Meeting the educational and social needs of children with language impairment or autism spectrum disorder: the parents' perspectives.

BACKGROUND: There is increasing interest in examining the perspectives of parents of children with special educational needs (SEN). Exploring the view of parents of a child with language impairment (LI) or autism spectrum disorder (ASD) is particularly important because of their high prevalence, at over 30% of children with SEN in England, and the increasing evidence of overlapping profiles of their needs. AIMS: To examine the similarities and differences between the perspectives of parents of children with LI or ASD on three issues: (1) their child's educational progress, and their behavioural, emotional and social development; (2) the provision made to support their child's education and meet their SEN; and (3) their own involvement in decision-making about provision for their child. METHODS & PROCEDURES: The parents of 129 children with LI (n = 76) or ASD (n = 53) were interviewed using a semi-structured protocol that gathered both quantitative data (parent ratings) and qualitative, in-depth explorations of their perspectives. OUTCOMES & RESULTS: There were no significant differences between the perspectives of parents of children with LI and parents of children with ASD with respect to their child's educational progress; the provision made to meet their child's educational needs; or their involvement in decision-making during the statutory assessment procedure, including the determination of a statement of SEN, and the current provision made by their child's school. Both parent groups were generally positive about these but parents of children with ASD were more concerned about their child's peer relationships. Parents whose child attended a mainstream school with a specialist resource tended to be more positive about the provision made than parents whose child was included individually into a mainstream school. CONCLUSIONS & IMPLICATIONS: Although previous research indicates that parents of children with ASD are overrepresented among those who express dissatisfaction with the provision made to meet their child's needs, this study indicates high levels of satisfaction and overlap between the perspectives of parents of children with LI or ASD regarding their child's educational progress and their own involvement in decision-making about the child's provision. The findings indicate the importance for policy and practice of focusing on identified needs rather than diagnostic category; and the importance of practitioners and administrators engaging meaningfully with parents in collaborative decision-making.

Integrating external evidence of intervention effectiveness with both practice and the parent perspective: development of 'What Works' for speech, language, and communication needs.

AIM: The aim of the study was to develop an ecologically valid synthesis of the evidence underpinning interventions for children with speech, language, and communication needs (SLCN), integrating a range of different data sources. METHOD: Three sources of information were integrated: the Cochrane Review of interventions for children with primary speech and language delays/disorder; current practice from an online survey of 534 speech and language therapists and other professionals working with children with SLCN; and parent reports of preferred outcomes. Evidence was ranked as strong, moderate, or indicative. RESULTS: Of the 58 interventions identified, three (5%) were found to have a strong level of evidence, 32 (56%) had moderate evidence, and 23 (39%) had indicative evidence. Five were universal interventions, the remainder targeted and universal. The integrated findings were then turned into an online interactive database, which is moderated and updated at regular intervals. INTERPRETATION: There are a number of interventions that have a moderate or strong level of evidence underpinning them but they tend not to be those used by practitioners who often favour well-established familiar programmes even if they have only indicative evidence. There is a degree of complementarity between professional and parent views about outcomes, albeit with different emphases.

Do children with specific language impairment and autism spectrum disorders benefit from the presence of orthography when learning new spoken words?

This experiment investigated whether children with specific language impairment (SLI), children with autism spectrum disorders (ASD), and typically developing children benefit from the incidental presence of orthography when learning new oral vocabulary items. Children with SLI, children with ASD, and typically developing children (n=27 per group) between 8 and 13 years of age were matched in triplets for age and nonverbal reasoning. Participants were taught 12 mappings between novel phonological strings and referents; half of these mappings were trained with orthography present and half were trained with orthography absent. Groups did not differ on the ability to learn new oral vocabulary, although there was some indication that children with ASD were slower than controls to identify newly learned items. During training, the ASD, SLI, and typically developing groups benefited from orthography to the same extent. In supplementary analyses, children with SLI were matched in pairs to an additional control group of younger typically developing children for nonword reading. Compared with younger controls, children with SLI showed equivalent oral vocabulary acquisition and benefit from orthography during training. Our findings are consistent with current theoretical accounts of how lexical entries are acquired and replicate previous studies that have shown orthographic facilitation for vocabulary acquisition in typically developing children and children with ASD. We demonstrate this effect in SLI for the first time. The study provides evidence that the presence of orthographic cues can support oral vocabulary acquisition, motivating intervention approaches (as well as standard classroom teaching) that emphasize the orthographic form.

