A survey of speech-language pathology service delivery in Australian schools.

PURPOSE: Speech-language pathologists (SLPs) work in Australian schools yet, little is documented about their service delivery practices. This study therefore explores Australian speech-language pathology service delivery in schools, inclusive of work activities, caseloads, and assessment and intervention practices. METHOD: An online survey comprising multiple choice, constant sum, Likert scale, and open text questions was completed by 105 SLPs. Quantitative data was analysed using descriptive statistics while open-text responses were analysed using content analysis. RESULT: Participants were predominantly government education department employees working in multiple schools, and caseloads ranged from 10 to 240 students for full-time SLPs. While responses varied considerably, some general trends emerged. Most time was spent on intervention, followed by non-contact tasks, and assessments, with differences across employment sectors. Language was the most common student need, followed by literacy and speech. Frequently reported factors contributing to client complexity and intervention frequency were co-occurring presentations, severity of student needs, caseload size, and impact on learning. Caseload manageability was a concern for participants who reported larger caseloads, spent more time in assessment or less time in therapy than others, and worked in education departments. CONCLUSION: Findings have implications for policy makers, professional bodies and employers, and provide direction for future systematic data collection.

Home language variation in the narratives of urban First Nations Australian children in their first year of school.

First Nations children may speak a dialect of English that has different grammatical rules from Standard Australian English (school language). Limited studies have investigated Aboriginal English (home language) dialect in First Nations children and its impact on differential diagnosis of language disorder. This study measured the density of home language dialect and grammatical accuracy in oral narratives produced by typically developing First Nations children. Non-standardised assessment narrative protocols were used to elicit language samples from 27 Australian First Nations children aged 4.5-6 years. Local home language dialectal features were coded into the sample and grammatical accuracy was calculated separately for school language and home language. All children displayed some use of home language features. The most common home language features used were alternative use of regular past tense and irregular past tense, zero use of regular and irregular past tense, and alternative use of pronouns. Dialect density varied highly amongst participants. Grammatical accuracy was higher for home language than school language. Speech pathologists and teachers need to be aware of differences between home and school language for First Nations children to avoid misdiagnosis of language disorder. More research is required to gain normative data that informs culturally appropriate assessment practices for this population.

Narrative comprehension skills of Indigenous and non-Indigenous Australian children in their first year of school.

Purpose: The suitability of existing speech-language pathology assessments for Australian Aboriginal and Torres Strait Islander (Indigenous) children is questioned in the literature. There is emerging evidence that the differences reported between Indigenous and non-Indigenous Australian children on standardised assessment are diminished on more naturalistic assessments such as narrative production (macrostructure and microstructure). Little is documented, however, about the narrative comprehension skills of Australian children. This study explores the narrative comprehension skills of 40 typically developing Indigenous and non-Indigenous Australian children in their first year of school.Method: A cross-sectional comparative research design was used. Three non-standardised narrative assessments incorporating comprehension-production protocols were administered. Question responses were scored for accuracy and categorised according to story grammar targeted and inference (literal vs. non-literal). In addition, all participants completed the Peabody Picture Vocabulary Test fourth edition (PPVT-4).Result: A repeated-measures ANOVA was used to compare response accuracy to comprehension questions between cultural groups and across narrative protocols. While there was a significant difference in PPVT-4 scores, no significant differences were identified between response accuracy for the Indigenous and non-Indigenous children. Furthermore, response accuracy to comprehension questions was correlated with PPVT-4 scores for the non-Indigenous children only.Conclusion: Findings support the use of naturalistic assessment strategies such as narrative comprehension with Indigenous Australian children.

Speech-language pathologists' perceptions and experiences when working with Aboriginal and Torres Strait Islander children.

