Forum on Morphosyntax Assessment and Intervention for Children.

Purpose This forum consists of articles that address the need for and approaches to assessment and treatment of morphology and syntax in children. Drawing on papers submitted by diverse laboratories working with multiple populations, this forum includes several articles describing different approaches to treatment, guidelines for goal setting, and assessment methods. Populations described include monolingual and bilingual children who speak English, Dutch, and Spanish, who use oral language and/or augmentative and alternative communication to communicate. Conclusion The current tools available to support traditional grammar therapy are changing and increasing. An emphasis on manualized treatments, treatments that include drill and explicit instruction, and assessment and treatment tools for a variety of populations across a wide age span are included here. Further work is needed to fully develop these promising tools and approaches for the most effective use.

Speech and Language Disorders in Friedreich Ataxia: Highlights on Phenomenology, Assessment, and Therapy.

Speech and language disorders are prominent signs in Friedreich ataxia (FRDA), which significantly impact on patients' quality of life. Despite such relevance, several issues regarding phenomenology, assessment, and treatment are still unmet. In this short review, we thus analyzed the existing literature to summarize what is known about the features of speech and language disorders in FRDA, which methods are used for evaluation and rating, and what are the available therapeutic strategies and future direction of scientific research in this field, in order to highlight critical aspects for a better clinical approach to the problem. FRDA patients often present dysarthria, resulting from central and peripheral causes and additional primary language disorders. Speech disturbances have peculiar characteristics, although variable among patients, and progress along the disease course. Assessment relies on multiple but not specific clinical scales, some of which can also reflect the general severity of ataxia; classical instrumental investigations and novel technologies allow more accurate measurements of several speech parameters, which could found application as potential disease's biomarkers. No successful treatments exist for communication disorders of FRDA patients; however, the tailored speech training or the non-invasive neuromodulation appear as the most reliable therapeutic options to be validate in future trials.

Percepção do Agente Comunitário de Saúde sobre as demandas fonoaudiológicas do município de Pirpirituba-PB / Perception of the Community Health Agent on the speech-language pathology demands in Pirpirituba-PB / Percepción del agente comunitario de salud sobre las demandas fonoaudiológicas en el municipio de Pirpirituba-PB

Objetivo: analisar a percepção dos ACSs sobre as demandas fonoaudiológicas existentes na Atenção Básica no município de Pirpirituba-PB. Método: O projeto de pesquisa foi submetido e aprovado pelo Comitê de Ética em Pesquisa da instituição, com o parecer nº 2.194.691. Esta é uma pesquisa do tipo transversal com abordagem quantitativa, realizada nas Unidades de Saúde da Família do município pesquisado. Foram analisadas as demandas fonoaudiológicas existentes na Atenção Básica. Foi aplicado um questionário sobre queixas e ações fonoaudiológicas, com 22 Agentes Comunitários De Saúde (ACSs). Resultados: De maneira geral, o estudo mostrou que as maiores queixas de demanda fonoaudiológica do município estão inseridas na área de linguagem: dificuldade para falar (72,7%; n=16), síndromes (63,6%; n = 14), atraso de linguagem (59,1%; n = 13), dificuldade de atenção/concentração (59,1%;n=13) e que há informações disponíveis sobre esse atendimento nas Unidades Básicas de Saúde (UBS). Todos concordaram (100%; n=22) que há necessidade de maiores esclarecimentos sobre Fonoaudiologia, direcionados aos profissionais atuantes nas UBS's. Conclusões: São necessários maiores esclarecimentos sobre a fonoaudiologia para estes profissionais e a contratação de mais um profissional fonoaudiólogo para o município em questão.

Objective: to analyze the perception of ACSs on the Speech-Language Pathology demands in the Primary Care in Pirpirituba-PB. Methods: The research project was submitted and approved by the Research Ethics Committee of the institution under the no. 2.194.691. This is a cross-sectional research with quantitative approach, which was conducted in the Family Health Units of the city and analyzed the existing speech-language pathology demands in the Primary Care. A questionnaire on complaints and speech-language pathology initiatives was applied to 22 Community Health Agents (ACSs). Results:Overall, the study showed that the main complaints of speech-language pathology in the city are related to language: Difficulty speaking (72.7%; n=16), Syndromes (63.6%; n=14), Language delay (59.1%; n=13), Attention/concentration difficulty (59.1%; n=13) and that there is information available on this service at the Primary Health Units (UBS).. In addition, all ACSs agreed (100%; n=22) that there is a need for further clarification on speech-language pathology aimed at professionals working in UBSs. Conclusion: Further clarification on speech-language pathology should be provided to these professionals and another speech-language pathologist is required to meet the demand of the city.