Emotional and behavioural problems in children with language impairments and children with autism spectrum disorders.

BACKGROUND: Although it is well-established that children with language impairment (LI) and children with autism spectrum disorders (ASD) both show elevated levels of emotional and behavioural problems, the level and types of difficulties across the two groups have not previously been directly compared. AIMS: To compare levels of emotional and behavioural problems in children with LI and children with ASD recruited from the same mainstream schools. METHODS & PROCEDURES: We measured teacher-reported emotional and behavioural problems using the Strengths and Difficulties Questionnaire (SDQ) in a sample of 5-13-year-old children with LI (N = 62) and children with ASD (N = 42) attending mainstream school but with identified special educational needs. OUTCOMES & RESULTS: Both groups showed similarly elevated levels of emotional, conduct and hyperactivity problems. The only differences between the LI and ASD groups were on subscales assessing peer problems (which were higher in the ASD group) and prosocial behaviours (which were higher in the LI group). Overall, there were few associations between emotional and behavioural problems and child characteristics, reflecting the pervasive nature of these difficulties in children with LI and children with ASD, although levels of problems were higher in children with ASD with lower language ability. However, in the ASD group only, a measure of family social economic status was associated with language ability and attenuated the association between language ability and emotional and behavioural problems. CONCLUSIONS & IMPLICATIONS: Children with LI and children with ASD in mainstream school show similarly elevated levels of emotional and behavioural problems, which require monitoring and may benefit from intervention. Further work is required to identify the child, family and situational factors that place children with LI and children with ASD at risk of emotional and behavioural problems, and whether these differ between the two groups. This work can then guide the application of evidence-based interventions to these children.

Evaluation of the national roll-out of parenting programmes across England: the parenting early intervention programme (PEIP).

BACKGROUND: Evidence based parenting programmes can improve parenting skills and the behaviour of children exhibiting, or at risk of developing, antisocial behaviour. In order to develop a public policy for delivering these programmes it is necessary not only to demonstrate their efficacy through rigorous trials but also to determine that they can be rolled out on a large scale. The aim of the present study was to evaluate the UK government funded national implementation of its Parenting Early Intervention Programme, a national roll-out of parenting programmes for parents of children 8-13 years in all 152 local authorities (LAs) across England. Building upon our study of the Pathfinder (2006-08) implemented in 18 LAs. To the best of our knowledge this is the first comparative study of a national roll-out of parenting programmes and the first study of parents of children 8-13 years. METHODS: The UK government funded English LAs to implement one or more of five evidence based programmes (later increased to eight): Triple P, Incredible Years, Strengthening Families Strengthening Communities, Families and Schools Together (FAST), and the Strengthening Families Programme (10-14). Parents completed measures of parenting style (laxness and over-reactivity), and mental well-being, and also child behaviour at three time points: pre- and post-course and again one year later. RESULTS: 6143 parents from 43 LAs were included in the study of whom 3325 provided post-test data and 1035 parents provided data at one-year follow up. There were significant improvements for each programme, with effect sizes (Cohen's d) for the combined sample of 0.72 parenting laxness, 0.85 parenting over-reactivity, 0.79 parent mental well-being, and 0.45 for child conduct problems. These improvements were largely maintained one year later. All four programmes for which we had sufficient data for comparison were effective. There were generally larger effects on both parent and child measures for Triple P, but not all between programme comparisons were significant. Results for the targeted group of parents of children 8-13 years were very similar. CONCLUSIONS: Evidence-based parenting programmes can be rolled out effectively in community settings on a national scale. This study also demonstrates the impact of research on shaping government policy.

