Natalie Munro

Paediatric speech-language pathology service delivery: an exploratory survey of Australian parents.

Abstract Consideration of client values and preferences for service delivery is integral to engaging with the evidence-based practice triangle (E3BP), but as yet such preferences are under-researched. This exploratory study canvassed paediatric speech-language pathology services around Australia through an online survey of parents and compared reported service delivery to preferences, satisfaction, and external research evidence on recommended service delivery. Respondents were 154 parents with 192 children, living across a range of Australian locations and socio-economic status areas. Children had a range of speech and language disorders. A quarter of children waited over 6 months to receive initial assessment. Reported session type, frequency, and length were incongruent with both research recommendations and parents’ wishes. Sixty per cent of parents were happy or very happy with their experiences, while 27% were unhappy. Qualitative responses revealed concerns such as; a lack of available, frequent, or local services, long waiting times, cut-off ages for eligibility, discharge processes, and an inability to afford private services. These findings challenge the profession to actively engage with E3BP including; being cognisant of evidence-based service delivery literature, keeping clients informed of service delivery policies, individualizing services, and exploring alternative service delivery methods.

Why Word Learning is not Fast.

Upon fast mapping, children rarely retain new words even over intervals as short as 5 min. In this study, we asked whether the memory process of encoding or consolidation is the bottleneck to retention. Forty-nine children, mean age 33 months, were exposed to eight 2- or-3-syllable nonce neighbors of words in their existing lexicons. Didactic training consisted of six exposures to each word in the context of its referent, an unfamiliar toy. Productions were elicited four times: immediately following the examiner’s model, and at 1-min-, 5-min-, and multiday retention intervals. At the final two intervals, the examiner said the first syllable and provided a beat gesture highlighting target word length in syllables as a cue following any erred production. The children were highly accurate at immediate posttest. Accuracy fell sharply over the 1-min retention interval and again after an additional 5 min. Performance then stabilized such that the 5-min and multiday posttests yielded comparable performance. Given this time course, we conclude that it was not the post-encoding process of consolidation but the process of encoding itself that presented the primary bottleneck to retention. Patterns of errors and responses to cueing upon error suggested that word forms were particularly vulnerable to partial decay during the time course of encoding.

A play-based intervention for children with ADHD : A pilot study

INTRODUCTION Many children with attention deficit hyperactivity disorder (ADHD) have serious social and peer difficulties that can lead to adverse outcomes in adolescence and adulthood. To date, psychosocial treatments have produced poor outcomes in reducing social impairments commonly associated with ADHD. This study aimed to examine the efficacy of a new intervention designed to improve the play and social skills of children with ADHD and their playmates within the natural context of play. METHODS Participants included children (aged 5-11 years) diagnosed with ADHD, age-matched typically developing playmates (n=14/group) and parents of children with ADHD. The intervention involved seven weekly video-recorded free-play sessions; video feed-forward/feedback and therapist- and peer-modelling were used to promote social play. The Test of Playfulness was used as a pre-/post-test measure. Data were subjected to Rasch analysis to calculate measure scores on interval level; dependant sample t-test and Cohen-d calculations were used to measure effect. RESULTS A dependant samples t-test revealed that both children with ADHD (t=8.1; d.f.=13; P<0.01) and their playmates (t=6.9; d.f.=13; P<0.01) improved in their social play. Results demonstrated a large effect in improving the social play of children with ADHD (d=1.5) and their playmates (d=1.3). DISCUSSION Results support the use of play, video feed-forward/feedback techniques, therapist- and peer-modelling and parent involvement as an effective means to develop the social play skills of children with ADHD. Further larger-scale research is required.

Building vocabulary knowledge and phonological awareness skills in children with specific language impairment through hybrid language intervention: a feasibility study

BACKGROUND & AIMS Preschool and early school-aged children with specific language impairment not only have spoken language difficulties, but also are at risk of future literacy problems. Effective interventions targeting both spoken language and emergent literacy skills for this population are limited. This paper reports a feasibility study of a hybrid language intervention approach that targets vocabulary knowledge and phonological awareness skills within the context of oral narrative, storybook reading, and drill-based games. This study also reports on two novel, experimental assessments that were developed to expand options for measuring changes in lexical skills in children. METHODS & PROCEDURES Seventeen children with specific language impairment participated in a pilot within-group evaluation of a hybrid intervention programme. The childrens performance at pre- and post-intervention was compared on a range of clinical and experimental assessment measures targeting both spoken language and phonological awareness skills. Each child received intervention for six one-hour sessions scheduled on a weekly basis. Intervention sessions focused on training phonological awareness skills as well as lexical-semantic features of words within the context of oral and storybook narrative and drill-based games. OUTCOMES & RESULTS The children significantly improved on clinical measures of phonological awareness, spoken vocabulary and oral narrative. Lexical-semantic and sublexical vocabulary knowledge also significantly improved on the experimental measures used in the study. CONCLUSIONS The results of this feasibility study suggest that a larger scale experimental trial of an integrated spoken language and emergent literacy intervention approach for preschool and early school-aged children with specific language impairment is warranted.

