supporting school improvement was noted as a potential means of supporting implementation. A knowledge gap in relation to school-based models of support for SLCN was identified which may negatively impact implementation. An implementation strategy targeting coherence, cognitive engagement and contextual integration is indicated if the tool is to be normalised into routine practice in Irish classrooms. Implementation needs appeared to vary at the school level. CONCLUSIONS The importance of early-stage exploration to guide implementation planning with regards to developing and testing universal level interventions for SLCN in schools is highlighted. Engaging an advisory panel provides important insights to guide implementation decisions. Findings suggest an adaptive design is required when planning implementation studies targeting classroom setting.
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Affiliation(s)
- Aoife Lily Gallagher
- Faculty of Education and Health Science, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rachel Murphy
- Faculty of Education and Health Science, University of Limerick, Limerick, Ireland
| | | | - Carol-Anne Murphy
- Faculty of Education and Health Science, Health Research Institute, University of Limerick, Limerick, Ireland
| | - James Law
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Foster ME, Choo AL, Smith SA. Speech-language disorder severity, academic success, and socioemotional functioning among multilingual and English children in the United States: The National Survey of Children's Health. Front Psychol 2023; 14:1096145. [PMID: 36891210 PMCID: PMC9987562 DOI: 10.3389/fpsyg.2023.1096145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023] Open
Abstract
Research points to negative associations between educational success, socioemotional functioning, and the severity of symptoms in some speech-language disorders (SLDs). Nonetheless, the majority of studies examining SLDs in children have focused on monolinguals. More research is needed to determine whether the scant findings among multilinguals are robust. The present study used parent report data from the U.S. National Survey of Children's Health (2018 to 2020) to gain a better understanding of the impacts of SLD severity on indicators of academic success and socioemotional functioning among multilingual (n = 255) and English monolingual (n = 5,952) children with SLDs. Tests of between-group differences indicated that multilingual children evidenced more severe SLDs, had lower school engagement, and had lower reports of flourishing than English monolingual children with SLDs. Further, a greater proportion of multilingual children with SLDs missed more school days than English monolinguals. However, multilinguals were less likely to bully others or have been bullied than monolinguals. While the previous between-group differences were statistically significant, they were small (vs ≤ 0.08). Increased SLD severity predicted an increased number of repeated school grades, increased absenteeism, and decreased school engagement, when age and socioeconomic status were controlled. Increased SLD severity also predicted greater difficulty making and keeping friends and decreased flourishing. The effect of SLD severity on being bullied was statistically significant for the monolinguals but not multilinguals. There was a statistically significant interaction for SLD severity and sex for school engagement and difficulty making and keeping friends for monolinguals but not multilinguals. The interactions indicated that school engagement decreased more for females than for males while difficulties making and keeping friends increased more for males than females as one's SLD severity increased. While some findings were specific to monolinguals, tests of measurement invariance indicated that the same general pattern of relations among the variables were evident across the groups of multilinguals and monolinguals. These final findings can inform the interpretation of the results from both the current and future studies, while the overall findings can inform the development of intervention programs, thereby improving the long-term academic and socioemotional outcomes of children with SLDs.
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Affiliation(s)
- Matthew E Foster
- Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Ai Leen Choo
- Communication Sciences and Disorders, College of Education and Human Development, Georgia State University, Atlanta, GA, United States
| | - Sara A Smith
- Technology in Education and Second Language Acquisition, College of Education, University of South Florida, Tampa, FL, United States
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12
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Yoon JA, An SW, Choi YS, Seo JS, Yoon SJ, Kim SY, Shin YB. Correlation of Language Assessment Batteries of Toddlers With Developmental Language Delay. Ann Rehabil Med 2022; 46:256-262. [DOI: 10.5535/arm.22045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022] Open
Abstract
Objective To analyze the correlation between standardized language assessment batteries of toddlers and developmental language delays.Methods A total of 319 children with suspected language developmental delays were enrolled in this study retrospectively. They underwent the Receptive and Expressive Vocabulary Test (REVT) for vocabulary development assessment and at least one of two language assessment batteries: The Sequenced Language Scale for Infants (SELSI) or the Preschool Receptive-Expressive Language Scale (PRES) for language development assessment. The correlation of the results for receptive and expressive language between the scales were analyzed.Results The participants were divided into two groups: SELSI and REVT (n=45) and PRES and REVT (n=273). When the children’s results were classified into groups (average, mild delay, and delay), receptive and expressive scores were significantly correlated with each other in both SELSI-REVT and PRES-REVT groups. In addition, the correlation of mean developmental age between tests are analyzed. In the SELSI-REVT group, there was weak correlation of mean developmental age between tests for receptive and expressive language. In the PRES-REVT group, there was a strong positive correlation of mean developmental age for receptive and expressive language in children aged >36 months. Attention deficits during the test was found to be the statistically significant factor affecting the differences between the tests. The odds ratios for receptive and expressive language were 2.60 (95% confidence interval,1.15–5.84) and 1.94 (95% confidence interval, 1.15–3.27), respectively.Conclusion This study examined the correlations and influencing factors between language development evaluation tools for toddlers. An integrated interpretation of comprehensive language and vocabulary evaluation tools may be possible in children older than 3 years of language developmental age.
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Fan S, Ma B, Song X, Wang Y. Effect of language therapy alone for developmental language disorder in children: A meta-analysis. Front Psychol 2022; 13:922866. [PMID: 36262431 PMCID: PMC9574219 DOI: 10.3389/fpsyg.2022.922866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022] Open
Abstract
Despite numerous studies on the treatment of developmental language disorder (DLD), the intervention effect has long been debated. Systematic reviews of the effect of language therapy alone are rare. This evidence-based study investigated the effect of language therapy alone for different expressive and receptive language levels in children with DLD. Publications in databases including PubMed, the Cochrane Library, the Wanfang Database and the China National Knowledge Infrastructure were searched. Randomized controlled trials were selected. The methodological quality of the included trials was assessed using the modified Jadad method. RevMan 5.3 software was used for the data analysis. Fifteen trials were included in this study. Compared with the control (no or delayed intervention) group, the intervention group showed significant differences in overall expressive language development [standard mean differences (SMD), 0.46; 95% confidence interval (CI), 0.12–0.80], mean length of utterances in a language sample (SMD, 2.16; 95% CI, 0.39–3.93), number of utterances in a language sample (SMD, 0.52; 95% CI, 0.21–0.84), parent reports of expressive phrase complexity (SMD, 1.24; 95% CI, 0.78–1.70), overall expressive vocabulary development (SMD, 0.43; 95% CI, 0.17–0.69) and different words used in a language sample (SMD, 0.62; 95% CI, 0.35–0.88). However, language therapy did not show satisfactory long-term effects on DLD. Although language therapy is helpful in improving the performance of children with DLD, its long-term effect is unsatisfactory.
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Affiliation(s)
- Shengfu Fan
- Department of Foreign Languages, Changzhi Medical College, Changzhi, China
- *Correspondence: Shengfu Fan
| | - Bosen Ma
- School of International Studies, Zhejiang University, Hangzhou, China
| | - Xuan Song
- Emergency Department, Dongying Honggang Hospital, Dongying, China
| | - Yuhong Wang
- Department of Foreign Languages, Changzhi Medical College, Changzhi, China
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14
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Davidson MM, Alonzo CN, Stransky ML. Access to Speech and Language Services and Service Providers for Children With Speech and Language Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1702-1718. [PMID: 35613324 DOI: 10.1044/2022_ajslp-21-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Ohtaras D, McCormack J, Dent L. Luck, our journey, doing the best we could: The experiences of speech-language pathologists, parents, and teachers in service delivery for school-aged children. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:320-329. [PMID: 35522007 DOI: 10.1080/17549507.2022.2069859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: Speech-language pathology intervention is effective in supporting the needs of school-aged children with speech and language difficulties, particularly when implemented collaboratively among speech-language pathologists (SLPs), parents, and teachers. However, such intervention is not always accessible, affordable, or timely. The present study explored the experiences of SLPs, parents, and teachers with regard to service delivery for school-aged children as recorded in submissions to the Senate Inquiry into speech-language pathology services in Australia almost 10 years ago and related those experiences to current service provision.Method: In 2013, the Australian Government Senate formed a committee for inquiry and report into the prevalence of speech, language, and communication disorders and speech-language pathology services in Australia. The current study used a phenomenological approach to analyse submissions from SLPs (n = 9), parents (n = 8), and teachers (n = 3) of primary school-aged children who had submitted their experiences of speech-language pathology intervention.Result: Themes that emerged from the submissions showed that participants' experiences of service delivery were associated with "luck", "our journey", and "doing the best we could". Participants described their experiences as "luck" when they were able to access services that they knew others could not; they described their experiences as a "journey" when they reflected on the process of seeking, accessing, and obtaining services which was often quite circuitous; and they described their experience as "doing the best we could" when they persisted in seeking or providing services, despite frustration in not fulfilling their perceived duty of care.Conclusion: The experiences of SLPs, parents and teachers highlight the importance of listening to the stories of these groups to understand the strengths and challenges of service delivery for school-aged children and the need for timely, targeted, and evidence-based care. The experiences of service delivery described by participants in the Senate Inquiry are still common today and thus the need to address the issues they raised remains.