Costing children's speech, language and communication interventions.

BACKGROUND: There are few economic evaluations of speech and language interventions. Such work requires underpinning by an accurate estimate of the costs of the intervention. This study seeks to address some of the complexities of this task by applying existing approaches of cost estimation to interventions described in published effectiveness studies. AIMS: The study has two aims: to identify a method of estimating unit costs based on the principle of long-run marginal opportunity costs; and to illustrate the challenges in estimating unit costs for speech and language interventions. METHOD & PROCEDURES: Descriptions of interventions were extracted from eight papers and combined with information on the unit cost of speech and language therapists to identify information requirements for a full-cost estimation of an intervention. OUTCOMES & RESULTS: Four challenges were found relating to the level of detail about the therapists, the participants, the scope of activities and parents. Different assumptions made about any of these elements will have a marked effect on the cost of the intervention. CONCLUSIONS & IMPLICATIONS: Nationally applicable unit cost data for speech and language therapists can be used as a reference point, but sufficient descriptive data about delivery and receipt of the intervention are key to accuracy.

Cost-effectiveness of interventions for children with speech, language and communication needs (SLCN): a review using the Drummond and Jefferson (1996) 'Referee's Checklist'.

BACKGROUND: Although economic evaluation has been widely recognized as a key feature of both health services and educational research, for many years there has been a paucity of such studies relevant to services for children with speech, language and communication needs (SLCN), making the application of economic arguments to the development of services difficult. AIMS: The study has two aims, namely to review systematically the cost-effectiveness literature related to services for children with SLCN and to highlight key issues that need to be included in future economic effectiveness studies. METHODS & PROCEDURES: A comprehensive search of the international literature for the last 30 years was completed and the studies were evaluated against the 'gold standard' criteria developed by Drummond and colleagues in 1996 and 2005. OUTCOMES & RESULTS: Five studies met the review inclusion criteria. All focused on young (2-11 years) children with SLCN and most compared clinic-based and parent-administered interventions. The studies provide variable levels of detail on the key elements needed, but few provided sufficient details of costs to draw comparisons across studies. Only two studies attempted to bring together costs and effectiveness data. CONCLUSIONS & IMPLICATIONS: The studies point to the importance of home-based and indirect intervention and, in many cases, emphasize the parental perspective. There is a need for intervention studies to include a cost dimension based on readily comparable methods of establishing unit costs and for greater use to be made of cost-effectiveness analysis more generally.

A comparison of the effectiveness of three parenting programmes in improving parenting skills, parent mental-well being and children's behaviour when implemented on a large scale in community settings in 18 English local authorities: the parenting early intervention pathfinder (PEIP).

BACKGROUND: There is growing evidence that parenting programmes can improve parenting skills and thereby the behaviour of children exhibiting or at risk of developing antisocial behaviour. Given the high prevalence of childhood behaviour problems the task is to develop large scale application of effective programmes. The aim of this study was to evaluate the UK government funded implementation of the Parenting Early Intervention Pathfinder (PEIP). This involved the large scale rolling out of three programmes to parents of children 8-13 years in 18 local authorities (LAs) over a 2 year period. METHODS: The UK government's Department for Education allocated each programme (Incredible Years, Triple P and Strengthening Families Strengthening Communities) to six LAs which then developed systems to intervene using parenting groups. Implementation fidelity was supported by the training of group facilitators by staff of the appropriate parenting programme supplemented by supervision. Parents completed measures of parenting style, efficacy, satisfaction, and mental well-being, and also child behaviour. RESULTS: A total of 1121 parents completed pre- and post-course measures. There were significant improvements on all measures for each programme; effect sizes (Cohen's d) ranged across the programmes from 0.57 to 0.93 for parenting style; 0.33 to 0.77 for parenting satisfaction and self-efficacy; and from 0.49 to 0.88 for parental mental well-being. Effectiveness varied between programmes: Strengthening Families Strengthening Communities was significantly less effective than both the other two programmes in improving parental efficacy, satisfaction and mental well-being. Improvements in child behaviour were found for all programmes: effect sizes for reduction in conduct problems ranged from -0.44 to -0.71 across programmes, with Strengthening Families Strengthening Communities again having significantly lower reductions than Incredible Years. CONCLUSIONS: Evidence-based parenting programmes can be implemented successfully on a large scale in community settings despite the lack of concentrated and sustained support available during a controlled trial.

