Understanding mental health in developmental dyslexia through a neurodiversity lens: The mediating effect of school-connectedness on anxiety, depression and conduct problems.

Dyslexia, a neurocognitive difference characterised by poor word-reading, is associated with elevated risk for internalising (e.g., anxiety) and externalising (e.g., aggression) mental health concerns, the reasons are largely unknown. We took a neurodiversity perspective and explored whether school-connectedness mediated these associations. A total of 283 primary school children (87 with dyslexia) and their caregivers (95.4% mothers) completed a battery of well-validated connectedness and mental health measures. Two mediation models (one for child-report and one for caregiver-report) tested direct and indirect effects of dyslexia on anxiety, depression and conduct problems via several domains of school-connectedness. After controlling for gender and neurodevelopmental conditions other than dyslexia, there were no direct effects of dyslexia on child- or caregiver-reported internalising symptoms or child-reported conduct problems. Dyslexia was associated with child and caregiver reported anxiety, depression and conduct problems via low levels of school (but not teacher, friend or peer) connectedness. Findings highlight school-connectedness as an important intervention target for the mental health of children with dyslexia. Future research is needed to test associations between dyslexia, school-connectedness and mental health over time.

Editorial Perspective: Maximising the benefits of intervention research for children and young people with developmental language disorder (DLD) - a call for international consensus on standards of reporting in intervention studies for children with and at risk for DLD.

Current methods for reporting interventions do not allow key questions of importance to practitioners, service providers, policy-makers and people with DLD to be answered, and hence limit the implementation of effective interventions in the real world. To extend the existing EQUATOR guidelines to the context of speech language therapy/pathology for children with language disorder and to provide more specific guidance on participants, interventions and outcomes within the CONSORT checklist (used to improve the reporting of randomised controlled trials) and TIDieR (Template for Intervention Description and Replication) to ensure consistency of reporting. We will develop a core team to include representatives from each of the key groups who will either use or be influenced by the final reporting guidance across different countries. To achieve each set of aims, we will conduct reviews of the literature (which present typologies of intervention characteristics in (D)LD and related disorders); carry out focus groups; and use systematic consensus methods such as the Delphi technique, nominal group technique or consensus development conferences. Through the development and adoption of standard intervention reporting criteria, we anticipate that we will overcome the numerous barriers for practitioners, services and policy-makers in applying intervention evidence to practice. We believe that establishing international consensus on reporting guidelines would significantly accelerate progress in DLD research and the ease with which it can be used in clinical practice, by capitalising on the growth in intervention studies to enable international collaboration and new methodologies of data pooling, meta-analyses and cross-study comparisons.

Growing up with dyslexia: Child and parent perspectives on school struggles, self-esteem, and mental health.

Children with dyslexia, compared with typically reading peers, are at increased risk of internalising (e.g., anxiety) and externalising (e.g., aggression) mental health concerns; why this is the case is largely unknown. Our aim was to explore the socio-emotional experience of growing up with dyslexia from both child and parent perspectives. In so doing, we aimed to gain a better understanding of self-esteem and mental health in the context of dyslexia. One-to-one semi-structured interviews with 17 children with reading difficulties (aged 9-14 years; 16 with a diagnosis of dyslexia) and their mothers (interviewed separately) were analysed using Braun and Clarke's reflexive thematic analysis approach with a neurodiversity lens. We developed three themes to address the research aim: (1) Different in a good/bad way; (2) Exhausted and overwhelmed; and (3) It takes a community: Family school connections. Children discussed having "worries" and experiencing school-related stress and embarrassment. Mothers perceived children's internalising and externalising behaviour (meltdowns), school refusal, and homework resistance as emotional responses to children's school struggles due to poor "person-environment fit." Our analysis highlights the particular importance of parent support, friendship, and school-connectedness for the wellbeing of children with dyslexia.

"I struggle at times to see her struggle": Mothers' perspectives on dyslexia-related school struggles and the inter-connected nature of mother and child well-being.