Objetivo: analizar la percepción de los CHAs sobre las demandas de la terapia del habla existentes en Atención Primaria en la ciudad de Pirpirituba-PB. Método: El proyecto de investigación fue presentado y aprobado por el Comité de Ética en Investigación de la institución, con el dictamen nº 2.194.691. Esta es una investigación transversal con enfoque cuantitativo, llevada a cabo en las Unidades de Salud Familiar del municipio investigado. Se analizaron las demandas de terapia del habla existentes en Atención Primaria. Aplicamos un cuestionario sobre quejas y acciones de terapia del habla, con 22 agentes de salud comunitarios (CHA). Resultados: En general, el estudio mostró que las principales quejas de la demanda de patología del habla y el lenguaje en el municipio se encuentran en el área lingüística, dificultad para hablar (72.7%; n=16), síndromes (63.6%; n=14). retraso en el lenguaje (59.1%; n=13), dificultad de atención / concentración (59.1%; n=13) e información sobre esta atención disponible en las Unidades Básicas de Salud (BHU). Todos estuvieron de acuerdo (100%; n=22) en que se necesitan más aclaraciones sobre la terapia del habla, dirigidas a los profesionales que trabajan en la UBS. Conclusiones: estos profesionales necesitan más aclaraciones sobre la terapia del habla y la contratación de otro terapeuta del habla para el municipio en cuestión.

Introduction to the Clinical Forum: Exploring Curriculum-Based Language Assessment and Interventions.

Purpose: The purpose of this article is to introduce the Clinical Forum: Exploring Curriculum-Based Language Assessment and Interventions, which investigates the current evidence supporting curriculum-based language intervention and assessment. Method: This introduction highlights the need for speech-language pathologists to approach intervention with knowledge of the best evidence available and highlights the 6 articles presented in this clinical forum. Conclusion: The articles in this clinical forum shed light on the current state of the evidence for curriculum-based language intervention and assessment across the educational continuum. Authors provide readers with access to techniques available to all school-based speech-language pathologists to advocate for, assess, and implement interventions within the classroom curriculum. This forum also establishes the need for more data to support current school-based models of assessment and intervention.

Parent-implemented home therapy programmes for speech and language: a systematic review.

BACKGROUND: Parent-delivered home programmes are frequently used to remediate speech and language difficulties in young children. However, the evidence base for this service delivery model is limited. AIMS: The aim of this systematic review is to investigate the effectiveness of parent-implemented home programmes in facilitating the development of children's speech and language skills, and to evaluate the cost-effectiveness and feasibility of this service delivery method. METHODS & PROCEDURES: A systematic search of the PsycINFO, CINAHL and ERIC databases was conducted. Quality appraisal of individual studies was conducted. Findings from each of the studies were then integrated to report on outcomes for the child, the parent and the service. OUTCOMES & RESULTS: There is preliminary evidence that home programmes can lead to growth in a child's speech and language skills and are more effective than no intervention, provided the home programmes are used with high dosage rates and direct parent training. CONCLUSIONS & IMPLICATIONS: Home programmes are a potentially useful service delivery model, but caution should be exercised when considering their use to address broader service delivery challenges. Further high-level evidence is needed across all facets of this service delivery model.

Inequalities in the provision of paediatric speech and language therapy services across London boroughs.

BACKGROUND: The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest. AIMS: To examine the provision of paediatric speech and language services across London boroughs and to relate provision to the level of deprivation of the boroughs. METHODS & PROCEDURES: Information on the employment of paediatric speech and language therapists was obtained from London boroughs by freedom-of-information requests. The relationship between the number of therapists and the index of multiple deprivation for the borough was examined. OUTCOMES & RESULTS: Twenty-nine of 32 boroughs responded. A positive relationship between provision and need was obtained, suggesting that the inverse-care law does not apply. However, large inequalities of provision were found particularly among the more socially deprived boroughs. In some instances boroughs had five times as many therapists per child as other boroughs. CONCLUSIONS & IMPLICATIONS: The data reveal that large differences in speech and language therapy provision exist across boroughs. The reasons for these inequalities are unclear, but the lack of comparative information across boroughs is likely to be unhelpful in planning equitable services. The use of freedom of information in assessing health inequalities is stressed and its future availability is desirable.

Morphological awareness assessment and intervention to improve language and literacy.

