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Abstract Background A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The E-PLAYS-2 study will test an intervention (‘E-PLAYS’) aimed at supporting such children. E-PLAYS uses a dyadic computer game to develop collaborative and communication skills. Preliminary studies by the authors show that E-PLAYS can produce improvements in children with social communication difficulties on communication test scores and observed collaborative behaviours. The study described here is a definitive trial to test the effectiveness and cost-effectiveness of E-PLAYS delivered by teaching assistants in schools. Methods The aim of the E-PLAYS-2 trial is to establish the effectiveness and cost-effectiveness of care as usual plus the E-PLAYS programme, delivered in primary schools, compared to care as usual. Cluster-randomisation will take place at school level to avoid contamination. The E-PLAYS intervention will be delivered by schools’ teaching assistants. Teachers will select suitable children (ages 5–7 years old) from their schools using guidelines provided by the research team. Assessments will include blinded language measures and observations (conducted by the research team), non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. A process evaluation will also include interviews with parents, children and teaching assistants, observations of intervention delivery and a survey of care as usual. The primary analysis will compare pragmatic language scores for children who received the E-PLAYS intervention versus those who did not at 40 weeks post-randomisation. Secondary analyses will assess cost-effectiveness and a mixed methods process evaluation will provide richer data on the delivery of E-PLAYS. Discussion The aim of this study is to undertake a final, definitive test of the effectiveness of E-PLAYS when delivered by teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions. Should E-PLAYS prove to be effective at the end of this trial, we believe it is likely to be welcomed by schools, parents and children. Trial registration ISRCTN 17561417, registration date 19th December 2022. Protocol version: v1.1 19th June 2023.

Research concerned with children and young people who have neurodevelopmental disabilities (ND) in relation to early language acquisition usually involves comparisons with matched group(s) of typically developing individuals. In these studies, several important and complex issues need to be addressed. Three major issues are related to: (1) the choice of a variables on which to carry out group matching; (2) recruiting children into the study; and (3) the statistical analysis of the data. To assist future research on this topic, we discuss each of these three issues and provide recommendations about what we believe to be the best course of action. To provide a comprehensive review of the methodological issues, we draw on research beyond the topic of early language acquisition. Our overall aim is to contribute to research that considers questions about delay or differences in development patterns of development and about identifying potentially causal variables.

This study compared the vegetable intake of preschool children from three European countries [Italy, Poland, and the United Kingdom (UK)] and explored the parent, child, and environmental factors that predicted intake in each country. A total of 408 parents of preschoolers (Italy: N = 61, Poland: N = 124, and UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardised questionnaires. For all three countries, the questionnaires included measures of children’s vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents’ mealtime goals (FMGs), and sociodemographic questions about family background and environment. In the UK and Italy, additional questionnaires were used to assess child temperament (EAS-T) and parents’ feeding practices (CFPQ). The results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (∼3 portions) and Italian children the least (∼1.5 portions). Between-country differences were seen in parents’ goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimise mealtime stress, increase family involvement in meal preparation, and share the same foods with family members. British and Italian parents also adopted different feeding practices; parents in the UK reported more use of healthy modelling behaviours and more use of foods to support their child’s emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than British children. Analyses of the relationships between the parent, child, and environmental factors and children’s vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in the UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in the UK. Positive predictors included the parental mealtime goal of ‘family involvement’ in the UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake, and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adopted to meet the specific needs of the countries in which they are implemented.

