Twice-exceptionality unmasked: A systematic narrative review of the literature on identifying dyslexia in the gifted child.

In this systematic narrative review, we synthesised the small existing body of research on children who are gifted and dyslexic (G-D) in order to investigate the claim that G-D students have a unique profile, characterised by well-masked word-level reading and spelling difficulties. Our focus was on both the cognitive and academic profiles of this subgroup of twice-exceptional (2e) children and the assessment protocols used to identify them. Findings suggest that despite having processing deficits associated with dyslexia, G-D students' gifted strengths, especially those relating to oral language, may enable them to compensate for their reading difficulties, at least to an extent that they fail to meet standard diagnostic criteria. However, G-D students also perform poorly on word-level reading, reading fluency and spelling tasks when compared with both control groups and their gifted, non-dyslexic peers, providing clear evidence of impaired achievement. Findings from this review highlight the need for (a) a more nuanced approach to the assessment of students presenting with highly discrepant profiles and (b) future research into both the cognitive and academic profiles and the instructional needs of this highly able yet poorly understood group of students, whose potential may be masked and thus underestimated in the school setting.

Teachers' perspectives on the role and scope of practice of speech-language pathologists working to support literacy in the early years of school.

Purpose: The purpose of this study was to explore the views of teachers in early year levels about the role and scope for speech-language pathologists (SLPs) to work on literacy support in schools.Method: Sixty-one teachers from mainstream government schools across Victoria, Australia, completed an anonymous, online survey.Result: Although many respondents reported knowing that SLPs support the literacy learning of some students in their school, they had limited awareness of the scope of speech-language pathology practice in literacy instruction and intervention.Conclusion: Limited awareness of SLPs' expertise and scope of practice may be leading to missed opportunities for collaborative practices. In order to capitalise on SLPs' skill set for the benefit of students, the speech-language pathology profession should better promote and raise awareness of the various ways in which SLPs can collaborate within interprofessional literacy teams in schools.

Elementary Teachers' Perspectives on Teaching Reading Comprehension.

PURPOSE: We report findings from a survey of elementary teachers regarding reading instruction. The purpose was to examine teachers' beliefs about how children in the first 7 years of schooling develop reading comprehension skills and to characterize the self-reported practices and strategies they use to support children to comprehend connected text. METHOD: A web-based survey was used to collect data from 284 Australian elementary teachers about their beliefs and practices regarding reading comprehension instruction. Selected Likert-scale items were aggregated to determine the degree to which participants held "child-centered" or "content-centered" views of reading instruction. RESULTS: Australian elementary school teachers hold a wide range of beliefs about reading instruction, some of which are in direct opposition to each other. Our findings indicate low consensus about what elements of instructional practice are useful in classrooms or how time should be apportioned to different tasks. Commercial programs had significant penetration in schools, and many participants reported using multiple commercial programs, with varying degrees of pedagogical harmony. Participants indicated that their most common source of knowledge about reading instruction was their own personal research, with few nominating university teacher education as a primary source of knowledge or expertise. CONCLUSIONS: Little agreement exists within the Australian elementary teacher community regarding the ways that reading skills can and should be taught. There is significant room for teacher practice to have improved theoretical underpinnings and to develop a consistent repertoire of classroom practices aligned with these.

Australian speech-language pathologists' self-rated confidence, knowledge, and skill on constructs essential to practising in literacy with children and adolescents.

PURPOSE: To investigate Australian speech-language pathologists' (SLPs') knowledge of language and literacy constructs, skills in linguistic manipulation, and self-rated ability and confidence. METHOD: Two hundred and thirty-one SLPs from across Australia completed an online knowledge and skill assessment survey. RESULT: There was substantial individual variability regarding performance on items measuring the knowledge and skills of essential literacy constructs. SLPs were most likely to rate their confidence in providing intervention for phonological and phonemic awareness as "very good" or "expert". They reported lower confidence providing intervention for all other aspects of literacy. The majority of SLPs reported what they described as inadequate preservice training to practise in literacy. There was variability between respondents in their self-reported alignment with approaches and beliefs that are unsupported by current research evidence on reading instruction and support. CONCLUSION: The level and consistency of SLPs' literacy knowledge and skills requires improvement. The perception of inadequate preparation to practise in literacy may mean that SLPs are reluctant to engage in this area of practice. Minimum accreditation requirements specifically for literacy are recommended, together with assurance of ongoing professional learning opportunities spanning all components of literacy.