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Affiliation(s)
- Dimitra Ohtaras
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Jane McCormack
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Lisa Dent
- School of Allied Health, Australian Catholic University, North Sydney, Australia
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16
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Beiting M. Diagnosis and Treatment of Childhood Apraxia of Speech Among Children With Autism: Narrative Review and Clinical Recommendations. Lang Speech Hear Serv Sch 2022; 53:947-968. [PMID: 35472263 DOI: 10.1044/2022_lshss-21-00162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Treatment for children with autism spectrum disorder (ASD) and low verbal ability is a largely neglected area of study. Existing research focuses on language abilities; however, a subset of children with ASD also has speech sound disorders (SSDs). The purpose of this tutorial is to provide clinicians with evidence-based recommendations to guide speech assessment and treatment among children with ASD, low verbal ability, and suspected childhood apraxia of speech (CAS). METHOD Multifaceted search procedures were used to identify studies that have assessed or treated speech sound production among children with ASD. A narrative review and synthesis of the literature is followed by practical clinical recommendations based on best available evidence. CONCLUSIONS It is critically important to consider all possible hindrances to the development of functional communication ability for children with ASD. Speech sound production has been identified as a key predictor of expressive language outcomes, yet there are very few studies that address assessment and treatment of SSDs among children with ASD. Less is known about the presentation of CAS among children with ASD and low verbal ability. More research is needed to determine whether existing speech assessment and treatment methods are appropriate for children with ASD, if modifications are needed, or if new methods should be designed.
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Affiliation(s)
- Molly Beiting
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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17
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To Game or Not to Game? Efficacy of Using Tablet Games in Vocabulary Intervention for Children with DLD. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The adoption of tablets by young children has raised enthusiasm and concern among speech and language pathologists. This study investigated whether tablet games can be used as effectively as real play objects in vocabulary intervention for children with developmental language disorder (DLD). A randomized, controlled non-inferiority trial was conducted with 70 3-year-old children with DLD. The novel intervention group (n = 35) received 12 10-min scripted intervention sessions with symbolic play using a tablet game spread out over 8–9 weeks. The standard intervention group (n = 35) received the same amount of intervention with real objects using the same vocabulary scripts. In each session, children were exposed to 22 target words. The primary outcome was the number of new target words learned. This was measured using a picture selection task including 22 target words and 22 control words at 3 time intervals: before the intervention, immediately post-intervention, and 5 weeks later. In both intervention groups, the children learned significantly more target words than control words. No significant differences in gains between the two intervention conditions were found. This study provides evidence that vocabulary intervention for toddlers with DLD using a tablet game is equally as effective as an intervention using real objects.
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Abstract
The function of the formation of speech skills is decisive in the development of a child in communication and assimilation of information. Early pediatric diagnosis should become a routine practice of monitoring children from infancy to school age for the timely correction of speech disorders and associated dysgraphia and dyslexia. According to the ICD-10 classification, speech developmental disorders are divided into the following options: articulation impairment, delay in expressive and impressive speech. Articulation disorders, stuttering, impaired expressive speech are the most common and most favorable prognosis for speech therapy interventions. The data on the effectiveness of disorders of the receptive (impressive) language are ambiguous, since there is a high likelihood of a combination with neurogenetic diseases and autism. The development of speech therapy programs will make it possible to broader coverage of those in need of treatment, including complex course therapy with neuropeptides (cortexin).
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Affiliation(s)
- V P Zykov
- Russian Medical Academy Continuing Professional Education, Moscow, Russia
| | - I B Komarova
- Russian Medical Academy Continuing Professional Education, Moscow, Russia
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19
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Spineli LM, Kalyvas C, Papadimitropoulou K. How robust are findings of pairwise and network meta-analysis in the presence of missing participant outcome data? BMC Med 2021; 19:323. [PMID: 34930276 PMCID: PMC8691029 DOI: 10.1186/s12916-021-02195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To investigate the prevalence of robust conclusions in systematic reviews addressing missing (participant) outcome data via a novel framework of sensitivity analyses and examine the agreement with the current sensitivity analysis standards. METHODS We performed an empirical study on systematic reviews with two or more interventions. Pairwise meta-analyses (PMA) and network meta-analyses (NMA) were identified from empirical studies on the reporting and handling of missing outcome data in systematic reviews. PMAs with at least three studies and NMAs with at least three interventions on one primary outcome were considered eligible. We applied Bayesian methods to obtain the summary effect estimates whilst modelling missing outcome data under the missing-at-random assumption and different assumptions about the missingness mechanism in the compared interventions. The odds ratio in the logarithmic scale was considered for the binary outcomes and the standardised mean difference for the continuous outcomes. We calculated the proportion of primary analyses with robust and frail conclusions, quantified by our proposed metric, the robustness index (RI), and current sensitivity analysis standards. Cohen's kappa statistic was used to measure the agreement between the conclusions derived by the RI and the current sensitivity analysis standards. RESULTS One hundred eight PMAs and 34 NMAs were considered. When studies with a substantial number of missing outcome data dominated the analyses, the number of frail conclusions increased. The RI indicated that 59% of the analyses failed to demonstrate robustness compared to 39% when the current sensitivity analysis standards were employed. Comparing the RI with the current sensitivity analysis standards revealed that two in five analyses yielded contradictory conclusions concerning the robustness of the primary analysis results. CONCLUSIONS Compared with the current sensitivity analysis standards, the RI offers an explicit definition of similar results and does not unduly rely on statistical significance. Hence, it may safeguard against possible spurious conclusions regarding the robustness of the primary analysis results.
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Affiliation(s)
- Loukia M Spineli
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany.
| | - Chrysostomos Kalyvas
- Biostatistics and Research Decision Sciences, MSD Europe Inc., Brussels, Belgium
| | - Katerina Papadimitropoulou
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Data Science and Biometrics, Danone Nutricia Research, Utrecht, The Netherlands
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Suttora C, Zuccarini M, Aceti A, Corvaglia L, Guarini A, Sansavini A. The Effects of a Parent-Implemented Language Intervention on Late-Talkers' Expressive Skills: The Mediational Role of Parental Speech Contingency and Dialogic Reading Abilities. Front Psychol 2021; 12:723366. [PMID: 34566804 PMCID: PMC8459088 DOI: 10.3389/fpsyg.2021.723366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Several qualitative and quantitative features of parental speech input support children’s language development and may play a critical role in improving such process in late talkers. Parent-implemented interventions targeting late-talkers have been developed to promote children’s language outcomes by enhancing their linguistic environment, i.e., parental speech input. This study investigated the effect of a parent-implemented intervention in increasing late talkers’ expressive skills through modifications in structural and functional features of parental speech input. Forty-six thirty-one-month-old late talkers differing in their birth condition (either low-risk preterm or full-term) participated in the study with a parent; 24 parent-child dyads received a parent-implemented intervention centered on dialogic reading and focused stimulation techniques, whereas the other 22 dyads constituted the control group. At pre- and post-intervention, dyads took part in a parent-child shared book-reading session and both parental and child’s speech measures were collected and examined. Results showed that the intervention positively affected parents’ use of responses and expansions of children’s verbal initiatives, as well as the parental amount of talking over reading, whereas no structural features of parental input resulted modified. Mediation analyses pointed out that the intervention indirectly enhanced late-talkers’ use of verbal types and tokens through changes in parental use of expansions and amount of talking over reading. As birth status was entered as a covariate in the analysis, these findings can be extended to children with different gestational age. We conclude that the parent-implemented intervention was effective in supporting late-talkers’ gains in language development as a cascade result of the improvements in parental contingency and dialogic reading abilities. These promising findings suggest to examine not only children and parental outcomes but also the intervention mechanisms promoting changes in late-talkers’ language development as a clearer view on such process can inform the development of feasible, ecological and effective programs.
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Affiliation(s)
- Chiara Suttora
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | | | - Arianna Aceti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luigi Corvaglia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Annalisa Guarini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Alessandra Sansavini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
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21
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Jullien S. Screening for language and speech delay in children under five years. BMC Pediatr 2021; 21:362. [PMID: 34496812 PMCID: PMC8424786 DOI: 10.1186/s12887-021-02817-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
We looked at existing recommendations and supporting evidence on the effectiveness of universal screening for language and speech delay in children under 5 years of age for short- and long-term outcomes. We conducted a literature search up to the 20th of November 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported on the accuracy of the screening tests for detecting language and speech delay, the efficacy of existing interventions for children with language and speech delay, and the potential harms associated with screening and the associated interventions. Several screening tools are used to assess language and speech delay with a wide variation in their accuracy. Targeted interventions improve some measures of speech and language delay and disorders. However, there is no evidence on the effectiveness of such interventions in children detected by screening with no specific concerns about their speech or language before screening. There is no evidence assessing whether universal screening for language and speech delay in a primary care setting improves short and long-term outcomes (including speech and language outcomes and other outcomes). Finally, there is no evidence on the harms of screening for language and speech delay in primary care settings, and there is limited evidence assessing the potential harms of interventions.
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Affiliation(s)
- Sophie Jullien
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
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Maggu AR, Kager R, To CKS, Kwan JSK, Wong PCM. Effect of Complexity on Speech Sound Development: Evidence From Meta-Analysis Review of Treatment-Based Studies. Front Psychol 2021; 12:651900. [PMID: 33995208 PMCID: PMC8113766 DOI: 10.3389/fpsyg.2021.651900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
In the current study, we aimed at understanding the effect of exposure to complex input on speech sound development, by conducting a systematic meta-analysis review of the existing treatment-based studies employing complex input in children with speech sound disorders. In the meta-analysis review, using a list of inclusion criteria, we narrowed 280 studies down to 12 studies. Data from these studies were extracted to calculate effect sizes that were plotted as forest plots to determine the efficacy of complexity-based treatment approaches. The outcome variables of interest were improvement on the treated and generalization to the untreated sounds. Meta-analysis revealed that the exposure to complex input not only promoted improvement in production of complex speech sounds (d = 1.08, CI = 0.98–1.19) but also facilitated the production of untreated simple speech sounds (d = 2.69, CI = 1.98–3.54). Overall, the current findings revealed that the exposure to complex input promotes acquisition of both complex and simple speech sounds. The current findings are in line with the models of language learnability. The current findings have implications in the treatment of speech sound disorders.
