Sarah Spencer

Measuring quality of life in children with speech and language difficulties: a systematic review of existing approaches

BACKGROUND Childrens and adolescents speech and language difficulties (SaLD) can affect various domains of quality of life (QoL), and speech and language therapy interventions are critical to improving QoL. Systematically measuring QoL outcomes in this population is highly complex due to factors such as heterogeneity in impairments and differing targets during intervention. However, measurements of QoL are increasingly required by healthcare commissioners and policy-makers to inform resource allocation. AIMS To review the use of QoL measures in research involving children (age ≤ 18 years) with SaLD. METHODS & PROCEDURES A systematic review was undertaken. A systematic search across various databases was performed. Information on the methodological details of each relevant study, along with descriptions of the QoL measures employed, were extracted into standardized data extraction forms. Findings were discussed in a narrative synthesis. OUTCOMES & RESULTS Twenty-one relevant studies were identified that deal with a range of subpopulations of children with SaLD. For the most part, generic QoL measures were used, although there was little convergence on the type of QoL measures employed throughout the literature. Five studies utilized preference-based QoL measures, including the 16D/17D, HUI3, EQ-5D and QWB-SA. Of these measures, the HUI3 demonstrated the most promising discriminant validity, although the preference weights for this measure were generated with adults. CONCLUSIONS & IMPLICATIONS QoL among children with SaLD is not yet being captured in a systematic way. The HUI3 measure appears to show some promise for generating relevant preference-based QoL estimates, although further testing of the measure is required.

‘I don’t come out with big words like other people’: Interviewing adolescents as part of communication profiling

Assessing adolescent language skills poses significant challenges due to the subtle nature of language proficiency at this age, along with the high linguistic demands both academically and socially. As with young children, the current range of language assessments designed specifically for adolescents mostly includes standardized tests. This article explores how interviews can contribute to the assessment of adolescents’ language and communication skills. Two case studies of adolescents with previously undetected language difficulties are presented. The case studies show how the adolescents were able to reflect upon their language skills in an interview situation. Case studies also compare adolescents’ comments with the outcomes of standardized assessments. The interview allowed consideration of adolescent’s perceptions of strengths and difficulties, and identified possible barriers for these adolescents to both language intervention and education. Relationships between assessment and interview data are discussed and implications for assessment procedures are highlighted.

Language, social class and education: listening to adolescents’ perceptions

Young peoples perceptions may offer an insight into the complex associations between language, education and social class. However, little research has asked young people what they think of their own talking. Forty-two British adolescents aged between 14 and 15 years were interviewed: 21 attended a school in a working class area; 21 attended school in a middle class area. This paper examines and compares interview extracts from the two groups of adolescents. Results of a thematic analysis suggest that adolescents in both schools use language to signal their identity and to identify the group membership of others. Identity was linked by participants to social class. For example, adolescents attending school in a working class area described how they avoid talking ‘posh’ and those in a middle class area avoided talking like a ‘chav’. Adolescents attending school in a working class area described differences between the requirements of talking with teachers versus with their peers. Those in a middle class area discussed how their language skills were related to literacy and educational success. Implications for educational policy and practice are examined.

Neonatal overfeeding disrupts pituitary ghrelin signalling in female rats long-term; Implications for the stress response

The hypothalamic-pituitary-adrenal (HPA) axis responses to psychological stress are exacerbated in adult female but not male rats made obese due to overfeeding in early life. Ghrelin, traditionally known for its role in energy homeostasis, has been recently recognised for its role in coordinating the HPA responses to stress, particularly by acting directly at the anterior pituitary where the growth hormone secretagogue receptor (GHSR), the receptor for acyl ghrelin, is abundantly expressed. We therefore hypothesised that neonatal overfeeding in female rats would compromise pituitary responsiveness to ghrelin, contributing to a hyperactive central stress responsiveness. Unlike in males where hypothalamic ghrelin signalling is compromised by neonatal overfeeding, there was no effect of early life diet on circulating ghrelin or hypothalamic ghrelin signalling in females, indicating hypothalamic feeding and metabolic ghrelin circuitry remains intact. However, neonatal overfeeding did lead to long-term alterations in the pituitary ghrelin system. The neonatally overfed females had increased neonatal and reduced adult expression of GHSR and ghrelin-O-acyl transferase (GOAT) in the pituitary as well as reduced pituitary responsiveness to exogenous acyl ghrelin-induced adrenocorticotropic hormone (ACTH) release in vitro. These data suggest that neonatal overfeeding dysregulates pituitary ghrelin signalling long-term in females, potentially accounting for the hyper-responsive HPA axis in these animals. These findings have implications for how females may respond to stress throughout life, suggesting the way ghrelin modifies the stress response at the level of the pituitary may be less efficient in the neonatally overfed.

