Dissemination Research in Communication Sciences and Disorders: A Tutorial.

PURPOSE: The purpose of this tutorial is threefold: (a) to bring attention to the role and value of dissemination research in communication sciences and disorders (CSD), (b) to introduce a model that can be used to guide dissemination research, and (c) to demonstrate strategic steps toward generating research questions and planning methods for dissemination research using an example from the authors' work. METHOD: This tutorial begins with a discussion of the role of dissemination in clinical research, with emphasis on differentiating the unique value of dissemination within the broader context of dissemination and implementation (D&I) research. The tutorial next presents a model of dissemination from the extant literature and describes how this model can be applied in CSD using examples from the authors' respective programs of clinical research. This is followed by an example that illustrates how the model can be used to determine research questions and guide the development of methods. Finally, the tutorial ends by discussing the potential impact of dissemination research for advancing efforts in CSD for closing the research-to-practice gap. CONCLUSIONS: Dissemination research is an often overlooked but critical component of D&I efforts. When approached systematically and rigorously, dissemination can make meaningful contributions to clinical research in CSD.

Prologue: Implementation Science in CSD and Starting Where You Are.

In this prologue, we introduce readers to the Forum: Clinicians and Researchers Navigating Implementation Science in CSD. Implementation science (IS), or the study of the adoption of evidence-based practice in real-world settings, is a key area of development in communication sciences and disorders (CSD). The goal of this forum was to show by example how researchers and clinicians are collaborating to begin to apply IS in CSD. This goal culminated in a scoping review of IS in CSD, a tutorial on incorporating IS into clinical practice research, three articles on stakeholder engagement, and three examples of IS studies in CSD included in this forum. We hope this forum helps clinicians and researchers to begin wherever they are in their knowledge and understanding of IS in CSD.

A Randomized Controlled Trial Investigating Online Training for Prelinguistic Communication.

Purpose This study explored the utility of online training as a platform for teaching early intervention speech-language pathologists to recognize potentially communicative, prelinguistic behaviors in young children with physical disabilities and complex communication needs. Method Using a randomized controlled trial, 45 early intervention speech-language pathologists were randomly assigned to one of three conditions within an online training: practice with implicit problem-solving (identification condition), practice with explicit problem-solving (reflection condition), or no practice (control condition). Knowledge about early communication, skill at recognizing prelinguistic behaviors, time taken to complete the training, and perceptions of the training experience were examined. Results Participants in the no-practice control condition took significantly less time to complete the training, achieved the same positive outcomes on the knowledge and skill assessments, and rated the training as appealing as compared with participants assigned to the more time-intensive identification and reflection practice conditions. Conclusions Results suggest the importance of considering efficiency and appeal when designing successful trainings for moving evidence into practice.

Implementation Research: Embracing Practitioners' Views.

Purpose: This research explores practitioners' perspectives during the implementation of triadic gaze intervention (TGI), an evidence-based protocol for assessing and planning treatment targeting gaze as an early signal of intentional communication for young children with physical disabilities. Method: Using qualitative methods, 7 practitioners from 1 early intervention center reported their perceptions about (a) early intervention for young children with physical disabilities, (b) acceptability and feasibility in the use of the TGI protocol in routine practice, and (c) feasibility of the TGI training. Qualitative data were gathered from 2 semistructured group interviews, once before and once after TGI training and implementation. Results: Qualitative results documented the practitioners' reflections on recent changes to early intervention service delivery, the impact of such change on TGI adoption, and an overall strong enthusiasm for the TGI protocol, despite some need for adaptation. Conclusion: These results are discussed relative to adapting the TGI protocol and training, when considering how to best bring about change in practice. More broadly, results highlighted the critical role of researcher-practitioner collaboration in implementation research and the value of qualitative data for gaining a richer understanding of practitioners' perspectives about the implementation process.

Motherese, affect, and vocabulary development: dyadic communicative interactions in infants and toddlers.

