Use of digital devices, family functioning, and language development in preschool children: a cross-sectional study. / Utilização de dispositivos digitais, funcionamento familiar e desenvolvimento da linguagem em crianças de idade pré-escolar: um estudo transversal.

PURPOSE: This study aimed to analyse the relationship between the use of digital devices, family function, and language development in preschool children. METHODS: This cross-sectional, descriptive-correlational study included a sample of 93 parent-child dyads. The children were of an average age of 57.01 ± 9.95 months, and the majority were female. The data collection instruments included a questionnaire on the use of digital devices, the Portuguese version of the Family Flexibility and Cohesion Evaluation Scale - Version IV (FACES-IV), and a Preschool Language Test (TL-ALPE). RESULTS: The findings showed a greater tendency of children to use smartphones, tablets, and television for 0-3 hours daily. The analysis of the responses on the FACES-IV and TL-ALPE instruments showed that most of the participating families were of the balanced type and that most children had normal language development. Statistically significant relationships were found between the FACES-IV subscales and TL-ALPE subtests, FACES-IV subscales and the use of digital devices, and the use of digital devices and TL-ALPE subtests. Notably, children in more balanced family functioning scored higher on TL-ALPE tests, and the time spent using digital devices may compromise language development. CONCLUSION: This study highlights the impact of digital device use and the role of family functioning on children's language development, suggesting that moderate digital device use and balanced family functioning are facilitating factors for good language development.

OBJETIVO: Este estudo teve como objetivo analisar a relação entre a utilização de dispositivos digitais, o funcionamento familiar e o desenvolvimento da linguagem em crianças de idade pré-escolar. MÉTODO: Estudo transversal, descritivo-correlacional com uma amostra de 93 díades pais-crianças. As crianças tinham uma média etária de 57,01 ± 9,95 meses, sendo a maioria do gênero feminino. Os instrumentos de recolha de dados incluíram um questionário sobre o uso de dispositivos digitais, a versão portuguesa da Escala de Avaliação da Flexibilidade e Coesão Familiar - Versão IV (FACES-IV) e o Teste de Linguagem - Avaliação de Linguagem Pré-Escolar (TL-ALPE). RESULTADOS: As respostas demonstram uma maior tendência para a utilização do smartphone, tablet e televisão entre 0 e 3 horas por dia nas crianças. Com a aplicação da FACES-IV e do TL-ALPE, verificou-se que a maioria das famílias participantes eram do tipo equilibrado e que a maioria das crianças apresenta um normal desenvolvimento da linguagem. Observaram-se relações estatisticamente significativas entre a FACES-IV e o TL-ALPE; a FACES-IV e a utilização de dispositivos digitais; a utilização de dispositivos digitais e o TL-ALPE. Verificou-se que crianças com um funcionamento familiar mais equilibrado pontuam mais alto nas provas do TL-ALPE e que o tempo de uso de dispositivos digitais pode comprometer o desenvolvimento da linguagem. CONCLUSÃO: Destaca-se o impacto da utilização dos dispositivos digitais e o papel do funcionamento familiar no desenvolvimento da linguagem da criança, sugerindo que uma utilização moderada de dispositivos digitais e um funcionamento familiar equilibrado são fatores facilitadores de um bom desenvolvimento da linguagem.

Breastfeeding knowledge, attitudes, beliefs and practices of refugee, migrant and asylum seeker women in Portugal.

