Using Telepractice to Deliver Pediatric Voice Care in a Changing World: Breaking down Challenges and Learning from Successes.

For children with voice disorders, access to care has long been a challenge. Reasons for this include the challenge of qualifying children with isolated voice disorders for services within the public-school system as well as a family's geographic proximity to experienced clinicians who are in the healthcare system. Over the past decade, there have been both formal and informal investigations into the use of telepractice to deliver services to communicatively disordered children and adults, including those with voice disorders. Although barriers and obstacles existed, use of telepractice to deliver such services demonstrated both feasibility and, in some studies, effective outcomes. However, prior to spring of 2020, use of telepractice to deliver speech pathology services was not mainstream. This changed when the nation was forced to shut down many of its in-person healthcare and educational delivery due to the COVID-19 pandemic. This article summarizes select relevant literature pertaining to the use of telepractice in speech language pathology over the past decade and provides a case-based discussion of how it was and is currently being used to deliver pediatric voice care.

Increasing adolescents' depth of understanding of cross-curriculum words: an intervention study.

BACKGROUND: There is some evidence that vocabulary intervention is effective for children, although further research is needed to confirm the impact of intervention within contexts of social disadvantage. Very little is known about the effectiveness of interventions to increase adolescent knowledge of cross-curriculum words. AIMS: To evaluate the effectiveness of an intervention programme designed to develop adolescents' knowledge of cross-curriculum words. METHODS & PROCEDURES: Participants were 35 adolescents aged between 12 and 14 years who were at risk of educational underachievement with low scores on a range of assessments. Participants received a 10-week intervention programme in small groups, targeting 10 cross-curriculum words (e.g., 'summarize'). This was evaluated using a bespoke outcome measure (the Word Knowledge Profile). The study involved an AABA design, with a repeated baseline, delayed intervention cohort and blind assessment. Intervention included both semantic and phonological information about the target words and involved the adolescents using the words in multiple contexts. OUTCOMES & RESULTS: Results were promising and participants' knowledge of the targeted words significantly increased following intervention. Progress was demonstrated on the Word Knowledge Profile on the item requiring participants to define the word (for the summer intervention group only). This increase in depth of knowledge was seen on taught words but not on matched non-taught words. CONCLUSIONS & IMPLICATIONS: Cross-curriculum words are not consistently understood by adolescents at risk of low educational attainment within a low socio-economic context. A 10-week intervention programme resulted in some increases to the depth of knowledge of targeted cross-curriculum words.

Functional hearing in the classroom: assistive listening devices for students with hearing impairment in a mainstream school setting.

OBJECTIVE: To assess the benefit of assistive listening devices (ALDs) for students with hearing impairment in mainstream schools. DESIGN: Speech recognition (CNC words) in background noise was assessed in a typical classroom. Participants underwent testing using four device configurations: (1) HA(s)/CI(s) alone, (2) soundfield amplification, (3) remote microphone (Roger Pen) on desk and (4) remote microphone at the loudspeaker. A sub-group of students subsequently underwent a 2-week classroom trial of each ALD. Degree of improvement from baseline [HA(s)/CI(s)] alone was assessed using teacher and student Listening Inventory for Education-Revised (LIFE-R) questionnaires. STUDY SAMPLE: In all, 20 students, aged 12.5-18.9 years, underwent speech recognition assessment. In total, 10 of these participated in the classroom trial. Hearing loss ranged from mild-to-profound levels. RESULTS: Performance in each ALD configuration was higher than for HAs/CIs alone (p < 0.001). Teacher and student LIFE-R results indicated significant improvement in listening/communication when using the remote microphone in conjunction with HAs/CIs (p < 0.05). There was no difference between the soundfield system and the baseline measurement (p > 0.05). CONCLUSION: Speech recognition improvements were demonstrated with the implementation of both remote microphones and soundfield systems. Both students and teachers reported functional hearing advantages in the classroom when using the remote microphone in concert with their standard hearing devices.

[School escorts in inclusive education- the current situation in the state of Baden-Wurttemberg]. / Schulbegleiter als Unterstützung von Inklusion im Schulwesen.

