Chantal Desmarais

Systematic Review of the Literature on Characteristics of Late-Talking Toddlers.

BACKGROUND Research has investigated late-talking toddlers because they are at great risk of continuing to experience language-learning difficulties once they enter school and hence are candidates for early intervention. It is also important to consider this group of children with regards to the immediate characteristics which are detrimental to their development and for which early intervention has become increasingly available. AIMS To review the literature on late-talking toddlers in order to identify the characteristics of this population whose importance has been clearly demonstrated, identify sources of incongruence in findings, and to underscore aspects of language delay at 2 years of age and characteristics about which additional knowledge is needed. MAIN CONTRIBUTION The review highlights the need to define the language difficulties found in late-talking toddlers based on clinical profiles that go beyond the criterion of an expressive vocabulary delay. It also underscores the association between vocabulary delay and characteristics of the child such as social-emotional development and characteristics of the socio-familial environment such as language stimulation. CONCLUSIONS Future research should take into account the lack of homogeneity observed within the population of children with a vocabulary delay at 2 years of age and attempt to identify subgroups within late-talking toddlers. It should also consider a multifactorial perspective of child development to further the understanding of this phenomenon.

The roles of effective communication and client engagement in delivering culturally sensitive care to immigrant parents of children with disabilities.

Abstract Purpose: Delivering pediatric rehabilitation services to immigrant parents of children with disabilities requires the practice of culturally sensitive care. Few studies have examined the specific nature of culturally sensitive care in pediatric rehabilitation, especially the notions of effective communication and client engagement. Method: Interviews were held with 42 therapists (10 social workers, 16 occupational therapists and 16 speech language pathologists) from two locations in Canada (Toronto and Quebec City). Data were analyzed using an inductive content analysis approach. Results: Study themes included the importance and nature of effective communication and client engagement in service delivery involving immigrant parents. Participants discussed using four main types of strategies to engage immigrant parents, including understanding the family situation, building a collaborative relationship, tailoring practice to the client’s situation and ensuring parents’ understanding of therapy procedures. Conclusions: The findings illuminate the importance of effective, two-way communication in providing the mutual understanding needed by therapists to engage parents in the intervention process. The findings also richly describe the engagement strategies used by therapists. Clinical implications include recommendations for strategies for therapists to employ to engage this group of parents. Furthermore, the findings are applicable to service provision in general, as engaging families in a collaborative relationship through attention to their specific situation is a general principle of good quality, family-centered care. Implications for Rehabilitation Effective communication permeates the delivery of culturally sensitive care and provides mutual understanding, which is fundamental to client engagement. The findings illuminate the nature of “partnership” by indicating the role of collaborative therapist strategies in facilitating engagement. Four main strategies facilitate effective communication and client engagement, including understanding the family situation, building a collaborative relationship, tailoring practice to the client’s situation and ensuring parents’ understanding of therapy procedures. Engaging families in a collaborative relationship through attention to their specific situation is a general principle of good quality, family-centered care.

Intervention for improving comprehension in 4–6 year old children with specific language impairment: practicing inferencing is a good thing

Few studies report on therapy to improve language comprehension in children with specific language impairment (SLI). We address this gap by measuring the effect of a systematic intervention to improve inferential comprehension using dialogic reading tasks in conjunction with pre-determined questions and cues. Sixteen children with a diagnosis of SLI aged 4–6 participated in 10 weekly treatment sessions carried out by their regular therapists. Baseline and maintenance periods were also tabulated. Two experimental measures and a standardized test revealed that childrens total scores and the quality of their responses post-treatment were better than those obtained pre-treatment. However, perhaps due to the use of non-equivalent probes, this change could not be interpreted solely as a significant effect of intervention. These results nevertheless suggest that a systematically designed intervention focusing on the comprehension of specific types of questions requiring inferencing and using a carefully scaffolded cueing strategy can be beneficial.

An examination of clinicians’ experiences of collaborative culturally competent service delivery to immigrant families raising a child with a physical disability

Abstract Purpose: Although collaborative, culturally competent care has been shown to increase positive health outcomes and client satisfaction with services, little is known about the ways that clinicians implement service delivery models with immigrant families having a child with a disability. The purpose of this study is to examine the experiences of clinicians working with immigrant families raising a child with a physical disability and to examine the views and experiences of clinicians providing collaborative, culturally competent care to immigrant families raising a child with a physical disability. Method: This study draws on in-depth interviews with 43 clinicians within two pediatric centers in Toronto and Quebec. Results: Our findings show that clinicians remove or create barriers for immigrant families in different ways, which affect their ability to provide culturally competent care for immigrant families raising a child with a physical disability. Conclusions: Our findings suggest that there is a need for more institutional support for collaborative, culturally competent care to immigrant families raising a child with a physical disability. There is a lack of formal processes in place to develop collaborative treatment plans and approaches that would benefit immigrant families. Implications for Rehabilitation Clinicians need greater institutional support and resources to spend more time with families and to provide more rehabilitative care in families’ homes. Building rapport with families includes listening to and respecting families’ views and experiences. Facilitate collaboration and culturally competent care by having team meetings with parents to formulate treatment plans.