Early Positive Approaches to Support (E-PAtS) for Families of Young Children With Intellectual Disability: A Feasibility Randomised Controlled Trial.

Background: Parents of children with intellectual disabilities are likely to experience poorer mental well-being and face challenges accessing support. Early Positive Approaches to Support (E-PAtS) is a group-based programme, co-produced with parents and professionals, based on existing research evidence and a developmental systems approach to support parental mental well-being. The aim of this study was to assess the feasibility of community service provider organisations delivering E-PAtS to parents/family caregivers of young children with intellectual disability, to inform a potential definitive randomised controlled trial of the effectiveness and cost-effectiveness of E-PAtS. Methods: This study was a feasibility cluster randomised controlled trial, with embedded process evaluation. Up to two parents/family caregivers of a child (18 months to <6 years old) with intellectual disability were recruited at research sites and allocated to intervention (E-PAtS and usual practise) or control (usual practise) on a 1:1 basis at cluster (family) level. Data were collected at baseline and 3 and 12 months' post-randomisation. The following feasibility outcomes were assessed: participant recruitment rates and effectiveness of recruitment pathways; retention rates; intervention adherence and fidelity; service provider recruitment rates and willingness to participate in a future trial; barriers and facilitating factors for recruitment, engagement, and intervention delivery; and feasibility of collecting outcome measures. Results: Seventy-four families were randomised to intervention or control (n = 37). Retention rates were 72% at 12 months post-randomisation, and completion of the proposed primary outcome measure (WEMWBS) was 51%. Recruitment of service provider organisations and facilitators was feasible and intervention implementation acceptable. Adherence to the intervention was 76% and the intervention was well-received by participants; exploratory analyses suggest that adherence and attendance may be associated with improved well-being. Health economic outcome measures were collected successfully and evidence indicates that linkage with routine data would be feasible in a future trial. Conclusions: The E-PAtS Feasibility RCT has demonstrated that the research design and methods of intervention implementation are generally feasible. Consideration of the limitations of this feasibility trial and any barriers to conducting a future definitive trial, do however, need to be considered by researchers. Clinical Trial Registration: https://www.isrctn.com, identifier: ISRCTN70419473.

Self-esteem of adolescents with specific language impairment as they move from compulsory education.

BACKGROUND: Children with specific language impairment (SLI) are at risk of low self-esteem during their school years. However, there is a lack of evidence of the self-esteem of young people with a history of SLI during adolescence, as they transfer from compulsory schooling to post-compulsory education, employment or training. AIMS: To examine the self-esteem of young people with a history of SLI at the transition from compulsory education (16 years) to the first year of post-compulsory education, employment and training (17 years) in England. METHODS & PROCEDURES: A total of 54 young people identified as having SLI at 8 years were followed up at 16 and at 17 years. The young people completed two measures of self-esteem: the Self-perception Profile for Adolescents (16 years) and the Self-perception Profile for College Students (17 years). Assessments of language, literacy and non-verbal ability were also conducted. OUTCOMES & RESULTS: Perceptions of scholastic competence were significantly lower than the norm at 16 years; the female students also had lower self-esteem in the social and physical appearance domains and global self-worth. However, at 17 years there were no significant differences from the norm for these self-esteem domains. There was evidence of stability within self-esteem domains over this period but also an improvement in self-perceptions of scholastic and job competence, physical appearance and athletic competence, and also global self-worth, but not the three social domains. Non-verbal cognitive ability was not correlated with any measures of self-esteem, at 16 or 17 years. Language and literacy ability, especially spelling, were correlated with scholastic and job competence at 16 years but only spelling correlated at 17 years. CONCLUSIONS & IMPLICATIONS: This study has provided evidence for improvements in self-esteem for young people with SLI after they leave school and enter the world of non-compulsory education (typically at a college), employment and training. The study has also indicated the importance of addressing self-esteem as a multi-dimensional construct and the consequent necessity to use instruments that assess different domains of self-esteem.