INTRODUCTION: Parents of children with dyslexia may be at elevated risk for parenting stress and mental health concerns. Our aim was to explore the emotional experience of growing up with dyslexia in Australia from parents' perspectives. In so doing, we also developed an understanding of parents' own mental health and support needs informed by their lived experience. METHODOLOGY: Seventeen interviews with mothers of children (9-14 years; 16 with a diagnosis of dyslexia) were analysed using Braun and Clarke's reflexive thematic analysis approach. ANALYSIS: Five themes were developed to address our aim: Theme 1: Years in the wilderness: Life before diagnosis; 2: "I struggle at times to see her struggle"; 3. School struggles: Advocating for our children and managing distress; 4. "It's a full-time job" and a "long slog"; 5: Care for the carer: Social support and coping strategies. CONCLUSIONS: Our analysis suggests that mothers of children with dyslexia may be at elevated risk for mental health concerns. Specifically, chronic worry and stress, secondary distress, challenges to parenting self-efficacy, and lack of support and understanding (feeling isolated) were highlighted as plausible risk factors. Mothers described coping strategies at the community level (e.g., school connectedness) and at the individual level (e.g., "acceptance") as protective.

The Engage with Developmental Language Disorder (E-DLD) project: Cohort profile.

BACKGROUND: Public awareness of Developmental Language Disorder (DLD) is lower than other neurodevelopmental disorders, despite its high prevalence of 7.6%. This lower awareness means recruitment for DLD research studies is difficult. DLD is both underfunded and under-researched, resulting in relatively limited research investigating individuals with DLD. Engage with Developmental Language Disorder (E-DLD) is a response to these considerations. E-DLD is the first international participant database of those affected by DLD. Parents of children with DLD under 16 and young people and adults over 16 from anywhere in the world can sign up to be a part of the E-DLD. AIMS: This paper aims to describe the families of children with DLD and adults with DLD in the database thus far. METHODS & PROCEDURES: E-DLD members sign up via our website, reporting demographic characteristics as part of this procedure. We request all E-DLD members subsequently fill in a yearly survey. The content of the yearly survey changes dependent on the age of the child, while the yearly survey for adults remains consistent. We measure a wide range of domains, such as speech and language therapy (SLT) support, school support, socialisation skills, and early developmental milestones for our youngest members, and health care support and mental well-being measurements for our adults. We also collect parent and self-reported reflections on strengths and challenges for the person with DLD using open-ended questions and the Strengths and Difficulties Questionnaire. OUTCOMES & RESULTS: The database currently consists of 196 parents of children with DLD and 20 individuals over the age of 16 with DLD or suspected DLD across a range of socioeconomic status (SES) backgrounds. Our initial results confirm that E-DLD members meet the linguistic profile of DLD in relation to self- or parent-rated language difficulties. Both children and adults show increased rates of psychosocial difficulties compared to established norms, consistent with past research on clinical samples of people with DLD. CONCLUSIONS & IMPLICATIONS: The findings indicate that a participant database for DLD research is feasible and useful. The rates of emotional, behavioural and sleep difficulties among the child probands are higher than reported rates amongst typically developing children. Initial data indicate that adults with DLD have poorer well-being than their peers. The E-DLD is a useful collection of data on those affected by DLD and is a promising method for connecting people with DLD with academic researchers. WHAT THIS PAPER ADDS: What is already known on this subject Developmental Language Disorder (DLD) is characterised by expressive and/or receptive language difficulties in the absence of another biomedical condition that could explain these difficulties. It is critically under-researched and underfunded. As such, there is a lack of public awareness and difficulty recruiting sufficient sample sizes for DLD research studies. What this paper adds to existing knowledge Engage with Developmental Language Disorder (E-DLD) is the first international participant database of individuals with DLD. This paper provides a preliminary report on the profile of linguistic and psychosocial skills among the individuals on the database, adding to current understanding of DLD across age groups. What are the potential or actual clinical implications of this work? Our aim is that the E-DLD will provide much-needed facilitation of research into DLD. E-DLD will enable those with DLD and their families more readily to shape research agendas and to participate in studies that interest them. Families may be recruited into research that could directly translate to better clinical treatment of DLD. We also believe that the E-DLD yearly survey holds potential to provide key information on the development and longitudinal experience of children and adults with DLD.

