Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses.

OBJECTIVE: Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS: Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA: systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS: The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION: Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS: Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.

A Randomized, Community-Based Feasibility Trial of Modified ESDM for Toddlers with Suspected Autism.

A randomized feasibility trial of a parent coaching (PC) intervention was conducted across 16 community agencies in a Canadian province. Parents of toddlers with suspected autism were assigned to either a PC group (n = 24) or an enhanced community treatment (ECT) group (n = 25). PC participants received 24 weeks of coaching support from community service providers trained in the project. Children in both groups also received available community services and supplementary materials. PC children made significantly greater gains in word understanding and PC parents had significantly higher quality of life, satisfaction, and self-efficacy scores. Results are discussed in terms of the challenges of conducting feasibility studies in community settings and the lessons learned in the project.

Training Coaches in Community Agencies to Support Parents of Children with Suspected Autism: Outcomes, Facilitators, and Barriers.

This study evaluated the fidelity and effectiveness of a parent coach training program for toddlers at risk for autism spectrum disorder and identified factors required for successful training implementation under real-world conditions. Training addressed four tiers of clinical competence and was delivered to early intervention providers across 23 partner agencies in a large Canadian province. Results indicated that mean trainee fidelity scores were within the range reported in previous community-based training studies but there was considerable variability across trainees. Implementation facilitators included agency learning climate, leadership support, and trainee readiness for change. Implementation barriers included time/caseload demands and challenges related to technology learning and infrastructure. Results have implications for parent coach training in community settings.

A multi-site review of policies affecting opportunities for children with developmental disabilities to become bilingual.

This review of special education and language-in-education policies at six sites in four countries (Canada, United States, United Kingdom, and Netherlands) aimed to determine the opportunities for bilingualism provided at school for children with developmental disabilities (DD). While research has demonstrated that children with DD are capable of learning more than one language (see Kay Raining Bird, Genesee, & Verhoeven, this issue), it was not clear whether recent policies reflect these findings. The review, conducted using the same protocol across sites, showed that special education policies rarely addressed second language learning explicitly. However, at all sites, the policies favoured inclusion and educational planning based on individual needs, and thus implied that students with DD would have opportunities for second language learning. The language-in-education policies occasionally specified the support individuals with special needs would receive. At some sites, policies and educational options provided little support for minority languages, a factor that could contribute to subtractive bilingualism. At others, we found stronger support for minority languages and optional majority languages: conditions that could be more conducive to additive bilingualism.

Professional practices and opinions about services available to bilingual children with developmental disabilities: An international study.

This study aimed to gather information from school- and clinic-based professionals about their practices and opinions pertaining to the provision of bilingual supports to students with developmental disabilities. Using an online survey, data were collected in six socio-culturally and linguistically diverse locations across four countries: the United States, Canada, the United Kingdom, and the Netherlands. In total, 361 surveys were included in the analysis from respondents who were primarily teachers and speech-language pathologists working in schools, daycares/preschools, or community-based clinics. The overall picture that emerged from the data reflected a disconnection between practice and opinion. In general, respondents believed that children with both mild and severe disabilities are capable of learning a second language, although their opinions were more neutral for the latter group. However, children with both mild and severe disabilities who spoke only a minority language at home had less access to services for second language learners than did their typically developing peers, although respondents agreed that such services should be more available. Regardless of clinical group, children who lived in homes where a minority language was spoken were often exposed to, assessed in, and treated in the majority language only; again, respondents generally disagreed with these practices. Finally, second language classes were less available to children in the two disability groups compared to typically developing bilingual children, with general agreement that the opportunity to acquire a second language should be more available, especially to those with mild disabilities. Although the results indicate that there is a considerable gap between current practices and professional opinions, professionals appear to be more supportive of bilingual educational opportunities for these populations than was suggested by previous research.

A Case Study on Vocal Loudness With a Young Adult With Autism Spectrum Disorder and Developmental Delay.