Meeting the needs of children and young people with speech, language and communication difficulties.

BACKGROUND: The UK government set up a review of provision for children and young people with the full range of speech, language and communication needs led by a Member of Parliament, John Bercow. A research study was commissioned to provide empirical evidence to inform the Bercow Review. AIMS: To examine the efficiency and effectiveness of different arrangements for organizing and providing services for children and young people with needs associated with primary speech, language and communication difficulties. METHODS & PROCEDURES: Six Local Authorities in England and associated Primary Care Trusts were selected to represent a range of locations reflecting geographic spread, urban/rural and prevalence of children with speech, language and communication difficulties. In each case study, interviews were held with the senior Local Authority manager for special educational needs and a Primary Care Trust senior manager for speech and language therapy. A further 23 head teachers or heads of specialist provision for speech, language and communication difficulties were also interviewed and policy documents were examined. OUTCOMES & RESULTS: A thematic analysis of the interviews produced four main themes: identification of children and young people with speech, language and communication difficulties; meeting their needs; monitoring and evaluation; and research and evaluation. There were important differences between Local Authorities and Primary Care Trusts in the collection, analysis and use of data, in particular. There were also differences between Local Authority/Primary Care Trust pairs, especially in the degree to which they collaborated in developing policy and implementing practice. CONCLUSIONS & IMPLICATIONS: This study has demonstrated a lack of consistency across Local Authorities and Primary Care Trusts. Optimizing provision to meet the needs of children and young people with speech, language and communication difficulties will require concerted action, with leadership from central government. The study was used by the Bercow Review whose recommendations have been addressed by central government and a funded action plan has been implemented as a result.

The Early Positive Approaches to Support (E-PAtS) study: study protocol for a feasibility cluster randomised controlled trial of a group programme (E-PAtS) for family caregivers of young children with intellectual disability.

BACKGROUND: Children with intellectual disability have an IQ < 70, associated deficits in adaptive skills and are at increased risk of having clinically concerning levels of behaviour problems. In addition, parents of children with intellectual disability are likely to report high levels of mental health and other psychological problems. The Early Positive Approaches to Support (E-PAtS) programme for family caregivers of young children (5 years and under) with intellectual and developmental disabilities is a group-based intervention which aims to enhance parental psychosocial wellbeing and service access and support positive development for children. The aim of this study is to assess the feasibility of delivering E-PAtS to family caregivers of children with intellectual disability by community parenting support service provider organisations. The study will inform a potential, definitive RCT of the effectiveness and cost-effectiveness of E-PAtS. METHODS: This study is a feasibility cluster randomised controlled trial, with embedded process evaluation. Up to 2 family caregivers will be recruited from 64 families with a child (18 months to 5 years) with intellectual disability at research sites in the UK. Participating families will be allocated to intervention: control on a 1:1 basis; intervention families will be offered the E-PAtS programme immediately, continuing to receive usual practice, and control participants will be offered the opportunity to attend the E-PAtS programme at the end of the follow-up period and will continue to receive usual practice. Data will be collected at baseline, 3 months post-randomisation and 12 months post-randomisation. The primary aim is to assess feasibility via the assessment of: recruitment of service provider organisations; participant recruitment; randomisation; retention; intervention adherence; intervention fidelity and the views of participants, intervention facilitators and service provider organisations regarding intervention delivery and study processes. The secondary aim is preliminary evaluation of a range of established outcome measures for individual family members, subsystem relationships and overall family functioning, plus additional health economic outcomes for inclusion in a future definitive trial. DISCUSSION: The results of this study will inform a potential future definitive trial, to evaluate the effectiveness and cost-effectiveness of the E-PAtS intervention to improve parental psychosocial wellbeing. Such a trial would have significant scientific impact internationally in the intellectual disability field. TRIAL REGISTRATION: ISRCTN70419473.