BACKGROUND: The World Health Organization recommends exclusive breastfeeding for the first six months after childbirth. However, breastfeeding is influenced by organizational, social, geopolitical, and cultural factors, which are understudied in the migrant population. This study aimed to assess the knowledge, attitudes, beliefs, and practices of refugee, migrant, and asylum-seeking mothers living in Lisbon. METHODS: A sociodemographic questionnaire and a Breastfeeding Knowledge, Attitudes, and Beliefs, and Practices questionnaire were used to gather information regarding baseline breastfeeding knowledge, attitudes and beliefs, and practices towards breastfeeding. RESULTS: Only 40% of the mothers received antenatal counselling regarding the benefits and management of breastfeeding. Of the 20 responses, 10 (50%) mothers were found to have fair breastfeeding knowledge, 14 (70%) had fair attitudes and beliefs, and 12 (60%) had fair breastfeeding practices. Correlation analysis indicated a positive correlation between mothers' breastfeeding attitudes (r = 0.531, p < 0.05) and their breastfeeding knowledge. There was no statistically significant correlation between the mothers' breastfeeding attitudes, beliefs, and practices. CONCLUSIONS: The findings of this study suggest that healthy breastfeeding behaviours can be stimulated by receiving proper counselling from health professionals. Countries must focus on improving breastfeeding practices, as they still fail to do all they can to promote, protect, and support breastfeeding globally. Universal interventions are necessary to improve breastfeeding, regardless of migrant or refugee status.

Current practices of Portuguese speech-language pathologists with preschool-age children with pragmatic impairment: A cross-sectional survey.

This study aims to investigate the practice patterns used by Portuguese speech-language pathologists (SLPs) with preschool-age children with pragmatic impairment and to identify the actual need(s) perceived by SLPs in this field. A total of 351 SLPs responded. The results reveal that 81.5 per cent of the respondents (n=286) reported working or had previously worked with preschool-age children with pragmatic impairment arising from autism spectrum disorder, developmental language disorder, or both. Considering the clinical practice, similarities and differences were found, many of which are due not to the inherent characteristics of each disorder but to the scarcity of research in clinical pragmatics. These results are also reflected in the needs perceived by SLPs and the degree of confidence with which they work with these children. Implications for clinical practice and directions for future research are discussed.

Utilização de dispositivos digitais, funcionamento familiar e desenvolvimento da linguagem em crianças de idade pré-escolar: um estudo transversal / Use of digital devices, family functioning, and language development in preschool children: a cross-sectional study

RESUMO Objetivo Este estudo teve como objetivo analisar a relação entre a utilização de dispositivos digitais, o funcionamento familiar e o desenvolvimento da linguagem em crianças de idade pré-escolar. Método Estudo transversal, descritivo-correlacional com uma amostra de 93 díades pais-crianças. As crianças tinham uma média etária de 57,01 ± 9,95 meses, sendo a maioria do gênero feminino. Os instrumentos de recolha de dados incluíram um questionário sobre o uso de dispositivos digitais, a versão portuguesa da Escala de Avaliação da Flexibilidade e Coesão Familiar - Versão IV (FACES-IV) e o Teste de Linguagem - Avaliação de Linguagem Pré-Escolar (TL-ALPE). Resultados As respostas demonstram uma maior tendência para a utilização do smartphone, tablet e televisão entre 0 e 3 horas por dia nas crianças. Com a aplicação da FACES-IV e do TL-ALPE, verificou-se que a maioria das famílias participantes eram do tipo equilibrado e que a maioria das crianças apresenta um normal desenvolvimento da linguagem. Observaram-se relações estatisticamente significativas entre a FACES-IV e o TL-ALPE; a FACES-IV e a utilização de dispositivos digitais; a utilização de dispositivos digitais e o TL-ALPE. Verificou-se que crianças com um funcionamento familiar mais equilibrado pontuam mais alto nas provas do TL-ALPE e que o tempo de uso de dispositivos digitais pode comprometer o desenvolvimento da linguagem. Conclusão Destaca-se o impacto da utilização dos dispositivos digitais e o papel do funcionamento familiar no desenvolvimento da linguagem da criança, sugerindo que uma utilização moderada de dispositivos digitais e um funcionamento familiar equilibrado são fatores facilitadores de um bom desenvolvimento da linguagem.