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.

The reliability of methodological ratings for speechBITE using the PEDro‐P scale

BACKGROUND speechBITE (http://www.speechbite.com) is an online database established in order to help speech and language therapists gain faster access to relevant research that can used in clinical decision-making. In addition to containing more than 3000 journal references, the database also provides methodological ratings on the PEDro-P (an adapted version of the PEDro) scale to assist clinicians in identifying the scientific quality of randomized (RCTs) and non-randomized control trials (NRCTs). While reliability of the PEDro scale has been established by similar allied health databases, the reliability of the PEDro-P scale has yet to be reported. AIMS To examine the reliability of PEDro-P scale ratings undertaken by raters on the speechBITE database and benchmark these results to the published reliability for the original PEDro scale. Both the total score (out of ten) as well as each of the 11 scale items were included in this analysis. METHODS & PROCEDURES speechBITEs volunteer rater network of 17 members rated the first 100 RCTs and NRCTs on the website. The criterion and overall scores for these ratings were compared with previously published reliability studies using the PEDro scale. Intra-class correlations and per cent agreement measures were used to establish and benchmark reliability. OUTCOMES & RESULTS The speechBITE PEDro-P ratings ranged from fair to excellent for both the total score and for each of the 11 scale items. Furthermore, reliability was equal to that of other databases. CONCLUSIONS & IMPLICATIONS speechBITE users can be confident of the reliability of ratings published on the website. Further analysis of differences between this study and previous PEDro scale reliability studies are discussed.

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 pragmatic language abilities of children with ADHD following a play-based intervention involving peer-to-peer interactions.

Abstract Children with Attention Deficit Hyperactivity Disorder (ADHD) commonly experience significant pragmatic language deficits which put them at risk of developing emotional and social difficulties. This study aimed to examine the pragmatic language exhibited in a peer-to-peer interaction between the children with ADHD and their playmates following a pilot play-based intervention. Participants were children (aged 5–11 years) diagnosed as having ADHD (n = 14) and their self-selected typically-developing playmate. Pragmatic language was measured using the Pragmatic Protocol (PP) and the Structured Multidimensional Assessment Profiles (S-MAPs). Childrens structural language was also screened and compared against their pragmatic language skills pre–post play-based intervention. The pragmatic language of children with ADHD improved significantly from pre–post intervention as measured by both the PP and S-MAPs. Both children with and without structural language difficulties improved significantly from pre- to post-intervention using S-MAPs; only children with structural language difficulties improved significantly using PP. The findings support the notion that pragmatic skills may improve following a play-based intervention that is characterized by didactic social interaction. As pragmatic language is a complex construct, it is proposed that clinicians and researchers reconsider the working definition of pragmatic language and the operationalization thereof in assessments.

Factors influencing speech and language outcomes of children with early identified severe/profound hearing loss: Clinician-identified facilitators and barriers

Abstract Purpose: Early identification of severe/profound childhood hearing loss (HL) gives these children access to hearing devices and early intervention to facilitate improved speech and language outcomes. Predicting which infants will go on to achieve such outcomes remains difficult. This study describes clinician identified malleable and non-malleable factors that may influence speech and language outcomes for children with severe/profound HL. Method: Semi-structured interviews were conducted with six experienced auditory verbal clinicians. A collective case study design was implemented. The interviews were transcribed and coded into themes using constant comparative analysis. Result: Clinicians identified that, for children with severe/profound HL, early identification, early amplification and commencing auditory-verbal intervention under 6 months of age may facilitate child progress. Possible barriers were living in rural/remote areas, the clinicians’ lack of experience and confidence in providing intervention for infants under age 6-months and belonging to a family with a culturally and linguistically diverse (CALD) background. Conclusion: The results indicate that multiple factors need to be considered by clinicians working with children with HL and their families to determine how each child functions within their own environment and personal contexts, consistent with the International Classification of Functioning, Disability and Health (ICF) framework. Such an approach is likely to empower clinicians to carefully balance potential barriers to, and facilitators of, optimal speech and language outcomes for all children with HL.

Recognising language impairment in secondary school student populations

Up to 16% of students in mainstream secondary schools present with language impairment (LI). As with other learning difficulties, students with LI experience many academic, social, emotional and behavioral problems. Associated presenting behaviors may, however, be masking the primary language impairment. As a result, secondary school students with LI are under-recognised and may therefore be missing out on appropriate supports and services. In order to increase the awareness of education professionals and to increase the likelihood of identification and effective support, this article describes the nature and impact of LI in secondary school student populations. Two hypothetical case studies highlight the educational and psychosocial impact of LI during adolescence.