Abstract Background This article reports the results from a feasibility study of an intervention (‘E-PLAYS’) aimed at supporting children who experience difficulties with social communication. E-PLAYS is based around a dyadic computer game, which aims to develop collaborative and communication skills. A pilot study found that when E-PLAYS was delivered by researchers, improvements on communication test scores and on collaborative behaviours were observed. The aim of this study was to ascertain the feasibility of running a full-scale trial to test the effectiveness of E-PLAYS in a National Health Service (NHS) setting with delivery by speech and language therapists and teaching assistants. Methods The study was a two-arm feasibility cluster-randomised controlled trial of the E-PLAYS intervention with a treatment as usual control arm. Data relating to recruitment and retention, treatment fidelity, acceptability to participants, suitability of outcomes and feasibility of collecting health economic measures and of determining cost-effectiveness were collected. Speech and language therapists selected suitable children (ages 4–7 years old) from their caseload. E-PLAYS intervention (experimental group) was then delivered by teaching assistants overseen by speech and language therapists. The control group received usual care. Assessments included blinded language measures and observations, non-blinded teacher-reported measures of peer relations and classroom behaviour and non-blinded parent-reported use of health and education resources and quality of life. Results Planned recruitment was for 70 children, in the event, 50 children were recruited which was sufficient for feasibility purposes. E-PLAYS was very highly rated by children, teaching assistants and speech and language therapists and treatment fidelity did not pose any issues. We were able to collect health economic data which suggests that E-PLAYS would be a low-cost intervention. Conclusion Based on recruitment, retention and adherence rates and our outcome measures, a full-scale randomised controlled trial estimated appears feasible and warranted to assess the effectiveness of E-PLAYS for use by the NHS and schools. Trial registration ISRCTN 14818949 (retrospectively registered).

Decoding abilities in individuals with intellectual disabilities (ID) are substantially lower than for typical readers. The underlying mechanisms of their poor reading remain uncertain. The aim of this study was to investigate the concurrent predictors of decoding ability in 136 adolescents with non-specific ID, and to evaluate the results in relation to previous findings on typical readers. The study included a broad range of cognitive and language measures as predictors of decoding ability. A LASSO regression analysis identified phonological awareness and rapid automatized naming (RAN) as the most important predictors. The predictors explained 57.73% of the variance in decoding abilities. These variables are similar to the ones found in earlier research on typically developing children, hence supporting our hypothesis of a delayed rather than a different reading profile. These results lend some support to the use of interventions and reading instructions, originally developed for typically developing children, for children and adolescents with non-specific ID.

Given the developmental inter-relationship between motor ability and spatial skills, we investigated the impact of physical disability (PD) on spatial cognition. Fifty-three children with special educational needs including PD were divided into those who were wheelchair users (n = 34) and those with independent locomotion ability (n = 19). This division additionally enabled us to determine the impact of limited independent physical exploration (i.e., required wheelchair use) on spatial competence. We compared the spatial performance of children in these two PD groups to that of typically developing (TD) children who spanned the range of non-verbal ability of the PD groups. Participants completed three spatial tasks; a mental rotation task, a spatial programming task and a desktop virtual reality (VR) navigation task. Levels of impairment of the PD groups were broadly commensurate with their overall level of non-verbal ability. The exception to this was the performance of the PD wheelchair group on the mental rotation task, which was below that expected for their level of non-verbal ability. Group differences in approach to the spatial programming task were evident in that both PD groups showed a different error pattern from the TD group. These findings suggested that for children with both learning difficulties and PD, the unique developmental impact on spatial ability of having physical disabilities, over and above the impact of any learning difficulties, is minimal.

Reading comprehension difficulties are common in individuals with intellectual disabilities (ID), but the influences of underlying abilities related to reading comprehension in this group have rarely been investigated. One aim of this study was to investigate the Simple View of Reading as a theoretical framework to describe cognitive and linguistic abilities predicting individual differences in reading comprehension in adolescents with non-specific ID. A second aim was to investigate whether predictors of listening comprehension and reading comprehension suggest that individuals with ID have a delayed pattern of development (copying early grade variance in reading comprehension) or a different pattern of development involving a new or an unusual pattern of cognitive and linguistic predictors. A sample of 136 adolescents with non-specific ID was assessed on reading comprehension, decoding, linguistic, and cognitive measures. The hypotheses were evaluated using structural equation models. The results showed that the Simple View of Reading was not applicable in explaining reading comprehension in this group, however, the concurrent predictors of comprehension (vocabulary and phonological executive-loaded working memory) followed a delayed profile.

