Meeting the educational and social needs of children with language impairment or autism spectrum disorder: the parents' perspectives

Implementation Science in School-Based, Universal-Level Intervention Research: A Scoping Review

PURPOSE

The aim of this study was to map the use of implementation science frameworks, models, and theories in intervention research targeting learning needs in the classroom.

METHOD

A scoping review was conducted. Electronic database and manual searches were conducted. Two reviewers independently completed screening, data extraction, and quality appraisal. Qualitative content analysis was undertaken using Nilsen's taxonomy and the domains of the Consolidated Framework for Implementation Research (CFIR). The data were further analyzed using the CFIR valence and strength rating scales.

RESULTS

Included papers (n = 22) used a diverse sample of implementation science frameworks and models. Most studies used determinant frameworks to guide data collection and analysis. Few studies used implementation science theory. Most studies were mixed methods (n = 11), published since 2019 (n = 20), and conducted in North America (n = 15). Over half of the interventions targeted social, emotional, and mental health (n = 13). A complex interplay of inner setting factors was identified as having a strong influence on implementation. Teachers' knowledge and beliefs, adaptability, and complexity of interventions were also identified as important considerations when conducting research in this context.

CONCLUSIONS

Early engagement with stakeholders in education is recommended when designing universal level speech, language, and communication interventions for use in the ordinary classroom. Adaptive, hybrid designs that test both implementation strategies and effectiveness of interventions may be warranted given the influence of inner setting factors on implementation outcomes.

Criteria and Terminology Applied to Language Impairments (CATALISE): A qualitative exploration of dissemination efforts to guide future implementation

BACKGROUND

Developmental language disorder (DLD) is a condition which affects an individual's ability to use and understand language. Terminological confusion, and the use of non-evidence-based diagnostic criteria has impacted access to services for this population for several decades. Changes in terminology and diagnosis were proposed as part of a UK-based consensus study, Criteria and Terminology Applied to Language Impairments (CATALISE), in 2016 and 2017. Since the publication of the recommendations, there have been active efforts across several English-speaking countries to support uptake of these recommendations into policy and practice.

AIMS

The aim of the study was to explore the experiences of individuals who have been leading the dissemination of the CATALISE recommendations since their publication in 2017. The study was undertaken to inform future implementation efforts aimed at facilitating the adoption of the recommendations into policy and practice.

METHODS & PROCEDURES

Researchers, practitioners and parents from nine countries were recruited to the study (n = 27). Online focus groups and semi-structured interviews were conducted using topic guides informed by the Consolidated Framework for Implementation Research. Inductive thematic analysis was undertaken. Preliminary findings were member-checked prior to completion of the analysis.

OUTCOMES & RESULTS

CATALISE recommendations were described as partially adopted by participants. Dissemination strategies included building a coalition, conducting educational meetings, and developing educational materials. Common barriers to implementation related to the complexity and compatibility of the recommendations, and practitioner confidence. Four themes were identified across the data set to guide future implementation efforts: (a) ride the wave, craft the narrative (b) reach across the divide, be brave (c) create space for multiple voices and, (d) support for speech and language therapistss on the front line.

CONCLUSIONS & IMPLICATIONS

Individuals with DLD and their families should be included in future implementation planning. Engaged leadership is essential to address issues of complexity, compatibility, sustainability and practitioner confidence if CATALISE recommendations are to be integrated into service workflow and processes. Implementation science can provide a useful lens to progress future research in this area.

WHAT THIS PAPER ADDS

What is already known on this subject Dissemination efforts have been undertaken to facilitate the uptake of recommendations from a UK-based consensus study (CATALISE) in relation to developmental language disorder since publication across several countries. What this study adds to existing knowledge The required changes in diagnostic practice are complex to implement. A lack of compatibility with healthcare processes and low practitioner self-efficacy were also identified as a challenge to implementation. What are the potential or actual clinical observations of this work? Parents and individuals with developmental language disorder need to be engaged as partners in future implementation planning. Organisational leaders need to facilitate the contextual integration of the changes within service systems. Speech and language therapists require ongoing case-based opportunities to enhance their confidence and clinical reasoning skills to implement CATALISE recommendations successfully in their everyday practice.

Exploring the acceptability, feasibility, and appropriateness of a communication-friendly classroom tool for use in Irish schools: A qualitative inquiry

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.