The grammaticality judgement of inflectional morphology in children with and without Developmental Language Disorder.

To explore the clinical potential of grammaticality judgement tasks, this study investigated whether a Grammaticality Judgment Task (GJT) of inflectional morphology could differentiate between a clinically selected sample of children with DLD and children in mainstream (i.e. regular education) schools. We also explored the relationship between grammaticality judgement and measures of receptive vocabulary, receptive grammar, and nonword repetition. Children with DLD (n = 30; age range = 69-80 months) and mainstream children in Pre-primary, Year 1, and Year 2 (n = 89, age range = 61-96 months) were assessed on a GJT of regular past tense, third person singular, and possessive 's. The GJT was sensitive to developmental differences in mainstream children and differentiated children with DLD from Year 1 and 2 mainstream children, with DLD results consistent with a one-year delay in performance compared to controls. The GJT was the strongest discriminator of membership to a clinically selected sample of children with DLD (ROC curve analysis, area under the curve = 88%). Receptive grammar, receptive vocabulary, and nonword repetition were related to performance on the GJT. The grammaticality judgement of inflectional morphology shows promise as a reliable indicator of DLD and a measure sensitive to developmental differences in mainstream children. GJTs should continue to be explored for clinical application as a potential tool for both assessment and intervention.

A profile of expressive inflectional morphology in early school-age children with developmental language disorder.

Previous research has established that children with developmental language disorder (DLD) have difficulties producing inflectional morphology, in particular, finiteness marking. However, other categories of inflectional morphology, such as possessive 's nominal inflection remain relatively unexplored. Analyses of the characteristics for marking inflection, such as allomorphic categories, may increase our understanding of patterns within disordered grammar to inform the design of interventions and target selection. Data from n = 30 early school-aged children (M = 75 months, SD = 3.38, range = 69-81 months) with DLD were analysed to develop a profile of inflectional morphology skills. Morphological categories included expressive regular past tense, third person singular, and possessive 's. Skills were profiled using an elicitation task. The relationships between expressive morphosyntax, and phonological short-term memory and working memory were also explored. Children demonstrated low accuracy in performance across all inflectional categories, including possessive 's. There were no significant differences between productions of different morphemes, but syllabic allomorphs ([əd]; [əz]) were produced with significantly lower accuracy than segmental allomorphs ([d], [t]; [z], [s]) across all morphological categories. All correlations between expressive morphosyntax and measures of memory were non-significant. Children with DLD show broad deficits in the ability to mark for inflection, including possessive 's; this has implications for theories explaining DLD. Findings may contribute to the design of urgently needed interventions for this clinical population.

Oral and written communication skills of adolescents with prenatal alcohol exposure (PAE) compared with those with no/low PAE: A systematic review.