An exploratory study of speech-language pathologists' clinical practice in the literacy domain: Comparing onsite practices with telepractice services during COVID-19.

PURPOSE: To explore speech-language pathologists' (SLP) practice in literacy prior to, and during, COVID-19 to understand the practicalities, feasibility and sustainability of telepractice literacy services. METHOD: This exploratory study employed a cross-sectional survey comprising 46 questions covering participants' caseload profile and service delivery models, their assessment and intervention practices and telepractice delivery of literacy services. RESULT: Participants were 44 SLPs working primarily in private practice and education with children and adolescents. Students with literacy difficulties comprised a significant proportion of SLPs' caseloads. Individual and group sessions were the most common format of delivery prior to COVID-19. In a telepractice model during COVID-19, SLPs saw fewer students overall. Most provided individual sessions only and reported cancellation of group sessions. SLPs described their practice in literacy as being aligned with evidence-based principles. A range of resources were used for literacy assessment and intervention. For most, their usual practice changed for telepractice. Many felt underprepared to use telepractice and experienced numerous challenges mostly relating to technology and family engagement. CONCLUSION: Literacy has become a core area of practice for SLPs; however, continued advocacy towards consultative and collaborative services is needed within onsite and telepractice models. Telepractice required SLPs to develop additional skills and modify usual practice. Despite experiencing challenges, many indicated they would continue with telepractice given its perceived benefits.

Improving access to COVID-19 information by ensuring the readability of government websites.

ISSUE ADDRESSED: This study evaluated the readability of web pages from two public-facing Victorian government websites that were responsible for communicating key health messages relating to the COVID-19 pandemic in 2020. METHODS: Webpages were downloaded and filtered to identify relevant materials (English language materials containing HTML files that referred to COVID-19). The files were converted to text files and two Python packages, SpaCy and TextStat were used to obtain the data presented here. In addition to running two well-established readability tests, SMOG Index (Simple Measure of Gobbledygook) and Flesch Reading Ease formula, we also calculated the figures for sentence length and word length, which drive the readability measures and allow a disaggregated view of the data. Type token ratio measures were conducted as a reflection of the breadth of vocabulary used in the web pages. RESULTS: Derived measures of text complexity were higher than recommended levels of text complexity for health promotion materials, which are generally set at senior primary school levels. This did not vary depending on the intended audience (public or professional). A senior secondary reading level was required for effective engagement with the text published on both sites. CONCLUSIONS: Improving the readability of materials on key government websites where information about COVID-19 is being communicated to the public, represents a low cost and potentially effective means of improving public understanding of the pandemic and the steps individuals need to take to protect themselves and the community. SO WHAT?: Given the challenges widely identified in ensuring compliance with protective behaviours, confidence in seeking vaccination and increasing distrust of government, it would be strategic to improve public communication to ensure health messages are simple and readily understood. SUMMARY: The complexity and readability of text contained in web pages during 2020 from two Victorian government departments were evaluated. Communication regarding the restrictions and the management of risks associated with COVID-19 was the main focus of these 367 individual web pages from the Department of Health and Human Services (DHHS) and the Department of Education and Training (DET). Results indicated that across both sites and on both readability measures used, an education level equivalent to senior secondary school would be required to readily understand the contents.

The oral language and emergent literacy skills of preschoolers: Early childhood teachers' self-reported role, knowledge and confidence.