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Affiliation(s)
- Akshay R Maggu
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Hong Kong, China.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States.,Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - René Kager
- Department of Languages, Literature and Communication, Utrecht Institute of Linguistics OTS, Utrecht University, Utrecht, Netherlands.,The Chinese University of Hong Kong - Utrecht University Joint Centre for Language, Mind and Brain, Hong Kong, China
| | - Carol K S To
- Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong, China
| | - Judy S K Kwan
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick C M Wong
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Hong Kong, China.,Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.,The Chinese University of Hong Kong - Utrecht University Joint Centre for Language, Mind and Brain, Hong Kong, China
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23
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Rinaldi S, Caselli MC, Cofelice V, D’Amico S, De Cagno AG, Della Corte G, Di Martino MV, Di Costanzo B, Levorato MC, Penge R, Rossetto T, Sansavini A, Vecchi S, Zoccolotti P. Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review. Brain Sci 2021; 11:brainsci11030407. [PMID: 33806938 PMCID: PMC8005159 DOI: 10.3390/brainsci11030407] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 01/08/2023] Open
Abstract
Background. Language disorder is the most frequent developmental disorder in childhood and it has a significant negative impact on children’s development. The goal of the present review was to systematically analyze the effectiveness of interventions in children with developmental language disorder (DLD) from an evidence-based perspective. Methods. We considered systematic reviews, meta-analyses of randomized controlled trials (RCTs), control group cohort studies on any type of intervention aimed at improving children’s skills in the phono-articulatory, phonological, semantic-lexical, and morpho-syntactic fields in preschool and primary school children (up to eight years of age) that were diagnosed with DLD. We identified 27 full-length studies, 26 RCT and one review. Results. Early intensive intervention in three- and four-year-old children has a positive effect on phonological expressive and receptive skills and acquisitions are maintained in the medium term. Less evidence is available on the treatment of expressive vocabulary (and no evidence on receptive vocabulary). Intervention on morphological and syntactic skills has effective results on expressive (but not receptive) skills; however, a number of inconsistent results have also been reported. Only one study reports a positive effect of treatment on inferential narrative skills. Limited evidence is also available on the treatment of meta-phonological skills. More studies investigated the effectiveness of interventions on general language skills, which now appears as a promising area of investigation, even though results are not all consistent. Conclusions. The effectiveness of interventions over expressive and receptive phonological skills, morpho-syntactic skills, as well as inferential skills in narrative context underscores the importance that these trainings be implemented in children with DLD.
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Affiliation(s)
- Sara Rinaldi
- Developmental Neurorehabilitation Service, UOC Infancy, Adolescence, Family Counseling, AULSS 6 Euganea—Padua Bacchiglione District, Via Dei Colli 4/6, 35143 Padua, Italy
- Federazione Logopedisti Italiani, Via Daniello Bartoli, 00152 Rome, Italy; (A.G.D.C.); (T.R.)
- Correspondence: ; Tel.: +39-0498217670
| | | | | | - Simonetta D’Amico
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, P.le S. Tommasi, 1, 67100 Coppito, Italy;
- CLASTA—Communication & Language Acquisition Studies in Typical & Atypical Population, Piazza Epiro 12D, 00183 Rome, Italy; (M.C.L.); (A.S.)
| | - Anna Giulia De Cagno
- Federazione Logopedisti Italiani, Via Daniello Bartoli, 00152 Rome, Italy; (A.G.D.C.); (T.R.)
| | | | - Maria Valeria Di Martino
- Health Professions Integrated Service, Azienda Ospedaliera dei Colli di Napoli, 80131 Napoli, Italy;
| | - Brigida Di Costanzo
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health, and Preventive Medicine, Luigi Vanvitelli University, Largo Madonna delle Grazie 1, 80138 Naples, Italy;
- Cinetic Center, Neuromotor Rehabilitation Centre, Via Santella 26, 81025 Marcianise, Italy
| | - Maria Chiara Levorato
- CLASTA—Communication & Language Acquisition Studies in Typical & Atypical Population, Piazza Epiro 12D, 00183 Rome, Italy; (M.C.L.); (A.S.)
- Department of Developmental Psychology and Socialization, University of Padua, Via Venezia, 8, 35131 Padova, Italy
| | - Roberta Penge
- Department of Human Neuroscience, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy;
| | - Tiziana Rossetto
- Federazione Logopedisti Italiani, Via Daniello Bartoli, 00152 Rome, Italy; (A.G.D.C.); (T.R.)
| | - Alessandra Sansavini
- CLASTA—Communication & Language Acquisition Studies in Typical & Atypical Population, Piazza Epiro 12D, 00183 Rome, Italy; (M.C.L.); (A.S.)
- Department of Psychology “Renzo Canestrari”, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00154 Rome, Italy;
| | - Pierluigi Zoccolotti
- Department of Psychology, Sapienza University of Rome, Via Dei Marsi 78, 00185 Rome, Italy;
- Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
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24
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Meinzen-Derr J, Sheldon R, Altaye M, Lane L, Mays L, Wiley S. A Technology-Assisted Language Intervention for Children Who Are Deaf or Hard of Hearing: A Randomized Clinical Trial. Pediatrics 2021; 147:peds.2020-025734. [PMID: 33452063 PMCID: PMC7891685 DOI: 10.1542/peds.2020-025734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children who are deaf or hard of hearing (DHH) often have persistent language delays despite early identification and interventions. The technology-assisted language intervention (TALI), which incorporates augmentative and alternative communication technology into a speech-language therapy model, was designed to support language learning. The study objective was to evaluate the impact of the TALI on spoken language outcomes in DHH children. METHODS Children aged 3 to 12 years with mild to profound bilateral hearing loss were enrolled in a single-site randomized controlled trial. Children were randomly assigned to receive the TALI or treatment as usual (TAU) (with no change in current care) and were followed for 24 weeks. Primary outcomes included spoken language measures elicited from language samples. Secondary outcomes included standardized assessments. Intention-to-treat analyses were used. RESULTS Analyses focused on 41 children randomly assigned to TALI (n = 21) or TAU (n = 20). Among all participants, mean age was 6.3 years (SD 2.5). Over 24 weeks, children in the TALI group, compared with those in the TAU group, had significantly greater increases in the length of phrases they used to express themselves (β = .91 vs .15, respectively; P< .0001). Similar findings were seen with conversational turn-taking and number of different words spoken. CONCLUSIONS Providing visual supports for language concepts that are typically challenging for DHH children to acquire allowed children to process and comprehend spoken language more fully. Such strategies can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings.
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Affiliation(s)
| | - Rose Sheldon
- Developmental and Behavioral Pediatrics, Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Laura Lane
- Divisions of Biostatistics and Epidemiology and
| | - Lindsay Mays
- Developmental and Behavioral Pediatrics, Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Susan Wiley
- Developmental and Behavioral Pediatrics, Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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25
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Hendriks GJ, van Zelst WH, van Balkom AJ, Uphoff E, Robertson L, Keijsers GPJ, Oude Voshaar RC. Cognitive behavioural therapy and third wave approaches for anxiety and related disorders in older people. Hippokratia 2021. [DOI: 10.1002/14651858.cd007674.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gert-Jan Hendriks
- “Overwaal” Centre of Expertise for Anxiety Disorders, OCD and PTSD; Institute for Integrated Mental Health Care “Pro Persona; Nijmegen Netherlands
- Behavioural Science Institute; Radboud University; Nijmegen Netherlands
- Department of Psychiatry; Radboud University Medical Centre; Nijmegen Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry; University Medical Centre Groningen; Groningen Netherlands
| | - Anton J van Balkom
- Department of Psychiatry and EMGO+ Institute; VU-University Medical Centre and GGZ inGeest; Amsterdam Netherlands
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Ger PJ Keijsers
- Behavioural Science Institute; Radboud University; Nijmegen Netherlands
- Department of Clinical Psychological Sciences; Maastricht University; Maastricht Netherlands
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26
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Tarvainen S, Launonen K, Stolt S. Oral language comprehension interventions in school-age children and adolescents with developmental language disorder: A systematic scoping review. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2021; 6:23969415211010423. [PMID: 36381528 PMCID: PMC9620681 DOI: 10.1177/23969415211010423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND & AIMS Difficulties understanding spoken language are associated with several social and academic risks in school-age children and adolescents with developmental language disorder (DLD). Still, interventions for this group have received little attention, and there are no reviews focusing on oral language comprehension interventions in school-age children and adolescents. The objective of this systematic scoping review was to identify interventions targeting oral language comprehension in school-age children and adolescents with DLD. Further, the aim was to examine the focus of intervention, efficacy, and level of evidence of the identified interventions. The present review is the second part of a larger search on oral language comprehension interventions. The first review examined the same factors in children 8 years and younger. METHODS A systematic scoping review of eight databases was conducted. Of the 2399 sourced articles, 12 met the inclusion criteria. Another 8 articles were identified through reference lists of sourced articles. In these 20 articles, containing 21 studies, 1661 children aged 5-16 years participated. The data were extracted and analysed, and the intervention focus, efficacy, and level of evidence were examined.Main contribution: In the interventions intended for school-age children and adolescents with DLD, three intervention foci were identified that targeted aspects of language and language processing, as well as modifying the communicative environment. Of the included studies, 57% reported positive results, 14% reported mixed results, and 29% reported no effects on oral language comprehension. The level of evidence varied. One can have high confidence in the results of 19%, moderate in 38%, and indicative confidence in 43% of the included studies. CONCLUSIONS Results of the present review suggest that there are a few interventions providing high confidence on the efficacy of improving oral language comprehension difficulties in school-age children and adolescents with DLD. Most interventions indicating efficacy provide moderate or indicative confidence in the results. More research with a high level of evidence is urgently needed. Most of the interventions indicating efficacy focused directly on language skills or modified the communicative environment. The results suggest that the therapy techniques focusing on improving language processing skills indicate efficacy only when they aim at compensating current language processing skills, not trying to improve them.Implications: The findings on different therapy techniques, their focus of intervention, efficacy, and level of evidence provide information for clinical practice and direct future investigations in this sparsely researched topic.