BACKGROUND: Prenatal alcohol exposure (PAE) is associated with growth deficits and neurodevelopmental impairment including foetal alcohol spectrum disorder (FASD). Difficulties with oral and written communication skills are common among children with PAE; however, less is known about how communication skills of adolescents who have PAE compare with those who do not. Adolescence is a critical time for development, supporting the transition into adulthood, but it is considered a high-risk period for those with FASD. AIMS: We conducted a systematic review to synthesize evidence regarding oral and written communication skills of adolescents with PAE or FASD and how they compare with those with no PAE. METHODS & PROCEDURES: A comprehensive search strategy used seven databases: Cochrane Library, Cinahl, Embase, Medline, PsycInfo, Eric and Web of Science. Included studies reported on at least one outcome related to oral and written communication for a PAE (or FASD) group as well as a no/low PAE group, both with age ranges of 10-24 years. Quality assessment was undertaken. MAIN CONTRIBUTION: Communication skills most often assessed in the seven studies included in this review were semantic knowledge, semantic processing, and verbal learning and memory. These communication skills, in addition to reading and spelling, were commonly weaker among adolescents with PAE compared with those with no/low PAE. However, the findings were inconsistent across studies, and studies differed in their methodologies. CONCLUSIONS & IMPLICATIONS: Our results emphasize that for adolescents with PAE, communication skills in both oral and written modalities should be comprehensively understood in assessment and when planning interventions. A key limitation of the existing literature is that comparison groups often include some participants with a low level of PAE, and that PAE definitions used to allocate participants to groups differ across studies. WHAT THIS PAPER ADDS: What is already known on the subject PAE and FASD are associated with deficits in oral and written communication skills. Studies to date have mostly focused on children with a FASD diagnosis as well as combined groups of children and adolescents with FASD or PAE. There is a gap in what is known about oral and written communication skills of adolescents, specifically, who have PAE or FASD. This has implications for the provision of assessment and supports during a period of increased social and academic demands. What this study adds to existing knowledge This review provides systematic identification, assessment and synthesis of the current literature related to oral and written communication skills of adolescents with PAE compared with those with no/low PAE. The review revealed a small knowledge base with inconsistent methodologies and findings across studies. However, the findings overall highlight that adolescents with PAE have weaker skills in oral and written language than those with no/low PAE. Results are discussed in relation to education, social and emotional well-being, and forensic contexts. What are the potential or actual clinical implications of this work? Findings emphasize that for adolescents with PAE, comprehensive assessment of both oral and written communication skills, through both standardized and functional tasks, should be undertaken. Speech-language pathologists have a key role in assessment with individuals who have PAE.

Evaluating two different dose frequencies and cumulative intervention intensities to improve past tense production for early school-aged children with developmental language disorder.

AIMS: This study compared two dose frequency conditions of an explicit intervention with 50 trials per session designed to improve past tense marking in early school-aged children with developmental language disorder (DLD). The influence of allomorphs on intervention effects was also examined. METHODS: Data from previously conducted intervention studies were combined and analysed. Participants included nine children (mean age = 6;5 years) who received 20-30-min intervention sessions provided twice per week for 10 weeks (1000 trials; 400-600 min) and 20 children (mean age = 6;6) who received 20-30-min intervention sessions provided once per week for 10 weeks (500 trials; 200-300 min). Repeated measures included criterion-referenced probes for production of untrained past tense verbs collected throughout baseline, intervention, and maintenance phases. The rate of progress in each phase was analysed using logistic regression. The proportion of participants who produced past tense allomorphs correctly at pre-intervention, post-intervention, and maintenance testing points was analysed. RESULTS: Logistic regression showed a stable baseline, highly significant progress during the intervention phase, and a marginally significant shallow decline during the maintenance phase. Those in the twice per week group showed a greater rate of progress during the intervention phase leading to significantly higher scores in the maintenance period when compared with the once per week group. The allomorphic category of past tense verbs did not appear to influence outcomes. CONCLUSIONS: Participants receiving intervention twice per week appeared to demonstrate a greater rate of progress with intervention than those receiving it once per week, although once per week was also effective. However, these results should be interpreted with caution. Limitations to study design indicate that a larger randomised controlled trial is required. All past tense allomorphs improve to a similar degree when treated with this intervention. WHAT THIS PAPER ADDS: What is already known on the subject Understanding the parameters of dosage and intensity are important for clinical practice. Research evaluating the efficacy and/or effectiveness of interventions delivered in different dose/intensity conditions is scarce. There appears to be different interpretations of what constitutes dosage and intensity in published research. What this paper adds to existing knowledge This study retrospectively compared dosage and intensity conditions of intervention provided twice per week to intervention provided once per week. Both dose frequencies could be delivered in clinical settings. Results from this study were analysed by grouping data from multiple testing points, rather than comparing pre-post results. This approach demonstrated the variability of individual performance that would otherwise be lost with conventional methods of analysis. This study demonstrated that all past tense allomorphs improve to a similar degree when treated with this intervention. What are the potential or actual clinical implications of this work? Parameters of dosage and intensity are still not clearly defined well enough for translation to clinical practice. In consideration of current research, this intervention may be more effective if delivered twice per week. If clinicians are treating past tense, all allomorphs should be considered as priorities for intervention targets.