Capturing communication supporting classrooms: The development of a tool and feasibility study

There is an increasing emphasis on supporting the oral language needs of children in the classroom. A variety of different measures have been developed to assist this process but few have been derived systematically from the available research evidence. A Communication Supporting Classrooms Observation Tool (CsC Observation Tool) for children aged 4–7 years (that is, in Reception and Key Stage 1 classrooms) was devised following a review of the research literature. The evidence derived from 62 research papers was rated based on the studies’ research design following specific rating criteria. Based on the review of the literature and rating of the evidence, three main areas were identified and included as dimensions in the CsC Observation Tool: Language Learning Environment, Language Learning Opportunities and Language Learning Interactions. A feasibility study was carried out in 101 classrooms in 39 schools across 10 local authorities in England. The results suggested that the CsC Observation Tool discriminated well between different age groups within the sample and between different schools. In addition, significant differences were found across the three dimensions of the CsC Observation Tool. For all year groups, scores for the Language Learning Environment dimension were significantly higher than scores for Language Learning Interactions, and scores for the Language Learning Interactions dimension were significantly higher than those for the dimension of Language Learning Opportunities. The study provided evidence for using the CsC Observation Tool in schools to support training and development. The tool has the potential to be used as a key feature in universal intervention studies to promote oral language in the classroom.

How Food Can Change a Baby’s Brain

Which snack would you prefer? A bag of chips or carrot sticks? Ice cream or an apple? Most of us would probably choose the junk food. While sometimes it is OK to have chips or ice cream, if you eat junk food all the time it is pretty obvious you will begin to gain weight. What might not be obvious is that a poor diet can also change your brain! Even before a baby is born, what the parents eat can affect how the baby’s brain develops. Here, we tested what happens to the brain if we begin to eat healthier as we grow, after eating poorly early on in life. We found that eating poorly when the brain is developing changes our decisions about food. However, we can fix some of this damage with a good diet. Excellent news for kids and adults who have health problems from eating a poor diet early in life.

A school-commissioned model of speech and language therapy

Many speech and language therapy (SLT) services have limited capacity for providing school-based input. Some offer commissioned SLT input, to enhance the service provided by the UK National Health Service (NHS), giving schools the option to increase the amount and scope of SLT intervention. This two-tiered model of service provision is relatively new and has not been researched. This study investigated the experiences of schools who had commissioned input from the local SLT service, in terms of (1) describing how this was utilized and (2) exploring perceptions of its value. Semi-structured interviews were carried out with special educational needs co-ordinators (SENCos) from 11 schools and were thematically analysed using Framework Analysis. SENCos reported many positive aspects of the commissioned model, including better communication with Speech and Language Therapists (SLTs) and improved outcomes for children. SENCos felt that the numbers of children with speech, language and communication needs (SLCN) had reduced following commissioned input. Very few disadvantages of the model were identified. SLTs delivered a range of activities, including training staff and providing direct input for children. SENCos would recommend the service, and perceived the cost to be moderate. These data suggest that SENCos place a high value on SLT in schools, and welcome the opportunity to purchase additional input.

Research as working class resistance: lessons learned from Getting by

Getting By is set on Nottingham’s St Ann’s council estate, home to 14,000 people, and home to its author for two decades. The book confronts external notions of a place ridden with crime, drugs and...

Developing a Multi-purpose E-Learning Application for Speech and Language Therapy Students and Professionals Using a Design Science Research Approach

This paper presents Teen Talk as a multi-purpose e-learning application that was designed and developed using Design Science Research (DSR) approach. Teen Talk offers training for professionals and students who work with adolescents and young adults with significant speech, language and communication needs (SLCN). It is a multi-purpose tool, offering traditional education content to students/trainees (for example, student Speech and Language Therapists) and a professional development opportunity for professionals working in the field (for example, professionals working with adolescents with SLCN in Youth Offending teams). The resource uses video material of adolescents with SLCN to structure interactive learning tasks. Finally, the structure as well as the different aspects and components of Teen Talk are presented and discussed.

Book review: Nippold MA and Scott CM (eds) (2009) Expository discourse in children, adolescents, and adults: Development and disorders. Psychology Press: New York. 336pp. Hardback £45.00. ISBN 978-1-84169-892-2

Careful consideration of the abilities of the child would be required when selecting or modifying activities. However, activities might also be used to explore whether or not a child has developed specific skills or knowledge such as self-other awareness, ability to understand emotions, and ability to use imagination to think about options for problem-solving. Given the importance of these fundamental skills for the development of effective interaction and relationships with others, activities from the book could helpfully be used to develop a clearer profile of skills for children with social communication difficulties. Strikingly, children with autistic spectrum disorders can be desperately in need of support in the area of change, stress and anxiety, but may not be able to access unmodified versions of the visualization activities. An exploration of the ways in which image work can and cannot be used to successfully build emotional awareness and resilience in this population could prove worthwhile. In summary, this book is a helpful addition to available resources. It prompts some important questions about how to ensure access to these informal psychotherapeutic approaches for children who might be at risk of acute difficulties in later life. It will not always be clear who should take responsibility for the work, but this book provides some excellent ideas that will suit a large proportion of children experiencing difficulties with change, stress and anxiety.