PURPOSE: This clinical focus article describes an exploratory case study addressing reduction of vocal loudness in a young adult with a history of autism spectrum disorder and developmental delay. The need for a short-term pullout individual intervention arose from his participation in the Advancing Language and Literacy group, a program that provides support for enhancement of speech, language, and literacy skills for young adults with developmental disabilities. METHOD: The participant attended individual treatment sessions weekly for 9 sessions, all of which were digitally audio-recorded. Client awareness of different loudness levels was first established using nonspeech sounds and speech samples. Loudness in spontaneous speech was monitored with support of verbal and visual feedback in the individual sessions and tracked in individual sessions as well as sessions of the Advancing Language and Literacy group, which served as a generalization context. RESULTS: In the individual sessions, the participant's spontaneous production of acceptable volume improved from 42% to 92% of utterances. Observation of group participation indicated generalization, with the majority of utterances produced posttreatment at an acceptable volume. CONCLUSIONS: This clinical focus article emphasizes suprasegmental aspects as a dimension of communicative competence and highlights the need for continued intervention research and services for young adults with developmental disabilities.

Who's Who? Memory updating and character reference in children's narratives.

PURPOSE: The capacity to update and monitor the contents of working memory is an executive function presumed to play a critical role in language processing. The current study used an individual differences approach to consider the relationship between memory updating and accurate reference to story characters in the narratives of typically developing children. METHOD: English-speaking children from kindergarten to grade 2 ( N = 63; M age = 7.0 years) completed updating tasks, short-term memory tasks, and narrative productions. The authors used multiple regression to test whether updating accounted for independent variability in referential adequacy. RESULTS: The capacity to update working memory was related to adequate character reference beyond the effects of age and of short-term memory capacity, with the strongest relationship emerging for maintaining reference over multiple utterances. CONCLUSIONS: This individual differences study is the first to show a link between updating and performance in a discourse production task for young school-age children. The findings contribute to the growing body of research investigating the role of working memory in shaping language production. This study invites extension to children of different ages and language abilities as well as to other language production tasks.

Content and form in the narratives of children with specific language impairment.

PURPOSE: This project investigated the relationship of content and form in the narratives of school-age children. METHOD: Two samples of children with specific language impairment (SLI) and their age-matched peers (British Columbia sample, M age = 9;0 [years;months], N = 26; Texas/Kansas sample, M age = 7;6, N = 40) completed the Test of Narrative Language (TNL; Gillam & Pearson, 2004). The relative strength of content elaboration and grammatical accuracy were measured for each child using variables derived from the TNL scoring system (Study 1) and from analysis of the story texts (Study 2). RESULTS: Both studies indicated that, compared with age peers, the children with SLI were more likely to produce stories of uneven strength--either stories with poor content that were grammatically quite accurate or stories with elaborated content that were less grammatical. CONCLUSIONS: These findings suggest that school-age children with SLI may struggle with the cumulative load of creating a story that is both elaborate and grammatical. They also show that the absence of errors is not necessarily a sign of strength. Finally, they underscore the value of comparing individual differences in multiple linguistic domains, including the elaboration of content, grammatical accuracy, and syntactic complexity.

Language following functional left hemispherectomy in a bilingual teenager.

A detailed language assessment was conducted with MM, a 17-year-old bilingual teenager with Rasmussen syndrome who had undergone a left functional hemispherectomy. Results revealed important deficits in French and English, affecting expressive and receptive language in both the written and the oral modality. MM's linguistic profile was coherent with previous description of language function following left hemispherectomy, and what is known of the linguistic potential of the right hemisphere (RH). The impairment pattern showed overall similarities between French and English, thus supporting the existence of a common underlying system for these two languages. However, the profiles in each language were not identical, implying that distinct subsystems may also be at play. These findings support previous descriptions of acquired language impairments and recovery in bilingual individuals.