WordDriver-1: evaluating the efficacy of an app-supported decoding intervention for children with reading impairment.

BACKGROUND: Fluent word reading is a key characteristic of skilled reading, yet most children with reading disorders have impaired word-reading skills. Previous research has demonstrated that multi-component interventions targeting phonemic awareness and the alphabetic principle are effective for children with reading disorders. However, about 25% of children fail to respond to these interventions. While it has been difficult to isolate the active ingredient, the findings of some studies suggest that tasks targeting phonological recoding and orthographic processing are essential elements in improving decoding. AIMS: To develop and evaluate an intervention that specifically targets phonological recoding and orthographic processing (a decoding intervention) for children with persistent word-reading impairment. METHODS & PROCEDURES: A single-subject crossover design with multiple treatments was used to examine the efficacy of the decoding intervention (15 × 20-min sessions) compared with a language intervention that controlled for individual therapy time. Eight children (aged 7:6-8:11 years) with persistent word-reading impairment were randomly assigned to one of two intervention sequences. The effect of the decoding intervention was evaluated by (1) changes in decoding accuracy measured by performance on researcher-developed non-word lists; and (2) generalization to other standardized measures of reading. OUTCOMES & RESULTS: The results showed that all participants demonstrated significant gains in non-word reading on researcher-developed non-word lists and standardized measures of non-word-reading accuracy and efficiency. Trends for improvement on standardized measures of word-reading efficiency, text-reading accuracy and reading comprehension were observed. CONCLUSIONS & IMPLICATIONS: This decoding intervention significantly improved non-word decoding skills in all participants who had not responded to previous reading interventions. As such, it may be an efficient adjunct to the first stage of reading interventions for this population. The relative lack of generalization to other word-reading skills may have been due to the nature of the outcome measures, the short intervention time and/or additional delays in participant orthographic processing skills.

The evaluation of word-learning abilities in people with developmental language disorder: a scoping review.

BACKGROUND: The ability to learn new words is critical in the development of oral and written language, and significantly impacts engagement in social, academic and vocational situations. Many studies have evaluated the word-learning process in people with developmental language disorder (DLD). However, methodologies for assessment are heterogeneous, creating difficulties in synthesizing findings and identifying gaps in the knowledge base. AIMS: To scope systematically the literature and identify key methodological parameters considered in evaluations of word learning in people with DLD; and to identify gaps in the literature to guide further research in this area. METHODS & PROCEDURES: Twelve databases were searched and a total of 70 studies that met eligibility criteria were identified. The studies were evaluated according to key parameters that researchers varied in their word-learning methodologies. MAIN CONTRIBUTION: Most research has focused on word learning in the oral modality, and specifically in children with DLD. Fewer studies have explored word learning in adults and adolescents with DLD, and in the written modality. Depending on the research question and theoretical perspective driving the investigation, methodologies for assessing word learning considered a range of parameters, including words being learned, learning context and cues to support learning in the tasks. CONCLUSIONS & IMPLICATIONS: This review aggregates a variety of methods used previously to assess word learning. Findings highlight the need for further research to explore areas such as: the learning of varied word types (e.g., adjectives and adverbs); learning in the written modality; and word learning (both oral and written) in adolescents and adults with DLD.