BACKGROUND: Early childhood teachers (ECTs) play a significant role in equipping children with oral language and emergent literacy skills ahead of school entry. They are well positioned to play a vital role in ensuring preschool children receive a high-quality preschool curriculum to prepare them for later literacy learning. AIMS: The purpose of this study was to explore early career ECTs' views and confidence regarding their role in providing preschoolers with oral language and emergent literacy support and to examine their perceptions of their preservice preparation. METHODS & PROCEDURES: Nine Australian early career ECTs were recruited via purposive sampling for an in-depth, semi-structured interview. Data were analysed using an inductive thematic analysis approach. OUTCOMES & RESULTS: Participants attached strong significance to their role in facilitating children's oral language growth and emergent literacy skills and reported a range of practices to support children's learning. However, they rarely referred to using established language facilitation strategies or using dialogic book reading prompts. Further, emergent literacy concepts such as phonological awareness and print awareness were not routinely described as features of participants' classroom activities. Participants did not consistently make a clear conceptual distinction between the constructs of oral language and emergent literacy and often used these terms interchangeably. Notably, participants indicated that they did not feel confident in their ability to identify preschool children who were not meeting developmental language milestones and reported that they felt poorly equipped to do so by their preservice training. CONCLUSIONS & IMPLICATIONS: ECTs' strong willingness to support preschool children's oral language and emergent literacy skills may be hindered by gaps in their knowledge; these may contribute to important and missed opportunities for identifying and supporting preschoolers' oral language and emergent literacy growth. WHAT THIS PAPER ADDS: What is already known on this subject? High-quality learning experiences in preschool are important for maximising preschoolers' oral language and emergent literacy growth. Early childhood teachers can play an important role in facilitating this development and preparing children for later literacy learning. What this paper adds to existing knowledge? The study findings provide insight into ECTs' perceptions of their role and support in developing children's oral language and emergent literacy skills. The results indicated ECTs did not feel confident with their knowledge of children's language milestones or identifying children with language difficulties. Participants reported that their preservice training left them underprepared in the area of oral language. What are the potential or actual clinical implications of this work? ECTs demonstrated a strong willingness to support preschoolers' oral language and emergent literacy skills. However, their self-reported knowledge gaps and low confidence may have implications for the early detection of children who are not reaching language developmental milestones in a timely way.

Leading Diverse Workforces: Perspectives from Managers and Employers about Dyslexic Employees in Australian Workplaces.

BACKGROUND: Dyslexia is a specific learning disability affecting around 1 in 10 Australian adults. It presents unique challenges for employees in the workforce, yet community and workplace awareness of the challenges of dyslexia is limited. The aim of this preliminary research was to explore the experiences and perspectives of Australian employers and managers responsible for supervising employees with dyslexia in the workplace. MATERIALS AND METHODS: Using a qualitative research design, we conducted in-depth interviews with four managers who had current or previous experience managing employees with dyslexia. We used a deductive approach to analyse the data and categorise responses to the study questions. RESULTS: Participant responses indicated that there is a lack of awareness and understanding of dyslexia within Australian workplaces. Participants identified challenges facing employees with dyslexia in the workplace including, differing personal levels of confidence and comfort in disclosing disability; the possibility of discrimination, and a lack of inclusive organisational practices and processes. Suggestions for ways to improve workplaces for dyslexic employees included: additional support for leaders and managers to drive inclusive leadership, and additional training for leaders and managers on how to best support employees with dyslexia. CONCLUSIONS: While only a small sample size, this study indicates that further research is needed to better understand the working environment of Australian leaders and managers. It appears that leaders and mangers need skills and knowledge to better support employees with dyslexia and in doing so create more inclusive workplaces.

"You Don't Look Dyslexic": Using the Job Demands-Resource Model of Burnout to Explore Employment Experiences of Australian Adults with Dyslexia.