Morphological awareness positively influences language and literacy development and may be an ideal intervention focus for improving vocabulary, sight word reading, reading decoding, and reading comprehension in students with and without language and literacy deficits. This article will provide supporting theory, research, and strategies for implementing morphological awareness intervention with students with language and literacy deficits. Additionally, functional connections are explored through the incorporation and application of morphological awareness intervention in academic literacy contexts linked to Common Core State Standards.

Healthcare costs associated with language difficulties up to 9 years of age: Australian population-based study.

PURPOSE: This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children. METHOD: Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. RESULT: It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $AU206, 95% CI = $90, $321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $AU1.2-$AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties. CONCLUSION: Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

Speech sound disorders in a community study of preschool children.

PURPOSE: To undertake a community (nonclinical) study to describe the speech of preschool children who had been identified by parents/teachers as having difficulties "talking and making speech sounds" and compare the speech characteristics of those who had and had not accessed the services of a speech-language pathologist (SLP). METHOD: Stage 1: Parent/teacher concern regarding the speech skills of 1,097 4- to 5-year-old children attending early childhood centers was documented. Stage 2a: One hundred forty-three children who had been identified with concerns were assessed. Stage 2b: Parents returned questionnaires about service access for 109 children. RESULTS: The majority of the 143 children (86.7%) achieved a standard score below the normal range for the percentage of consonants correct (PCC) on the Diagnostic Evaluation of Articulation and Phonology (Dodd, Hua, Crosbie, Holm, & Ozanne, 2002). Consonants produced incorrectly were consistent with the late-8 phonemes ( Shriberg, 1993). Common phonological patterns were fricative simplification (82.5%), cluster simplification (49.0%)/reduction (19.6%), gliding (41.3%), and palatal fronting (15.4%). Interdental lisps on /s/ and /z/ were produced by 39.9% of the children, dentalization of other sibilants by 17.5%, and lateral lisps by 13.3%. Despite parent/teacher concern, only 41/109 children had contact with an SLP. These children were more likely to be unintelligible to strangers, to express distress about their speech, and to have a lower PCC and a smaller consonant inventory compared to the children who had no contact with an SLP. CONCLUSION: A significant number of preschool-age children with speech sound disorders (SSD) have not had contact with an SLP. These children have mild-severe SSD and would benefit from SLP intervention. Integrated SLP services within early childhood communities would enable earlier identification of SSD and access to intervention to reduce potential educational and social impacts affiliated with SSD.

Clinicians' management of young children with co-occurring stuttering and speech sound disorder.

Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants' main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload.

Algunos retos y propuestas en la conceptualización, evaluación e intervención del Trastorno Específico del Lenguaje (TEL) / Some challenges and proposals in the conceptualization, assessment and intervention of Specific Language Impairment (SLI)

El presente trabajo tiene como objetivo principal reflexionar sobre algunos tópicos actuales en torno al Trastorno Específico del Lenguaje (TEL), fruto de nuestro trabajo investigador de los últimos años y de los nuevos retos que hemos afrontado. En primer lugar, se revisan aquellos aspectos cruciales en la conceptualización de este trastorno. En segundo lugar, se analiza la problemática alrededor de su evaluación y se hacen propuestas de instrumentos a utilizar para una identificación temprana. Finalmente, se sugiere un modelo de trabajo basado en diferentes niveles de intervención, en la colaboración profesional y en la combinación de procedimientos y estrategias.

The main objective of this paper is to reflect on some current issues about the Specific Language Impairment (SLI), as a result of our research work carried out lately and the new challenges we have faced up to. Firstly, we go through the key aspects in the conceptualization of this impairment. Secondly, we analyze the problems associated with assessment and we proposed some instruments to be used for early identification. Finally, we suggest a working approach based on different levels of intervention, on professional collaboration and on the combination of procedures and strategies.

A new era in speech-language pathology practice: innovation and diversification.

A new era in speech-language pathology practice is pending, and one that impels us to innovate and diversify as we move forward into the 21(st) century. The impetus for this transformation will include the increasing cost and demand for healthcare services as the population ages, changes in Australian society, rapid developments in technology, and major advances in neuroscience. New models of service delivery will need to be considered in line with evidence-based treatment protocols, the concept of a continuum of care for chronic disorders, and the need to engage clients in self-management. Innovations in technology will provide the means by which these new models of service delivery might be achieved. The exponential increase in electronic therapy resources and devices will transform the therapeutic process and provide clinicians with engaging and flexible therapy options. Clinicians will be challenged by this paradigm shift in service delivery, and their long-held perceptions of their clients' capacity to respond to these changes. Other challenges will include the preparation of future speech-language pathologists, reimbursement for services, availability of appropriate technology, and widespread connectivity. The future of the profession is an exciting one as we move forward into an era of unprecedented change.

Survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: patients' and carers' perspectives.

BACKGROUND: Communication and swallowing changes are prominent in Parkinson's disease, but there remains a lack of information regarding the experiences and expectations of people with Parkinson's disease in respect of speech-language therapy (SLT) services. AIMS: To conduct a survey of people with Parkinson's disease and their carers in the United Kingdom to elicit their views concerning communication and swallowing changes in Parkinson's disease and the support they envisage in helping with these changes. METHODS & PROCEDURES: A national survey utilizing a questionnaire developed for the project, accessible by people with Parkinson's disease in web-based, e-mail or paper forms. OUTCOMES & RESULTS: A total of 168 people with Parkinson's disease (median = 7 years since diagnosis, range = 0.5-30) and 47 carers who provided their impression of the experience of the PwPD responded. Of these 215, 92 (43%) had no contact with SLT services. In general those who had seen an SLT found it a positive experience. Pointers for improvement centred around timing, intensity, duration and access to SLT as well as issues around transfer and maintenance of gains outside of clinic and (lack of) attention to psychosocial dimensions. Availability of ongoing support as the situation evolved and access to SLT when it was needed were two prominent features desired of a responsive service. CONCLUSIONS & IMPLICATIONS: Responses suggest that when SLT is available it offers positive support, but respondents felt (re)access when and where SLT is needed could improve, as well as what aspects of swallowing and communication were addressed in assessment and therapy. We reflect on possible recommendations to address the challenges for SLT services in considering organization and content of provision.

Working memory and specific language impairment: an update on the relation and perspectives on assessment and treatment.

PURPOSE: Children with specific language impairment (SLI) demonstrate significant language impairments despite normal-range hearing and nonverbal IQ. Many of these children also show marked deficits in working memory (WM) abilities. However, the theoretical and clinical characterization of the association between WM and language limitations in SLI is still sparse. Our understanding of this association would benefit greatly from an updated and thorough review of the literature. METHOD: We review the newest developments in these areas from both a theoretical and clinical perspective. Our intent is to provide researchers and practicing clinicians (a) a conceptual framework within which the association between WM and language limitations of children with SLI can be understood and (b) potentially helpful suggestions for assessing and treating the memory-language difficulties of children with SLI. CONCLUSIONS: In the past 10 years, important new theoretical insights into the range and nature of WM deficits and relation between these limitations and the language difficulties in SLI have occurred. New, robust diagnostic assessment tools and computerized treatment methods designed to enhance children's WM functioning have also been developed. The assessment, diagnosis, and treatment of the language difficulties in SLI should consider the potential influence of WM.

What makes a caseload (un)manageable? School-based speech-language pathologists speak.

PURPOSE: Large caseload sizes and a shortage of speech-language pathologists (SLPs) are ongoing concerns in the field of speech and language. This study was conducted to identify current mean caseload size for school-based SLPs, a threshold at which caseload size begins to be perceived as unmanageable, and variables contributing to school-based SLPs' feelings of caseload manageability. METHOD: Approximately 2,000 public-school-based SLPs from across the country were solicited to participate in an online, Web-based survey between April and May of 2007. Of those SLPs who were contacted, 634 full-time SLPs from 49 states completed the survey. The data were evaluated using descriptive statistics and logistic regression. RESULTS: The mean caseload size for SLPs in this study was 49 students. At the caseload range of 41-50 students, approximately 60% of the SLPs perceived their caseload size as unmanageable. Logistic regression revealed caseload size, years of experience, and extent of collaboration as significant predictors of an SLP's likelihood of feeling that his or her caseload size is manageable. CONCLUSIONS: Caseload size continues to be an area of concern for school-based SLPs, and efforts to address this problem must continue in order to prevent long-term struggles with SLPs' dissatisfaction, shortages, and turnover. Policy, research, and clinical implications are discussed.

Response to intervention and dynamic assessment: do we just appear to be speaking the same language?

In this article we compare and contrast two frameworks for assessment that appear to share the same language yet produce very different approaches and outcomes: response to instruction/intervention and dynamic assessment. We explore the nature of each, elaborate their similarities and differences, and suggest there are sufficient similarities in goals and principles that the two should be melded into a single model that promotes development of learning competence in children. We specifically consider the relevance of the combined model of response to intervention plus dynamic assessment for professionals involved with language development and disorders.

Automatic speech recognition (ASR) and its use as a tool for assessment or therapy of voice, speech, and language disorders.