A profile of the language and cognitive skills contributing to oral inferential comprehension in young children with developmental language disorder.

BACKGROUND: Children with developmental language disorder (DLD) demonstrate poor oral inferential comprehension. Research investigating the skills that underpin oral inferential comprehension in young children with DLD is necessary in order to better understand and improve inferential comprehension in this population. AIMS: To profile the language and cognitive skills that contribute to oral inferential comprehension in young children with DLD. METHODS & PROCEDURES: Seventy-six children aged 5-6 years with a diagnosis of DLD were assessed on a wide range of language and cognitive measures. Oral inferential comprehension of narrative was the primary outcome measure. OUTCOMES & RESULTS: Narrative macrostructure and microstructure, literal comprehension, vocabulary, phonological loop, and theory of mind were significant predictors of inferential comprehension in bivariate analyses. However, multivariate regression analysis indicated that only narrative retell macrostructure and theory of mind contributed a significant amount of unique variance to inferential comprehension. CONCLUSIONS & IMPLICATIONS: This study profiled the skills contributing to oral inferential comprehension in young children with DLD, to support the clinical and theoretical understanding of the ability in this population. The findings have implications for future intervention studies.

Why Are Reading Difficulties Associated with Mental Health Problems?

A growing literature indicates that children with reading difficulties are at elevated risk for mental health problems; however, little attention has been given to why this might be the case. Associations between reading difficulties and mental health differ substantially across studies, raising the possibility that these relationships may be ameliorated or exacerbated by risk or resilience-promoting factors. Using socio-ecological theory as a conceptual framework, we outline four potential lines of research that could shed light on why children with reading difficulties are at risk of mental health problems and identify potential targets for intervention. Copyright © 2016 John Wiley & Sons, Ltd.

The relationship between phonological short-term memory, receptive vocabulary, and fast mapping in children with specific language impairment.

BACKGROUND: Children with specific language impairment (SLI) often experience word-learning difficulties, which are suggested to originate in the early stage of word learning: fast mapping. Some previous research indicates significantly poorer fast mapping capabilities in children with SLI compared with typically developing (TD) counterparts, with a range of methodological factors impacting on the consistency of this finding. Research has explored key issues that might underlie fast mapping difficulties in children with SLI, with strong theoretical support but little empirical evidence for the role of phonological short-term memory (STM). Additionally, further research is required to explore the influence of receptive vocabulary on fast mapping capabilities. Understanding the factors associated with fast mapping difficulties that are experienced by children with SLI may lead to greater theoretically driven word-learning intervention. AIMS: To investigate whether children with SLI demonstrate significant difficulties with fast mapping, and to explore the related factors. It was hypothesized that children with SLI would score significantly lower on a fast mapping production task compared with TD children, and that phonological STM and receptive vocabulary would significantly predict fast mapping production scores in both groups of children. METHODS & PROCEDURES: Twenty-three children with SLI (mean = 64.39 months, SD = 4.10 months) and 26 TD children (mean = 65.92 months, SD = 2.98) were recruited from specialist language and mainstream schools. All participants took part in a unique, interactive fast-mapping task whereby nine novel objects with non-word labels were presented and production accuracy was assessed. A non-word repetition test and the Peabody Picture Vocabulary Test-Fourth Edition (PPVT-IV) were also administered as measures of phonological STM capacity and receptive vocabulary, respectively. OUTCOMES & RESULTS: Results of the fast-mapping task indicated that children with SLI had significantly poorer fast mapping production scores than TD children. Scores from the non-word repetition task were also significantly lower for the SLI group, revealing reduced phonological STM capacity. Phonological STM capacity and receptive vocabulary emerged as significant predictors of fast mapping performance when the group data were combined in a multiple regression analysis. CONCLUSIONS & IMPLICATIONS: These results suggest that the word-learning difficulties experienced by children with SLI may originate at the fast mapping stage, and that phonological STM and receptive vocabulary significantly predict fast mapping ability. These findings contribute to the theoretical understanding of word-learning difficulties in children with SLI and may inform lexical learning intervention.