ABSTRACT Purpose This study aimed to analyse the relationship between the use of digital devices, family function, and language development in preschool children. Methods This cross-sectional, descriptive-correlational study included a sample of 93 parent-child dyads. The children were of an average age of 57.01 ± 9.95 months, and the majority were female. The data collection instruments included a questionnaire on the use of digital devices, the Portuguese version of the Family Flexibility and Cohesion Evaluation Scale - Version IV (FACES-IV), and a Preschool Language Test (TL-ALPE). Results The findings showed a greater tendency of children to use smartphones, tablets, and television for 0-3 hours daily. The analysis of the responses on the FACES-IV and TL-ALPE instruments showed that most of the participating families were of the balanced type and that most children had normal language development. Statistically significant relationships were found between the FACES-IV subscales and TL-ALPE subtests, FACES-IV subscales and the use of digital devices, and the use of digital devices and TL-ALPE subtests. Notably, children in more balanced family functioning scored higher on TL-ALPE tests, and the time spent using digital devices may compromise language development. Conclusion This study highlights the impact of digital device use and the role of family functioning on children's language development, suggesting that moderate digital device use and balanced family functioning are facilitating factors for good language development.

The Impact of Morphological Awareness on Reading and Spelling / O Impacto da Consciência Morfológica na Leitura e na Ortografia

ABSTRACT: Morphological awareness is characterized by the ability to intentionally reflect and manipulate morphemes. The present study aimed to characterize the development of morphological awareness in school-age children and to analyze its impact on reading and spelling. The sample was comprised of 60 children with typical language development in Portuguese primary schools with a mean age of 8.6 (standard deviation = 0.1), 30of which attended the 2nd grade and 30 the 4th grade. The data was analyzed considering the use of language assessment instruments, reading and spelling and morphological awareness tests adapted from other studies. The results showed a significant difference in morphological awareness between the 2nd grade and the 4th grade. Although with different statistical proportions, there was a positive correlation between morphological awareness and reading, and between this metalinguistic capacity and spelling in both groups. An association is suggested between morphological awareness and reading and spelling and a difference in this correlation between the two degrees.

RESUMO: A consciência morfológica é caracterizada pela capacidade de refletir e manipular intencionalmente os morfemas. O presente estudo visou caracterizar o desenvolvimento da consciência morfológica em crianças em idade escolar e analisar o seu impacto na leitura e na ortografia. A amostra foi composta por 60 crianças portuguesas com desenvolvimento linguístico típico a frequentar o 1º ciclo do Ensino Básico, com uma média de idades de 8,6 anos (desvio padrão = 0.1), 30 das quais frequentam o 2º ano e 30 o 4º ano. Os dados foram analisados com recurso a instrumentos de avaliação linguística, leitura e ortografia e testes de consciência morfológica adaptados de outros estudos. Os resultados mostraram uma diferença significativa na consciência morfológica entre o 2º ano e o 4º ano. Embora com diferentes proporções estatísticas, houve uma correlação positiva entre consciência morfológica e leitura, e entre esta capacidade metalinguística e ortográfica em ambos os grupos. É sugerida uma associação entre consciência morfológica e leitura e ortografia e uma diferença nesta correlação entre os dois anos de escolaridade.

Early predictors of reading success in first grade.

Reading acquisition is a complex process that can be predicted by several components which, in turn, can be affected by the orthography depth. This study aims to explore the early predictors of (un)success in reading acquisition within an intermediate transparent orthography. At the beginning of the school year, 119 European Portuguese-speaking first graders were assessed regarding (i) sociodemographic variables: mothers' education and socioeconomic status (SES); (ii) cognitive variables: phonological working memory and vocabulary; (iii) reading-related variables: letter-sound knowledge, phonemic awareness, and rapid naming. Results of the three variable clusters were correlated with the final classification obtained in the Portuguese discipline. Specifically, there was a correlation between the Portuguese discipline classification with all reading and cognitive-related variables, with the highest correlations occurring with mother education and letter spelling. A regression analysis was conducted to assess the predictor impact of mother education and letter spelling (variables that correlated stronger with the Portuguese classification) on Portuguese classifications. Letter spelling was the sole significant predictor of the Portuguese classification. Based on these results, a path analysis was run to test whether letter spelling is a mediator of the relationship between the mother's education and the Portuguese classification. The results of the model test yielded a reasonable fit, indicating a relationship between the mother's education and letter spelling, which in turn, relates to the Portuguese classification. The identification of reading predictors in an intermediate-depth orthography such as European Portuguese contributes to more accurate identification of at-risk children.