Responsive parental communication during an infant's first year has been positively associated with later language outcomes. This study explores responsivity in mother-infant communication by modeling how change in guiding language between 7 and 11 months influences toddler vocabulary development. In a group of 32 mother-child dyads, change in early maternal guiding language positively predicted child language outcomes measured at 18 and 24 months. In contrast, a number of other linguistic variables - including total utterances and non-guiding language - did not correlate with toddler vocabulary development, suggesting a critical role of responsive change in infant-directed communication. We further assessed whether maternal affect during early communication influenced toddler vocabulary outcomes, finding that dominant affect during early mother-infant communications correlated to lower child language outcomes. These findings provide evidence that responsive parenting should not only be assessed longitudinally, but unique contributions of language and affect should also be concurrently considered in future study.

Moving Triadic Gaze Intervention Into Practice: Measuring Clinician Attitude and Implementation Fidelity.

Purpose: This research investigated a first step in implementing the dynamic assessment (DA) component of Triadic Gaze Intervention (Olswang, Feuerstein, Pinder, & Dowden, 2013; Olswang et al., 2014), an evidence-based protocol for teaching early signals of communication to young children with physical disabilities. Clinician attitudes about adopting external evidence into practice and implementation fidelity in DA protocol delivery were examined following training. Method: Seven early intervention clinicians from multiple disciplines were trained to deliver the four essential elements of the DA protocol: (a) provide communication opportunity, (b) recognize child's potentially communicative signal, (c) shape child's signal toward triadic gaze, and (d) reinforce with play. Clinician attitude regarding adopting evidence into practice was measured at baseline and follow-up, with the Evidence-Based Practice Attitude Scale (Aarons, 2004). Implementation fidelity in delivering the protocol was measured for adherence (accuracy) and competence (quality) during trial implementation. Results: Clinicians' attitudes about trying new evidence that at first was perceived as incongruent with their practice improved over the course of the research. Clinicians demonstrated strong adherence to the DA protocol; however, competence varied across clinicians and appeared related to child performance. Conclusions: The results provided insight into moving Triadic Gaze Intervention into practice and yielded valuable information regarding the implementation process, with implications for future research.

Practice-Based Research: Another Pathway for Closing the Research-Practice Gap.

PURPOSE: Practice-based research is proposed as an additional way to bridge the divide between research and practice. METHOD: The article compares the traditional, laboratory-based research with research that is generated from practice: practice-based research. The defining features of each are described, with an emphasis on contrasting internal and external validity. Retrospective and prospective practice-based studies are described. Guidelines for designing a retrospective study are provided along with a specific example from practice focusing on social communication learning. Last, the authors discuss the value of information generated from practice-based research for contributing to the knowledge base of not only a practice, but also a discipline. CONCLUSION: The argument is made that approaching research from more than one perspective is necessary for ultimately improving the quality of client and patient care. Practice-based research acknowledges the value of understanding clinical decision making in everyday contexts as an important complement to evidence generated in laboratories. This article is intended to invigorate interest in the uniqueness of practice-based research as a way of encouraging the talents of researchers and practitioners as they work together to gather evidence for improving the lives of individuals with communication disorders.

Bridging the Gap Between Research and Practice: Implementation Science.

PURPOSE: This article introduces implementation science, which focuses on research methods that promote the systematic application of research findings to practice. METHOD: The narrative defines implementation science and highlights the importance of moving research along the pipeline from basic science to practice as one way to facilitate evidence-based service delivery. This review identifies challenges in developing and testing interventions in order to achieve widespread adoption in practice settings. A framework for conceptualizing implementation research is provided, including an example to illustrate the application of principles in speech-language pathology. Last, the authors reflect on the status of implementation research in the discipline of communication sciences and disorders. CONCLUSIONS: The extant literature highlights the value of implementation science for reducing the gap between research and practice in our discipline. While having unique principles guiding implementation research, many of the challenges and questions are similar to those facing any investigators who are attempting to design valid and reliable studies. This article is intended to invigorate interest in the uniqueness of implementation science among those pursuing both basic and applied research. In this way, it should help ensure the discipline's knowledge base is realized in practice and policy that affects the lives of individuals with communication disorders.

Triadic gaze intervention for young children with physical disabilities.