In general opinion computerized automatic speech recognition (ASR) seems to be regarded as a method only to accomplish transcriptions from spoken language to written text and as such quite insecure and rather cumbersome. However, due to great advances in computer technology and informatics methodology ASR has nowadays become quite dependable and easier to handle, and the number of applications has increased considerably. After some introductory background information on ASR a number of applications of great interest for professionals in voice, speech, and language therapy are pointed out. In the foreseeable future, the keyboard and mouse will by means of ASR technology be replaced in many functions by a microphone as the human-computer interface, and the computer will talk back via its loud-speaker. It seems important that professionals engaged in the care of oral communication disorders take part in this development so their clients may get the optimal benefit from this new technology.

Cost analysis of direct versus indirect and individual versus group modes of manual-based speech-and-language therapy for primary school-age children with primary language impairment.

BACKGROUND: The study is the first within trial cost analysis of direct versus indirect and individual versus group modes of speech-and-language therapy for children with primary language impairment. AIMS: To compare the short-run resource consequences of the four interventions alongside the effects achieved measured by standardized scores on a test of expressive and receptive language. METHODS & PROCEDURES: The study design was a cost analysis integrated within a randomized controlled trial using a 2x2 factorial design (direct/indirect versus individual/group therapy) together with a control group that received usual levels of community-based speech-and-language therapy. Research interventions were delivered in school settings in Scotland, UK. Children aged between 6 and 11 years, attending a mainstream school, with standard scores on the Clinical Evaluation of Language Fundamentals (CELF-III(UK)) of less than -1.25 standard deviation (SD) (receptive and/or expressive) and non-verbal IQ on the Wechsler Abbreviated Scale of Intelligence (WASI) above 75, and no reported hearing loss, no moderate/severe articulation/phonology/dysfluency problems or otherwise requiring individual work with a speech-and-language therapist. The intervention involved speech-and-language therapists and speech-and-language therapy assistants working with individual children or small groups of children. A therapy manual was constructed to assist the choice of procedures and activities for intervention. The cost analysis focused on the salary and travel costs associated with each mode of intervention. The cumulative distribution of total costs arising from the time of randomization to post-intervention assessment was estimated. Arithmetic mean costs were compared and reported with their 95% confidence intervals. OUTCOMES & RESULTS: The results of the intention-to-treat analysis revealed that there were no significant post-intervention differences between direct and indirect modes of therapy, or between individual and group modes on any of the primary language outcome measures. The cost analysis identified indirect therapy, particularly indirect group therapy, as the least costly of the intervention modes with direct individual therapy as the most costly option. The programme cost of providing therapy in practice over 30 weeks for children could represent between 30% and 75% of the total gross revenue spend in primary school per pupil, depending on the choice of assistant led group therapy or therapist-led individual therapy. CONCLUSIONS & IMPLICATIONS: This study suggests that speech-and-language therapy assistants can act as effective surrogates for speech-and-language therapists in delivering cost-effective services to children with primary language impairment. The resource gains from adopting a group-based approach may ensure that effective therapy is provided to more children in a more efficient way.

Direct versus indirect and individual versus group modes of language therapy for children with primary language impairment: principal outcomes from a randomized controlled trial and economic evaluation.

BACKGROUND: Many school-age children with language impairments are enrolled in mainstream schools and receive indirect language therapy, but there have been, to the authors' knowledge, no previous controlled studies comparing the outcomes and costs of direct and indirect intervention delivered by qualified therapists and therapy assistants, and each delivery mode offered to children individually or in groups. AIMS: To investigate the relative effectiveness of indirect and direct intervention therapy modes delivered individually or in groups for children with primary language impairment. METHODS & PROCEDURES: A multi-centre randomized controlled trial investigated 161 children with primary language impairment aged 6-11 years randomized to a usual-therapy control group or to direct individual, indirect individual, direct group or indirect group therapy modes. Intervention was delivered three times a week for 30-40-min sessions in mainstream schools over 15 weeks. Language performance was assessed at baseline, post-therapy and at 12 months. Cost analysis was based on salary and travel costs for intervention modes and usual therapy. OUTCOMES & RESULTS: Compared with controls, children receiving project therapy made short-term improvements in expressive (p = 0.031), but not receptive, language immediately following intervention. Children with specific expressive language delay were more likely to show improvement than those with mixed receptive-expressive difficulties. The four project therapy modes did not differ on primary language outcomes (all p-values>0.392) and there were no further improvements evident at follow-up. Indirect group therapy was the least costly mode, with direct individual therapy the most costly. CONCLUSIONS & IMPLICATIONS: Intervention in this age group can be effective for expressive language and can be delivered equally effectively though speech and language therapy assistants and to children in groups.