A randomised controlled trial of the effectiveness of parent-based models of language intervention for 2- to 3-year-old children with speech, language and communication needs (SLCN) in areas of social disadvantage.

BACKGROUND: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. AIMS: To compare the impact of standard parent-based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. METHODS AND PROCEDURES: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent-based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20-week period. Participants received one of two interventions: (1) Standard Care - indirect group PBI - (PBI) (2) Enhanced Care: indirect group enhanced PBI - (EPBI). Both standardised and non-standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure - Speech & Language Therapy (PAM-SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well-being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. OUTCOMES AND RESULTS: One hundred fifty-five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur-Bates Communicative Development Inventories Sentence Length, from pre-intervention to post-intervention and 6 months post-intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval -0.02 to 0.76), although wide variation was found. CONCLUSIONS AND IMPLICATIONS: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS: What is already known on the subject Speech, language and communication needs (SLCN) have a knock-on effect on emotional well-being, school readiness, literacy and school attainment, putting children at increased risk of long-term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work? This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes.

Making the case for the collection of a minimal dataset for children with speech sound disorder.

BACKGROUND: NHS case note data are a potential source of practice-based evidence which could be used to investigate the effectiveness of different interventions for individuals with a range of speech, language and communication needs. Consistency in pre- and post-intervention data as well as the collection of relevant variables would need to be demonstrated as a precursor to adopting this approach in future investigations of speech and language therapy intervention. AIMS: To explore whether routine clinical data collection for children with speech sound disorder (SSD) could be a potential source for examining the effectiveness of intervention(s). METHODS & PROCEDURES: We examined case notes from three UK NHS services, reviewing 174 sets of case notes and 234 blocks of therapy provided for school-age children with SSD. MAIN CONTRIBUTION: We found there was significant variation in pre- and post-intervention data and variables collected by the services. The assessment data available in the case notes across all sites were insufficient to be used to compare the effectiveness of different interventions. Specific issues included lack of consistent reporting of pre- and post-intervention data, and use of a variety of both formal and informal assessment tools. CONCLUSIONS & IMPLICATIONS: The case notes reviewed were from three sites and may not represent wider clinical practice, nevertheless the findings suggest the sample explored indicates the need for more consistent and contemporaneous collection of data for children with SSD to facilitate the investigation of different interventions in practice. Researchers should work with the clinical community to determine a minimal dataset that includes a core outcome set and potential variables. This should be feasible to collect in clinical practice and provide a dataset for future investigations of clinically relevant research questions. This would provide an invaluable resource to the clinical academic and research communities enabling research questions to be addressed that have the potential to lead to improved outcomes and more cost-effective services. WHAT THIS PAPER ADDS: What is already known on the subject While there is some evidence for the efficacy of therapy for children with SSD, studies typically focus on very specific populations who meet strict selection criteria and take place in university clinics or laboratory-style settings which do not reflect typical clinical practice in the UK and elsewhere. An alternative approach to investigating the effectiveness of interventions would be to use NHS case note data. It is not clear from the existing literature whether case note data are sufficiently robust to facilitate such an analysis. What this paper adds to existing knowledge This study found that case note data, in particular assessment data, were highly variable across services and would be insufficient to compare different interventions for this population. Agreement on what should be included in a minimal dataset for children with SSD is required to maximize the potential for NHS clinical case notes to become a resource for future research. What are the actual or potential clinical implications of this work? This study indicates that current clinical practice in SLT for children with SSD is inconsistent with regards to the reporting of pre- and post-intervention assessment data and other important variables in case notes. We make the case for agreeing a minimal dataset with a need for clinicians to work with researchers to determine core outcomes and additional relevant data, which can be feasibly collected in clinical practice.

Perspectives of preschool children in England with speech and language needs in the development of evidence-based activities.

BACKGROUND: The existing evidence is limited in terms of perspectives of preschool children with speech and language needs and their views on activities used to support their needs. This paper discusses a stream of work from the interdisciplinary research programme known as "Child Talk," based in England, UK. The overall purpose of this work stream was to gain the perspectives of preschool children aged 2 to 5 years and 11 months, with speech and language needs, to use in the development of an evidence-based framework of activities. METHODS: Twenty-four preschool children with a variety of needs from diverse backgrounds took part. An observational methodology was used to capture children's experiences. Children were filmed during a series of sessions, with innovative head-mounted cameras worn by the children and supported by researcher field notes. Framework analysis was used to analyse the data based on the body movement, vocalization, and visual attention of the children during these sessions. RESULTS AND CONCLUSIONS: Results included that children expressed enjoyment and engagement in the activities. The children expressed themselves and demonstrated their focus "multimodally" through combinations of body language, vocalization, and visual attention. These modalities were present across all contexts and children. It highlights the importance of encouraging participation in preschool children and consequently this innovative piece of work has national and international importance.