PURPOSE: This study explored the perceptions of speech-language pathologists with regards to culturally responsive service delivery, assessment practices, and confidence when working with Aboriginal and Torres Strait Islander children. METHOD: An online survey was used. Descriptive statistics were analysed with SPSS. Themes were derived from text responses using Braun and Clarke's thematic analysis method. RESULT: The 48 respondents were almost all non-Indigenous, equally spread across metropolitan and non-metropolitan regions, and had varied levels of experience. Respondents reported moderate to high levels of confidence. Identified barriers included accessibility, policy, impacts of colonisation, awareness of services and expectations and speech pathologist knowledge, training and experience. Engagement emerged as a facilitator to provision of culturally responsive services. A variety of speech-language pathology assessment methods were reported, not all of which were consistent with current recommendations. CONCLUSION: Identified barriers and facilitators were consistent with previous research exploring work with adults with acquired communication disorders. A need to explore the perspectives of Aboriginal and Torres Strait Islander communities as users of speech-language pathology services was identified. Clinical implications are described for future training, clinical guidelines, and flexible service delivery.

Story-telling abilities of young Indigenous and non-Indigenous Australian children across three protocols.

Purpose: Little is documented about the story-telling skills of Indigenous Australian children. Therefore, this study explores the complexity of stories produced by Indigenous and non-Indigenous Australian children in their first year of school.Method: An observational design allowed comparison across cultural groups and story protocols. Three stories were elicited from 49 Indigenous and non-Indigenous children aged 4;10 to 6;5. Stories were analysed using the Index of Narrative Complexity (INC) to generate scores for each story element. Story elements were further categorised and evaluated for level of use across participants. Story protocol and cultural group effects were explored using ANOVA.Result: Participant stories featured high use of characters, initiating events, attempts, and consequences; and little use of internal plans, formulaic markers, causal adverbial markers and evaluations. Story complexity scores did not differ between the Indigenous and non-Indigenous children, but significant differences were evident among the three, story protocols.Conclusion: Findings suggest that story elicitation protocols and analysis methods used in this study may be appropriate for use with both Indigenous and non-Indigenous children from urban contexts. However, caution is needed when making diagnostic decisions based on story complexity without well-developed, culturally appropriate protocols and normative data.

First year allied health student transition to a regional university.

OBJECTIVE: Students from regional and remote backgrounds are more likely to stay and work in regional and remote locations. Health students transition and retention at university impacts the retainment of a competent rural health workforce. This study aimed to examine the perceptions of allied health students as they reflected upon their first six weeks at university and identified strategies which enhanced these experiences. DESIGN: A cross-sectional study. Surveys were administered to students who then completed a reflection exercise. Data were analysed using Pearson correlation coefficient and chi-squares. SETTING: An Australian regional university. PARTICIPANTS: First year occupational therapy, physiotherapy and speech pathology students. MAIN OUTCOME MEASURES: Factors influencing the first 6 weeks at university. RESULTS: One hundred and forty-three students participated. Homesickness was the major challenge in transitioning to university life. Subthemes identified were adjusting to being away from home, adjusting to university culture and the mature-aged student. Specific issues included a lack of familiarity with university campuses and services, being unprepared for the workload and confusion while learning new skills. CONCLUSION: Orientation week activities assist students transition into university and age-appropriate and family-friendly activities should be considered for mature-age students. All students were found to benefit from support to address economic pressures and skill development focusing on coping with university workload. The development of regional university policy including these strategies is likely to enhance student success.

Language abilities of Indigenous and non-Indigenous Australian children from low socioeconomic backgrounds in their first year of school.

PURPOSE: Concern exists about the cross-cultural appropriateness of existing language assessments for non-mainstream populations, including Indigenous children who may speak a non-standard dialect of the mainstream language. This study therefore aims to investigate the language skills of Indigenous Australian children in comparison with non-Indigenous children, with a view to exploring the cultural appropriateness of language sampling assessment methods. METHOD: The performance of 51 typically developing Indigenous and non-Indigenous Australian children was compared on a standardised assessment and a spoken narrative protocol using language sample analysis measures. All children were in their first year of school and from the same regional city. RESULT: While the Indigenous children attained significantly lower receptive vocabulary scores than the non-Indigenous children, most language sampling measures from the spoken narrative protocol were similar across the two groups of children. CONCLUSION: Flexible, naturalistic language sampling approaches using a spoken narrative protocol are thus recommended for Indigenous children from the under-researched Australian context. However, normative data for language sampling are lacking, and further research is needed to explore the cultural validity of assessment and diagnostic procedures for Indigenous Australian children, as well as the influence of socioeconomic and family factors on language skills.