The Usability and Acceptability of the mHealth "Health and Voice" for Promoting Teachers' Vocal Health.

OBJECTIVE: To evaluate the usability and acceptability of "Health and Voice" for the promotion of vocal health, and to analyze the same with sociodemographic data, work data, self-knowledge data on vocal care, voice disadvantage, and vocal fatigue symptoms in elementary school teachers. MATERIAL AND METHODS: A cross-sectional observational study, with a sample of 277 elementary school teachers from a Brazilian capital. Teachers were invited to access, interact and evaluate the mHealth: "Health and Voice". The evaluation instruments were the questionnaire with information on socio-demographic and work data, the System Usability Scale (SUS), the questionnaire with questions about acceptability, the Voice Handicap Index Protocol (VHI-10), and the Vocal Fatigue Index Protocol (VFI). Descriptive and association analyses were performed by the Chi-square, Fisher exact, Mann-Whitney, and Wilcoxon tests (P ≤ 0.05) RESULTS: the mean SUS score was 81.9 points; the mean of the acceptability questions was 17.24; the VHI-10 was 6.96 points; the VFI was 21.11 points. Most participants rated the acceptability of mHealth as high. There was an association between acceptability and working in two shifts (P = 0.019); between acceptability and usability (P < 0.001); and between usability and self-perception of knowledge about voice care after using mHealth (P = 0.000). The activity perceived as most important was guidance on voice care. CONCLUSION: "Health and Voice" is a vocal guidance tool for teachers that promotes vocal health. It has high usability and acceptability by elementary school teachers. Self-reported knowledge about vocal care increases after its use and those who evaluate the technology with high acceptability are 3.6 times more likely to also classify it with high usability.

Psychometric Properties of Standardized Instruments that are Used to Measure Pragmatic Intervention Effects in Children with Developmental Language Disorder: A Systematic Review.

This review aimed to analyze the psychometric properties of standardized instruments that are used to measure pragmatic intervention effects in children with developmental language disorder. Following PRISMA structure, a comprehensive literature research was conducted in five electronic indexing databases: Central, PubMed, Medline, Web of Science and Scopus. Six studies between 2005 and 2019 were included and seven standardized instruments have been analyzed. All instruments present some evidence of validity and reliability, but none reported responsiveness. The instruments reviewed were not used for their original purpose, which may explain the results. The small number of studies prevent drawing clear conclusions. Future studies should focus on appropriate, valid, reliable, and responsive measures. Research focusing on psychometric properties is crucial, mostly about responsiveness.

The Effects of the Pragmatic Intervention Programme in Children with Autism Spectrum Disorder and Developmental Language Disorder.

PURPOSE: Children with Autism Spectrum Disorder (ASD) and Developmental Language Disorder (DLD) frequently face pragmatic impairments which may result in learning, socialization, and mental health difficulties, therefore early intervention is crucial. In Portugal, the Pragmatic Intervention Programme (PICP) has been recently developed and validated, but its effects are unknown. This study aims to determine the effects of the PICP on preschool-age children with ASD or DLD with pragmatic impairments. METHODS: A non-randomized controlled trial has been conducted. The children (n = 20) were assigned to the intervention (n = 11) or the control group (waiting list) (n = 9). Each child attended 24 PICP-based intervention sessions provided by a Speech and Language Therapist in kindergarten. The primary outcome measure was a Goal Attainment Scale (GAS) rated by parents and kindergarten teachers. Secondary outcomes include parent/teacher-reported communication skills (Escala de Avaliação de Competências Comunicativas) and an assessment of the child's general language ability (Teste de Linguagem-Avaliação da Linguagem Pré-Escolar). RESULTS: GAS results show that all the children in the intervention group made progress. Statistically significant differences between pre- and post-intervention assessments were found for all secondary outcomes. CONCLUSIONS: The main findings suggest that the PICP improves language in preschool-age children with ASD and DLD with pragmatic difficulties. Further research is needed to analyse the effects of the PICP for each neurodevelopmental disorder individually. These results are crucial and will contribute to future research and evidence-based practice.

