Victoria Joffe

The case for Dynamic Assessment in speech and language therapy

This paper highlights the appeal of dynamic assessment (DA) for speech and language therapists (SLTs), and describes the usefulness of various DA models and methods. It describes the background to DA, and the uses to which DA has been put, by educational psychologists in the UK, and by SLTs in the USA. The research and development of methods of DA are described, and the case for developing DA methods for use in a) research and predictive applications, and b) clinical applications to inform interventions by SLTs and in collaborative practice, is made. Implications for future research are presented.

Comprehension problems in children with specific language impairment: does mental imagery training help?

BACKGROUND Children with specific language impairment experience story comprehension deficits. Research with typically developing children, poor comprehenders and poor readers has shown that the use of mental imagery aids in the comprehension of stories. AIMS To evaluate the effectiveness of an intervention programme in the use of mental imagery to improve the literal and inferential comprehension of children with specific language impairment. METHODS & PROCEDURES Nine children with specific language impairment were trained to produce mental images for sentences and stories in five 30-min sessions. Their ability to answer literal and inferential questions about short narratives was assessed pre- and post-intervention and compared with the performance of 16 same-age typically developing controls. OUTCOME & RESULTS The intervention improved the question-answering performance of the children with specific language impairment for both literal and inferential questions: the improvement was only significant for the literal questions. CONCLUSIONS The findings demonstrate that a relatively short intervention in the use of mental imagery is an effective way to boost the story comprehension of children with specific language impairment.

Patterns of syntactic development in children with Williams syndrome and Down's syndrome: Evidence from passives and wh‐questions

This study investigates the syntactic abilities of ten individuals with Williams syndrome (WS) (mean chronological age: 8;9 years; mean mental age: 4;8 years) and Downs syndrome (DS) (mean chronological age: 8;7 years; mean mental age: 4;6 years), matched individually on chronological age, mental age and performance IQ. The syntactic components investigated include the comprehension of passives and the production, comprehension and repetition of wh‐questions. Performance is compared to ten younger typically developing (TD) controls matched individually to both experimental groups on mental age (mean chronological age: 4;4 years; mean mental age: 5;0 years). Participants were given a standardized measure of grammatical ability and non‐standardized tasks exploring the comprehension of active and passive sentences, and the production, comprehension and repetition of a range of wh‐question types: wh‐subject, wh‐object, which NP‐subject and which NP‐object. Participants with WS and DS performed similarly on the standardized measure of grammatical ability, as well as on the experimental tasks that tapped comprehension of passives, and production and comprehension of wh‐questions. Participants with DS performed significantly more poorly than both the WS cohort and TD controls on the repetition of wh‐questions. Both the WS and DS cohorts performed significantly more poorly on most of the syntactic tasks compared to the younger TD controls. Individuals with WS and DS experienced significant difficulties in tasks measuring aspects of syntactic ability and performed more poorly than mental age‐matched TD controls. Implications of these findings, with regards to the debates around language “intactness” in WS, as well as the similarities and differences in language abilities in WS and DS, dependent on age and developmental stages studied, are explored.

Intelligibility as a Clinical Outcome Measure Following Intervention with Children with Phonologically Based Speech-Sound Disorders.

BACKGROUND The effectiveness of two treatment approaches (phonological therapy and articulation therapy) for treatment of 14 children, aged 4;0-6;7 years, with phonologically based speech-sound disorder (SSD) has been previously analysed with severity outcome measures (percentage of consonants correct score, percentage occurrence of phonological processes and phonetic inventory). Considering that the ultimate goal of intervention for children with phonologically based SSD is to improve intelligibility, it is curious that intervention studies focusing on childrens phonology do not routinely use intelligibility as an outcome measure. It is therefore important that the impact of interventions on speech intelligibility is explored. AIMS This paper investigates the effectiveness of the two treatment approaches (phonological therapy and articulation therapy) using intelligibility measures, both in single words and in continuous speech, as the primary outcome. METHODS & PROCEDURES Fourteen children with phonologically based SSD participated in the intervention. The children were randomly assigned to phonological therapy or articulation therapy (seven children in each group). Two assessment methods were used for measuring intelligibility: a word identification task (for single words) and a rating scale (for continuous speech). Twenty-one unfamiliar adults listened and judged the childrens intelligibility. Reliability analyses showed overall high agreement between listeners across both methods. OUTCOMES & RESULTS Significant improvements were noted in intelligibility in both single words (paired t(6)=4.409, p=0.005) and continuous speech (asymptotic Z=2.371, p=0.018) for the group receiving phonology therapy pre- to post-treatment, but no differences in intelligibility were found for those receiving the articulation therapy pre- to post-treatment, either for single words (paired t(6)=1.763, p=0.128) or continuous speech (asymptotic Z=1.442, p=0.149). CONCLUSIONS & IMPLICATIONS Intelligibility measures were sensitive enough to show changes in the phonological therapy group but not in the articulation therapy group. These findings emphasize the importance of using intelligibility as an outcome measure to complement the results obtained with other severity measures when exploring the effectiveness of speech interventions. This study presents new evidence for the effectiveness of phonological therapy in improving intelligibility with children with SSD.

The working practices and clinical experiences of paediatric speech and language therapists: a national UK survey.