Psychometric Properties of Language Assessments for Children Aged 4-12 Years: A Systematic Review.

Introduction: Standardized assessments are widely used by speech pathologists in clinical and research settings to evaluate the language abilities of school-aged children and inform decisions about diagnosis, eligibility for services and intervention. Given the significance of these decisions, it is important that assessments have sound psychometric properties. Objective: The aim of this systematic review was to examine the psychometric quality of currently available comprehensive language assessments for school-aged children and identify assessments with the best evidence for use. Methods: Using the PRISMA framework as a guideline, a search of five databases and a review of websites and textbooks was undertaken to identify language assessments and published material on the reliability and validity of these assessments. The methodological quality of selected studies was evaluated using the COSMIN taxonomy and checklist. Results: Fifteen assessments were evaluated. For most assessments evidence of hypothesis testing (convergent and discriminant validity) was identified; with a smaller number of assessments having some evidence of reliability and content validity. No assessments presented with evidence of structural validity, internal consistency or error measurement. Overall, all assessments were identified as having limitations with regards to evidence of psychometric quality. Conclusions: Further research is required to provide good evidence of psychometric quality for currently available language assessments. Of the assessments evaluated, the Assessment of Literacy and Language, the Clinical Evaluation of Language Fundamentals-5th Edition, the Clinical Evaluation of Language Fundamentals-Preschool: 2nd Edition and the Preschool Language Scales-5th Edition presented with most evidence and are thus recommended for use.

Pragmatic Language Outcomes of Children With Attention Deficit Hyperactivity Disorder After Therapist- and Parent-Delivered Play-Based Interventions: Two One-Group Pretest-Posttest Studies With a Longitudinal Component.

OBJECTIVE: The pragmatic language outcomes of children with attention deficit hyperactivity disorder (ADHD) were explored across two feasibility studies. METHOD: Five children with ADHD (ages 6-11 yr), their parents, and 5 typically developing peers completed an assessment 18 mo after a therapist-delivered intervention (Study 1). Participants then completed a parent-delivered intervention (Study 2). Blinded ratings of peer-to-peer play interactions documented changes in children's pragmatic language 18 mo after the Study 1 intervention and before, immediately after, and 1 mo after the Study 2 intervention. Nonparametric statistics and Cohen's d were used to measure change. RESULTS: Children's pragmatic language outcomes were maintained 18 mo after the therapist-delivered intervention and significantly improved from before to 1 mo after the parent-delivered intervention. CONCLUSION: Interventions involving occupational therapist and speech-language pathologist collaboration, play, and parent and peer involvement may facilitate children's pragmatic language skills.

Evaluating the pragmatic language skills of children with ADHD and typically developing playmates following a pilot parent-delivered play-based intervention.

BACKGROUND/AIM: Children with attention deficit hyperactivity disorder (ADHD) often present with pragmatic language deficits and difficulties with peer-peer friendships. Parents and typically developing peers (TDPs) may be able to assist via parent and peer-mediated intervention approaches when adequately supported by trained adult facilitators. This study investigated whether a parent-delivered play-based intervention supported by occupational therapists and speech language pathologists was feasible and improved the pragmatic language skills of children with ADHD and their TDPs. METHODS: Nine children with ADHD paired with nine TDPs (mean age = 8.2 years) participated. The seven-week intervention was delivered by parents of children with ADHD at their home and consisted of weekly assigned home-based modules, supported play-dates between the pairs of children and supplemented by three clinic visits. Parent adherence to intervention activity was monitored on a weekly basis. Blinded ratings of observed peer-peer play interactions were used to detect changes in pragmatic language from pre-post intervention and one month follow-up using the Pragmatic Observation Measure (POM). RESULTS: All parents reported completing the seven weekly home-based modules and attended all clinic visits. Significant improvements in observed pragmatic language skills were found from pre-follow-up for both the ADHD and TDP children and pre-post for the ADHD children. CONCLUSION: The preliminary findings suggest that using parents to facilitate their child's pragmatic language skills was a feasible intervention approach with parents acting as agents of change to improve the pragmatic language of their children. This exploratory study identifies the need for further large-scale research to address the pragmatic language skills of children with ADHD using parent-delivery in a play-based, peer-peer context.