In the context of inclusive education, so-called «Schulbegleiter¼ (school escorts) have been installed to assist children with special needs. However, adequate conceptions of their role are lacking, and no provisions exist describing the exact tasks and duties of these school escorts. This article presents data on a statewide empirical study and provides information on the professional background, qualifications, and assignments of such escorts as well as the nature of the assisted children in the German state of Baden-Württemberg. The data were collected in nearly 50 % of all schools providing general education in Baden-Württemberg, and a total of 526 school escorts completed a questionnaire on their work. Children with special needs who received such assistance were aged 6 to 19 years (M = 10.4) and had a mental disorder in nearly three-fourths of all cases, with autism spectrum disorders being most common (59.4 %). The most frequent assignments of the escorts were providing practical assistance during classes and mobilizing the child as well as providing direct support in emotionally challenging situations. Such escorts can make a significant contribution to the inclusive education of disabled children. They do, however, need an adequate qualification and practical competences to meet the diverse challenges of children with special needs. Child and adolescent psychiatrists are supposed to stay involved in the process, not only by planning interventions, but also during the course of inclusive education itself. Thus, the emotional situation and adjustment of included children with mental disorders over time must be monitored adequately.

More academics in regular schools? The effect of regular versus special school placement on academic skills in Dutch primary school students with Down syndrome.

BACKGROUND: Studies from the UK have shown that children with Down syndrome acquire more academic skills in regular education. Does this likewise hold true for the Dutch situation, even after the effect of selective placement has been taken into account? METHOD: In 2006, an extensive questionnaire was sent to 160 parents of (specially and regularly placed) children with Down syndrome (born 1993-2000) in primary education in the Netherlands with a response rate of 76%. Questions were related to the child's school history, academic and non-academic skills, intelligence quotient, parental educational level, the extent to which parents worked on academics with their child at home, and the amount of academic instructional time at school. Academic skills were predicted with the other variables as independents. RESULTS: For the children in regular schools much more time proved to be spent on academics. Academic performance appeared to be predicted reasonably well on the basis of age, non-academic skills, parental educational level and the extent to which parents worked at home on academics. However, more variance could be predicted when the total amount of years that the child spent in regular education was added, especially regarding reading and to a lesser extent regarding writing and math. In addition, we could prove that this finding could not be accounted for by endogenity. CONCLUSION: Regularly placed children with Down syndrome learn more academics. However, this is not a straight consequence of inclusive placement and age alone, but is also determined by factors such as cognitive functioning, non-academic skills, parental educational level and the extent to which parents worked at home on academics. Nevertheless, it could be proven that the more advanced academic skills of the regularly placed children are not only due to selective placement. The positive effect of regular school on academics appeared to be most pronounced for reading skills.

The role of the speech-language pathologist in the schools for the treatment of voice disorders: working within the framework of the individuals with disabilities education improvement act.

The role of the speech-language pathologist (SLP) has developed considerably over the past 20 years given the medical and technological advances in life-sustaining procedures. Children born with congenital, surgical, or "medically fragile" conditions become mainstreamed into regular school-based settings, thus extending the traditional role of the treating SLP and multidisciplinary team. Understanding the impact of associated voice disorders on educational performance requires dissemination of additional and important information, as eligibility decisions for students in school-based settings must be made within the framework of the federal legislation and regulations governing the provision of services for students with disabilities. This article discusses how to identify children with voice disorders under the Individuals with Disabilities Education Improvement Act (IDEA), the role of the SLP in various triaging scenarios, and how models of voice therapy can be integrated in a school-based setting.

The impact of including children with intellectual disability in general education classrooms on the academic achievement of their low-, average-, and high-achieving peers.

BACKGROUND: This study aimed at assessing the impact of including children with intellectual disability (ID) in general education classrooms with support on the academic achievement of their low-, average-, and high-achieving peers without disability. METHOD: A quasi-experimental study was conducted with an experimental group of 202 pupils from classrooms with an included child with mild or moderate ID, and a control group of 202 pupils from classrooms with no included children with special educational needs (matched pairs sample). The progress of these 2 groups in their academic achievement was compared over a period of 1 school year. RESULTS: No significant difference was found in the progress of the low-, average-, or high-achieving pupils from classrooms with or without inclusion. CONCLUSIONS: The results suggest that including children with ID in primary general education classrooms with support does not have a negative impact on the progress of pupils without disability.

Effects of inclusion on the academic achievement and adaptive behaviour of children with intellectual disabilities.

BACKGROUND: While an extensive body of research has examined the outcomes of inclusion for pupils with special needs, in particular learning disabilities, its effects on the development of children with intellectual disabilities (ID) have been less explored. As inclusive practices tend to be more common for this group of children, it is important to acquire more knowledge on this issue. METHODS: A comparative study with an experimental group of 34 children with ID fully included in general education classrooms with support, and a control group of 34 comparable children in special schools has been conducted. The progress accomplished by these two groups in their academic achievement and adaptive behaviour has been compared over two school years. RESULTS: Included children made slightly more progress in literacy skills than children attending special schools. No differences were found between the progress of the two groups in mathematics and adaptive behaviour. CONCLUSIONS: Inclusive education is an appropriate educational option for primary pupils with ID who require extensive support in school.