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Affiliation(s)
- Sirpa Tarvainen
- Sirpa Tarvainen, Department of Psychology
and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3
(P.O. Box 21), 00014, Finland. Emails: ;
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27
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Decke S, Deckert K, Lang M, Laub O, Loidl V, Schwettmann L, Grill E. "We're in good hands there." - Acceptance, barriers and facilitators of a primary care-based health coaching programme for children and adolescents with mental health problems: a qualitative study (PrimA-QuO). BMC FAMILY PRACTICE 2020; 21:273. [PMID: 33341115 PMCID: PMC7749989 DOI: 10.1186/s12875-020-01344-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
Background 11.5 % of girls and 17.8 % of boys are affected by a mental health problem (MHP). The most prevalent problem areas are behavioural problems (girls/boys in %: 11.9/17.9), emotional problems (9.7/8.6) and hyperactivity problems (4.8/10.8). Primary care paediatricians are the first in line to be contacted. Nevertheless, even for less severely affected patients, referral rates to specialised care are constantly high. Therefore, a major statutory health insurance fund introduced a Health Coaching (HC) programme, including a training concept for paediatricians, standardised guidelines for actions and additional payments to strengthen primary care consultation for MHP and to decrease referrals to specialised care. The aim of this study was to examine how the HC is perceived and implemented in daily practice to indicate potential strengths and challenges. Methods During a one-year period starting in November 2017, a series of guideline-based interviews were conducted by phone with HC-developers, HC-qualified paediatricians, parents and patients (≥14 years) treated according to the HC programme. Paediatricians were selected from a Bavarian practice network with a total of 577 HC qualified paediatricians. Parents of patients with the four most common MHP diagnoses were approached by their health insurance: [World Health Organization, 2013] developmental disorder of speech and language [Wille N, et al., 2008] head/abdominal pain (somatoform) [Holling H, et al., 2003-2006 and 2009-2012] conduct disorder [Plass-Christl A, et al., 2018] non-organic enuresis. 23 paediatricians, 314 parents and 10 adolescents consented to be interviewed. Potential participants were selected based on purposeful sampling, according to principles of maximum variance. All interviews were recorded and transcribed verbatim. Two researchers analysed the transcripts independently of each other. Structuring content analysis derived from Mayring was used for analysis. Results 11 paediatricians, 3 co-developers, 22 parents and 4 adolescents were included. Families were generally satisfied with paediatric care received in the programme’s context. The HC supported paediatricians’ essential role as consultants and improved their diagnostic skills. Lack of time, financial restrictions and patients’ challenging family structures were reported as major barriers to success. Conclusion The HC programme is perceived as a facilitator for more patient-centred care. However, structural barriers remain. Starting points for improvement are further options to strengthen families’ resources and expanded interdisciplinary networking. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01344-1.
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Affiliation(s)
- Siona Decke
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany. .,Pettenkofer School of Public Health, Munich, Germany.
| | | | - Martin Lang
- Berufsverband der Kinder- und Jugendärzte (BVKJ) e.V., Cologne, Germany.,PaedNetz Bayern e.V., Munich, Germany
| | - Otto Laub
- PaedNetz Bayern e.V., Munich, Germany
| | - Verena Loidl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management (IGM), Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany. .,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.
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Stankova M, Rodríguez-Ortiz IR, Matić A, Levickis P, Lyons R, Messarra C, Kouba Hreich E, Vulchanova M, Vulchanov V, Czaplewska E, Ringblom N, Hansson K, Håkansson G, Jalali-Moghadam N, Dionissieva K, Günhan Senol NE, Law J. Cultural and Linguistic Practice with Children with Developmental Language Disorder: Findings from an International Practitioner Survey. Folia Phoniatr Logop 2020; 73:465-477. [PMID: 33291100 DOI: 10.1159/000511903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The cultural and language diversity across many European countries presents a range of challenges and opportunities for speech and language therapists and other practitioners working with children with developmental language disorders (DLD) and their families. OBJECTIVE The aim of this study was to explore practitioners' perceptions of cultural and linguistic differences in response to children with DLD across different countries. METHODS A survey was developed by practitioners and researchers working with children with DLD across Europe and beyond as part of the work of Cost Action IS1406. Data from 1,358 practitioners from 8 European countries - Ireland, UK, Bulgaria, Poland, Croatia, Spain, Norway and Sweden - and 2 neighbour countries - Turkey and Lebanon - were included in the present analyses, which address two groups of questions. The first focuses on practitioners' perceptions of the way that parents think about cultural differences and their relationship to language development in their children. The second concerns the extent to which practitioners consider themselves to have the skills to work with children from other cultures and using different languages. RESULTS/CONCLUSIONS Most countries present a similar profile with intermediate results about their perception of cultural issues, but Lebanon and Turkey are the group with the most positive responses. In terms of bilingual issues most practitioners indicated that they only worked in their country's primary language. The only country where this was not the case was Lebanon. Professionals from Spain and Lebanon form a subgroup in terms of their confidence to work with different cultural/language groups. The paper highlights both the universal importance of cultural and linguistic competence in managing young children's needs and indicates that in most cases professionals do not think they have the necessary expertise to work with cultural and linguistic diversity.
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Affiliation(s)
- Margarita Stankova
- Department of Health Care and Social Work, New Bulgarian University, Sofia, Bulgaria,
| | | | - Ana Matić
- Department of Speech and Language Pathology, University of Zagreb, Zagreb, Croatia
| | - Penny Levickis
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia
| | - Rena Lyons
- Discipline of Speech and Language Therapy, National University of Ireland Galway, Galway, Ireland
| | - Camille Messarra
- Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Edith Kouba Hreich
- Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Mila Vulchanova
- Department of Language and Literature, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Valentin Vulchanov
- Department of Language and Literature, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ewa Czaplewska
- Institute of Logopaedics, Faculty of Languages, University of Gdansk, Gdansk, Poland
| | - Natalia Ringblom
- Department of Modern Languages, Uppsala University, Uppsala, Sweden.,Department of Slavic and Baltic Studies, Finnish, Dutch and German, Stockholm University, Stockholm, Sweden
| | - Kristina Hansson
- Department of Clinical Sciences, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | | | - Niloufar Jalali-Moghadam
- Department of Psychiatry, Østfold Hospital Trust, Moss, Norway.,Blekinge Center of Competence, Blekinge County Council, Karlskrona, Sweden
| | - Katya Dionissieva
- Department of Logopedics, South-West University N. Rilski, Blagoevgrad, Bulgaria
| | - N Evra Günhan Senol
- Department of Speech and Language Therapy, Istanbul Medipol University, Istanbul, Turkey
| | - James Law
- Department of Speech and Language Sciences, School of Education, Communication and Language Sciences, Newcastle University, Newcastle, United Kingdom
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Evaluation of a manualised speech and language therapy programme for children with social communication disorder: the SCIP feasibility study. Pilot Feasibility Stud 2020; 6:137. [PMID: 32983554 PMCID: PMC7510260 DOI: 10.1186/s40814-020-00658-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/02/2020] [Indexed: 01/04/2023] Open
Abstract
Background Children with Social (Pragmatic) Communication Disorder (SPCD) have long-term needs in using and processing social language and have a high risk of later mental health difficulties. A manualised speech and language therapy programme, the Social Communication Intervention Programme (SCIP) provides therapy content for SPCD. A feasibility study is required to derive more precise estimates of key parameters for a future trial of SCIP. Aims To assess the feasibility of conducting a substantive randomized controlled trial of SCIP for children with SPCD. Methods A questionnaire was distributed to paediatric speech and language therapists in England. Survey questions addressed number of eligible children, routine intervention provision and trial recruitment factors. In the second phase, a single-arm intervention feasibility study was completed. Fifteen speech and language practitioners identified 24 children aged 5-11 years with SPCD. Practitioners received training/supervision to deliver 20 SCIP therapy sessions to each child. At time 1, parents of participating children provided three communication goals; expected steps in each goal were defined. After intervention, parents and practitioners independently rated each goal compared to baseline ability. Two research practitioners compared parent post-intervention commentaries with outcome scores to derive guidance about clinical significance. All practitioners recorded audio commentaries on therapy experiences. Post-intervention interviews were conducted with 6 practitioners and 6 parents. An expert panel completed a Delphi consultation on trial design. Results Routine practice for SPCD varies widely. Children tend to be embedded in autism provision. Participation in a future trial was well supported provided resources are available to services. Outcomes analysis indicated all children except one made some progress on parent ratings; all children made progress on practitioner ratings. A power analysis for a future trial was carried out using current outcome measure as putative primary endpoint. Practitioners' audio-diaries provided suggestions for training and adaption in a future trial. Outcomes and therapy methods were acceptable to practitioners and parents. Conclusions The feasibility study evaluated a novel outcome measure of social communication skills in SPCD. A power calculation indicated a feasible framework for a trial within a realistic period of time. Recommendations for recruitment methods, adaptation of manual and training were supported by practitioners and an expert panel. Trial registration Title: Speech-language therapy for child social communication disorderTrial ID: ISRCTN48030419. Date registered: January 1, 2017. Registered retrospectively.