Explicit Instructions Do Not Enhance Auditory Statistical Learning in Children With Developmental Language Disorder: Evidence From Event-Related Potentials.

A current issue in psycholinguistic research is whether the language difficulties exhibited by children with developmental language disorder [DLD, previously labeled specific language impairment (SLI)] are due to deficits in their abilities to pick up patterns in the sensory environment, an ability known as statistical learning (SL), and the extent to which explicit learning mechanisms can be used to compensate for those deficits. Studies designed to test the compensatory role of explicit learning mechanisms in children with DLD are, however, scarce, and the few conducted so far have led to inconsistent results. This work aimed to provide new insights into the role that explicit learning mechanisms might play on implicit learning deficits in children with DLD by resorting to a new approach. This approach involved not only the collection of event-related potentials (ERPs), while preschool children with DLD [relative to typical language developmental (TLD) controls] were exposed to a continuous auditory stream made of the repetition of three-syllable nonsense words but, importantly, the collection of ERPs when the same children performed analogous versions of the same auditory SL task first under incidental (implicit) and afterward under intentional (explicit) conditions. In each of these tasks, the level of predictability of the three-syllable nonsense words embedded in the speech streams was also manipulated (high vs. low) to mimic natural languages closely. At the end of both tasks' exposure phase, children performed a two-alternative forced-choice (2-AFC) task from which behavioral evidence of SL was obtained. Results from the 2-AFC tasks failed to show reliable signs of SL in both groups of children. The ERPs data showed, however, significant modulations in the N100 and N400 components, taken as neural signatures of word segmentation in the brain, even though a detailed analysis of the neural responses revealed that only children from the TLD group seem to have taken advantage of the previous knowledge to enhance SL functioning. These results suggest that children with DLD showed deficits both in implicit and explicit learning mechanisms, casting doubts on the efficiency of the interventions relying on explicit instructions to help children with DLD to overcome their language difficulties.

Efectividad de la estimulación de la conciencia fonológica en preescolares: una revisión sistemática / Effectiveness of phonological awareness stimulation in preschoolers: a systematic review

La conciencia fonológica es un predictor importante del aprendizaje de la lectoescritura. Se han desarrollado y probado diferentes programas para su estimulación, sin embargo, el grado de variabilidad entre los métodos utilizados dificulta la comparación de resultados. Es necesaria una síntesis de la literatura para analizar la efectividad de programas de estimulación de la conciencia fonológica, que considere la variabilidad existente entre metodologías. Se planteó una revisión con los siguientes objetivos:1) sintetizar la literatura sobre estudios que investigan programas de estimulación de la conciencia fonológica en niños con desarrollo típico; 2) examinar la eficacia de dichos programas; 3) evaluar críticamente su metodología.Para esta investigación bibliográfica se utilizaron las siguientes bases de datos: Central, Medline, Pubmed, Scopus y Web of Knowledge. Diez artículos cumplieron con los criterios de elegibilidad establecidos y fueron incluidos en el presente estudio. En general, los resultados mostraron la efectividad de los programas de estimulación de conciencia fonológica utilizados. Sin embargo, la calidad metodológica es variable entre los estudios; esto incluye una falta de detalle en cuanto a los criterios de inclusión, capacitación limitada de los/las profesionales que llevaron a cabo los programas de CF, participación inconsistente de los padres y falta de seguimiento. Se discuten algunas pautas para futuras investigaciones con el objetivo de mejorar la calidad metodológica de los estudios y reducir el riesgo de sesgo.

Phonological awareness is a strong predictor of reading and writing skills development. Several programs have been developed and tested for the stimulation of phonological awareness, but the degree of variation among them makes it difficult to compare the different methods. A synthesis of the literature on phonological awareness stimulation programs is needed to examine the effectiveness of PA programs while considering the variability that exists between the methodologies used. This systematic review aimedto 1) synthesize the literature on PA stimulation programs in typically developing children; 2) examine the effectiveness of PA programs; 3) critically appraise the methodology of PA stimulation programs. Central, Medline, Pubmed, Scopus, and Web of Knowledge were used to conduct an extensive literature search. A total of 10 articles met the eligibility criteria and were included in the present study. Results showed that, in general, the phonological awareness stimulation programs carried out in the analyzed research were effective. However, the quality of the methodology varied significantly across studies, showing in some cases a lack of detail in the inclusion criteria, limited training of the professionals who carried out the PA programs, an inconsistency in parent involvement, and a lack of follow-up. Guidelines for future research are discussed to enhance the methodological quality of this line of research and reduce the risk of bias.

