"Measuring up" to ethical standards in service delivery to college students on the Autism Spectrum: A practical application of Powell's model for ethical practices in clinical phonetics and linguistics.

This paper examined an interdisciplinary college-based support programme, the Communication Coaching Program (CCP), designed for students diagnosed on the autism spectrum in light of six ethical constructs described by Powell. Collecting data to monitor the successes and ongoing needs of individual participants in the programme is of vital importance, of course, but only addresses a portion of the efficacy question. In addition, the authors, who co-direct the programme and represent different professional expertise and perspectives, recognize the importance of determining whether their evolving intervention model has also been successful in meeting the ethical standards of their respective professions. Careful review of the 4 years of the CCP's operation in terms of ethical constructs has yielded evidence that the CCP, although based on sound principles of theory and scholarship, should be further individualized to meet the particular needs of participants diagnosed with deficits in social communication and executive functioning skills.

Eating Disorder Symptomatology Among Adolescents Presenting for Bariatric Surgery Candidacy: Examining Differences by Sex and Racial Minority Status.

BACKGROUND: Research on adolescent bariatric surgery candidates is limited by insufficient inclusion of ethnic minorities and males, and lack of consideration of the full spectrum of disordered eating behaviors (i.e., restriction, compensatory behaviors [e.g., purging], overeating/binge eating behaviors). OBJECTIVES: The current study investigated differences in the full range of disordered eating behaviors across sex and ethnicity among adolescents seeking bariatric surgery. SETTING: Teaching hospital, United States. METHODS: Data were collected using retrospective chart review of 79 adolescent bariatric surgery candidates (59% female, 46.8% Hispanic, MBMI = 50.2, SDBMI = 10.0, Mage = 17.3, SDage = 2.02) who had completed the self-reported Eating Disorder Diagnostic Scale for DSM-5 at intake. RESULTS: Approximately 33% of study participants met self-reported criteria for an eating disorder, with 35% endorsing binge eating behaviors and 50% endorsing compensatory behaviors. Few differences in behavior frequencies were observed across sex or racial/ethnic status. CONCLUSIONS: Findings underscore the importance of assessing the full spectrum of disordered eating behaviors among adolescent bariatric surgery candidates.

Consonant production and language skills in Mandarin-speaking children with cochlear implants.

OBJECTIVES: To investigate the phonemic inventories of syllable-initial consonants in Mandarin-speaking children with cochlear implants, assessing the relationship between the children's mastery levels of consonant production and their receptive and expressive language skills. DESIGN: Descriptive study. SETTING: Chi-Mei Medical Center, Tainan, Taiwan. PATIENTS: The 30 prelingually deaf children with cochlear implants who participated in the study ranged in age from 6 years to 12 years 6 months, and their age at implantation ranged from 2 years 3 months to 10 years 3 months. The average length of device experience was 3 years 7 months (range, 1 year 7 months to 6 years 5 months). None of the children was identified with concomitant learning disabilities. OUTCOME MEASURES: The 21 Mandarin syllable-initial consonants were elicited using a set of 105 pictures. Two language assessment tools were used to evaluate the children's receptive vocabulary skills as well as their overall receptive and expressive language development. RESULTS: The mean +/- SD score for correct consonant production was 57.9% +/- 19.5%. Regarding the manner of articulation, plosives received the highest average correct percentage whereas nasals, affricates, fricatives, and the lateral approximant /l/ were less frequently correct. The children's overall percentage of correct scores for consonant production and receptive vocabulary measure were significantly correlated (r = 0.51; P =.005). Additionally, correlation coefficients were significant between the overall score for correct consonant production and both the scores for receptive language measure (r = 0.65; P<.001) and expressive language measure (r = 0.76; P<.001). The participants' consonant production skills were negatively correlated with age at implantation (r = - 0.46; P =.01) and positively correlated with length of experience with cochlear implant (r = 0.45; P =.02). CONCLUSIONS: Mastery levels of Mandarin syllable-initial consonants remained moderately low in prelingually deaf children with cochlear implants. The present results suggest a significant association between consonant production skills and language development in these children.

What pediatricians should know about normal language development: ensuring cultural differences are not diagnosed as disorders.

