Listening to the voice of children with developmental speech and language disorders using narrative inquiry: Methodological considerations

"It's not that bad but it's not so fun either"- A qualitative study on school-aged children's perceptions of speech and language therapy for developmental language disorders

INTRODUCTION

Different studies have explored the experiences and perspectives of parents on developmental language disorders (DLD). Recently, different authors also called for more research hearing the children's voices. Unfortunately, this topic is under-researched. Therefore, this study investigated how school-aged Flemish children with DLD experience speech and language therapy for DLD.

METHODS

Seven Flemish children with DLD, aged between 6 and 12 years, were included in this study. Child-friendly semi-structured interviews were conducted to investigate their perceptions of speech and language therapy. Data derived from these interviews were analysed using an descriptive thematic content analysis. Trustworthiness of the data was achieved by applying researcher triangulation and use of narrative autobiographies.

RESULTS

During the analyses, six major teams were identified: (1) mixed emotions towards therapy, (2) challenges and difficulties in therapy, (3) impact of therapy context and timing, (4) social reactions and peer awareness, (5) engagement through play, and (6) learning and therapy goals. Each theme was divided into different subthemes. The theme 'mixed emotions towards therapy' was divided into the subthemes positive feelings, mixed feelings, and shame and embarrassment. Confronting difficulties and task focus were the subthemes of the major theme 'challenges and difficulties in therapy'. The theme 'impact of therapy context and timing' consisted of two subthemes, namely after-school therapy and in-school therapy. Reactions from peers was the subtheme of 'social reactions and peer awareness'. Engagement through play was divided into enjoyment of games and rewards. And the theme 'learning and therapy goals' was divided into the subthemes value of learning and collaboration with teachers.

CONCLUSION

While most children had positive attitudes on speech hand language therapy, some reported embarrassment or discomfort. The timing of therapy sessions, whether during or outside school hours, influenced engagement, as did the use of games and rewards. Children generally valued a playful approach, though variety in activities was important. Understanding the goals and benefits of speech and language therapy also increased intrinsic motivation for some children. SLTs should consider these factors and minimize biases to improve therapy outcomes. Future research should explore ways to better align therapy with children's preferences and developmental needs.

Interpretive description as a qualitative research framework in speech-language pathology: A scoping review

PURPOSE

Interpretive description is a constructivist, flexible, qualitative research approach used to generate knowledge to inform practice in applied disciplines. Despite potential value for the speech-language pathology profession, there has been limited discussion of interpretive description in our field to date. The purpose of this scoping review was to describe how interpretive description has been used in speech-language pathology research. We asked: a) How and to what extent has interpretive description been used as a methodological framework for primary research in the field of SLP and b) what features of interpretive description are most salient in the speech-language pathology studies that have used interpretive description to date?

METHOD

Arksey and O'Malley's (2005) methodological framework for scoping reviews was used. In May 2023, we searched five databases for peer-reviewed, primary research publications that reported using ID, were specific to speech-language pathology, and were written in English. Two researchers independently reviewed articles for inclusion. A third researcher provided input when consensus could not be reached.

RESULT

Nineteen articles met criteria. Data were extracted regarding article characteristics including use of theory, types of findings, clinical applicability, and description of disciplinary epistemology.

CONCLUSION

Interpretive description is an emerging methodological framework in speech-language pathology research. Advantages and challenges of interpretive description for speech-language pathology are discussed.

Lived experiences of children who stutter in their own voices

INTRODUCTION

Significant research has explored the lived experiences of adults who stutter, but less research exists regarding the lived experiences of children who stutter. The opinions and ideas of children who stutter may differ from those of adults, making it important for clinicians and researchers to obtain information directly from children who stutter. Asking children directly can lead to treatment outcomes and research questions that better align with the children's needs and values.

METHOD

Interviews with 18 children who stutter (9 girls/9 boys) ages 8-17 were sourced from the Voices of Children Who Stutter database located at Talkbank.org. Interview questions asked the children about living with a stutter, participating in stuttering support organizations (SSOs), and their perspectives on treatment. Qualitative, phenomenological analysis was performed on their answers following standardized qualitative procedures.

RESULTS

Analysis of 910 total utterances yielded 7 themes and 9 subthemes. Themes indicated that the children: (a) had significant knowledge regarding their own stuttering, (b) had opinions regarding what constituted worthwhile treatment outcomes, (c) were clear about desirable clinician characteristics for working with kids who stutter, and (d) saw the benefits of being part of a community.

CONCLUSIONS

Themes revealed that overall, children who stutter exhibit deep understanding regarding their experiences with stuttering, which clinicians can harness in person-centered goal setting. Additionally, the participants express the importance of participating in stuttering support organizations.

A Generic Implementation Framework for School-Based Research and Practice

PURPOSE

One of our biggest challenges is integrating evidence-based research into practice to serve students with communication disorders. To encourage the systematic application of research findings into practice, implementation science offers frameworks and tools, many of which have a narrow scope. It is important to have comprehensive frameworks that encompass all essential implementation concepts to support implementation in schools.