Clinical Experience of Using Cortical Auditory Evoked Potentials in the Treatment of Infant Hearing Loss in Australia.

This article presents the clinical protocol that is currently being used within Australian Hearing for infant hearing aid evaluation using cortical auditory evoked potentials (CAEPs). CAEP testing is performed in the free field at two stimulus levels (65 dB sound pressure level [SPL], followed by 55 or 75 dB SPL) using three brief frequency-distinct speech sounds /m/, /É¡/, and /t/, within a standard audiological appointment of up to 90 minutes. CAEP results are used to check or guide modifications of hearing aid fittings or to confirm unaided hearing capability. A retrospective review of 83 client files evaluated whether clinical practice aligned with the clinical protocol. It showed that most children could be assessed as part of their initial fitting program when they were identified as a priority for CAEP testing. Aided CAEPs were most commonly assessed within 8 weeks of the fitting. A survey of 32 pediatric audiologists provided information about their perception of cortical testing at Australian Hearing. The results indicated that clinical CAEP testing influenced audiologists' approach to rehabilitation and was well received by parents and that they were satisfied with the technique. Three case studies were selected to illustrate how CAEP testing can be used in a clinical environment. Overall, CAEP testing has been effectively integrated into the infant fitting program.

Dialectal grammatical differences in oral narratives of school-aged Indigenous Australian children.

PURPOSE: Children's oral language samples are regularly analysed in order to describe levels of language development and develop learning goals. However, diagnostic interpretation of language samples from Indigenous Australian children is problematic due to overlap between features of Aboriginal English and features of language impairment in the mainstream non-Indigenous population. Limited studies explore the use of Aboriginal English and its diagnostic impact. This research, therefore, describes the grammatical features of language samples from one group of Indigenous Australian children. METHOD: Participants were 19 children aged 8;1-13;4 from the same school in a regional city with 100% Indigenous enrolment. The Test of Narrative Language was administered, eliciting three oral narratives, and features of Aboriginal English grammar were coded. RESULT: Dialect density was highly variable and greater in the Verb Phrase than in the Noun Phrase or Clause Structure. High teacher ratings of oral language ability aligned with lower measures of dialect density and higher grammatical accuracy for Standard Australian English. Grammatical accuracy was frequently higher for Aboriginal English than Standard Australian English. CONCLUSION: Over-identification of language impairment was identified as a risk when evaluating the language ability of Indigenous Australian children.

Reliability and validity of the Pragmatics Observational Measure (POM): a new observational measure of pragmatic language for children.

There is a need for a reliable and valid assessment of childhood pragmatic language skills during peer-peer interactions. This study aimed to evaluate the psychometric properties of a newly developed pragmatic assessment, the Pragmatic Observational Measure (POM). The psychometric properties of the POM were investigated from observational data of two studies - study 1 involved 342 children aged 5-11 years (108 children with ADHD; 108 typically developing playmates; 126 children in the control group), and study 2 involved 9 children with ADHD who attended a 7-week play-based intervention. The psychometric properties of the POM were determined based on the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy of psychometric properties and definitions for health-related outcomes; the Pragmatic Protocol was used as the reference tool against which the POM was evaluated. The POM demonstrated sound psychometric properties in all the reliability, validity and interpretability criteria against which it was assessed. The findings showed that the POM is a reliable and valid measure of pragmatic language skills of children with ADHD between the age of 5 and 11 years and has clinical utility in identifying children with pragmatic language difficulty.

The cultural appropriateness and diagnostic usefulness of standardized language assessments for Indigenous Australian children.