Implementation of a manualized communication intervention for school-aged children with pragmatic and social communication needs in a randomized controlled trial: the Social Communication Intervention Project.

BACKGROUND: Speech-language interventions are often complex in nature, involving multiple observations, variable outcomes and individualization in treatment delivery. The accepted procedure associated with randomized controlled trials (RCT) of such complex interventions is to develop and implement a manual of intervention in order that reliable treatment delivery can be achieved. AIMS: To present the rationale, structure and content of an intensive manualized intervention as implemented within an RCT for children with complex pragmatic and social communication needs; to investigate factors associated with implementation in a mainstream school environment; and to determine treatment fidelity. METHODS & PROCEDURES: The manualized SCIP intervention, including procedures for developing individualized treatment plans, was developed and then implemented within an RCT with 57 school-aged children with complex pragmatic communication needs (CwPLI). The paper describes the delivery protocol, staffing requirements, and content and structure of the intervention. A mapping procedure for individualization of intervention and the implemented components of intervention are presented. The findings from a school-therapy alliance checklist for recording factors affecting implementation in a school context are also reported. Treatment fidelity was carried out using measures of delivered versus planned treatment content and quality of therapy. OUTCOMES & RESULTS: The manual was effective at detailing intervention procedures and allowing for development of individualized treatment plans whilst maintaining satisfactory treatment fidelity. Treatment planning and delivery required continuous specialist speech and language therapist input with assistants needing substantive training and supervision. Key components of intervention for CwPLI were therapies aimed at improving conversation skills, narrative construction, comprehension monitoring, understanding of social cues and metapragmatic awareness. The school-therapy alliance checklist indicated high rates of therapist-education staff and therapist-parent liaison. Parents were nearly always involved in treatment planning though only half-attended therapy sessions. Learning support provision in schools for participating children was highly variable. CONCLUSIONS & IMPLICATIONS: Predetermining theoretical background, structure, and content in a treatment manual contributed towards the quality and reliability of intervention within the context of an RCT. The implementation of SCIP intervention in a broader clinical context is discussed with reference to staff expertise, the therapeutic process and the essential ingredients of social communication intervention.

Parent-Child Interaction Therapy (PCIT) in school-aged children with specific language impairment.

BACKGROUND: Parents play a critical role in their child's language development. Therefore, advising parents of a child with language difficulties on how to facilitate their child's language might benefit the child. Parent-Child Interaction Therapy (PCIT) has been developed specifically for this purpose. In PCIT, the speech-and-language therapist (SLT) works collaboratively with parents, altering interaction styles to make interaction more appropriate to their child's level of communicative needs. AIMS: This study investigates the effectiveness of PCIT in 8-10-year-old children with specific language impairment (SLI) in the expressive domain. It aimed to identify whether PCIT had any significant impact on the following communication parameters of the child: verbal initiations, verbal and non-verbal responses, mean length of utterance (MLU), and proportion of child-to-parent utterances. METHODS & PROCEDURES: Sixteen children with SLI and their parents were randomly assigned to two groups: treated or delayed treatment (control). The treated group took part in PCIT over a 4-week block, and then returned to the clinic for a final session after a 6-week consolidation period with no input from the therapist. The treated and control group were assessed in terms of the different communication parameters at three time points: pre-therapy, post-therapy (after the 4-week block) and at the final session (after the consolidation period), through video analysis. It was hypothesized that all communication parameters would significantly increase in the treated group over time and that no significant differences would be found in the control group. OUTCOMES & RESULTS: All the children in the treated group made language gains during spontaneous interactions with their parents. In comparison with the control group, PCIT had a positive effect on three of the five communication parameters: verbal initiations, MLU and the proportion of child-to-parent utterances. There was a marginal effect on verbal responses, and a trend towards such an effect for non-verbal responses. CONCLUSIONS & IMPLICATIONS: Despite the small group sizes, this study provides preliminary evidence that PCIT can achieve its treatment goals with 8-10-year-olds who have expressive language impairments. This has potentially important implications for how mainstream speech and language services provide intervention to school-aged children. In contrast to direct one-to-one therapy, PCIT offers a single block of therapy where the parents' communication and interaction skills are developed to provide the child with an appropriate language-rich environment, which in turn could be more cost-effective for the service provider.