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30
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Wiefferink K, van Beugen C, Wegener Sleeswijk B, Gerrits E. Children with language delay referred to Dutch speech and hearing centres: caseload characteristics. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:573-582. [PMID: 32459389 PMCID: PMC7383695 DOI: 10.1111/1460-6984.12540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision. AIMS To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification. METHODS & PROCEDURES A database of 11,450 children was analysed consisting of data on children, aged 2-7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono- and bilingualism, nature of the language delay, and language profile of the children. OUTCOMES & RESULTS Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems. CONCLUSIONS & IMPLICATIONS This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children. What this paper adds What is already known on the subject Identifying language disorders before children enter school can foster the initiation of early interventions before these problems interfere with formal education and behavioural adjustment. Information on caseload characteristics is important to plan speech and language therapy service provision. There are only a few studies on the caseload characteristics of children at first referral for language assessment. What this paper adds to existing knowledge This study provides a detailed description of the caseload characteristics of children referred to Dutch speech and hearing centres. The results reveal an age bias in referral: boys were referred earlier than girls, and monolingual children were revealed earlier than bilingual children. On top of that, bilingual children seemed to have more complex problems at referral. What are the potential or actual clinical implications of this work? This study indicates that it is important to be aware of bias in the age of referral of subgroups of children with language disorders. Solutions might be to implement a language screening instrument designed for use by non-speech-language therapists, and training in early recognition of girls and multilingual children with (less complex) language disorders for health professionals in key positions in child healthcare. In addition, it might be worthwhile to assign speech and language therapists with diverse ethnic and language backgrounds and/or with experience with bilingual/cultural children in a regional mentoring function to support referral agents and parents.
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Affiliation(s)
- Karin Wiefferink
- Dutch Foundation for the Deaf and Hard of Hearing ChildNSDSKAmsterdamthe Netherlands
| | | | | | - Ellen Gerrits
- Utrecht UniversityUtrechtthe Netherlands
- HU University of Applied Sciences UtrechtUtrechtthe Netherlands
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31
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Davidson R, Randhawa G. The Sign 4 Little Talkers Intervention to Improve Listening, Understanding, Speaking, and Behavior in Hearing Preschool Children: Outcome Evaluation. JMIR Pediatr Parent 2020; 3:e15348. [PMID: 32452813 PMCID: PMC7367544 DOI: 10.2196/15348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/17/2020] [Accepted: 02/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gaining age-appropriate proficiency in speech and language in the early years is crucial to later life chances; however, a significant proportion of children fail to meet the expected standards in these early years outcomes when they start school. Factors influencing the development of language and communication include low income, gender, and having English as an additional language (EAL). OBJECTIVE This study aimed to determine whether the Sign 4 Little Talkers (S4LT) program improves key developmental outcomes in hearing preschool children. S4LT was developed to address gaps in the attainment of vocabulary and communication skills in preschool children, identified through routine monitoring of outcomes in early years. Signs were adapted and incorporated into storybooks to improve vocabulary, communication, and behavior in hearing children. METHODS An evaluation of S4LT was conducted to measure key outcomes pre- and postintervention in 8 early years settings in Luton, United Kingdom. A total of 118 preschool children were tested in 4 early years outcomes domains-listening, speaking, understanding, and managing feelings and behavior-as well as Leuven well-being scales and the number of key words understood and spoken. RESULTS Statistically significant results were found for all measures tested: words spoken (P<.001) and understood (P<.001), speaking (P<.001), managing feelings and behavior (P<.001), understanding (P<.001), listening and attention (P<.001), and well-being (P<.001). Approximately two-thirds of the children made expected or good progress, often progressing multiple steps in educational attainment after being assessed as developmentally behind at baseline. CONCLUSIONS The findings reported here suggest that S4LT may help children to catch up with their peers at a crucial stage in development and become school ready by improving their command of language and communication as well as learning social skills. Our analysis also highlights specific groups of children who are not responding as well as expected, namely boys with EAL, and who require additional, tailored support.
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Affiliation(s)
- Rosemary Davidson
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
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O'Toole C, Lyons R, Ó'Doibhlín D, O'Farrell F, Houghton C. Stage 1 Registered Report: The experiences and perceptions of parent-child interaction therapy for parents of young children with communication difficulties: A qualitative evidence synthesis protocol. HRB Open Res 2020; 2:36. [PMID: 32566893 PMCID: PMC7281664 DOI: 10.12688/hrbopenres.12974.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Parent-child interaction therapy refers to a group of interventions mediated by trained parents to address areas of developmental difficulties in children. In the field of speech and language therapy it is used in early intervention for children with speech, language and communication difficulties. The intervention involves training parents and caregivers on the importance of responsivity and language input in daily interactions and coaches them on strategies to implement these with the children. As the success of the intervention is heavily influenced by caregiver engagement, understanding and acceptance, it is important to consider their views. However, to date there has been limited work on synthesising parental views of this intervention. Methods: This is a protocol for a qualitative evidence synthesis of peer-reviewed qualitative papers addressing the experiences and perceptions of parent-child interaction therapy for parents of children with communication difficulties. We will complete a systematic search of 11 databases, review the reference lists and complete a cited reference search of all included studies. Two authors will independently screen tests for inclusion, initially by title and abstract, with full-text screening as necessary. Thematic synthesis will be used for all included studies. We will appraise the quality of included studies using CASP and confidence in the review findings using GRADE CERQual. Discussion: As the views of parents are pivotal in the success of this intervention, the findings from this synthesis should help to guide best practice and policy for the future implementation of parent child interaction therapy for children with communication difficulties..
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Affiliation(s)
- Ciara O'Toole
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Rena Lyons
- Discipline of Speech and Language Therapy, National University of Ireland, Galway, Galway, Ireland
| | - Donna Ó'Doibhlín
- Boston Scientific Library, University College Cork, Cork, Ireland
| | | | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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Piazzalunga S, Salerni N, Limarzi S, Ticozzell B, Schindler A. Assessment of children's communicative participation: a preliminary study on the validity and reliability of the Italian Focus on the Outcomes of Communication Under Six (FOCUS-I) in preschool age. SPEECH LANGUAGE AND HEARING 2020. [DOI: 10.1080/2050571x.2020.1738037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Silvia Piazzalunga
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | | | - Sofia Limarzi
- Scientific Institute IRCCS “E. Medea”, Bosisio Parini, Italy
| | - Benedetta Ticozzell
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
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Dodd B. Re-Evaluating Evidence for Best Practice in Paediatric Speech-Language Pathology. Folia Phoniatr Logop 2020; 73:63-74. [PMID: 31940655 DOI: 10.1159/000505265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Systematic reviews of treatment trials for children with speech and language difficulties often exemplify the limited clinical usefulness of the evidence base, reflecting recent literature in evidence-based medicine. Other studies report that clinicians often fail to seek information about best practice, across the health professions. Consequently, clinical researchers, including those in speech-language pathology, have sought alternative methodologies for determining best practice. SUMMARY Some approaches focus on "pragmatic trials," usually as part of existing health services. Others place case management of individuals at the centre of intervention presenting studies of one or more cases, including N-of-1 randomized controlled trials and cross-over group designs. Clinical case studies can provide important theoretical data contributing to our understanding of the development of typical and atypical communication. Precision medicine (also known as personalized medicine) is an emerging approach to building the clinical evidence base that acknowledges the importance of individual genetic and environmental differences between people. With increasing knowledge of aetiological heterogeneity, even within children presenting with the same diagnosis (e.g., childhood apraxia of speech), data reinforce the edict that children are not all born equal. Key Message: This review argues that to understand response to treatment, it is critical to examine child-related factors as well as the variables of the intervention itself.
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Affiliation(s)
- Barbara Dodd
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia,
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Tarvainen S. Oral language comprehension interventions in 1-8-year-old children with language disorders or difficulties: A systematic scoping review. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2020; 5:2396941520946999. [PMID: 36381544 PMCID: PMC9620463 DOI: 10.1177/2396941520946999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS The most severe problems in language manifest as difficulties in comprehending oral language. These difficulties are persistent and expose individuals to several risk factors. There is a lack of intervention research in the area of oral language comprehension, and no reviews have focused solely on oral language comprehension interventions in young children. The aim of this review was to identify interventions targeting oral language comprehension in children 8 years or younger with language disorders or difficulties. The review also examined the possible intervention foci, efficacy, and level of evidence of these interventions. METHODS A systematic scoping review of eight databases was carried out. Twenty of 2399 articles met the inclusion criteria and a further six articles were identified through reference lists of sourced articles. These 26 articles described 25 studies. Altogether 2460 children aged 1-8 years participated in the 25 studies. The data from these studies were extracted and analysed, and the intervention foci, efficacy, and level of evidence were evaluated.Main contribution: The reviewed interventions focused on three aspects: modifying the communicative environment of the child; targeting aspects of the child's language; or targeting the child's language processing. Of the included studies, 80% indicated positive effects on participants' oral language comprehension. The level of evidence of the included studies varied. With few exceptions, researchers and practitioners can have moderate confidence in the results of the included studies indicating that it is possible to ameliorate difficulties in oral language comprehension. CONCLUSIONS This review summarises the existing evidence on oral language comprehension interventions in young children with language disorders or difficulties. The evidence base is still limited, and more research is urgently needed. The results suggest that though not all interventions seem to provide desired outcomes, there are several interventions indicating efficacy to target problems in oral language comprehension in 1-8-year-old children with language disorders or difficulties. A careful choice of therapy technique and collaboration with people in the child's environment is required to maximize outcomes.Implications: The results suggest that young children's oral language comprehension skills can be improved by guiding parents and clinicians in their communication strategies, and by clinician-implemented interventions targeting aspects of the child's language. The research on interventions targeting children's language processing is limited, and the results mixed. The present study provides information on different oral language comprehension interventions and their outcomes. The findings are readily applicable for clinical use.