Voices of young people with a history of specific language impairment (SLI) in the first year of post-16 education.

BACKGROUND: Giving young people more and better opportunities to have their voices heard is a key feature of current educational policy and research internationally and in the UK. AIMS: To examine the views of young people with a history of specific language impairment (SLI) as they entered post-16 education. METHODS & PROCEDURES: A total of 54 students identified as having SLI at 8 years of age were followed up through primary and secondary school to post-16 destinations. Most had been educated in mainstream schools. The young people were interviewed individually in relation to their perceptions of their special educational needs, their views on service provision, the role of family and friends as support systems, and their aspirations and barriers to future education at the early stages of post-16 education, training and work. OUTCOMES & RESULTS: The young people were able to offer accurate accounts of their history of special educational needs and to explore issues related to their development. Most young people were aware of the specific difficulties they experienced and had positive views about the support offered to them during their schooling. All the young people had at least one person in their family or friendship circle to whom they could talk about their joys and concerns, and friendships were an important and positive element in their lives. Additionally, most had a positive view of their post-16 courses, with comparable numbers hoping to undertake further study or training, or to go into work. They also had optimistic hopes for their futures five years ahead. CONCLUSIONS: The current study has demonstrated that young people with a history of SLI have an awareness of their difficulties and of the impact that these needs have on different aspects of their lives. They were also able to provide valuable views of service provision, both in terms of evaluating the support they received and suggesting ways of improving it. Ascertaining the views of younger children with SLI and including them in decision-making about their education and lives should be an important aspect of the role of those professionals working with this group of children. The study supports the importance of gaining the views of young people with SLI not only as a matter of rights, but also for the practical benefits that can ensue.

Defining the construct of Masters level clinical practice in healthcare based on the UK experience.

BACKGROUND: Growing emphasis on Masters level provision has been facilitated by the migration of education into Higher Education and the requirement for Continuing Professional Development. Paralleling this has been the development of specialisation in clinical practice. These factors have contributed to a proliferation of Masters courses aiming to develop specialist clinical practice. AIMS: The aim of the study was to define the behaviours that are indicative of the construct of masters level clinical practice, using the UK experience as an example. METHOD: A modified Delphi study employed a total population sample of course tutors of masters courses (nursing/midwifery, physiotherapy, radiography, interprofessional) in the UK assessing clinical practice (n = 48). Round 1 requested behaviours indicative of the construct of Masters level clinical practice. Data were analysed through descriptive coding identifying emerging themes to inform the behaviours included in round 2 that asked the participants to rank the importance of each behaviour on a 1-5 scale. Round 3 requested ranking the importance of the different behaviours to the construct. Descriptive analysis and the use of Kendall's coefficient of concordance and Spearman's rho enabled interpretation of consensus in rounds 2 and 3. RESULTS: The response rate for the Delphi study was very good. There was good consensus amongst the 28 behaviours identified for round 1. The second round enabled 21 behaviours agreed to be very important indicators of the construct to be taken into round 3. The ranking process in round 3 highlighted the importance of for example, a critical approach to practice and advanced clinical reasoning. CONCLUSION: The resulting 20 behaviours demonstrate good measurement validity and external validity. The components of the construct can therefore be used as the basis for further research.