Challenging situations when teaching children with autism spectrum disorders in general physical education.

As the first step of an instrument development, teaching challenges that occur when students with autism spectrum disorders are educated in general physical education were elicited using Goldfried and D'Zurilla's (1969) behavioral-analytic model. Data were collected from a convenience sample of 43 certified physical educators (29 women and 14 men) using a demographic questionnaire and an elicitation questionnaire. Participants listed 225 teaching challenges, 46% related to cooperative, 31% to competitive, and 24% to individualistic learning situations. Teaching challenges were categorized into nine themes: inattentive and hyperactive behaviors, social impairment, emotional regulation difficulties, difficulties understanding and performing tasks, narrow focus and inflexible adherence to routines and structure, isolation by classmates, negative effects on classmates' learning, and need for support.

Effects of an Inclusive Physical Activity Program on the Motor Skills, Social Skills and Attitudes of Students with and without Autism Spectrum Disorder.

This study investigated the effects of an inclusive physical activity (IPA) program on the motor and social skills and attitudes of students with and without autism spectrum disorder (ASD). The study sample consisted of 45 ASD and typical development (TD) students aged between 6 and 11 years. The students were randomly divided into two groups: a training group consisting of 27 students (n = 13 with ASD and n = 14 with TD) and a control group consisting of 18 students (n = 9 with ASD and n = 9 with TD). In conclusion, the IPA program increased the motor and social skills of the ASD students and improved the motor skills of the TD students and positively affected their attitudes towards the ASD students.

The Association Between Autism Spectrum Traits and the Successful Transition to Mainstream Secondary School in an Australian School-Based Sample.

The transition to secondary school is an important educational milestone impacting wellbeing and academic achievement. Students with Autism Spectrum Disorder may be vulnerable during transition however little is known about how Autism Spectrum (AS) traits influence transition outcomes. Generalised estimating equations were used to examine how AS traits were associated with four indicators of successful transition in a school-based sample of 51 students. Higher AS traits were associated with lower quality of life, school belonging and mental health, however the hypothesised decline after school transition was not supported. Characteristics of both the primary and secondary school appeared to be contributing to the wellbeing of students with high AS traits which could be clarified by further investigation with a larger sample.

Descriptive study of young disabled children aged 2-6, enrolled in mainstream schools, and benefiting from special needs assistants in the Bouches-du-Rhône in 2014.

BACKGROUND: Since the law of February 11, 2005, in France, the number of children with disabilities enrolled in ordinary schools has increased steadily. As a result, the amount of personal support provided by a special needs assistant (personal support) is also increasing. The aim of the study was to describe the diseases and impairments of disabled children aged 2-6, enrolled in mainstream schools and benefiting from personal support for schooling by special needs assistants in the Bouches-du-Rhône (France) in 2014. METHODS: A cross-sectional descriptive study was performed. Children included were benefiting from either an individual or shared personal support. Physicians from the territorial organization in charge of disability coded diseases and deficiencies using the International Classification of Diseases, 10th revision, and nomenclature inspired by the International Classification of Functioning, Disability and Health. RESULTS: Medical data were coded for 990 children out of 1260 of the total population. These young disabled children were most frequently children with pervasive developmental disorders (23.3%), lack of expected normal physiological development (19.9%), or mixed specific developmental disorders (13.5%), and most often had behavioral, personality, and relational skills disorders (61.8%), psychomotor function impairments (51.9%), or written or oral language learning impairment (43.2%). Finally, the two main types of impairments most represented among these children were psychological impairments (86.7%) and language and speech impairments (79.8%). The children were most often supported by an individual personal support (for one child only) than by a shared personal support (60% vs. 40%). They were mainly boys (almost 75%). CONCLUSION: This study provides working guidelines for the management of health policies relating to disability at the territorial or even national level.

Pragmatic language impairment and associated behavioural problems.