Beyond narrative: Is there an implicit structure to the way in which adults organise their discourse?

Understanding the structure of discourse in healthy adults is fundamental to the assessment and diagnosis of discourse level impairments in clinical populations and the development of effective treatment regimes. Exploring discourse genre in healthy speakers that extend beyond the traditional narrative is equally paramount in facilitating maximum impact of clinical interventions in everyday speaking contexts. This study aimed to characterise the discourse of 30 healthy adult speakers across three age groups (20-39, 40-59 and 60+ years) and four discourse genres (recount, procedural, exposition and narrative), drawing on discourse frameworks used in classroom teaching. A clinically useful discourse protocol and analytic procedure using SALT was developed that profiled the macrostructure and key aspects of linguistic microstructure of the different genres, exploring coherence and cohesion within and across genre in a systematic manner. Analyses considered whether there were differences in coherence and cohesion among the different age groups, different genres and specific topics. Results showed that, while individual variability was present, healthy adults structured their discourse consistently, adhering to the frameworks described in the developmental literature, across all four genres. Significant age differences were only seen in the amount of information contained in the body of the discourse (i.e. events, steps or statements offered) with older participants offering less information. This dataset will enable comparisons to be drawn with clinical populations to determine the utility and the feasibility of the use of this framework for diagnosis and intervention.

The model of access to speech-language pathology services.

PURPOSE: Within Australia, some families face challenges in accessing paediatric speech-language pathology services. This research sought to investigate the factors that impact access to paediatric speech-language pathology services within Western Australia. METHOD: Researchers used constructivist grounded theory to investigate the construct of access, as experienced and perceived by service decision-makers, namely caregivers of children with communication needs and speech-language pathologists who provide communication services. Eleven speech-language pathologists and 16 caregivers took part in 32 semi-structured in-depth interviews. Researchers used layers of coding of interviews transcripts and the constant comparative method to investigate data. RESULT: Findings outline the factors that impact access to speech-language pathology services, as organised into the seven categories of the Model of Access to Speech-Language Pathology Services (MASPS). The categories and properties of this model are grounded within experiences and perspectives that participants contributed to the dataset. CONCLUSION: MASPS provides a theoretical structure that has been constructed using inductive and abductive reasoning. This model can be used by service designers and decision-makers to reflect upon and improve experiences of service for a range of consumers. MASPS can also be used as a basis for further investigation into aspects of service access.

Effective intervention for expressive grammar in children with specific language impairment.

BACKGROUND: Children with specific language impairment are known to struggle with expressive grammar. While some studies have shown successful intervention under laboratory conditions, there is a paucity of evidence for the effectiveness of grammar treatment in young children in community settings. AIM: To evaluate the effectiveness of a school-based intervention programme for expressive grammar in 5-year-olds with specific language impairment. METHOD & PROCEDURES: Thirty-four 5-year-old children attending a specialized school for children with language impairment participated in the study. Nineteen children received treatment for expressive grammar (experimental group) and 15 children received a control treatment. Treatment consisted of weekly 1-h sessions of small group activities in a classroom setting for 8 weeks. Techniques included direct instruction, focused stimulation, recasting and imitation. OUTCOMES & RESULTS: Results were analysed at the group level and as a case series with each child as their own control in a single-subject design. There was a significant difference in grammatical performance pre- and post-treatment for children who received grammar treatment (Cohen's d = 1.24), but not for a group of children who received a control treatment. Further, no difference in performance was found in the equivalent time period prior to treatment, nor for an untreated target. Treatment success was more pronounced in children without articulation difficulties which interfered with their ability to produce the grammatical targets (Cohen's d = 1.66). Individual analyses indicated the treatment effect was significant for the majority of children. CONCLUSIONS & IMPLICATIONS: Individually targeted intervention delivered in small groups in a classroom setting was effective in improving production of expressive grammatical targets in 5-year-old children with specific language impairment.