BACKGROUND: Employment and job security are key influences on health and wellbeing. In Australia, little is known about the employment lifecycle of adults with dyslexia. MATERIALS AND METHODS: Using a qualitative research design, this study sought to explore the experiences faced by adults with dyslexia seeking and retaining employment. In-depth interviews were conducted with a cohort either currently or previously in the labour market. We used the Job Demands Resource Model of Burnout (JD-R Model) to explore links between workplace characteristics and employee wellbeing. Deductive content analysis attained condensed and broad descriptions of participants' workplace experiences. RESULTS: Dyslexic adults (n = 14) participated; majority employed part/full-time and experienced challenges throughout their employment; exhaustion and burnout at work were reported, also fear and indecision about disclosure of dyslexia. A minority reported receiving positive, useful support from team members following disclosure. CONCLUSION: The JD-R Model provided a guiding framework. We found participants experienced a myriad of challenges that included risk of mental exhaustion, discrimination, limited access to support and fatigue, leaving them vulnerable to job burn-out. Dyslexia does not have to be a major barrier to success in any occupation. Yet, when in supportive, informed workplace environments, employees with dyslexia thrive.

An evidence-based synthesis of instructional reading and spelling procedures using telepractice: A rapid review in the context of COVID-19.

BACKGROUND: Due to COVID-19, many educators and allied health practitioners are facing the challenge of rapidly transitioning to telepractice delivery of instructional reading and spelling procedures without being fully informed of the evidence. AIMS: A rapid review was conducted to provide educators, allied health practitioners and policymakers with a synthesis of valid, relevant and actionable evidence relating to telepractice delivery of instructional reading and spelling procedures. The aim was to investigate the nature and outcomes of studies examining instructional reading and spelling procedures delivered via telepractice to school-aged students. METHODS & PROCEDURES: A rapid review was undertaken in accordance with the eight-step process published by the Cochrane Rapid Reviews Methods Group. Medline (all databases), Embase, Cochrane and ProQuest Central were systematically searched with predefined search terms organized across four key concepts relating to the research questions. OUTCOMES & RESULTS: Nine studies were included in this rapid review. Reading and spelling instruction and intervention using telepractice can be feasible and engaging. Telepractice assessment for reading and spelling can be equally effective as onsite assessment. CONCLUSIONS & IMPLICATIONS: The evidence base for telepractice delivery of reading and spelling procedures is in its infancy in terms of both the quantity and the quality of the evidence. Insufficient evidence exists to draw clear conclusions about its efficacy, and therefore practitioners should proceed cautiously. What this paper adds What is already known on the subject For onsite delivery, evidence-based reading and spelling assessment, instruction and interventions delivered by educators and allied health practitioners have been shown to accelerate students' skills; less is known about the efficacy of instructional reading and spelling procedures in a telepractice model, which have rapidly become the new norm in many countries due to the COVID-19 pandemic. The benefits of telepractice include improved access to services, increased service availability, convenience, time efficiency, caseload management efficiency and removal of logistical barriers relating to cost and geographical location. During the COVID-19 pandemic, telepractice has facilitated continued access to services. What this study adds to existing knowledge Reading and spelling instruction and intervention delivered via telepractice can be feasible and engaging. Telepractice is a viable mode to deliver reading and spelling assessments with strong agreement between telepractice and onsite scores. Given their low methodological quality, the studies in this review provide valuable information around the how of telepractice reading and spelling procedures and highlight the factors that may contribute to positive outcomes with this service delivery model. What are the potential or actual clinical implications of this work? Educators and allied health practitioners need a thorough understanding of the student's telepractice environment and require adequate training and support to engage in telepractice service delivery. Educators and allied health practitioners should consider students for telepractice on a case-by-case basis. Practitioners should proceed cautiously with telepractice reading and spelling assessment, intervention and instruction, with the knowledge that the current available evidence is of limited quality.

Tablet-Based Apps for Phonics and Phonological Awareness: Protocol for Evidence-Based Appraisal of Content, Quality, and Usability.

