Sue Roulstone

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.

The Speech and Language of Children Aged 25 Months: Descriptive Data from the Avon Longitudinal Study of Parents and Children.

A major epidemiological study, the Avon Longitudinal Study of Parents and Children, has provided the opportunity for a population study of childrens speech and language. Data collected via direct assessments and maternal self-completion questionnaire on 1127 children aged 25 months is presented in this paper. The speech and language of the children shows great range in terms of the stage of expressive language development achieved, with some children already accomplished talkers and others only just entering the world of words As in other studies, girls showed more advanced skills than boys. A clear pattern emerges regarding the childrens use of sound classes with errors in postvocalic sounds reducing first, followed by velars, fricatives, liquids and finally, consonant clusters. Associations were found between the childrens verbal comprehension and their reported expressive stage, pretend play, turn taking in games, imitation of words and sounds and singing of nursery rhymes.

The Influence of Bilingualism on Speech Production: A Systematic Review.

BACKGROUND Children who are bilingual and have speech sound disorder are likely to be under-referred, possibly due to confusion about typical speech acquisition in bilingual children. AIMS To investigate what is known about the impact of bilingualism on childrens acquisition of speech in English to facilitate the identification and treatment of bilingual children with speech sound disorder. METHODS & PROCEDURES A systematic review of studies from the last 50 years was conducted. Studies investigating speech acquisition in bilingual infants and children (where one language was English) were identified through searching seven electronic databases, bibliographies of relevant articles and e-mailing authors. Sixty-six studies investigating bilingual speech production met inclusion criteria, with 53 describing typically developing children and 13 describing children with speech sound disorder. The 66 studies were analysed thematically and summarized in terms of methods, key findings and underlying theories. MAIN CONTRIBUTION There was limited evidence to suggest that bilingual children develop speech at a slower rate than their monolingual peers; however, there was evidence for qualitative differences and increased variation in speech production. Nearly all studies provide evidence for transfer between the two phonological and language structures, although the amount of transfer varied between studies. There was evidence of positive and negative transfer of features from the dominant language (L1) to the second language (L2) as well as from L2 to L1. Positive transfer became more evident with increased age and length of exposure to a second language. More recently researchers have moved away from investigating whether there are one or two phonological systems and accept that there are two systems that interact. Interest has shifted to examining how phonological systems interact and to identifying factors that influence interactions. The review revealed a number of inconsistencies in the findings of studies due to differences in methodology, languages investigated and degree of language exposure. Overall, measurement issues were addressed well but most studies provided limited sample information about language experience, schooling and socio-economic status. CONCLUSIONS & IMPLICATIONS There are differences in speech sound acquisition between monolingual and bilingual children in terms of rate and patterns of error, with both positive and negative transfer occurring in bilingual children.

Children's views of speech and language therapy in school: consulting children with communication difficulties

Children have the right to express their views and to participate actively in decisions that concern them. Implementing this principle in clinical practice poses a methodological challenge to therapists working with children with communication difficulties. In a pilot study, therapists working in mainstream primary schools conducted semi-structured interviews with 12 clients, aged 6–11 years with communication difficulties. The interviews elicited valuable information about these childrens experience of speech and language therapy and about their general communication at school and at home. Methods of interviewing were evaluated and recommendations made for ways of increasing childrens participation in planning and reviewing therapy.

Supporting children with speech, language and communication needs: an overview of the results of the better communication research programme

Children and young people with speech, language and communication needs raise considerable challenges for professionals in terms of the identification of the nature of need and effective intervention. Drawing on 19 reports emanating from the Better Communication Research Programme, the current paper provides an evidence base to support the development of clinical and educational frameworks to meet the children’s needs. Furthermore it highlights areas in need of future research and evaluation.

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.

A comparison between computer and tabletop delivery of phonology therapy

This paper reports on the development and evaluation of a software program aimed at assisting children with phonological impairment. An experimental approach was used whereby childrens speech output was assessed pre- and post-therapy. Children were randomly assigned to a computer, a tabletop or a no therapy group. Those children receiving the computer therapy were exposed to an experimental software program that mirrored the tabletop activities using interactive computer games. The results showed no significant difference between any of the three groups with regard to change in speech output. These results may relate to the amount and frequency of therapy given and also to the heterogeneous nature of children included in the study. There was considerable variation in individual performance across all three groups and the data were therefore analysed to look for patterns that might predict performance. Stimulability and gender were identified as possible predictors. Female children and those who were able to produce a greater number of consonant speech sounds in isolation were more likely to make progress in their speech output. Future research might use a similar methodology to compare the therapy conditions but with a more homogenous group in terms of stimulability and using a greater intensity of intervention.

Distinguishing groups of children with persistent speech disorder: Findings from a prospective population study

Abstract As part of a large-scale study of childrens development, 7390 children were assessed on a range of speech tasks. These were used to identify three groups of children with speech errors within the sample: persistent speech disorder (PSD); speech errors but below the threshold for classification as persistent speech disorder (non-PSD); and common clinical distortions only (CCD). These three groups were compared on demographic factors, performance on IQ, non-word repetition, and diadochokinetic tests. Findings showed that the PSD group and the non-PSD group were most similar for gender, socio-economic status, IQ, and non-word repetition. In the diadochokinetic tasks, the PSD group and the CCD groups were more similar. Implications for these findings in terms of clinical practice are discussed.

The natural history of speech impairment of 8-year-old children in the Avon Longitudinal Study of Parents and Children: Error rates at 2 and 5 years

This prospective longitudinal population study observed the speech of 741 children at the ages of 2, 5 and 8 years. At the age of 8, 132 children were categorized as speech impaired. There was strong evidence of differences between the case and control groups in speech sound error rate at the two earlier age points. The pattern of the proportion of errors was similar for cases and controls. There was evidence of a strong relationship between the childs error rate and expressive language at age 2 and between the childs error rate and sentence length at age 5. In multivariable analyses, adjusting for expressive language, parents social status, maternal age, gender and childs exact age, the increase in odds of being a case as the proportion of errors increased disappeared at 2 years but remained at 5 years. At 5 years, the proportion of speech errors was predictive of ongoing speech errors at the age of 8 years; the adjusted odds of having speech errors at 8 years increased by between 21 and 44% with every 10% rise in the proportion of errors in the target patterns.

A model for a mainstream school-based speech and language therapy service

This report of the Withywood Speech and Language Therapy (WiSaLT) project describes the process of setting up and evaluating a mainstream school-based and -funded speech and language therapy service. Outcomes for the child, the classroom setting, the teacher/therapist relationship and the school as a whole were monitored. Progress towards each of the outcomes was demonstrated but it was found that those children with phonological difficulties made more progress than those with language problems. The reasons for this and implications for the future of the service are discussed.