Complex Language Use in Children With Hearing Loss: A Scoping Review.

PURPOSE: Understanding what is known about the language profiles of children with hearing loss (CHL) is vital so that researchers and teachers can identify the specific complex syntactic structures that CHL may struggle to master. An understanding of which aspects of complex syntax pose difficulties for CHL is necessary to inform the kind of intervention that will facilitate learning complex syntax for this cohort of children. This scoping review aims to identify what is currently known about the complex syntax use of CHL who communicate through spoken language, and uncover gaps in the literature to guide further research. METHOD: Ascoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The Covidence software was utilized to manage the initial and full-text screening process for the search. RESULTS: From a total of 304 studies, 42 studies were identified that met the eligibility criteria. The review highlights the use of broad-based language assessments and limited use of specific descriptions of the types of complex syntactic structures and skills. CONCLUSIONS: Findings highlight the need for assessment protocols and analysis methods that better support the description of complex syntax profiles for CHL. School-age CHL continue to display challenges with complex syntax development. The review highlighted the need for further research to improve understanding of the complex syntax strengths and vulnerabilities of CHL. Further investigation is needed to better understand their ability to combine ideas and build complexity in their language use, which in turn can inform teaching in schools and interventions for children who require support. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21980177.

Update on Identification and Treatment of Infants and Toddlers With Suspected Childhood Apraxia of Speech.

PURPOSE: The purpose of this tutorial is to (a) provide an updated review of the literature pertaining to proposed early features of childhood apraxia of speech (CAS), (b) discuss the findings of recent treatment studies of infants and toddlers with suspected CAS (sCAS), and (c) present evidence-based strategies and tools that can be used for the identification of and intervention for infants and toddlers with sCAS or at high risk for the disorder. METHOD: Since Davis and Velleman's (2000) seminal work on assessment and intervention in infants and toddlers with sCAS, limited research has guided clinicians in the complex task of identifying and treating early speech motor difficulties prior to a definitive diagnosis of CAS. Following the structure of Davis and Velleman, we explore the proposed early characteristics of CAS with reference to contemporary research. Next, we describe the limited treatment studies that have investigated intervention for infants and toddlers at risk of or suspected of having CAS. Finally, we present practical suggestions for integrating this knowledge into clinical practice. CONCLUSIONS: Many of the originally proposed correlates of CAS in infants and toddlers now have research supporting their presence. However, questions remain about the developmental trajectory of the disorder. Although limited in number and restricted by lack of experimental control, emerging treatment studies can help guide clinicians in providing appropriate intervention to infants and toddlers with sCAS who need not wait for a definitive diagnosis to initiate intervention.

Understanding Mental Health in Developmental Dyslexia: A Scoping Review.

Children with dyslexia are at elevated risk of internalising and externalising mental health concerns. Our aim was to scope the extent and nature of the literature investigating factors which may influence this association. We systematically searched the peer-reviewed and grey literature with no restrictions on the date. We included both qualitative and quantitative studies. Inclusion criteria included: (1) a focus on childhood (≤18 years) reading/learning difficulties; (2) internalising and/or externalising symptoms; and (3) a potentially modifiable third factor (e.g., self-esteem). Ninety-eight studies met the inclusion criteria. We organised the studies according to individual, family, and community-level third factors. Whilst a range of third factors were identified, relatively few researchers tested associations between the third factor and mental health in the context of dyslexia. Furthermore, there was a focus on primary rather than secondary school experience and a reliance, in many cases, on teacher/parent perspectives on children's mental health. Future researchers are encouraged to explore links between socio-emotional skills, coping strategies, school connectedness, and mental health in the context of dyslexia. Research of this nature is important to assist with the identification of children who are more (or less) at risk of mental health concerns and to inform tailored mental health programs for children with dyslexia.