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Affiliation(s)
- Sirpa Tarvainen
- Sirpa Tarvainen, Department of Psychology
and Logopedics, University of Helsinki, Haartmaninkatu 3, Helsinki 00014,
Finland. Emails: ;
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O'Toole C, Lyons R, Ó’Doibhlín D, O’Farrell F, Houghton C. Stage 1 Registered Report: The experiences and perceptions of parent-child interaction therapy for parents of young children with communication difficulties: A qualitative evidence synthesis protocol. HRB Open Res 2019; 2:36. [DOI: 10.12688/hrbopenres.12974.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Parent-child interaction therapy is an early intervention for children with speech, language and communication difficulties. It involves training parents and caregivers on the importance of responsivity and language input in daily interactions and coaches them on strategies to implement this with the children. As the success of the intervention is heavily influenced by caregiver engagement, understanding and acceptance, it is important to consider their views. However, to date there has been limited work on synthesizing parental views of this intervention. Methods: This is a protocol for a qualitative evidence synthesis of peer-reviewed papers addressing the experiences and perceptions of parent-child interaction therapy for parents of young children with communication difficulties. We will complete a systematic search of 11 databases, review the reference lists and complete a cited reference search of all included studies. Two authors will independently screen tests for inclusion, initially by title and abstract, with full-text screening as necessary. Thematic synthesis will be used for all included studies. We will appraise the quality of included studies using CASP and confidence in the review findings using GRADE CERQual. Discussion: The findings from this synthesis will help to guide best practice and policy for the implementation of parent child interaction therapy by considering the views of parents.
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Plante E, Mettler HM, Tucci A, Vance R. Maximizing Treatment Efficiency in Developmental Language Disorder: Positive Effects in Half the Time. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1233-1247. [PMID: 31343897 PMCID: PMC6802914 DOI: 10.1044/2019_ajslp-18-0285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/19/2019] [Accepted: 04/12/2019] [Indexed: 06/01/2023]
Abstract
Purpose When a behavioral treatment is generally efficacious, the central research questions shift to optimized dose delivery. In this study, we determine whether a validated treatment method can be made more effective or efficient by increasing the dose density employed. Method Twenty children were treated with Enhanced Conversational Recast methods to treat morphological errors. Half received 24 doses per session within a half hour (approximately 1 dose/1.25 min), and the other received the same number of doses within 15 min (approximately 1 dose/38 s). Generalization of morpheme use was probed throughout treatment and at a 6-week follow-up. Spontaneous use of treated morphemes was also tracked. Results Although the treatment was effective overall, there were no significant differences between treatment conditions on any of the outcome measures. Follow-up performance correlated significantly with performance at the end of the treatment period. Conclusion Minimal between-groups differences suggest that performance does not suffer when dose rates are compressed into half the time during treatment, making the high-density dose delivery method a more efficient delivery method. This could make time available within a treatment session to address other goals or allow for more classroom instructional time for the child. Supplemental Material https://doi.org/10.23641/asha.8968559.
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Affiliation(s)
- Elena Plante
- Department of Speech, Language, & Hearing Sciences, The University of Arizona, Tucson
| | - Heidi M. Mettler
- Department of Speech, Language, & Hearing Sciences, The University of Arizona, Tucson
| | - Alexander Tucci
- Department of Speech, Language, & Hearing Sciences, The University of Arizona, Tucson
| | - Rebecca Vance
- Department of Speech, Language, & Hearing Sciences, The University of Arizona, Tucson
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Abstract
Pediatric clinicians are on the front line for prevention of language and speech disorders. This review uses prevailing theories and recent data to justify strategies for prevention, screening and detection, diagnosis, and treatment of language and speech disorders. Primary prevention rests on theories that language learning is an interaction between the child's learning capacities and the language environment. Language learning occurs in a social context with active child engagement. Theories support parent education and public programs that increase children's exposure to child-directed speech. Early detection of delays requires knowledge of language milestones and recognition of high-risk indicators for disorders. Male sex, bilingual environments, birth order, and chronic otitis media are not adequate explanations for significant delays in language or speech. Current guidelines recommend both general and autism-specific screening. Environmental and genetic factors contribute to primary language and speech disorders. Secondary and tertiary prevention requires early identification of children with language and speech disorders. Disorders may be found in association with chromosomal, genetic, neurologic, and other health conditions. Systematic reviews find that speech-language therapy, alone or in conjunction with other developmental services, is effective for many disorders. Speech-language interventions alter the environment and stimulate children's targeted responding to improve their skills.
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Affiliation(s)
- Heidi M Feldman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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Enderby PM, Law J. Speech, Language, and Communication in a Public Health Context: A UK Perspective with Potential Global Application - An Opinion Piece. Folia Phoniatr Logop 2019; 71:168-175. [PMID: 31048575 DOI: 10.1159/000495785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
Speech and language therapists often contribute to public awareness campaigns as well as supporting, teaching and promoting the facilitation of speech, language, communication, and safe swallowing with the general public and health and social care professionals. These are sometimes considered as public health interventions. It is important to consider the objectives, costs, and impact of this involvement in the same way as reviewing the evidence associated with the more personally targeted interventions with individuals or groups of clients with specific conditions. This opinion piece discusses speech and language therapy in the context of public health, clarifies the terminology, and proposes different approaches to demonstrate its influence associated with its objectives. The content has been informed by a Working Party of the Royal College of Speech and Language Therapists (2017-2018).
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Affiliation(s)
- Pamela M Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom,
| | - James Law
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Lourenço I, Rocha J, Peixoto V, Lousada M. Effects of the Narrative Intervention Program for Preschool Portuguese Children. Folia Phoniatr Logop 2019; 72:211-217. [PMID: 30999303 DOI: 10.1159/000496793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This article analyzes the contribution of a narrative intervention program in linguistic performance (measured by the percentage of correct consonants [PCC], mean length of utterance [MLU], and auditory memory [AM]) of children. PATIENTS AND METHODS A group of 14 children with primary language impairments participated in this study. The children were divided into two groups (seven children in each): the narrative intervention group (experimental group) and the control group. All children were treated by the same speech-language therapist. The narrative intervention program consisted of eight weekly group sessions. Outcome measures of PCC, MLU, and AM (of pseudowords, words, sentences, and orders) were taken before and after intervention. A qualitative assessment of the intervention effects from the perspective of the children's parents was also included. RESULTS The results suggest improvements in PCC and MLU but no support for intervention effectiveness on these measures. In AM, the results indicate a significant intervention effect on words and orders. Parents reported intervention to be favorable/very favorable. CONCLUSION The narrative intervention program was effective in enhancing children's AM. However, further investigation is required to provide clinical evidence for speech and language therapists to employ this program for children with primary language impairments.
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Affiliation(s)
- Isabel Lourenço
- University Fernando Pessoa Hospital (HE-UFP), University Fernando Pessoa (UFP), Porto, Portugal
| | - Joana Rocha
- School of Health Sciences, University Fernando Pessoa (UFP), Porto, Portugal
| | - Vânia Peixoto
- School of Health Sciences, University Fernando Pessoa (UFP), Porto, Portugal
| | - Marisa Lousada
- CINTESIS.UA - Center for Health Technology and Services Research (UID/IC/04255/2013) and School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal,
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Tomas E, Vissers C. Behind the Scenes of Developmental Language Disorder: Time to Call Neuropsychology Back on Stage. Front Hum Neurosci 2019; 12:517. [PMID: 30687040 PMCID: PMC6333853 DOI: 10.3389/fnhum.2018.00517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/07/2018] [Indexed: 01/24/2023] Open
Abstract
Although the Developmental Language Disorder (DLD), also known as Specific Language Impairment in children has been the focus of unceasing scientific attention for decades, the nature and mechanisms of this disorder remain unclear. Most importantly, we still cannot reliably identify children requiring urgent intervention among other ‘late talkers’ at an early age and understand the high prevalence of comorbidity with psychiatric phenomena such as Autism Spectrum Disorder. One of the main reasons for this is the traditional ‘diagnosis-by-exclusion,’ resulting in heterogeneity of the DLD population. This paper proposes an alternative approach to the diagnosis, treatment and research of DLD, claiming that it is these children’s multiple deficits in neuropsychological development, which impede the spontaneous acquisition of their first language. Specifically, this review of the state-of-the-art in DLD research demonstrates deep and systematic interconnections between the speech and other higher cognitive functions developing in early childhood, including perception, attention and executive functions. In the proposed framework, speech is, therefore, considered as one of neuropsychological abilities, and the delay in its development is explained by other neuropsychological deficits, resulting in highly individual clinical profiles. By considering DLD as a complex neuropsychological syndrome, whose successful treatment depends on a holistic approach to diagnosis and intervention, we may significantly increase the efficacy of speech therapy, and also better understand the flexibility of the developing brain, its compensatory mechanisms and hence the comorbidity of DLD with psychiatric symptoms. Implications for using this paradigm in future scientific research are discussed.