Ejercicios motores orofaciales no verbales: uso y conocimiento de los fonoaudiólogos que trabajan con personas con trastornos de los sonidos del habla / Nonspeech oral motor exercises: use and knowledge of speech-language pathologists working with people with speech sound disorders

Estudios realizados en diferentes países (por ejemplo, Australia, Canadá, India, República de Irlanda, EE.UU., Reino Unido) han demostrado que los fonoaudiólogos utilizan ejercicios motores orofaciales no verbales (EMONV) para tratar los trastornos de los sonidos del habla (TSH), atrayendo atención hacia el sustancial debate que existe respecto a la eficacia clínica de estos ejercicios. En este contexto, el presente estudio tuvo como objetivo investigar y caracterizar el uso de los EMONV por parte de fonoaudiólogos portugueses que realizan intervenciones en TSH y evaluar el conocimiento que lo respalda. Para ello, se invitó a profesionales de la fonoaudiología que trabajan con niños con TSH a completar un cuestionario basado en Thomas y Kaipa (2015). Un total de 184 participantes respondió a la encuesta; 93,5% informó contar con conocimientos sobre los EMONV, 78.5% utiliza EMONV para el tratamiento de TSH y 80,2% los considera efectivos en el tratamiento del TSH (89% indicó que adquirió su conocimiento sobre EMONV a través de cursos de pregrado y posgrado; 98,5% informó que utiliza los EMONV para mejorar las funciones motoras de los órganos fonoarticulatorios). Este estudio ofrece una descripción general del uso de los EMONV por parte de fonoaudiólogos portugueses en la intervención en niños con TSH. Muchos de los participantes en este estudio informaron que utilizan EMONV en el tratamiento de TSH, independientemente de la falta de evidencia para respaldar su uso en este contexto. Estos hallazgos demuestran que el porcentaje de fonoaudiólogos en Portugal que utilizan EMONV es similar al encontrado en los EE.UU., Reino Unido, Canadá e India, pero diferente del porcentaje en Australia e Irlanda.

Previous studies, conducted in different countries (e.g. Australia, Canada, India, Republic of Ireland, USA, UK), have shown that speech-language pathologists (SLPs) use nonspeech oral motor exercises (NSOMEs) to treat speech sound disorders (SSDs), bringing attention to the substantial debate regarding the clinical effectiveness of NSOMEs. The aim of the present study was to investigate and characterize the use of NSOMEs by Portuguese SLPs in the intervention of SSDs, and to analyze the evidence that supports it. To do so, SLPs who provide therapy to children with SSDs were invited to complete an online questionnaire, based on a previous survey conducted in India by Thomas and Kaipa (2015). A total of 184 participants responded to the survey; 93.5% reported knowing about NSOMEs, 78.5% used NSOMEs in their intervention for SSDs, and 80.2% considered them effective in treating SSDs (89% indicated that their knowledge about NSOMEs was acquired through graduate and post-graduate courses; 98.5% reported that theyused NSOMEs to improve the motor function of the articulators). This study offers an overview of Portuguese speech-language pathologists' reported use of NSOMEs as part of the intervention of speech sound disorders in children. Many of the participants in this study reported that they did use NSOMEs in SSD treatments, regardless of the lack of evidence to support their use in this context. Furthermore, the results show that the percentage of SLPs in Portugal using NSOMEs is similar to those found in the USA, UK, Canada, and India, but different from those in Australia and Ireland.

Effects of the Narrative Intervention Program for Preschool Portuguese Children.

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.

Validity and reliability of the Intelligibility in Context Scale: European Portuguese version.