BACKGROUND: The use of mobile apps to manage and promote health is becoming increasingly popular. Mobile apps are gaining popularity particularly in educational and interventional settings owing to their perceived advantages including support for and engagement of individuals with reading difficulties. In the context of COVID-19, the need for technology-based tools has increased. For practitioners and educators who wish to use apps in their practice or recommend apps to individuals with reading difficulties, it is challenging to identify high-quality apps in app stores. OBJECTIVE: This protocol describes a systematic search, selection, and appraisal process for tablet apps targeting phonics knowledge and phonological awareness skills. This protocol aimed to (1) provide a systematic method for identifying tablet apps targeting phonics knowledge and phonological awareness skills in the Google Play Store and Apple's App Store and (2) describe an evidence-based approach for quality appraisal of these apps by using structured tools. METHODS: This protocol describes an evidence-based method guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework to systematically search, select, and appraise apps targeting phonics knowledge and phonological awareness skills, present in Google Play and the App Store. We intend to perform a systematic and comprehensive search and a 2-step process for screening: (1) broad screening (app titles) and (2) narrow screening (marketing descriptions). Quality appraisal of the included apps will involve two structured appraisal tools: (1) the Mobile Application Rating Scale and (2) the Appraising Apps for Reading Checklist. RESULTS: This method will help determine the number of apps targeting phonics knowledge and phonological awareness, present on the Android and iOS platforms. The content, quality, and usability of these apps will be determined using structured appraisal tools. We have planned to conduct searches on Google Play and the App Store in January-March 2021; broad and focused screening, from April 2021; and data extraction and quality appraisal in October 2021. CONCLUSIONS: This protocol provides a basis for locating and evaluating apps targeting phonics knowledge and phonological awareness skills. This protocol will support practitioners, educators, and families to make informed decisions when purchasing apps for instructional use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/23921.

Treating Childhood Speech Sound Disorders: Current Approaches to Management by Australian Speech-Language Pathologists.

Purpose This study explored the intervention processes used by speech-language pathologists (SLPs) to treat children with speech sound disorders (SSDs). Method Semistructured, individual, in-depth interviews were conducted with 11 Australian SLPs. Inductive content analysis was used to classify the data to provide a description of current intervention processes for children with SSDs. Results Three main factors were identified relating to the intervention processes used by SLPs: (a) target selection, (b) therapy approaches, and (c) structural and procedural aspects of therapy sessions, including feedback. The findings revealed that SLPs often combine elements of four therapies: the minimal pairs approach, traditional articulatory approaches, auditory discrimination, and Cued Articulation. Initial therapy targets typically aligned with a developmental approach or were functional speech targets with meaningful relevance to the child and their family. Conclusions These findings contribute to the current state of knowledge about the intervention processes used by SLPs for children with SSDs. The use of hybrid speech pathology therapies, which combined elements of favored approaches, was common. Hybrid methods were intended to help tailor the interventions to individual needs. Client needs were highly prioritized by SLPs and influenced their choice of therapy targets and therapy approaches.

Narrative storytelling as both an advocacy tool and a therapeutic process: Perspectives of adult storytellers with acquired brain injury.

As part of a larger study exploring narrative storytelling, this paper focuses upon the experiences of eight adults with ABI who had participated in storytelling workshops facilitated by an advocacy organization. Following participation in the storytelling workshops, each storyteller was interviewed twice, with three shorter interviews conducted with one participant with significant communication challenges. In total, 25 interview transcripts (17 interviews plus eight transcripts of produced personal narratives) were analysed using constructivist grounded theory methods. Data analysis produced two main themes and sub-themes; (1) Sharing and helping (feeling heard & releasing emotions) and, (2) Re-visiting my story (reflecting and learning). The themes capture insights into the process of storytelling and reveal the therapeutic potential of narrative storytelling when coupled with an altruistic opportunity to help others through story sharing. This study contributes to an emerging area of research and practice supporting positive identity growth following ABI. The findings present substantial implications for goal setting and meaningful productive engagement in brain injury rehabilitation.

The oral language and reading comprehension skills of adolescents in flexible learning programmes.

Purpose: Access to flexible learning programmes (FLPs) for students who have been excluded or diverted from mainstream school settings is increasing internationally. While still technically "engaged with education" such students face long-term vulnerability with respect to acquiring marketable employment skills post-school. Language and literacy skills are central to such training; hence, this study describes the oral language and reading comprehension profiles of a sample of flexible learning programmes (FLP) students.Method: Fifty young people (mean age 16 years) enrolled in three FLPs in Victoria, Australia were assessed by a speech-language pathologist in order to profile their oral language and reading comprehension skills.Result: Seventy-two percent of participants had oral language skills that placed them in an at-risk range on standardised measures, and 47.5% had reading comprehension ages of ≤12 years. A moderate significant association existed between oral language and reading comprehension skills.Conclusion: Language and reading comprehension difficulties are prevalent in this population and may be missed in the context of the mental health and adjustment difficulties experienced by this group, but are likely to be key to academic engagement and success. Speech-language pathology scope of practice needs to include FLP settings.