The roles and responsibilities of speech-language pathologists and pediatricians have become greater with the changing population demographics in the United States. In some states, the majority of the population belongs to a national cultural minority, eg, New Mexico. Even a state such as Iowa, with only a 5% nonmajority population, has a school-aged population that is almost 10% nonmajority. This growth of diversity is likely to continue. Rather than viewing sensitivity to the influence of culture on language learning and other developmental areas as an "add-on" to a practice, it may be wiser to recognize that approaching all clients with as few assumptions about their behaviors as possible will guarantee nonbiased service delivery for all. Without nonbiased service delivery, incorrect diagnoses and provision of inappropriate therapy become more likely. Fortunately, many resources are available to assist pediatricians and speech-language pathologists in learning about various cultures. Institutional review boards have become more vigilant about the inclusion of a cross-section of subject populations as participants in research studies in addition to protecting the rights of all participants. Funding agencies also have expressed as a priority the inclusion of research subjects from minority populations to add to the information available about the incidence and prevalence of disorders across the range of our potential patients. In a society in which cultural differences are not just defined by race or ethnicity, but by gender, sexual orientation, age, geographic region, and religion, belief systems about disease, disability, and treatment are dynamic entities for health professionals to take into consideration. It is a challenge that speech-language pathologists and pediatricians must meet if they are to provide the best and most appropriate services for their patients.

Recasts in parents' language to their school-age children who stutter: a preliminary study.

UNLABELLED: Language samples collected from 13 school-age children diagnosed as stutterers (CWS) in conversation with a parent and a similar corpus of data collected from a matched control group of 13 normally-fluent children (CWNS) were analyzed for the quality and quantity of recast usage in the parents' language. Recasts, a frequently studied type of child-directed language (CDL) pattern hypothesized to increase the length and complexity of young children's expressive language, have not been studied typically in older children's conversations with parents nor have they been studied in the CDL of parents of CWS. Comparisons of these samples revealed that both groups of parents were frequent users of imitations, as well as simple and complex type recasts. Indeed, the rank order of recast types used was identical for the two groups of caregivers. When parents' conversations with the CWS were analyzed further, it was noted that they were not more likely to focus on stuttered utterances as the utterances on which to base their recasts (i.e., "platform utterances") than on the child's fluently-produced utterances. These results suggest there is one additional conversation parameter for which there are evident similarities in the CDL used by parents of CWS and CWNS. Clinical implications gleaned from this preliminary study are discussed, as are suggestions for future study. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe (1) the role of recasts in young children's language development; (2) the types of recasts that were observed in the conversations of parents of CWS and CWNS; and (3) the similarities observed in the recasts produced by parents of CWS and CWNS.

Why we should consider pragmatics when planning treatment for children who stutter.

Pragmatics, the use of language in context, has been investigated only recently in the language used by children who stutter (CWS). Historically researchers compared the length and complexity of the syntactic constructions produced by these children with those of children who do not stutter (CWNS) and generally found the CWS to be relatively deficient. More recently, some investigators have begun to address how the language and fluency of CWS are influenced in different communicative settings. This article describes several findings concerning the pragmatic competencies of CWS set against the traditional famework of pragmatic language development. Most studies have shown no significant differences between the CWS and CWNS groups, although some aspects of pagmatic language use have yielded an exacerbation of stuttering for CWS. These findings have suggested specific ways of incorporating a pragmatic focus in the treatment programming for CWS where the degree of difficulty of language use is increased gradually.

Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent?

PURPOSE: Adolescents frequently rely on emergency medical care, rather than using primary care providers (PCPs). Our objectives were to characterize a population of adolescents presenting to a large, urban emergency department (ED) and to examine the reasons why they present to the ED, rather than to their PCP's office. METHODS: Adolescents ages 12 to 21 years and their parents/guardians were invited to participate and asked to complete a brief online survey. Demographic data and triage information were collected from electronic medical records. RESULTS: Of 203 participants, 66% (n = 134) had public insurance, and 40% (n = 82) were triaged as nonurgent. Nearly all (93%, n = 189) reported having a PCP or primary clinic. The most common reasons given for presenting to the ED were participant perception of illness requiring immediate care (34%), followed by PCP referral to the ED (21%). Those with public insurance (odds ratio = 4.44; 95% CI 2.01 to 9.81) or no insurance/unknown insurance status (odds ratio = 4.77; 95% CI 1.34 to 17.01) were more likely to be triaged as nonurgent than those with private insurance. CONCLUSIONS: Many adolescents in this study were triaged as nonurgent, with several participants perceiving they were acutely ill requiring immediate physician care. Further analyses revealed that private insurance was significantly associated with urgent triage status. Future studies could educate adolescents and families about appropriate use of the ED or examine PCP offices directly to determine practices for phone triage and ED referrals of adolescents.