An Alternative Approach to Measuring Reliability of Transcription in Children's Speech Samples: Extending the Concept of Near Functional Equivalence.

AIM: To explore a novel and efficient way of calculating transcription reliability of connected speech data using the concept of near functional equivalence. Using this approach, differences between two transcribed phonemes that are nearly phonetically equivalent are disregarded if both reflect two plausible and acceptable pronunciations for the word produced. METHOD: The study used transcriptions of connected speech samples from 63 five-year-olds who participated in a large-scale population study. Each recording was phonetically transcribed by two speech and language therapists. Two independent researchers then examined agreement -between the two sets of transcripts, marking differences in vowels, consonants and diacritics and identifying segments which represented near functional equivalence. RESULTS: Overall percentage agreement between the transcripts was 77%. One quarter of the differences between the two transcripts were identified as showing near functional equivalence. When this category was excluded, the transcripts showed 82% reliability. CONCLUSIONS: This study demonstrates the issues to consider when calculating transcription reliability. Other methods are often time-intensive and may highlight differences between transcribed units which are audibly very similar and would be negligible in ordinary conversation. Inclusion of the concept of "near functional equivalence" can result in higher reliability scores for transcription, without loss of rigour.

'It depends': Characterizing speech and language therapy for preschool children with developmental speech and language disorders.

BACKGROUND: Several studies have suggested that practitioners hold speech and language therapy (SLT) practice as tacit and consequently it is difficult for the therapist to describe. The current study uses a range of knowledge elicitation (KE) approaches, a technique not used before in SLT, as a way of accessing this tacit knowledge. There is currently no agreed framework that establishes key factors underpinning practice for preschool children with speech and language disorders. This paper attempts to address that gap. AIMS: To develop a framework of SLTs' practice when working with preschool children with developmental speech and language disorders (DS&LD). METHODS & PROCEDURES: A mixed-methods approach was adopted for this study. Data were collected iteratively, from 245 SLTs with experience of working with preschool children with DS&LD across sites in England, by means of focus groups and national events. There were three stages of data collection: local sites, specific-interest groups and two national events. KE techniques were used to gather data, with initial data being collected in local site focus groups. Findings from groups were taken to subsequent larger groups where a combination of concept mapping, teach-back and sorting exercises generated a more detailed description of practice, using discussion of consensus and disagreement to stimulate further exploration and definition and provide validatory evidence. OUTCOMES & RESULTS: This paper provides a high-level framework of therapy for preschool children with DS&LD that makes practice explicit in this area. The framework proposes that therapists' aims for this group of children fall into three categories: addressing children's areas of impairment and skills; achieving functionally meaningful skills and carryover; and supporting adults to provide a supportive communication environment. The exact configuration is shaped by the child's context and needs. CONCLUSIONS & IMPLICATIONS: The framework highlights themes that are well researched in the literature (e.g., speech) and others that have been little studied (e.g., adult understanding), indicating a disconnect between research evidence and practice. The research also highlights the complex nature of interventions for preschool children with DS&LD and the importance therapists attribute to tailoring therapy to individual needs. The framework provides a scaffold upon which SLTs can focus their clinical practice and encourages the profession to understand and explore better the gaps between research evidence and clinical practice for preschool children with DS&LD.

Nested prospectivity in perception: perceived maximum reaching height reflects anticipated changes in reaching ability.

Perception of possibilities for behavior is a necessarily prospective (i.e., forward-looking) act. Such prospectivity is highlighted by the fact that, in general, behaviors are nested within behaviors over a number of spatial and temporal scales. Participants reported their maximum vertical reaching height when they expected to walk across the room and (1) reach for an object while standing on the floor, (2) step up on a step stool and then reach for the object, and (3) pick up a plastic rod and use it to reach for the object. The results show that perception of maximum reaching height was action scaled both when participants expected to perform a nested behavior that would change their action capabilities and when they expected to perform a nested behavior that would not do so. Moreover, the results suggest that nested behaviors that change reaching ability in functionally equivalent ways may bring about functionally equivalent changes in perception of maximum reaching height.