PURPOSE: This randomized controlled study investigated whether a supplemental treatment designed to teach triadic gaze (TG) as a signal of coordinated joint attention would yield a significantly greater increase in TG in the experimental versus control group. METHOD: Eighteen 10- to 24-month-old children with severe motor impairments were randomly assigned to an experimental ( n = 9) or control group ( n = 9). For approximately 29 sessions over 17 weeks, experimental participants received TG treatment twice weekly with a speech-language pathologist in addition to standard practice. Control participants received only standard practice from birth-to-three therapists. Coders who were masked to group assignment coded TG productions with an unfamiliar speech-language pathologist at baseline, every 3 weeks during the experimental phase, and at the final measurement session. RESULTS: TG increased across groups from baseline to final measurement, with the experimental group showing slightly greater change. Performance trends were examined using experimental phase moving averages. Comparisons revealed significant differences between groups at 2 time points (at 12 weeks, r = .30, a medium effect, and at the end of the phase, r = .50, a large effect). CONCLUSION: The results suggest the promise of a short-term, focused treatment to teach TG as a behavioral manifestation of coordinated joint attention to children with severe physical disabilities.

Validating dynamic assessment of triadic gaze for young children with severe disabilities.

PURPOSE: This research investigated the use of a dynamic assessment (DA) to identify differences among young children with severe disabilities, which would predict progress in learning behaviors indicating coordinated joint attention (CJA). METHOD: Six children 10-24 months of age were enrolled in a 16-week treatment for behaviors indicating CJA, specifically triadic gaze (TG), which is a 3-point gaze shift between object and adult. An initial static assessment documented the children's eligibility for the study and their baseline performance of TG. DA procedures were then implemented to determine each child's performance with examiner support in producing behaviors suggesting joint attention (i.e., tracking, gaze toward an object or an adult, scanning between objects, scanning an object and adult, and TG). RESULTS: Results demonstrated differences among children during the DA via a DA score and a behavioral profile. These results were predictive of differences among children in subsequent learning of TG. CONCLUSION: These data support the validity of DA for describing heterogeneity among young children with severe disabilities who look similar on static assessment but appear differentially ready to learn behaviors associated with joint attention. This knowledge will assist clinicians in planning more efficacious services for young children who struggle to communicate and are at risk for extended therapeutic needs.

Variability in classroom social communication: performance of children with fetal alcohol spectrum disorders and typically developing peers.

PURPOSE: In this study, the authors examined how variability in classroom social communication performance differed between children with fetal alcohol spectrum disorders (FASD) and pair-matched, typically developing peers. METHOD: Twelve pairs of children were observed in their classrooms, 40 min per day (20 min per child) for 4 days over a 2-week period. Coders documented classroom social communication during situations of Cooperation and following School Rules by recording performance on handheld computers using the Social Communication Coding System (SCCS). The SCCS consists of 6 behavioral dimensions (prosocial/engaged, passive/disengaged, irrelevant, hostile/coercive, assertive, and adult seeking). The frequency of occurrence and duration of each dimension were recorded. These measures were then used to examine variability in performance within and across days (changeability and stability, respectively). RESULTS: Independent of classroom situation, children with FASD were more variable than their typically developing peers in terms of changing behavioral dimensions more often (changeability) and varying their behavior more from day to day (stability). CONCLUSIONS: Documenting performance variability may provide a clearer understanding of the classroom social communication difficulties of the child with mild FASD.

Development of the communication complexity scale.

PURPOSE: Accurate description of an individual's communication status is critical in both research and practice. Describing the communication status of individuals with severe intellectual and developmental disabilities is difficult because these individuals often communicate with presymbolic means that may not be readily recognized. Our goal was to design a communication scale and summary score for interpretation that could be applied across populations of children and adults with limited (often presymbolic) communication forms. METHOD: The Communication Complexity Scale (CCS) was developed by a team of researchers and tested with 178 participants with varying levels of presymbolic and early symbolic communication skills. Correlations between standardized and informant measures were completed, and expert opinions were obtained regarding the CCS. RESULTS: CCS scores were within expected ranges for the populations studied, and interrater reliability was high. Comparison across other measures indicated significant correlations with standardized tests of language. Scores on informant report measures tended to place children at higher levels of communication. Expert opinions generally favored the development of the CCS. CONCLUSIONS: The scale appears to be useful for describing a given individual's level of presymbolic or early symbolic communication. Further research is needed to determine whether it is sensitive to developmental growth in communication.