Abstract Background A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The proposal presented in this article describes a feasibility study for a trial to test an intervention (‘E-PLAYS’) aimed at supporting children with social communication impairments. E-PLAYS harnesses technology in the form of a novel computer game in order to develop collaborative and communication skills. Preliminary studies by the authors show that when E-PLAYS was administered by the research team, children with social communication impairments showed improvements on communication test scores and on observed collaborative behaviours. The study described here is a pragmatic trial to test the application of E-PLAYS delivered by NHS speech and language therapists together with schools. Methods This protocol outlines a two-arm feasibility cluster-randomised controlled trial of the E-PLAYS intervention with treatment as usual control arm, with randomisation at the level of the speech and language therapist. The aim of this study is to ascertain whether it will be feasible to progress to running a full-scale definitive trial to test the effectiveness of E-PLAYS in an NHS setting. Data relating to recruitment and retention, the appropriateness of outcomes and the acceptability of E-PLAYS to participants will be collected. Speech and language therapists will select suitable children (ages 4–7 years old) from their caseloads and deliver either the E-PLAYS intervention (experimental group) or treatment as usual (control group). Assessments will include blinded language measures and observations, non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. There will also be a qualitative process evaluation. Discussion The findings of this study will inform the decision as to whether to progress to a full-scale definitive randomised controlled trial to test the effectiveness of E-PLAYS when delivered by speech and language therapists and teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions. Trial registration ISRCTN 14818949 (retrospectively registered).

Background:. The main surgical options for treatment of breast cancer are breast-conserving surgery and mastectomy. BCS aims to achieve complete excision of the tumor while achieving a pleasing cosmetic result. Excision of tumors in the lateral aspect of the breast has been associated with issues such as contour deformities and asymmetry. Development of volume replacement techniques such as the lateral intercostal artery perforator flap (LICAP) aimed to address these issues. Our modification of the traditional LICAP offers a less visible scar, good access to the axilla, and no need to reposition the patient. Methods:. All patients undergoing a modified LICAP were identified from our database. The lateral intercostal artery perforators were marked with ultrasound and 2 “lazy S” lines were drawn to mark the flap. The wide local excision (with or without axillary surgery) was performed and the flap mobilized to fill the defect. Results:. Twenty-two patients underwent modified LICAP in 14 months. The mean specimen weight was 86 g. Four patients (18%) had a re-excision for positive margins. Nineteen patients had axillary surgery performed at the time of their modified LICAP flap. No patients had a scar that extended posterior to the posterior axillary line; no patients required a separate incision for axillary surgery; and no patients needed to be repositioned intraoperatively. Conclusions:. Our early experience with this innovative procedure has been favorable. The perioperative complication rate is low. Due to the relatively short follow-up, longer term outcomes such as postradiotherapy appearance are yet to be determined.

Preparing young people to meet emerging contemporary challenges has become a global imperative. Over two decades, there has been a call for students' active participation in the life of school and society, and an important feature of this call is student-led research (SLR). However, this pedagogical and empowering call with many potential benefits is not unproblematic. There are far-reaching differences between various conceptions and use of student-led research in secondary schools both within and between different countries, reflecting a contrast between skill development and voice. This contrast, however, has not been previously scrutinised and discussed. We review student-led research in England, Ireland, and Russia showing that its development has been initiated and carried out in different countries with very different goals and focuses. Our study is in the form of a case study of the three countries covering a wide range of discussions related to SLR. By looking critically at how SLR is conceived and supported in various contexts, we evaluate facilitators and barriers, which ultimately offers a better understanding of how ideologies and political decisions influence students and teachers, and how educational policies and educational values are transferred into practice.