Personal narrative approaches in rehabilitation following traumatic brain injury: A synthesis of qualitative research.

Although narrative storytelling has been found to assist identity construction, there is little direct research regarding its application in rehabilitation following traumatic brain injury (TBI). The aim of this review was to identify published evidence on the use of personal narrative approaches in rehabilitation following TBI and to synthesise the findings across this literature. A systematic search of four databases was conducted in December 2016. No limit was set on the start date of the search. Personal narrative approaches were defined as direct client participation in sharing personal stories using written, spoken or visual methods. The search retrieved 12 qualitative research articles on the use of personal narrative approaches in TBI rehabilitation. Thematic synthesis of the narrative data and authors' reported findings of the 12 articles yielded an overall theme of building a strengths-based identity and four sub-themes: 1) expressing and communicating to others; 2) feeling validated by the act of someone listening; 3) reflecting and learning about oneself; and 4) being productive. The findings of this review support the use of personal narrative approaches in addressing loss of identity following TBI. Healthcare professionals and the community are encouraged to seek opportunities for survivors of TBI to share their stories.

Processes and challenges in clinical decision-making for children with speech-sound disorders.

BACKGROUND: Children with speech-sound disorders (SSD) constitute a significant proportion of speech-language pathologists' (SLPs) caseloads. Previous research has investigated the clinical practice of SLPs intervening with children with SSD; however, little is known about the clinical decision-making underpinning their practice. AIMS: The clinical decision-making of SLPs working with children with SSD was explored to understand how their clinical decisions were influenced by: (1) beliefs about what works in therapy; (2) prior clinical experience; and (3) client and service-related variables. METHODS & PROCEDURES: Semi-structured, individual, in-depth interviews were conducted with 11 SLPs. Inductive thematic analysis was used to identify and explore key ideas and themes. OUTCOMES & RESULTS: Four themes emerged: (1) clinical decision-making procedures were highly individualized; (2) parental involvement was viewed as central to the success and progression of therapy; (3) therapy procedures were influenced by practice-setting constraints; and (4) engaging in evidence-based practice within clinical settings was perceived as challenging. CONCLUSIONS & IMPLICATIONS: In clinical settings, a range of factors influence decision-making and therapy provided by SLPs to children with SSD. These SLPs had a high regard for clients' values and preferences. Prior clinical experiences also shaped clinical practice. Clinical decision-making was influenced by practice-setting constraints. SLPs are under pressure in their workplaces and are struggling to manage the competing demands on their time. Large clinical caseloads, heavy workloads, current service-delivery models and changing family structures are all impacting on the provision of therapy to children with SSD and therapy outcomes. As a profession, there is a need to consider these barriers and identify ways to overcome them in order to assist SLPs to routinely adopt the highest standards of clinical practice for children with SSD.

Testing of a synthetic phonics-based targeted reading intervention for students with reading difficulties in Year 1: protocol for an efficacy randomised controlled trial.