Observation of classroom social communication: do children with fetal alcohol spectrum disorders spend their time differently than their typically developing peers?

PURPOSE: In this research, the authors examined how social communication profiles during classroom activities differed between children with fetal alcohol spectrum disorders (FASD) and typically developing pair-matched peers. METHOD: Twelve pairs of children were observed in their classrooms 20 min a day for 4 days across 2 weeks. Coders documented classroom social communication by recording performance on handheld computers using the Social Communication Coding System (L. B. Olswang, L. Svensson, T. E. Coggins, J. Beilinson, & A. L. Donaldson, 2006). The Social Communication Coding System consists of 6 behavioral dimensions (prosocial/engaged, passive/disengaged, irrelevant, hostile/coercive, assertive, and adult seeking) that account for all verbal and nonverbal productions during a specified timeframe. The frequency of occurrence and duration of each dimension (as measured by proportion of time and average length of time spent performing each dimension) were recorded. RESULTS: Children with FASD had significantly more occurrences of passive/disengaged and irrelevant behavior, and the proportion and average length of time in these behaviors were larger and longer than those of their peers. Further, children with FASD had significantly more occurrences of prosocial/engaged behavior; however, the proportion and average length of time that they spent being prosocial were smaller and shorter than those of their peers. Implications Results suggest children with mild FASD performed differently than their peers in regard to classroom social communication, which was consistent with parent and teacher behavioral reports.

Discovering indices of contingency awareness in adults with multiple profound disabilities.

We conducted two studies to examine parameters of social attention in contingency awareness training using switch activation with individuals who had multiple profound disabilities. In Study 1 we compared leisure devices and social attention as reinforcing stimuli with 5 individuals. Results indicated the reinforcing qualities of social attention over leisure devices with 2 individuals and documented the importance of session length in training. In Study 2 we investigated idiosyncratic behaviors as indicators of responsiveness with 3 of the 5 original participants as they activated switches. Behavior changes during switch activation versus nonactivation times in the leisure device and social attention conditions suggested volitional movement supporting contingency awareness and preference. Implications for clinical practice are discussed.

A state of double jeopardy: impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school-age children with fetal alcohol spectrum disorder.

PURPOSE: This article is a retrospective examination of environmental risk, language performance, and narrative discourse data from a clinical database of school-age children with fetal alcohol spectrum disorder (FASD). METHOD: A case-defined diagnostic approach for measuring and reporting the full spectrum of disabilities in children with prenatal alcohol exposure is presented. Demographic, environmental, language, and social communication (as reflected by narrative discourse) data are reported for a large cohort of children with FASD between the ages of 6;0 (years;months) and 12;0. RESULTS: Children with FASD are a heterogeneous group with varying levels of compromise. The data demonstrate a substantial comorbidity between the effects of prenatal alcohol exposure and adverse caregiving environments. The data further reveal that school-age children with FASD often exhibit clinically meaningful deficits in language and social communication. CLINICAL IMPLICATION: Children with FASD may be particularly vulnerable to language and social communication deficits as a result of prenatal alcohol exposure and atypical or adverse social interactive experiences. Comprehensive assessment is recommended. Dynamic and functional assessment paradigms may document the language and social communicative deficits in children with FASD and other clinical populations with complex neurodevelopmental profiles.

Reliability issues and solutions for coding social communication performance in classroom settings.