BACKGROUND: Specific language impairment (SLI) is diagnosed when a child shows isolated structural language problems. The diagnosis of pragmatic language impairment (PLI) is given to children who show difficulties with the use of language in context. Unlike children with SLI, these children tend to show relatively intact structural language skills while they do exhibit clear communicative deficits. There is hardly any research on the relationship between pragmatic competence and behavioural problems. Existing research suggests a strong relationship, but has only been executed on clinical SLI samples. Moreover, it is not known whether pragmatic language problems are related to specific types of behavioural problems. AIMS: This study aims to clarify the incidence and nature of behavioural problems in children with PLI using a prognostic design in mainstream education. This design should provide valuable insights into the general relationship between PLI and various behavioural problems. METHODS & PROCEDURES: Teachers completed the Children's Communication Checklist (CCC) and the Strengths and Difficulties Questionnaire (SDQ) and provided additional data for a sample of 1364 children aged 4 years. OUTCOMES & RESULTS: Within the community sample, pragmatic competence is highly correlated with behavioural problems. Pragmatic competence is a good predictor of behavioural problems, and once pragmatic competence is accounted for, structural language abilities do not predict behavioural problems. Children with pragmatic language impairment often show behavioural problems, largely of an externalizing nature. The most prominent problems are hyperactivity and the lack of prosocial behaviour, which reach clinical levels for this group. However, all problem levels are elevated compared with normally developing children. CONCLUSIONS & IMPLICATIONS: Young children with PLI show a wide variety of behavioural problems. Early assessment of pragmatic competence may benefit early detection of children at risk of behavioural problems. Furthermore, due to the relationship between pragmatic competence, behavioural problems and possible underlying disorders such as autism and attention-deficit hyperactivity disorder (ADHD), early assessment of pragmatic competence may also provide an early marker for the detection of autism or ADHD.

[The performance of school integration according to the perception of specialist teachers in therapeutic pedagogy]. / Funcionamiento de la integración en la enseñanza según la percepción de los maestros especialistas en Pedagogía Terapéutica.

The main purpose of this article is to analyse the perception that specialist teachers in therapeutic pedagogy have of the integration of students with specific needs for educational support. Diverse groups of students are differentiated. More specifically, it aims to know how teachers perceive students' performance and participation, and also certain attitudes towards the students (acceptance, involvement of fellow students…). Teachers' opinions of various measures to improve integration are also analysed as are the diverse preferred means of schooling and support. For this purpose, a 114-item Lickert-type questionnaire, with 8 additional personal identification items, was used. The sample comprised 106 specialist teachers who work in Asturias, out of an entire sample of 406. The results reveal that specialist teachers do not perceive the same attitudes in the different groups studied. Students with behaviour disorders are the most rejected and the ones from whom teachers can expect the least. The group of ethnic minorities needs to improve family involvement. The specialists demand more human and physical resources and most of them think that ordinary centres provide the most suitable form of schooling.

Evaluation of a Transition to University Programme for Students with Autism Spectrum Disorder.

Applying to university can be an anxiety-provoking time for many autistic students, though enrolment can be increased by actively involving them in transition planning. We provide an evaluation of a transition to university pilot programme (Autism Summer School) for autistic students (16-19 years) who are seeking to apply/attend university. The content focused on introducing students to various aspects of university life including academic (sample lectures), social (e.g., clubs and societies), and daily living (eating in university canteen and staying in student accommodation). Students' quantitative and qualitative feedback are positive and promising, showing significant reduction across a range of concerns related to transition to university after the programme, as well as general optimism related to starting university.

A Meta-analysis of Challenging Behavior Interventions for Students with Developmental Disabilities in Inclusive School Settings.

Challenging behavior is a significant barrier in accessing the general education curriculum for students with developmental disabilities. This necessitates the identification of evidence-based practices for addressing challenging behavior in inclusive settings. The purpose of our meta-analysis is to (a) quantify the magnitude of effect of interventions targeting the reduction of challenging behavior in students with developmental disabilities in inclusive educational settings and (b) determine if participant and intervention characteristics moderate intervention effects. A systematic search of academic databases was conducted to identify studies, which were evaluated for methodological rigor and analyzed for effects using Tau-U. Results indicate a strong overall effect of .94 (95% CI [.87, 1]) and moderating variables associated with behavior topography, interventionist, and intervention components were identified.

Early Interventionists' Appraisals of Intervention Strategies for Toddlers with Autism Spectrum Disorder and Their Peers in Inclusive Childcare Classrooms.

Mounting evidence supports several naturalistic developmental behavioral interventions (NDBI) for toddlers and preschoolers within inclusive childcare centers and preschools. However, these interventions pose many barriers to community implementation. As part of a larger project to create an adapted NDBI for early educators in childcare centers, we surveyed 101 early interventionists who had worked with a toddler with autism within the last 12 months. Early interventionists rated 22-of-31 NDBI strategies to be significantly more effective for All Toddlers versus Toddlers with Autism. However, when comparing the top 10 rated strategies between groups, there was a large degree of overlap. Moreover, many of these highly rated NDBI strategies are consistent with best practice accreditation and early education standards within the United States.