Parents' perceptions of the impact of COVID-19 and school transition on autistic children's friendships

LAY ABSTRACT

Research shows that moving schools can be a challenging time for autistic children and young people. One factor that has been found to support successful transition is friendships. However, there is little research exploring how transition between schools affects autistic children's friendships, and even less on how children's relationships during transition have been impacted by COVID-19. Fourteen parents of autistic children and young people were interviewed about their child's move to a new school and the impact they felt this had on their friendships. Parents described how moving with existing friends helped some children to find the transition less challenging. Others had differing experiences, with their children's friendships playing a much smaller role in the move. Differences were also seen with regard to the impact of COVID-19, with some parents speaking of how hard being away from friends was for their child, while others found the social restrictions a welcome break from interacting with peers. The study highlights how different the experiences of autistic individuals, and their parents, can be and the importance of a child-centred approach to transition support.

What is the nature of peer interactions in children with language disorders? A qualitative study of parent and practitioner views

BACKGROUND AND AIMS

Children with Language Disorders (LDs) can exhibit increased levels of social withdrawal, aggression and problems managing social conflicts. The reasons underlying this pattern of social interaction profiles remain unclear. This qualitative study aimed to document the nature of social interactions between children with LDs and their peers, and to evaluate explanations for their social behaviour, as understood by parents and practitioners.

METHODS

This study focused on children with LDs who spend school hours with other children with LDs. Three parent focus groups (n = 8) and three practitioner focus groups (n = 10) were conducted with parents of children aged 4-12 attending specialist language schools and practitioners working at these schools. This was a mixed clinical sample. All children of participating parents had LD as their primary area of need, which was the reason they required specialist schooling. Focus groups were conducted across two specialist schools in the UK between March and June 2018.

RESULTS

An inductive reflective thematic analysis of the data identified three themes; social knowledge, coping strategies, and emotional competence. Parents and school staff reported that children with LDs experience difficulties managing peer interactions due to a combination of challenges including difficulties with understanding and regulating emotions, and difficulties understanding social situations. Some of the children with LDs were described as having developed strategies to cope with their challenges, for example imposing structure on their social interactions to manage uncertainty, which has implications for their social interactions with peers.

CONCLUSIONS

Children with LDs have difficulties understanding emotions, difficulties understanding their peer's intentions and difficulties resolving conflict situations independently according to their parents and practitioners working with these children. Participants proposed a novel explanation that social withdrawal may be used adaptively by children with LDs to process information. This study demonstrates the complexity of the relationship between Language Disorders and peer interaction profiles.Implications: Suggestions are offered regarding future research directions, such as investigating the specific contribution language skills make to children's emotion understanding, to better understand the reasons for peer interaction difficulties in children with Language Disorders.

Predictors of Childhood Injury in Children Reported to Child Protective Services

BACKGROUND

Adverse childhood experiences, such as child maltreatment, have been shown to result in negative health outcomes throughout an individual's life. Previous research has found that children with a prior allegation of maltreatment die due to unintentional injuries at twice the rate of children who were not reported to Child Protective Services, however, death is only one outcome of injury and many unintentional injuries do not result in death.

METHODS

This secondary analysis of Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) data examined predictors of injury in children whose family has been reported to CPS utilizing the ecological-developmental framework theoretical domains which guided LONGSCAN: child characteristics, family/caregiver characteristics, parental and family functioning, extrafamilial relationship skills, community ecology, child outcomes, and systems of care factors.

RESULTS

Logistic regression modeling showed that the likelihood of childhood injury significantly increased for those children who did not recognize or appropriately respond to cues of ending a conversation (OR=.37), caregiver reported child always has a good place to play in their neighborhood (OR=1.57), and child utilized educational services (OR=2.06).

CONCLUSION

Understanding the predictors of injury is necessary to implement injury prevention interventions targeting the unique needs of this vulnerable population and increase awareness of prevention strategies to reduce childhood injuries.

School satisfaction in parents of children with severe developmental disabilities

BACKGROUND

Previous research suggests parents' level of satisfaction with their child's school experience is highly variable. The present author explored school satisfaction in a Canadian sample of parents of children with severe and often complex developmental disabilities.

METHOD

Parents of 185 children completed questionnaires regarding their satisfaction with nine aspects of their child's school experience. Satisfaction was examined in relation to child's age, diagnosis of Autism, adaptive level, and maladaptive behaviour; parents' mental health difficulties and perception of caring burden; and the child's classroom type and level of clinical services at school.