BACKGROUND The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. AIMS To investigate the working practices and professional experiences of paediatric SLTs working in the UK through an online survey. METHODS & PROCEDURES The survey was conducted online using Survey Monkey. Therapists were alerted to the survey through the Bulletin of the Royal College of Speech and Language Therapists and by e-mails to national special interest groups. OUTCOMES & RESULTS A total of 516 clinicians completed the survey. A large majority worked in the National Health Service (NHS). A varied pattern of working was revealed. Most worked in several settings and saw a range of clients. A typical clinician spends less than one-quarter of their time giving direct therapy and more than one-quarter training parents and other professionals. Nearly half of respondents felt that their time could be better used. Too little time for direct therapy and the time required for administration emerged as their principal concerns. Most clinicians have specialist knowledge of particular client groups and spend more time with them than do non-specialists. Nevertheless, clients are more likely to be treated by a therapist who does not claim to have specialist knowledge of their condition than by one who does. The only clients for whom this is not the case are those with dysphagia. Eighty per cent of respondents felt that proposed changes to the NHS would not benefit the children they treat and there was widespread concern about cuts and the effects of general practitioner commissioning. Despite this, a large majority expected to remain speech and language therapists 5 years from now. CONCLUSIONS & IMPLICATIONS This survey provides an overview of the working practices of paediatric speech and language therapists. Its findings have significant implications for training and workforce development in the profession.

An international perspective: supporting adolescents with speech, language, and communication needs in the United Kingdom.

This article provides an overview of the education system in the United Kingdom, with a particular focus on the secondary school context and supporting older children and young people with speech, language, and communication needs (SLCNs). Despite the pervasive nature of speech, language, and communication difficulties and their long-term impact on academic performance, mental health, and well-being, evidence suggests that there is limited support to older children and young people with SLCNs in the United Kingdom, relative to what is available in the early years. Focus in secondary schools is predominantly on literacy, with little attention to supporting oral language. The article provides a synopsis of the working practices of pediatric speech and language therapists working with adolescents in the United Kingdom and the type and level of speech and language therapy support provided for older children and young people with SLCNs in secondary and further education. Implications for the nature and type of specialist support to adolescents and adults with SLCNs are discussed.

Exploring the feasibility of a classroom-based vocabulary intervention for mainstream secondary school students with language disorder

Vocabulary knowledge has been shown to be a predictor of academic success, posing a challenge for children and young people with language disorder. Language disorder can persist into adolescence and yet there is limited evidence on how to support the vocabulary skills of adolescents with language disorder in a mainstream setting. This article describes an experimental study aimed at investigating the feasibility of a whole-class approach to increase the understanding and use of curriculum vocabulary in adolescents with language disorder. Ten curriculum words were taught by the science teacher using a phonological-semantic approach, and 10 matched same-topic words were taught using routine teaching practice. Progress was made post-intervention in word knowledge of both low-frequency experimental and control words, with significantly greater change in knowledge of the experimental words. Most students, and the teacher, viewed the phonological-semantic word-learning approach favourably.

Explicit print referencing enhances early literacy in preschoolers

Children were sampled from classrooms using procedures from recent large-scale studies on preschool program quality (Multi-State Study of Pre-Kindergarten; and State-Wide Early Education Program Study; see Mashburn et al., 2008). A random sample of children for whom consent had been given was selected from each classroom. An average of 6 children (range: 3–9) per classroom was selected. Blinding: It is not reported what information was given to the teachers on the purpose of the study or whether the researchers collecting and analyzing the data were blind to group membership.

The joint delivery of personal and social education (PSE) in a special school.

There is a growing need for teachers and speech and language therapists (SLTs) to work together in the joint planning and implementation of lessons in the educational context to ensure successful differentiation of the national curriculum (NC) to students with special educational needs (SEN). This paper describes and evaluates the development and delivery of a language and social communication programme as part of the PSE subject from the NC to final year students at a special needs school for children with significant speech, language and communication impairment. The topics covered across a variety of common social settings are outlined as well as the controlled and progressive manner in which they were introduced.

Preregistration research training of speech and language therapists in the United Kingdom: a nationwide audit of quantity, content and delivery

Aim: To carry out an audit of the quantity and content of research teaching on UK preregistration speech and language therapy (SLT) degree programmes. Method: Lecturers delivering research teaching from each higher education institution providing preregistration training were invited to complete an online survey. Questions included: Amount of research teaching, content of research teaching (including final-year projects), perceived confidence by staff of graduates in research awareness, research activity and leading research. Responses were received for 14 programmes (10 undergraduate and four postgraduate), representing 73% of all undergraduate courses and 44% of all postgraduate courses in the United Kingdom. Results: Fifty percent of courses included over 30 h of research teaching, with wide variability across both undergraduate and postgraduate courses in number of hours, modules and credits devoted to research. There was no association between quantity of research teaching and perception of adequacy of quantity of teaching. Critical appraisal, statistical software and finding literature were the most common topics taught. Conversely, service evaluation and audit was the least common topic covered. All institutions provided a final-year project, with 11/14 requiring empirical research. Perceived confidence of graduates was higher for research awareness than active research and leading research, but this varied across institutions. There was a strong correlation between lecturers’ perceived confidence of graduates in research awareness and number of hours of research teaching. Conclusion: Despite the requirements for healthcare professionals to engage in evidence-based practice, the amount and nature of research training in preregistration courses for SLTs in the United Kingdom is highly variable. Levels of perceived confidence of graduates were also variable, not only for active participation in research, and for leading research, but also for research awareness. This has implications for the ability of SLTs to use and embed research in their routine clinical practice.