METHOD

Guided by the generic implementation framework (GIF; Moullin et al., 2015), we reviewed implementation science literature to identify and tailor frameworks and tools covering all core concepts of implementation: (a) the process of implementation, (b) the domains and determinants of practice, (c) implementation strategies, and (d) evaluations.

RESULTS

We created a version of the GIF for school settings, called the GIF-School, to bring together frameworks and tools that sufficiently cover core concepts of implementation. The GIF-School is accompanied by an open access toolkit, which lists selected frameworks, tools, and useful resources.

CONCLUSION

Researchers and practitioners, in speech-language pathology and education more broadly, who seek to apply implementation science frameworks and tools to improve school services for students with communication disorders may turn to the GIF-School as a resource.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23605269.

Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools

PURPOSE

Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district.

METHOD

Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district.

RESULTS

Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public.

CONCLUSION

Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23661876.

New perspectives, theory, method, and practice: Qualitative research and innovation in speech-language pathology

Purpose: Research in speech-language pathology has been dominated by experimental, empirical, and scientific approaches, which build on hypothesis testing and logical, deductive reasoning. Qualitative approaches stem from a different paradigm or world view which imply different questions and methodologies which, for example, emphasise codesign, reciprocity, individual experience and context. This article explores the relationship between qualitative inquiry in the field of speech-language pathology and innovation. It aims to show how the aspirations of the profession can be supported, and how innovation can be achieved, through research which sheds light on the lived experiences and perceptions of clients and families and builds an understanding of how they function in their everyday contexts.Method: We summarise qualitative approaches in speech-language pathology, explain the notion of innovation, and review qualitative research as a source of theoretical, methodological, and practice innovation in speech-language pathology.Result: Not only has qualitative inquiry underpinned examples of theoretical, methodological and practice innovations in speech-language pathology, but it can also play a part in enhancing translation and implementation of research innovations.Conclusion: An explicit consideration of what we mean by innovation is useful for speech-language pathologists. Qualitative research complements other forms of research in the field and has prompted new theoretical understandings, new methodologies and methods of research, and new ways to deliver our services in ways that are responsive to our clients and communities.

Understanding the perspectives of children and young people with speech, language and communication needs: How qualitative research can inform practice

Much of the published research is "on" rather than "with" children and young people with speech, language and communication needs (SLCN). According to the UN Convention on the Rights of the Child (1989), children's views must be considered and taken into account in all matters affecting them. In this paper, we discuss ways in which innovative qualitative methods have been used to explore the views of children and young people with SLCN. We also discuss how we can apply concepts from qualitative research, in particular critical reflexivity, to shape our thinking, inform our practice, and lead to innovation in our work with children and young people with SLCN.

"Tell Me About Your Child": A Grounded Theory Study of Mothers' Understanding of Language Disorder

Purpose The purpose of this study was to generate a theory grounded in data explaining caregivers' understanding of their child's language disorder and the perceived role of speech-language pathologists in facilitating this knowledge. Method This study employed grounded theory as a conceptual framework. Qualitative data were generated based on semistructured interviews conducted with 12 mothers of children who had received speech-language pathology services. Results The following themes emerged from the data analysis: (a) Many mothers reported receiving confusing or irrelevant diagnostic terms for language disorder, (b) mothers of children with language disorders were distressed about their children's language problems, (c) mothers did not always trust or understand their children's speech-language pathologist, and (d) mothers were satisfied with the interventions their child had been receiving. Mothers described their children's language disorder using a total of 23 labels, most of which were not useful for accessing meaningful information about the nature of their child's communication problem. Generally, mothers reported they did not receive language-related diagnostic labels from speech-language pathologists for their child's language disorder. Conclusions Two theories were generated from the results: (a) Lack of information provided to mothers about their child's language disorder causes mothers psychological harm that appears to be long lasting. (b) Difficulties in successfully relaying information about language disorders to parents result in negative perceptions of speech-language pathology. Implications and future directions are discussed. Supplemental Material https://doi.org/10.23641/asha.12177390.

Eligibility and Speech Sound Disorders: Assessment of Social Impact

Purpose

The purpose of this article is to discuss the social impact of speech sound disorders for children, specifically in the public school system, and to examine different methods of social impact assessment for speech-language therapy services using 3 hypothetical cases.

Method

This article presents 3 common cases seen by school-based speech-language pathologists and discusses the types of assessments that may be conducted for each child's needs. One child has errors on many sounds, 1 child has errors on only /r/, and 1 child produces strident sounds with a lateral lisp.

Results

As these are hypothetical cases, possibilities are discussed for each case. Similarities and differences exist among the 3 cases in terms of assessing the social impact of their speech sound disorder; however, each child could qualify for services based on social impact assessments.

Conclusion

Social impact assessments are an important portion of a speech sound evaluation; however, they are often overlooked. Emphasis is placed on articulation assessments and/or commonly accepted developmental norms. The determination of social impact supplies a more complete picture for making eligibility decisions for children with speech sound disorders and may lead to more meaningful treatment methods for the student.