Speech-language pathologists experience uncertainty about how to interpret standardized assessment results for Indigenous Australian children. There are risks for inappropriate diagnosis: both over- and under-diagnosis of language impairment may occur due to a convergence of linguistic features which causes difficulty in distinguishing between impairment and difference. While the literature suggests that standardized assessments are inappropriate for Indigenous Australian children, there is an absence of empirical documentation to show how Indigenous children perform on standardized tests of language ability. This study examined the performance of 19 Indigenous Australian children, aged 8;01-13;08, from one school on the Clinical Evaluation of Language Fundamentals, Fourth Edition, Australian Standardized Edition. Standardized scores were compared with teacher ratings of children's oral language skills. Analysis showed poor alignment between teacher ratings and language assessment, and assessment scores were negatively influenced by features of Aboriginal English. Children rated with above average language skills presented with different linguistic profiles from the children rated with average and below average language abilities. The inappropriateness of current standardized language assessments for Indigenous children and the need for further research to guide appropriate assessment are discussed.

A comparison of oral narratives in children with specific language and non-specific language impairment.

This research investigated whether children with specific language impairment (SLI) and non-specific language impairment (NLI) could be differentiated by their oral narrative characteristics. Oral narrative samples were collected from 69 children and comparisons were made among four groups of participants. The two language impairment groups (SLI and NLI), aged 4;11-6;03, were matched for age and their linguistics skills. Their oral narratives were compared between these diagnostic groups and with age-matched and language-matched control groups. Measures of narrative structure, cohesion, and information did not significantly differentiate the SLI and NLI groups, suggesting that the influence of their similar linguistic skills on oral narrative measures was stronger than the influence of their differing non-verbal cognition. The SLI group produced significantly more complex and informative oral narratives than the language-matched group, while the NLI group differed from the language-matched group on fewer measures. Interactions among linguistic, cognitive, maturational, and task factors are discussed.

Cortical auditory evoked potentials in the assessment of auditory neuropathy: two case studies.

Infants with auditory neuropathy and possible hearing impairment are being identified at very young ages through the implementation of hearing screening programs. The diagnosis is commonly based on evidence of normal cochlear function but abnormal brainstem function. This lack of normal brainstem function is highly problematic when prescribing amplification in young infants because prescriptive formulae require the input of hearing thresholds that are normally estimated from auditory brainstem responses to tonal stimuli. Without this information, there is great uncertainty surrounding the final fitting. Cortical auditory evoked potentials may, however, still be evident and reliably recorded to speech stimuli presented at conversational levels. The case studies of two infants are presented that demonstrate how these higher order electrophysiological responses may be utilized in the audiological management of some infants with auditory neuropathy.

The relationship between obligatory cortical auditory evoked potentials (CAEPs) and functional measures in young infants.

Finding ways to evaluate the success of hearing aid fittings in young infants has increased in importance with the implementation of hearing screening programs. Cortical auditory evoked potentials (CAEP) can be recorded in infants and provides evidence for speech detection at the cortical level. The validity of this technique as a tool of hearing aid evaluation needs, however, to be demonstrated. The present study examined the relationship between the presence/absence of CAEPs to speech stimuli and the outcomes of a parental questionnaire in young infants who were fitted with hearing aids. The presence/absence of responses was determined by an experienced examiner as well as by a statistical measure, Hotelling's T(2). A statistically significant correlation between CAEPs and questionnaire scores was found using the examiner's grading (rs = 0.45) and using the statistical grading (rs = 0.41), and there was reasonably good agreement between traditional response detection methods and the statistical analysis.

Exploring the boundaries of SLI: findings from morphosyntactic and story grammar analyses.

The nature of morphosyntactic and story-grammar differences were examined between children with SLI and children with language impairments that fell outside the diagnostic category for SLI solely because of their low non-verbal cognitive abilities (LNVA). Two oral narratives were elicited from 5-year-old children with language impairments and age-matched children with normally developing language. Morphosyntactic difficulties were found to be similar for children with SLI and children with LNVA. The children with SLI produced more complex stories than the children with LNVA when a complex wordless picture book was used, but not for a single scene picture stimulus. These findings challenge notions about the unique nature of SLI and, understandings of differences and similarities with other language impairments.