Little is known about the relationship between working memory (WM) abilities and reading in children with cerebral palsy (CP) who have age-appropriate communication and language. The aim of this group case study is to analyze the WM abilities and their relationship to reading in children with CP and age-appropriate communication and language. Fifteen children with CP (6:9 to 11:6 years) and age-appropriate communication and language were identified. They were given tests of communication and language, reading (decoding), and three aspects of WM: phonological short-term memory (PSTM); visuospatial short-term memory (VSTM); and the central executive (CE). The children were divided into two groups; five who had age-appropriate reading (Age-appropriate Readers), and ten with very low reading abilities (Developing Readers). The results showed that PSTM was mostly age appropriate in both reading groups and their scores mostly correlated with their reading abilities. VSTM scores were very poor in both groups and not related to reading group membership or reading. CE abilities were mostly as would be expected for the Age-appropriate Readers, but low for the Developing Readers; CE scores correlated with reading abilities. The findings suggest that there are variations in the working memory abilities in this group of children and that the CE may be an important contributor to their reading development.

There has been considerable debate and interest in the factor structure of executive functioning (EF). For children and young people, there is evidence of a progression from a single factor to a more differentiated structure, although the precise nature of these factors differs between investigations. The purpose of the current study was to look at this issue again with another sample, and try to understand possible reasons for previous differences between investigations. In addition, we examined the relationship between less central EF tasks, such as fluency and planning, to the more common tasks of updating/executive working memory (EWM), inhibition, and switching/shifting. A final aim was to carry out analyses which are relevant to the debate about whether EF is influenced by language ability, or language ability is influenced by EF. We reasoned that if language ability affects EF, a factor analysis of verbal and non-verbal EF tasks might result in the identification of a factor which predominantly contains verbal tasks and a factor that predominately contains non-verbal tasks. Our investigation involved 128 typically developing participants (mean age 10:4) who were given EF assessments that included verbal and non-verbal versions of each task: EWM; switching; inhibition; fluency; and planning. Exploratory factor analyses on EWM, switching, and inhibition produced a structure consisting of inhibition in one factor and the remaining tasks in another. It was decided to exclude verbal planning from the next analyses of all the ten tasks because of statistical considerations. Analysis of the remaining nine EF tasks produced two factors, one factor containing the two inhibition tasks, and another factor that contained all the other tasks (switching, EWM, fluency, and non-verbal planning). There was little evidence that the verbal or non-verbal elements in these tasks affected the factor structure. Both these issues are considered in the discussion, where there is a general evaluation of findings about the factor structure of EF.

Internet-delivered mindfulness and relaxation training were compared with each other and a no-treatment control on stress, coping, and mindfulness measures. Participants ( n = 114) were assessed before and after treatment, and their compliance with the intervention they received was tracked. The treatments were received at a time, place, and computer of the participants’ choosing with the proviso that three exercises be completed during each of three successive weeks. Both mindfulness and relaxation reduced stress, but only mindfulness training increased mindfulness and reduced emotion-focused coping.

AbstractObjective:To examine whether lexical access problems in children with word finding difficulties (WFDs) are restricted to measures of naming or include wider language impairments and the extent to which language skills are related to performance in the accuracy, latency and definitions of lexical items that are comprehended. Patients and Methods:Thirty-one children with identified WFDs completed a set of standardized language measures and an experimental naming and definition task. Results:The current cohort had difficulties with a range of language tasks. Phonological fluency and non-word repetition measures were significantly impaired and different from those of typically developing children. Phonological processes and measures of receptive and expressive language predicted accuracy in naming comprehended items but failed to predict the latency to name or the provision of accurate definitions. Conclusion:Children with WFDs often have additional language difficulties; these difficulties are predictive of performance on confrontational naming tasks. Latency to name, although a significant impairment, was not related to the standardized measures. Further research is needed to identify measures associated with speed of lexical retrieval. The data highlight the importance of examining the precursors to lexical access difficulties and examining different indices of lexical performance when intervening with children’s WFDs.Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]