The purpose of the study was to evaluate the validity, reliability, sensitivity and specificity of the European-Portuguese version of the Intelligibility in Context Scale (ICS-EP). Seventy-six children (age: M = 60.6, SD = 8.1 months), 25 having a parent or teacher concern about how they talked and 51 with no concern, were assessed with the phonetic-phonological test (TFF-ALPE) to calculate the following severity measures: percentage of phonemes correct (PPC), percentage of consonants correct (PCC), and percentage of vowels correct (PVC). Parents also filled out a questionnaire about their child's development (e.g. concern about how the child talks). The ICS was then completed by parents to estimate their children's intelligibility with different communicative partners. The results showed that item-level scores were different according to communicative partners. The mean ICS score for the whole sample was 4.5 (SD = 0.6), showing that children were "usually" to "always" intelligible. The ICS had excellent internal consistency (α = 0.96). Children with parental concern about their speech presented significantly lower mean scores (M = 3.91, SD = 0.59) than children without parental concerns (M = 4.78, SD = 0.36). There was a positive correlation between the ICS scores and PPC (r = .655), PCC (r = .654), and PVC (r = .588). A simple linear model was also obtained between the ICS mean score and the severity measures analyzed. High values were obtained for sensitivity (0.80) and specificity (0.84), using a cut-off point of 4.36. We conclude that the ICS-EP has good psychometric properties, suggesting it to be a valid tool for estimating children's intelligibility when talking with different communicative partners. Therefore, this version of the ICS can be used as a screening measure for children's speech intelligibility.

Visual stimuli in intervention approaches for pre-schoolers diagnosed with phonological delay.

The aim of this study was to develop and content validate specific speech and language intervention picture cards: The Letter-Sound (L&S) cards. The present study was also focused on assessing the influence of these cards on letter-sound correspondences and speech sound production. An expert panel of six speech and language therapists analysed and discussed the L&S cards based on several criteria previously established. A Speech and Language Therapist carried out a 6-week therapeutic intervention with a group of seven Portuguese phonologically delayed pre-schoolers aged 5;3 to 6;5. The modified Bland-Altman method revealed good agreement among evaluators, that is the majority of the values was between the agreement limits. Additional outcome measures were collected before and after the therapeutic intervention process. Results indicate that the L&S cards facilitate the acquisition of letter-sound correspondences. Regarding speech sound production, some improvements were also observed at word level. The L&S cards are therefore likely to give phonetic cues, which are crucial for the correct production of therapeutic targets. These visual cues seemed to have helped children with phonological delay develop the above-mentioned skills.

The letter knowledge assessment tool.

PURPOSE: There is a need to develop letter knowledge assessment tools to characterise the letter knowledge in Portuguese pre-schoolers and to compare it with pre-schoolers from other countries, but there are no tools for this purpose in Portugal. The aim of this paper is to describe the development and validation procedures of the Prova de Avaliação de Competências de Pré-Literacia (PACPL), which assesses letter knowledge. METHOD: This study includes data that has been gathered in two phases: pilot and main study. In the pilot study, an expert panel of six speech and language pathologists analysed the instrument. Children (n = 216) aged 5;0-7;11 participated in the main study that reports data related to the psychometric characteristics of the PACPL. Content validity, internal consistency, reliability and contributing factors to performance were examined statistically. RESULTS: A modified Bland-Altman method revealed good agreement amongst evaluators. The main study showed that the PACPL has a very good internal consistency and high inter-rater (96.2% of agreement and a Cohen's k value of 0.92) and intra-rater (95.6% of agreement and a Cohen's k value of 0.91) agreement. Construct validity of the PCAPL was also assured (Cronbach's α of 0.982). Significant differences were found between age groups with children increasing their letter knowledge with age. In addition, they were better at identifying than at producing both letter names and letter sounds. CONCLUSIONS: The PACPL is a valid and reliable instrument to assess letter knowledge in Portuguese children.

Generalization and maintenance of treatment gains in primary progressive aphasia (PPA): a systematic review.