PURPOSE: To explore the utility of time-interval analysis for documenting the reliability of coding social communication performance of children in classroom settings. Of particular interest was finding a method for determining whether independent observers could reliably judge both occurrence and duration of ongoing behavioral dimensions for describing social communication performance. METHOD: Four coders participated in this study. They observed and independently coded 6 social communication behavioral dimensions using handheld computers. The dimensions were mutually exclusive and accounted for all verbal and nonverbal productions during a specified time frame. The technology allowed for coding frequency and duration for each entered code. Data were collected from 20 different 2-min video segments of children in kindergarten through 3rd-grade classrooms. Data were analyzed for interobserver and intraobserver agreements using time-interval sorting and Cohen's kappa. Further, interval size and total observation length were manipulated to determine their influence on reliability. RESULTS: The data revealed interval sorting and kappa to be a suitable method for examining reliability of occurrence and duration of ongoing social communication behavioral dimensions. Nearly all comparisons yielded medium to large kappa values; interval size and length of observation minimally affected results. Implications The analysis procedure described in this research solves a challenge in reliability: comparing coding by independent observers of both occurrence and duration of behaviors. Results indicate the utility of a new coding taxonomy and technology for application in online observations of social communication in a classroom setting.

Communication in young children with motor impairments: teaching caregivers to teach.

Communication between caregivers and children with moderate to severe motor impairments is a tremendous challenge, and one that deserves attention as a central component of early intervention programs. This article examines a caregiver-training program that explored key elements to creating strong communicative interactions between young children with moderate to severe motor impairments and their primary caregiver. Three caregiver-child dyads participated in a 3-week treatment program teaching caregivers how to provide communicative opportunities, wait for a clear communication signal from their children, recognize their children's signal, and finally, shape a more advanced communicative behavior. These adult behaviors were designed to increase the children's use of conventional engaging signals of communication. Results revealed that caregivers demonstrated success learning all behaviors except for shaping during the brief treatment period. Children's engaging communicative behaviors increased correspondingly with the caregivers' changes. These findings have positive implications for caregiver training. Implications for "best practice" are considered.

Social communication interventions for preschoolers: targeting peer interactions during peer group entry and cooperative play.

Some preschoolers with language impairment approach and manage peer interactions less effectively than typically developing peers. This article discusses assessment and intervention strategies for targeting preschoolers' social communication skills during peer entry and cooperative play situations. Essential features of effective interventions include identification of appropriate social communication targets, addressing and facilitating children's use of these targets during small group sessions with peers, and supporting generalization of newly acquired social communication behaviors to children's peer interactions within the classroom setting.

"Do I know what I need to do?" A social communication intervention for children with complex clinical profiles.

PURPOSE: Speech-language pathologists frequently address social communication difficulties in children with diverse clinical profiles. The purpose of this study was to investigate the feasibility of a social communication intervention for a school-age child with a complex cognitive and behavioral profile secondary to diagnosis of a fetal alcohol spectrum disorder. METHOD: A case study is presented to describe the implementation of the intervention targeting mental state verb production and social cognitive skills. The intervention included group role play of social scripts and a checklist to elicit the participant's statements about others' perspectives and strategies for completing the social script. Treatment data monitored the participant's responses to the checklist questions. Probe sessions, consisting of theory of mind false belief tasks, were used to examine mental state verb use. RESULTS: Treatment data demonstrated that the participant stated more strategies in response to checklist questions. The participant did not produce any mental state verbs during baseline probes, but did produce mental state verbs during the treatment phase. CLINICAL IMPLICATIONS: The results support use of this intervention to change children's linguistic and social cognitive skills. Suggestions for extending this intervention to include a generalization plan targeting classroom social communication interactions are provided.

Effects of ambient stimuli on measures of behavioral state and microswitch use in adults with profound multiple impairments.

The effects of different types and amounts of environmental stimuli (visual and auditory) on microswitch use and behavioral states of three individuals with profound multiple impairments were examined. The individual's switch use and behavioral states were measured under three setting conditions: natural stimuli (typical visual and auditory stimuli in a recreational situation), reduced visual stimuli, and reduced visual and auditory stimuli. Results demonstrated differential switch use in all participants with the varying environmental setting conditions. No consistent effects were observed in behavioral state related to environmental condition. Predominant behavioral state scores and switch use did not systematically covary with any participant. Results suggest the importance of considering environmental stimuli in relationship to switch use when working with individuals with profound multiple impairments.