INTRODUCTION: Literacy is fundamental for educational achievement, and in the longer term contributes substantially to a range of life skills. Literacy difficulties during the early years of school are associated with long-term impacts on academic success, with differences in academic achievement sustained through children's schooling. Therefore, addressing literacy difficulties during the early years of school is essential in reducing the risk of children progressing onto negative academic, psychosocial and vocational trajectories. This trial will determine whether a phonics-based reading intervention can improve the reading comprehension of students identified as low-progress readers in the second year of primary school. METHODS/DESIGN: We recruited 236 students fromnine schools after screening for reading difficulties in the second year of primary school (Year 1). Schools in Sydney and Central Coast of New South Wales will be invited to participate via an opt-out consent process. All children identified as being in the bottom 25th percentile using the Wheldall Assessment of Reading Lists will be eligible for the trial. These children will be randomised into either 'usual teaching' or 'intervention' groups. Trained school support teachers will deliver the MiniLit intervention. Intervention: In groups of four, children will complete a daily 1-hour lesson with their MiniLit teacher over 20 school weeks. Follow-up: Immediately after intervention completion and 6 months later using child face-to-face assessments. Primary outcome: Reading comprehension at 6 months after intervention completion. The study will have an embedded process and cost-effectiveness evaluation. DISCUSSION: The Building Better Readers trial will be the first efficacy randomised controlled trial comparing usual teaching with a phonics-based reading intervention for children with reading difficulties in Year 1 of primary school in Australia. The randomised design will limit the effect of bias on outcomes seen in other studies. TRIAL REGISTRATION NUMBER: ACTRN12617000179336.

Mobile apps for treatment of speech disorders in children: An evidence-based analysis of quality and efficacy.

BACKGROUND: Recently there has been exponential growth in mobile health (mHealth) applications (apps) for children with speech disorders. A challenge for health professionals and families is knowing how to find high quality apps that are therapeutically beneficial. We systematically search and critique the quality of mobile apps for childhood speech disorders. An evidence-based method for identifying suitable apps in the Google Play and Apple iTunes stores is also proposed. METHODS AND FINDINGS: A systematic search of the Google Play and Apple iTunes app stores was conducted from November 2016 to May 2017. Twelve pre-defined search terms were applied, identifying 5076 apps. Systematic screening resulted in 132 unique apps for full appraisal. These were appraised by two raters using the Mobile Application Rating scale. None were of excellent quality. Twenty-five were of good quality, 105 average and 2 were poor or very poor. DISCUSSION: It can be challenging for consumers to locate high quality speech therapy apps for children. Although we found more than 5000 apps, less than 3% met criteria for evaluation. Difficulties sourcing valid apps included: (i) Boolean operators were not available and therefore only one search term could be used each time (ii) the order of app listings in online stores continually changed (iii) apps were organised in online stores according to relevance and popularity (iv) there was no easy way to extract app titles and eliminate duplicates (v) app cost did not always correlate with therapeutic quality. CONCLUSIONS: The rapid growth of mHealth heightens the need to develop rigorous and efficient systems to search and retrieve apps and evaluate their therapeutic benefits. Given the difficulty accessing speech therapy services worldwide, mHealth promises therapy benefits when apps are reliable, valid and easily found.

Quality of Mobile Phone and Tablet Mobile Apps for Speech Sound Disorders: Protocol for an Evidence-Based Appraisal.

BACKGROUND: Although mobile apps are readily available for speech sound disorders (SSD), their validity has not been systematically evaluated. This evidence-based appraisal will critically review and synthesize current evidence on available therapy apps for use by children with SSD. OBJECTIVE: The main aims are to (1) identify the types of apps currently available for Android and iOS mobile phones and tablets, and (2) to critique their design features and content using a structured quality appraisal tool. METHODS: This protocol paper presents and justifies the methods used for a systematic review of mobile apps that provide intervention for use by children with SSD. The primary outcomes of interest are (1) engagement, (2) functionality, (3) aesthetics, (4) information quality, (5) subjective quality, and (6) perceived impact. Quality will be assessed by 2 certified practicing speech-language pathologists using a structured quality appraisal tool. Two app stores will be searched from the 2 largest operating platforms, Android and iOS. Systematic methods of knowledge synthesis shall include searching the app stores using a defined procedure, data extraction, and quality analysis. RESULTS: This search strategy shall enable us to determine how many SSD apps are available for Android and for iOS compatible mobile phones and tablets. It shall also identify the regions of the world responsible for the apps' development, the content and the quality of offerings. Recommendations will be made for speech-language pathologists seeking to use mobile apps in their clinical practice. CONCLUSIONS: This protocol provides a structured process for locating apps and appraising the quality, as the basis for evaluating their use in speech pathology for children in English-speaking nations.