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Affiliation(s)
- Ekaterina Tomas
- National Research University Higher School of Economics, Moscow, Russia
| | - Constance Vissers
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Royal Dutch Kentalis, Sint-Michielsgestel, Netherlands
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O'Toole C, Lee AS, Gibbon FE, van Bysterveldt AK, Hart NJ. Parent-mediated interventions for promoting communication and language development in young children with Down syndrome. Cochrane Database Syst Rev 2018; 10:CD012089. [PMID: 30321454 PMCID: PMC6516877 DOI: 10.1002/14651858.cd012089.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Communication and language development are areas of particular weakness for young children with Down syndrome. Caregivers' interaction with children influences language development, so many early interventions involve training parents how best to respond to their children and provide appropriate language stimulation. Thus, these interventions are mediated through parents, who in turn are trained and coached in the implementation of interventions by clinicians. As the interventions involve a considerable commitment from clinicians and families, we undertook this review to synthesise the evidence of their effectiveness. OBJECTIVES To assess the effects of parent-mediated interventions for improving communication and language development in young children with Down syndrome. Other outcomes are parental behaviour and responsivity, parental stress and satisfaction, and children's non-verbal means of communicating, socialisation and behaviour. SEARCH METHODS In January 2018 we searched CENTRAL, MEDLINE, Embase and 14 other databases. We also searched three trials registers, checked the reference lists of relevant reports identified by the electronic searches, searched the websites of professional organizations, and contacted their staff and other researchers working in the field to identify other relevant published, unpublished and ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that compared parent-mediated interventions designed to improve communication and language versus teaching/treatment as usual (TAU) or no treatment or delayed (wait-listed) treatment, in children with Down syndrome aged between birth and six years. We included studies delivering the parent-mediated intervention in conjunction with a clinician-mediated intervention, as long as the intervention group was the only group to receive the former and both groups received the latter. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures for data collection and analysis. MAIN RESULTS We included three studies involving 45 children aged between 29 months and six years with Down syndrome. Two studies compared parent-mediated interventions versus TAU; the third compared a parent-mediated plus clinician-mediated intervention versus a clinician-mediated intervention alone. Treatment duration varied from 12 weeks to six months. One study provided nine group sessions and four individualised home-based sessions over a 13-week period. Another study provided weekly, individual clinic-based or home-based sessions lasting 1.5 to 2 hours, over a six-month period. The third study provided one 2- to 3-hour group session followed by bi-weekly, individual clinic-based sessions plus once-weekly home-based sessions for 12 weeks. Because of the different study designs and outcome measures used, we were unable to conduct a meta-analysis.We judged all three studies to be at high risk of bias in relation to blinding of participants (not possible due to the nature of the intervention) and blinding of outcome assessors, and at an unclear risk of bias for allocation concealment. We judged one study to be at unclear risk of selection bias, as authors did not report the methods used to generate the random sequence; at high risk of reporting bias, as they did not report on one assessed outcome; and at high risk of detection bias, as the control group had a cointervention and only parents in the intervention group were made aware of the target words for their children. The sample sizes of each included study were very small, meaning that they are unlikely to be representative of the target population.The findings from the three included studies were inconsistent. Two studies found no differences in expressive or receptive language abilities between the groups, whether measured by direct assessment or parent reports. However, they did find that children in the intervention group could use more targeted vocabulary items or utterances with language targets in certain contexts postintervention, compared to those in the control group; this was not maintained 12 months later. The third study found gains for the intervention group on total-language measures immediately postintervention.One study did not find any differences in parental stress scores between the groups at any time point up to 12 months postintervention. All three studies noted differences in most measures of how the parents talked to and interacted with their children postintervention, and in one study most strategies were maintained in the intervention group at 12 months postintervention. No study reported evidence of language attrition following the intervention in either group, while one study found positive outcomes on children's socialisation skills in the intervention group. One study looked at adherence to the treatment through attendance data, finding that mothers in the intervention group attended seven out of nine group sessions and were present for four home visits. No study measured parental use of the strategies outside of the intervention sessions.A grant from the Hospital for Sick Children Foundation (Toronto, Ontario, Canada) funded one study. Another received partial funding from the National Institute of Child Health and Human Development and the Department of Education in the USA. The remaining study did not specify any funding sources.In light of the serious limitations in methodology, and the small number of studies included, we considered the overall quality of the evidence, as assessed by GRADE, to be very low. This means that we have very little confidence in the results, and further research is very likely to have an important impact on our confidence in the estimate of treatment effect. AUTHORS' CONCLUSIONS There is currently insufficient evidence to determine the effects of parent-mediated interventions for improving the language and communication of children with Down syndrome. We found only three small studies of very low quality. This review highlights the need for well-designed studies, including RCTs, to evaluate the effectiveness of parent-mediated interventions. Trials should use valid, reliable and similar measures of language development, and they should include measures of secondary outcomes more distal to the intervention, such as family well-being. Treatment fidelity, in particular parental dosage of the intervention outside of prescribed sessions, also needs to be documented.
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Affiliation(s)
- Ciara O'Toole
- University College CorkDepartment of Speech and Hearing SciencesBrookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Alice S‐Y Lee
- University College CorkDepartment of Speech and Hearing SciencesBrookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Fiona E Gibbon
- University College CorkDepartment of Speech and Hearing SciencesBrookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Anne K van Bysterveldt
- University of CanterburySchool of Health SciencesKirkwood AvenueIlamChristchurchNew Zealand8041
| | - Nicola J Hart
- Down Syndrome IrelandNational Resource Team6, Carrig GlenCalverstownKildareIreland
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Hirai AH, Kogan MD, Kandasamy V, Reuland C, Bethell C. Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood. JAMA Pediatr 2018; 172:857-866. [PMID: 29987317 PMCID: PMC6143066 DOI: 10.1001/jamapediatrics.2018.1524] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Since 2001, the American Academy of Pediatrics has recommended universal developmental screening and surveillance to promote early diagnosis and intervention and to improve the outcomes of children with developmental delays and disabilities. OBJECTIVE To examine the current prevalence and variation of developmental screening and surveillance of children by various sociodemographic, enabling, and health characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of the Health Resources and Services Administration's 2016 National Survey of Children's Health-a nationally representative survey of US children completed between June 2016 and February 2017-examined 5668 randomly selected children 9 through 35 months of age whose parent or caregiver responded to the address-based survey by mail or via a website. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population counts of all noninstitutionalized US children residing in housing units. MAIN OUTCOMES AND MEASURES Developmental screening was measured through a validated set of 3 items indicating receipt in the past year of parent-completed screening from a health care professional with age-appropriate content regarding language development and social behavior. Surveillance was determined by an item capturing verbal elicitation of developmental concerns by a health care professional. RESULTS Of the estimated 9.0 million children aged 9 through 35 months, an estimated 30.4% (95% CI, 28.0%-33.0%) were reported by their parent or guardian to have received a parent-completed developmental screening and 37.1% (95% CI, 34.4%-39.8%) were reported to have received developmental surveillance from a health care professional in the past year. Characteristics associated with screening and/or surveillance that remained significant after adjustment included primary household language, family structure, household education, income, medical home, past-year preventive visit, child health status, and special health care needs. Having health care that meets medical home criteria was significantly associated with both developmental screening (adjusted rate ratio, 1.34; 95% CI, 1.13-1.57) and surveillance (adjusted rate ratio, 1.24; 95% CI, 1.08-1.42), representing an 8 to 9 absolute percentage point increase. State-level differences spanned 40 percentage points for screening (17.2% in Mississippi and 58.8% in Oregon) and surveillance (19.1% in Mississippi and 60.8% in Oregon), with approximately 90% of variation not explained by child and family characteristics. CONCLUSIONS AND RELEVANCE Despite more than a decade of initiatives, rates of developmental screening and surveillance remain low. However, state-level variation indicates continued potential for improvement. Systems-level quality improvement efforts, building on the medical home, will be necessary to achieve recommended screening and surveillance goals.
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Affiliation(s)
- Ashley H. Hirai
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Michael D. Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Veni Kandasamy
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Colleen Reuland
- Department of Pediatrics, Oregon Health and Sciences University, Portland
| | - Christina Bethell
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Gray S, Kvalsvig A, O'Connor M, O'Connor E, Incledon E, Tarasuik J, Goldfeld S. Can a teacher-reported indicator be used for population monitoring of oral language skills at school entry? INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:447-457. [PMID: 28290724 DOI: 10.1080/17549507.2017.1294200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 12/15/2016] [Accepted: 02/04/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE Monitoring oral language skills at the population level would provide valuable data to inform policy decisions to better support children's oral language skills in schools. The Australian Early Development Census (AEDC) is a teacher-rated population measure of early child development that includes a rating of children's oral communication in the classroom (OCC). METHOD This study evaluates the validity of the OCC indicator for population monitoring of children's oral language skills, capitalising on data from two datasets: the 2012 AEDC cohort (n = 289 973) and a subsample of children from the Longitudinal Study of Australian Children for whom AEDC data were also collected (n = 720). RESULT Construct validity was demonstrated by showing significant differences in OCC ratings between subpopulations of children who would be expected to differ in terms of oral language skills at school entry (e.g. children with a diagnosed speech-language impairment compared to those with no impairment). OCC ratings were associated with externally validated measures of language, suggesting convergent validity. No relationship was found between OCC ratings and physical health scores, indicating divergent validity. CONCLUSION The findings support the use and interpretation of the OCC indicator as a tool for population-level monitoring of oral language in Australian school entrants.
