Margaret Glogowska

Randomised controlled trial of community based speech and language therapy in preschool children

Abstract Objective: To compare routine speech and language therapy in preschool children with delayed speech and language against 12 months of “watchful waiting.” Design: Pragmatic randomised controlled trial. Setting: 16 community clinics in Bristol. Participants: 159 preschool children with appreciable speech or language difficulties who fulfilled criteria for admission to speech and language therapy. Main outcome measures: Four quantitative measures of speech and language, assessed at 6 and 12 months; a binary variable indicating improvement, by 12 months, on the trial entry criterion. Results: Improvement in auditory comprehension was significant in favour of therapy (adjusted difference in means 4.1, 95% confidence interval 0.5 to 7.6; P=0.025). No significant differences were observed for expressive language (1.4, −2.1 to 4.8; P=0.44); phonology error rate (−4.4, −12.0 to 3.3; P=0.26); language development (0.1, −0.4 to 0.6; P=0.73); or improvement on entry criterion (odds ratio 1.3, 0.67 to 2.4; P=0.46). At the end of the trial, 70% of all children still had substantial speech and language deficits. Conclusions: This study provides little evidence for the effectiveness of speech and language therapy compared with watchful waiting over 12 months. Providers of speech and language therapy should reconsider the appropriateness, timing, nature, and intensity of such therapy in preschool children. Continued research into more specific provision to subgroups of children is also needed to identify better treatment methods. The lack of resolution of difficulties for most of the children suggests that further research is needed to identify effective ways of helping this population of children.

Should I Go Or Should I Stay? A Study of Factors Influencing Students' Decisions on Early Leaving.

The article reports on selected findings from a multi-method research project on student retention on a nursing programme. Although the research identified some factors specific to the experiences of students on the particular programme, this article focuses on findings and recommendations of generic interest. The article compares data from semi-structured interviews with two groups of students: students who had withdrawn without completing their programme and students who considered leaving, but chose to stay. The article suggests that, in most cases, decisions to leave cannot be reduced to single factors, but are the culmination of complex interacting factors. Six ‘push’ factors are explored. These factors were mentioned by both groups of students. The article also discusses four ‘pull’ factors which act to hold students on their courses. Recommendations for improving retention include increasing support for students, and adapting provision to meet the needs of a diverse student population.

Early speech- and language-impaired children: linguistic, literacy, and social outcomes

The aim of this study was to follow-up prospectively a cohort of preschool children originally recruited from successive referrals to speech and language therapy community clinics and to investigate their linguistic, literacy, and social outcomes at 7 to 10 years of age. Three hundred and fifty children aged 84 to 113 months (mean age 99.9mo [SD 5.4mo]) were singletons from monolingual backgrounds where there was concern about their speech and language development. Children who had severe learning difficulties, autism, oromotor deficits, dysfluency, or dysphonia were excluded. Altogether 196 (56%), 134 males and 62 females, were seen at follow-up. A control group of children who had never been referred for speech and language therapy, 57% of whom were males, was also recruited (n=94; mean age 104.4mo [SD 6.8mo]). All children were assessed on standardized measures of speech, language, and literacy. Teachers and parents completed questionnaires on educational and social outcomes. In total, 139 children in the cohort were within the normal range on standardized language assessments. About 30% of the original cohort of children continue to struggle with language, literacy, and social difficulties. The study demonstrates the long-term nature of language impairment and reinforces the need for awareness among professionals in child development and education of the ongoing needs of this population of children.

Day in, day out : The everyday therapy of community clinics

This paper describes the timing and nature of therapy provided within a recent randomised controlled trial (RCT) of preschool speech and language therapy services. There is literature that describes and evaluates speech and language therapy but there is little indication of how this is translated into everyday practice. The study collected data from 21 speech and language therapists (SLTs) in 16 community clinics. The areas targeted, goals, approaches used, the frequency and timing of contact for the 68 children who received treatment were documented. The data show that several aspects of therapy were frequently targeted simultaneously, that approaches were combined and that the frequency of therapy did not vary with severity. The discussion will consider the gap between published programmes and everyday practice and the implications for effectiveness.

Running a Randomised Controlled Trial in a Service Setting: A Progress Report

This paper will give a progress report on a randomised controlled trial which is currently underway in the Bristol area. Some of the key influencing literature will be summarised, followed by an overview of the study design. The paper will also highlight some of the methodological and practical advantages and disadvantages afforded by the service setting of the study.