Sustained Effectiveness of Evidence-Based Parenting Programs After the Research Trial Ends.

Despite ample evidence of the efficacy and effectiveness of evidence-based parenting programs (EBPPs) within research-led environments, there is very little evidence of maintenance of effectiveness when programs are delivered as part of regular service provision. The present study examined the effectiveness of EBPPs provided during a period of sustained service-led implementation in comparison to research-led effectiveness evaluation. Data from 3706 parents who received EBPPs during sustained implementation by services were compared to data from 1390 parents who had participated in an earlier researcher-led effectiveness trial of a national roll-out of EBPPs in England. In both phases, parents completed measures of child behavior problems, parenting style and parental mental well-being prior to starting parenting programs (pre-test), at the end of the programs (post) and at 12-months follow up. Results from Generalized Estimating Equations controlling for potential covariates indicated significant improvements in child behavior problems during sustained implementation, similar to the effectiveness phase; significant improvements in parenting style which were larger than the effectiveness phase at 12-month follow up; and significant improvements in parental mental well- being. Our findings demonstrate effective maintenance of gains when EBPPs are provided as part of regular provision across a large sample of English parents. Successful long-term implementation should consider effectiveness of EBPPs across the population, given the large contextual changes that take place between researcher-led evaluations and service take-up. Our findings support the integration of EBPPs in public health approaches to addressing child behavior problems and parent well-being.

Educational psychology and the effectiveness of inclusive education/mainstreaming.

BACKGROUND: Inclusive education/mainstreaming is a key policy objective for the education of children and young people with special educational needs (SEN) and disabilities. AIMS: This paper reviews the literature on the effectiveness of inclusive education/mainstreaming. The focus is on evidence for effects in terms of child outcomes with examination also of evidence on processes that support effectiveness. SAMPLES: The review covers a range of SEN and children from pre-school to the end of compulsory education. METHOD: Following an historical review of evidence on inclusive education/mainstreaming, the core of the paper is a detailed examination of all the papers published in eight journals from the field of special education published 2001-2005 (N=1373): Journal of Special Education, Exceptional Children, Learning Disabilities Research and Practice, Journal of Learning Disabilities, Remedial and Special Education, British Journal of Special Education, European Journal of Special Needs Education, and the International Journal of Inclusive Education. The derived categories were: comparative studies of outcomes: other outcome studies; non-comparative qualitative studies including non-experimental case studies; teacher practice and development; teacher attitudes; and the use of teaching assistants. RESULTS: Only 14 papers (1.0%) were identified as comparative outcome studies of children with some form of SEN. Measures used varied but included social as well as educational outcomes. Other papers included qualitative studies of inclusive practice, some of which used a non-comparative case study design while others were based on respondent's judgements, or explored process factors including teacher attitudes and the use of teaching assistants. CONCLUSIONS: Inclusive education/mainstreaming has been promoted on two bases: the rights of children to be included in mainstream education and the proposition that inclusive education is more effective. This review focuses on the latter issue. The evidence from this review does not provide a clear endorsement for the positive effects of inclusion. There is a lack of evidence from appropriate studies and, where evidence does exist, the balance was only marginally positive. It is argued that the policy has been driven by a concern for children's rights. The important task now is to research more thoroughly the mediators and moderators that support the optimal education for children with SEN and disabilities and, as a consequence, develop an evidence-based approach to these children's education.

Longitudinal patterns of behaviour problems in children with specific speech and language difficulties: child and contextual factors.

BACKGROUND: The purpose of this study was to examine the stability of behavioural, emotional and social difficulties (BESD) in children with specific speech and language difficulties (SSLD), and the relationship between BESD and the language ability. METHODS: A sample of children with SSLD were assessed for BESD at ages 8, 10 and 12 years by both teachers and parents. Language abilities were assessed at 8 and 10 years. RESULTS: High levels of BESD were found at all three ages but with different patterns of trajectories for parents' and teachers' ratings. Language ability predicted teacher- but not parent-rated BESD. CONCLUSIONS: The study confirms the persistence of high levels of BESD over the period 8-12 years and the continuing comorbidity of BESD and language difficulties but also indicates a complex interaction of within-child and contextual factors over time.