Inferential comprehension of 3–6 year olds within the context of story grammar: a scoping review

BACKGROUND The ability to make inferences plays a crucial role in reading comprehension and the educational success of school-aged children. However, it starts to unfold much earlier than school entry and literacy. Given that it is likely to be targeted in speech language therapy, it would be useful for clinicians to have access to information about a developmental sequence of inferential comprehension. Yet, at this time, there is no clear proposition of the way in which this ability develops in young children prior to school entry. AIMS To reduce the knowledge gap with regards to inferential comprehension in young children by conducting a scoping review of the literature. The two objectives of this research are: (1) to describe typically developing childrens comprehension of causal inferences targeting elements of story grammar, with the goal of proposing milestones in the development of this ability; and (2) to highlight key elements of the methodology used to gather this information in a paediatric population. METHODS & PROCEDURES A total of 16 studies from six databases that met the inclusion criteria were qualitatively analysed in the context of a scoping review. This methodological approach was used to identify common themes and gaps in the knowledge base to achieve the intended objectives. MAIN CONTRIBUTION Results permit the description of key elements in the development of six types of causal inference targeting elements of story grammar in children between 3 and 6 years old. Results also demonstrate the various methods used to assess this ability in young children and highlight particularly interesting procedures for use with this younger population. CONCLUSIONS These findings point to the need for additional studies to understand this ability better and to develop strategies to stimulate an evidence-based developmental sequence in children from an early age.

Comprehension of Inferences in a Narrative in 3- to 6-Year-Old Children

Purpose This study aimed to describe the development of inferential abilities of children age 3 to 6 years in a narrative using a dialogic reading task on an iPad. Method Participants were 121 typically developing children, divided into 3 groups according to age range (3-4 years old, 4-5 years old, 5-6 years old). Total score of inferential comprehension, subscores by causal inference type targeting elements of the story grammar, and quality of response were examined across groups. Results Inferential comprehension emerged early, from 3 to 4 years old, with considerable interindividual variability. Inferential comprehension scores increased significantly in relation to age, leading to developmental steps with regards to the type of causal inferences. The ability to infer the problem of the story, the internal response of a character, and predictions were easier starting at age 4 years. Then, the 5- to 6-year-olds were better able to infer the goal, the attempt to solve the problem, and the resolution. Last, between the ages of 3 and 6 years, children improved in terms of the quality of response they provided. Conclusion This study addresses important gaps in our knowledge of inferential comprehension in young children and has implications for planning of early education in this realm.

Prediction of the outcome of children who had a language delay at age 2 when they are aged 4: Still a challenge

Abstract Purpose: This study investigated the role that variables related to children and their environment play in the prediction of outcomes at 4 years of age for children with a language delay at 2 years. Method: A longitudinal study was undertaken where 64 children (45 boys, 19 girls; mean age = 53.3 months; SD = 4.4) with language delay at age 2 years were re-evaluated at age 4 years. Three developmental trajectories were analysed. Result: The early stages of grammar, as estimated by mean length of utterance at 3.5 years, are an important prognosis factor of subsequent language impairment (LI). Children who are exposed to several risk factors simultaneously are more likely to have a language delay (LD) or a LI, but the profile of LD children is more akin to that of the typically developing (TD) children. Children with LI tend to have profiles with a greater number of risk factors. Conclusion: The results of this study encourage different intervention approaches depending on the child’s language profile at 2 years, due to differing language prognosis. The results also point to the need to assess the child’s environment. Future studies with large diverse population samples may give more precise information on potential risk factors and their cumulative effect.

Services de soutien utilisés par les parents migrants d’un enfant en situation de handicap

Prendre soin d’un enfant en situation de handicap implique de relever des defis au quotidien, ce qui rend les parents vulnerables dans toutes les spheres de leur vie. Lorsque s’ajoute a ce vecu un parcours migratoire, les sources de difficultes augmentent, obligeant les parents a s’adapter en meme temps a leur nouvel environnement de vie et a la prise en charge de leur enfant. Bien que des services de soutien existent pour aider les parents a ne pas s’epuiser dans leurs responsabilites, peu d’etudes demontrent dans quelle mesure cette aide sert aux familles migrantes, population en augmentation dans de nombreux pays. En interrogeant 28 parents dans cette situation lors d’entrevues semi-dirigees au Quebec, il est question de mieux saisir l’utilisation des services de soutien et de determiner les facteurs de recours aux mesures d’aide formelle. Les resultats de l’analyse thematique exploratoire indiquent que cinq elements-cles peuvent expliquer ce recours. Une reflexion en decoule sur la necessite d’adapter les mesures d’aide aux attentes et aux besoins specifiques des familles migrantes.