BACKGROUND: Cognitive-linguistic treatments and interventions targeting communication have been developed within the context of primary progressive aphasia (PPA), however knowledge about the scope of generalization and maintenance of therapy gains considering PPA subtypes remains scarce and awaits systematic investigation. AIMS: To analyse the effects of semantic therapy on generalization and maintenance of treatment outcomes in individuals with PPA, considering its different subtypes. METHODS & PROCEDURES: Central, PubMed, Medline, Web of Knowledge and Scopus were used to retrieve articles of interest. A total of 25 non-randomized studies published between 2000 and 2016 met the eligibility criteria and therefore were included in this study. MAIN CONTRIBUTION: This systematic review provides evidence-based information for clinical practice in PPA. Generalization and maintenance effects post-treatment for each PPA variant are analysed and discussed. Several factors are described as important to maximize the scope for generalization and maintenance of treatment gains. CONCLUSIONS & IMPLICATIONS: Generalization is particularly hard to achieve in the semantic variant, as in the face of degraded semantic knowledge learning is rigid and context dependent. In contrast, non-fluent and logopenic variants offer better scope for generalization. Maintenance patterns do not seem to be influenced by PPA subtype, but rather by other factors such as continued practice, treatment length and frequency of sessions. In the future, clinicians should consider the PPA subtype when planning the treatment protocol.

Paediatric Automatic Phonological Analysis Tools (APAT).

PURPOSE: To develop the pediatric Automatic Phonological Analysis Tools (APAT) and to estimate inter and intrajudge reliability, content validity, and concurrent validity. METHOD: The APAT were constructed using Excel spreadsheets with formulas. The tools were presented to an expert panel for content validation. The corpus used in the Portuguese standardized test Teste Fonético-Fonológico - ALPE produced by 24 children with phonological delay or phonological disorder was recorded, transcribed, and then inserted into the APAT. Reliability and validity of APAT were analyzed. RESULTS: The APAT present strong inter- and intrajudge reliability (>97%). The content validity was also analyzed (ICC = 0.71), and concurrent validity revealed strong correlations between computerized and manual (traditional) methods. CONCLUSIONS: The development of these tools contributes to fill existing gaps in clinical practice and research, since previously there were no valid and reliable tools/instruments for automatic phonological analysis, which allowed the analysis of different corpora.

Effectiveness of the Language Intervention Programme for Preschool Children.

OBJECTIVE: This paper investigates the effectiveness of the Language Intervention Programme for the treatment of 14 preschool-aged children with primary language impairment. PATIENTS AND METHODS: We used a waiting list control design, in which half the sample (7 children) received immediate intervention with the Language Intervention Programme, whereas the remaining children received treatment after a 4-week delay. The intervention consisted of 8 individual biweekly sessions. Outcome measures of language ability (receptive semantic and morphosyntactic, expressive semantic and morphosyntactic, and metalinguistic) were taken before and after intervention. RESULTS: After 4 weeks of intervention, the experimental group showed significant improvements in language (receptive, expressive and metalinguistic skills), but no differences were found for those in the waiting control group. After 4 weeks of intervention for the control group, significant progress in language was also observed. CONCLUSION: The Language Intervention Programme was found to be effective in treating language skills of children with language impairment, providing clinical evidence for speech and language therapists to employ this programme for the treatment of preschool children with language disorders.

Exploring the Clinical Practice of Speech and Language Therapists with Adults with Dementia: A Cross-Sectional Survey in Portugal.

BACKGROUND/AIMS: Adults with acquired communication and swallowing disorders secondary to dementia can benefit from speech and language therapy services. However, there is limited information on the role of speech and language therapists (SLTs) in the treatment of individuals with dementia. The aim of this study was to explore the clinical practice of SLTs with adults with dementia. METHODS: A cross-sectional survey of SLTs was conducted in Portugal using a web-based questionnaire designed specifically for the purpose of this study. RESULTS: A total of 230 SLTs responded to the survey. Among the respondents, 52.2% had limited clinical practice with individuals with dementia, with only 14.3% having worked with more than 10 cases. CONCLUSION: In Portugal, the clinical practice of SLTs in dementia is limited and mostly centred on the assessment of language, communication, and swallowing. The current findings highlight the need to address training in dementia within graduate and post-graduate programmes for SLTs.