RESULTS

School satisfaction was unrelated to parents' mental health or burden scores, was related to child's adaptive and maladaptive behaviour, as well as type of classroom placement.

CONCLUSIONS

It is important to understand what aspects of the school experience are influential for different children and families so that their experience can be optimized as far as possible.

Views of professionals about the educational needs of children with neurodevelopmental disorders

BACKGROUND

Professionals play a key role in supporting children with special educational needs in schools. However, the views of those working with neurodevelopmental disorders are less known.

AIMS

This study examined the views of professionals (including teachers, teaching assistants, educational psychologists, speech and language therapists, physio and occupational therapists etc.) working with children with Williams Syndrome (WS), Down Syndrome (DS) or with Autism Spectrum Disorders (ASD) in terms of how informed professionals are about the disorder and their views about the type of support these children need to be receiving.

METHODS AND PROCEDURES

Professionals working with 77 children with ASD, 26 with DS and 38 with WS completed an online questionnaire.

OUTCOMES AND RESULTS

Professionals in all three groups highlighted relevant areas of difficulty for these children, but they did not recognise some of the less phenotypical difficulties that children with a specific disorder may experience. In addition, there was a disconnect between the difficulties identified by the professionals and the type of specialist support that may be necessary.

CONCLUSIONS AND IMPLICATIONS

Although professionals have a lot of knowledge about the specific neurodevelopmental disorders, further evidence-based training would allow more effective support for children with neurodevelopmental disorders in the classroom but also equip professionals better and raise their confidence in meeting these children's needs.

Evidence-based pathways to intervention for children with language disorders

BACKGROUND

Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs.

AIMS

To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence-based model of SLT service delivery and a flowchart to aid clinical decision-making.

METHODS & PROCEDURES

Meta-analyses and systematic reviews, together with controlled, peer-reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted.

MAIN CONTRIBUTION

The service-delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non-SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT-specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored.

CONCLUSIONS & IMPLICATIONS

SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost-effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches.

Parental views on special educational needs provision: Cross-syndrome comparisons in Williams Syndrome, Down Syndrome, and Autism Spectrum Disorders

BACKGROUND

The current study examined parents' views about their child's educational provision for children with Williams syndrome (WS), Down syndrome (DS), and Autism Spectrum Disorders (ASD).

AIMS

This cross-syndrome comparison explored the specific and general difficulties that parents of children with neurodevelopmental disorders experience about their child's educational provision.

METHODS AND PROCEDURES

Parents of children aged 4-18;11 years old, including 99 with WS, 88 with DS, and 82 with ASD completed a survey.

OUTCOMES AND RESULTS

Children with DS were more likely to access mainstream settings and 1-to-1 support compared to those with WS and ASD. Parental satisfaction was lowest for those with ASD but all parents mentioned concerns about professionals' knowledge of how to support children with special educational needs and disabilities (SEND). There were also group differences for access to specialist support but overall access to occupational therapy and mental health was low.

CONCLUSIONS AND IMPLICATIONS

In contrast to previous studies, educational provision and satisfaction with educational provision are syndrome-specific. These results also highlight the need for training and raising awareness about the specific needs of children with neurodevelopmental disorders. In addition, our findings suggest improved communication between parents and the school is required about the type of support children with SEND are receiving.

Psychiatric care of children with autism spectrum disorder - What do their siblings think about it? A qualitative study

The expectations and role of families in the care of children with autism spectrum disorder are increasingly important. Nonetheless, no study has thus far explored the perspectives of siblings about the care received by a brother or sister with this disorder. The objective of this study was to fill this gap in the literature. This multicentre qualitative study took place in France, where we conducted semi-structured interviews with adolescents who were older siblings of children receiving care in a day hospital for an autism spectrum disorder. Data collection by purposive sampling continued until we reached 'theoretical sufficiency', and data analysis was thematic. The study included 20 participants: 13 sisters and 7 brothers. Four themes emerged in the data analysis: (1) the treatment targets, (2) the treatment's perceived effectiveness, (3) the complex questions it raises and (4) the role of intrafamily relationships. Our results allowed us to report original aspects of the experience of siblings, in particular, their confusion with regard to the treatment, their difficulty in separating themselves from their parents' discourse and their assertion of their role as caregivers for their younger brothers and sisters.