The effectiveness of universal parenting programmes: the CANparent trial.

BACKGROUND: There is substantial evidence for the efficacy and effectiveness of targeted parenting programmes but much less evidence regarding universal parenting programmes. The aim of the present study was to evaluate the effectiveness of the CANparent Trial of 12 universal parenting programmes, which were made available to parents of all children aged 0-6 years in three local authorities in England. To the best of our knowledge, this is the first study of universal parenting programmes on this scale. METHODS: Parents accessed a voucher, value £100, to attend an accredited programme of parenting classes. Parents completed measures of their mental well-being, parenting efficacy, parenting satisfaction, and parenting stress, at pre- and post-course. Comparative data were derived from a sample of non-participant parents in 16 local authorities not providing CANparent programmes. A quasi-experimental design was adopted following estimation of propensity scores to balance the two groups on socio-demographic variables. RESULTS: Following their programme, changes in parenting stress were small and nonsignificant (Cohen's d frequency 0.07; intensity, 0.17). Participating parents showed significantly greater improvements than the comparison group for parenting efficacy (0.89) but not parenting satisfaction (-0.01). Mental well-being improved from 0.29 SD below the national norm to the national norm after the course. Parents were overwhelmingly positive about their course (88-94%) but this was lower for improvement in their relationship with their child (74%) and being a better parent (76%). CONCLUSIONS: The CANparent Trial demonstrated that universal parenting programmes can be effective in improving parents' sense of parenting efficacy and mental well-being when delivered to the full range of parents in community settings. However, there was no evidence of a reduction in levels of parenting stress; nor was there a significant improvement in satisfaction with being a parent. This is the first study of its kind in the UK; although the results point to a population benefit, more research is needed to determine whether benefits can be maintained in the longer term and whether they will translate into better parenting practices.

Initial protocol for a national evaluation of an area-based intervention programme (A Better Start) on early-life outcomes: a longitudinal cohort study with comparison (control) cohort samples.

INTRODUCTION: Pregnancy and the first few years of a child's life are important windows of opportunity in which to equalise life chances. A Better Start (ABS) is an area-based intervention being delivered in five areas of socioeconomic disadvantage across England. This protocol describes an evaluation of the impact and cost-effectiveness of ABS. METHODS AND ANALYSIS: The evaluation of ABS comprises a mixed-methods design including impact, cost-effectiveness and process components. It involves a cohort study in the 5 ABS areas and 15 matched comparison sites (n=2885), beginning in pregnancy in 2017 and ending in 2024 when the child is age 7, with a separate cross-sectional baseline survey in 2016/2017. Process data will include a profiling of the structure and services being provided in the five ABS sites at baseline and yearly thereafter, and data regarding the participating families and the services that they receive. Eligible participants will include pregnant women living within the designated sites, with recruitment beginning at 16 weeks of pregnancy. Data collection will involve interviewer-administered and self-completion surveys at eight time points. Primary outcomes include nutrition, socioemotional development, speech, language and learning. Data analysis will include the use of propensity score techniques to construct matched programme and comparison groups, and a range of statistical techniques to calculate the difference in differences between the intervention and comparison groups. The economic evaluation will involve a within-cohort study economic evaluation to compare individual-level costs and outcomes, and a decision analytic cost-effectiveness model to estimate the expected incremental cost per unit change in primary outcomes for ABS in comparison to usual care. ETHICS AND DISSEMINATION: Ethical approval to conduct the study has been obtained. The learning and dissemination workstream involves working within and across the sites to generate learning via communities of practice and a range of learning and dissemination events.