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Affiliation(s)
- Sarah Gray
- a Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital , Parkville , Australia and
| | - Amanda Kvalsvig
- a Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital , Parkville , Australia and
| | - Meredith O'Connor
- a Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital , Parkville , Australia and
- b Department of Paediatrics , University of Melbourne, Royal Children's Hospital , Parkville , Australia
| | - Elodie O'Connor
- a Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital , Parkville , Australia and
| | - Emily Incledon
- a Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital , Parkville , Australia and
| | - Joanne Tarasuik
- a Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital , Parkville , Australia and
| | - Sharon Goldfeld
- a Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital , Parkville , Australia and
- b Department of Paediatrics , University of Melbourne, Royal Children's Hospital , Parkville , Australia
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Pennington L, Akor WA, Laws K, Goldbart J. Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders. Cochrane Database Syst Rev 2018; 7:CD012507. [PMID: 30040119 PMCID: PMC6513435 DOI: 10.1002/14651858.cd012507.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facial expression (or a combination of these), making their communication difficult to understand. Parents may be offered training to help recognise and interpret their child's signals and to stimulate their children's development of new communication skills. OBJECTIVES To assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual or clinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have non-progressive motor disorders. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. We also searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies. SELECTION CRITERIA We included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication intervention with no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders up to five years of age. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS This review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and their mothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected their gestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or three home visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took place at an intervention centre in Canada and the other in South Korea.Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending or therapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated one study at high risk of attrition bias, and both studies at low risk of reporting bias.There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children's initiation of conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became more responsive to their children's communication, but there were no differences in the extent to which they controlled conversation by directing their children. Missing data meant that we were unable to evaluate the effects of training on children's frequency of communication, frequency of spoken language in conversation, speech production, or receptive or expressive language development. There were no effects on maternal stress. We found no reports of the effects of parent training on children's use of individual communication skills, such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports of mothers' satisfaction with treatment, its acceptability or their compliance with it. AUTHORS' CONCLUSIONS There is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples and high risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lack of detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication. Some speech and language therapists currently provide communication training for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures, coupled with detailed reporting of children's baseline skills, is needed to test whether communication training for parents can help them to promote the communication development of their young children with movement disorders.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Wanwuri A Akor
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Kate Laws
- Northumberland, Tyne and Wear NHS Foundation Trust, Walkergate Park Centre for Neuro‐Rehabilitation and Neuro‐PsychiatryRegional Communication Aid ServiceBenfield RoadNewcastle upon TyneUKNE6 4 QD
| | - Juliet Goldbart
- Manchester Metropolitan UniversityFaculty of Health, Psychology & Social CareBrooks Building, Birley Fields Campus53 Bonsall StreetManchesterUKM15 6GX
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Wren Y, Humphries K, Stock NM, Rumsey N, Lewis S, Davies A, Bennett R, Sandy J. Setting up a cohort study in speech and language therapy: lessons from The UK Cleft Collective Speech and Language (CC-SL) study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:421-430. [PMID: 29265580 DOI: 10.1111/1460-6984.12364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/01/2017] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Efforts to increase the evidence base in speech and language therapy are often limited by methodological factors that have restricted the strength of the evidence to the lower levels of the evidence hierarchy. Where higher graded studies, such as randomized controlled trials, have been carried out, it has sometimes been difficult to obtain sufficient power to detect a potential effect of intervention owing to small sample sizes or heterogeneity in the participants. With certain clinical groups such as cleft lip and palate, systematic reviews of intervention studies have shown that there is no robust evidence to support the efficacy of any one intervention protocol over another. AIMS To describe the setting up of an observational clinical cohort study and to present this as an alternative design for answering research questions relating to prevalence, risk factors and outcomes from intervention. METHODS The Cleft Collective Speech and Language (CC-SL) study is a national cohort study of children born with cleft palate. Working in partnership with regional clinical cleft centres, a sample size of over 600 children and 600 parents is being recruited and followed up from birth to age 5 years. Variables being collected include demographic, psychological, surgical, hearing, and speech and language data. MAIN CONTRIBUTION The process of setting up the study has led to the creation of a unique, large-scale data set which is available for researchers to access now and in future. As well as exploring predictive factors, the data can be used to explore the impact of interventions in relation to individual differences. Findings from these investigations can be used to provide information on sample criteria and definitions of intervention and dosage which can be used in future trials. CONCLUSIONS The observational cohort study is a useful alternative design to explore questions around prevalence, risk factors and intervention for clinical groups where robust research data are not yet available. Findings from such a study can be used to guide service-delivery decisions and to determine power for future clinical trials.
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Affiliation(s)
- Yvonne Wren
- Faculty of Health Sciences, University of Bristol /Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust
| | | | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England
| | - Sarah Lewis
- Faculty of Health Sciences, University of Bristol
| | - Amy Davies
- Faculty of Health Sciences, University of Bristol
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Wren Y, Harding S, Goldbart J, Roulstone S. A systematic review and classification of interventions for speech-sound disorder in preschool children. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:446-467. [PMID: 29341346 DOI: 10.1111/1460-6984.12371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Multiple interventions have been developed to address speech sound disorder (SSD) in children. Many of these have been evaluated but the evidence for these has not been considered within a model which categorizes types of intervention. The opportunity to carry out a systematic review of interventions for SSD arose as part of a larger scale study of interventions for primary speech and language impairment in preschool children. AIMS To review systematically the evidence for interventions for SSD in preschool children and to categorize them within a classification of interventions for SSD. METHODS & PROCEDURES Relevant search terms were used to identify intervention studies published up to 2012, with the following inclusion criteria: participants were aged between 2 years and 5 years, 11 months; they exhibited speech, language and communication needs; and a primary outcome measure of speech was used. Studies that met inclusion criteria were quality appraised using the single case experimental design (SCED) or PEDro-P, depending on their methodology. Those judged to be high quality were classified according to the primary focus of intervention. OUTCOMES & RESULTS The final review included 26 studies. Case series was the most common research design. Categorization to the classification system for interventions showed that cognitive-linguistic and production approaches to intervention were the most frequently reported. The highest graded evidence was for three studies within the auditory-perceptual and integrated categories. CONCLUSIONS & IMPLICATIONS The evidence for intervention for preschool children with SSD is focused on seven out of 11 subcategories of interventions. Although all the studies included in the review were good quality as defined by quality appraisal checklists, they mostly represented lower-graded evidence. Higher-graded studies are needed to understand clearly the strength of evidence for different interventions.
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Affiliation(s)
- Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
- Faculty of Health Sciences, University of Bristol, UK
| | - Sam Harding
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
| | - Juliet Goldbart
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| | - Sue Roulstone
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Davis SF, Enderby P, Harrop D, Hindle L. Mapping the contribution of Allied Health Professions to the wider public health workforce: a rapid review of evidence-based interventions. J Public Health (Oxf) 2018; 39:177-183. [PMID: 26989160 DOI: 10.1093/pubmed/fdw023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives The objective was to identify a selection of the best examples of the public health contributions by Allied Health Professionals (AHPs) in order to encourage a wider awareness and participation from that workforce to public health practice. Study design A mapping exercise was used to identify evidence-based interventions that could lead to health improvements across a population. Methods A rapid review was undertaken to identify evidence, followed by a survey of Allied Health Profession (AHP) practitioners and an expert panel consensus method to select the examples of AHP public health interventions. Results Nine evidence-based interventions are identified and selected as examples of current AHP good practice. These examples represent a contribution to public health and include screening interventions, secondary prevention and risk management. Conclusions This study contributes to a strategy for AHPs in public health by appraising the effectiveness and impact of some exemplar AHP practices that contribute to health improvement. There is a need for AHPs to measure the impact of their interventions and to demonstrate evidence of outcomes at population level.
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Affiliation(s)
- S Fowler Davis
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - P Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - D Harrop
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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Morgan AT, Haaften LV, van Hulst K, Edley C, Mei C, Tan TY, Amor D, Fisher SE, Koolen DA. Early speech development in Koolen de Vries syndrome limited by oral praxis and hypotonia. Eur J Hum Genet 2017; 26:75-84. [PMID: 29225339 DOI: 10.1038/s41431-017-0035-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
Communication disorder is common in Koolen de Vries syndrome (KdVS), yet its specific symptomatology has not been examined, limiting prognostic counselling and application of targeted therapies. Here we examine the communication phenotype associated with KdVS. Twenty-nine participants (12 males, 4 with KANSL1 variants, 25 with 17q21.31 microdeletion), aged 1.0-27.0 years were assessed for oral-motor, speech, language, literacy, and social functioning. Early history included hypotonia and feeding difficulties. Speech and language development was delayed and atypical from onset of first words (2; 5-3; 5 years of age on average). Speech was characterised by apraxia (100%) and dysarthria (93%), with stuttering in some (17%). Speech therapy and multi-modal communication (e.g., sign-language) was critical in preschool. Receptive and expressive language abilities were typically commensurate (79%), both being severely affected relative to peers. Children were sociable with a desire to communicate, although some (36%) had pragmatic impairments in domains, where higher-level language was required. A common phenotype was identified, including an overriding 'double hit' of oral hypotonia and apraxia in infancy and preschool, associated with severely delayed speech development. Remarkably however, speech prognosis was positive; apraxia resolved, and although dysarthria persisted, children were intelligible by mid-to-late childhood. In contrast, language and literacy deficits persisted, and pragmatic deficits were apparent. Children with KdVS require early, intensive, speech motor and language therapy, with targeted literacy and social language interventions as developmentally appropriate. Greater understanding of the linguistic phenotype may help unravel the relevance of KANSL1 to child speech and language development.
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Affiliation(s)
- Angela T Morgan
- Murdoch Childrens Research Institute, Melbourne, Australia. .,Department of Speech Pathology and Audiology, University of Melbourne, Melbourne, Australia. .,Royal Children's Hospital, Melbourne, Australia.
| | - Leenke van Haaften
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Karen van Hulst
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carol Edley
- Cook Children's Medical Centre, Fort Worth, TX, USA
| | - Cristina Mei
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Tiong Yang Tan
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David Amor
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Simon E Fisher
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - David A Koolen
- Department of Human Genetics, Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Kim J, Kim SW, Jeon HR, Woo MR, Kim HI. Speech and Linguistic Features of Children With Articulation Disorder. Ann Rehabil Med 2017; 41:836-842. [PMID: 29201823 PMCID: PMC5698671 DOI: 10.5535/arm.2017.41.5.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/23/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To analyze speech and linguistic features in children with articulation disorder characterized by consonant and vowel phonological errors. Methods Between February 2007 and June 2015, 117 children who showed articulation disorder were selected for the study. Based on comprehensive speech and language assessments, the subjects were classified into articulation dysfunction (AD), or AD overlapping with language delay. Detailed information of articulation, including percentage of consonants correct (PCC) and normal percentage of variable consonants derived from the Assessment of Phonology and Articulation for Children test, were compared between the two groups. Results Totally, 55 children were diagnosed as AD and 62 as AD with language delay. Mean PCC was not significantly different between the two groups. In both groups, the acquisition order of consonants followed the universal developmental sequence. However, differences were observed in the nasal & plosive consonants abnormality between the two groups. When adjusted to their delayed language level in AD with language delay group, 53% of children had appropriate articulation function for their expressive language level. Conclusion Speech and linguistic characteristics in children with articulation disorder were variable. Therefore, comprehensive assessment is required in children with inaccurate pronunciation, and a proper treatment plan based on the results of assessment should be followed.
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Affiliation(s)
- Jiyong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Ilsanpaik Hospital, Goyang, Korea
| | - Seong Woo Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ha Ra Jeon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Mee Ryung Woo
- Rehabilitation Treatment Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyo In Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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