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Background The existing evidence is limited in terms of perspectives of pre-school children with speech and language needs, and their views on activities used to support their needs. This paper discusses a stream of work from the interdisciplinary research programme known as [‘Child Talk’, based in England, UK. The overall purpose of this work stream was to gain the perspectives of pre-school children aged 2 to 5 years 11 months, with speech and language needs, to use in the development of an evidence-based framework of activities. Methods Twenty-four pre-schoolchildren with a variety of needs from diverse backgrounds took part. An observational methodology was used to capture children’s experiences. Children were filmed during a series of sessions, with innovative head mounted cameras worn by the children and supported by researcher field notes. Framework analysis was used to analyse the data based on the body movement, vocalisation and visual attention of the children during these sessions. Results and Conclusions. Results included that children expressed enjoyment and engagement in the activities. The children expressed themselves and demonstrated their focus ‘multimodally’ through combinations of body language, vocalisation, and visual attention. These modalities were present across all contexts and children. It highlights the importance of encouraging participation in pre-school children and consequently this innovative piece of work has national and international importance.

Linguistic interactions between parents and their children are frequently studied to investigate how children acquire language. From observations, researchers have identified interaction strategies that foster children’s language development. In turn, interventions to support children’s early language skills employ styles of interaction derived from these observations. However, researchers have not often considered how the activity context selected forobservation may affect the language used, or whether these contexts reflect children’s diverse experiences.The aim of this scoping review was to explore the breadth of literature about language use across a range of activities. Included studies described linguistic outputs of parents and typically developing children (aged 1;0 to 5;11 years) and activity context(s). Searches were conducted in PsycInfo, Medline, CINAHL, ERIC-ProQuest and Google Scholar. From 16,718 records, 59 studies were retained. Studies were charted according to the population included, linguistic outputs recorded, activity contexts studied and the methodological design. To allow for comparison of results across activity contexts, five thematic categories were identified: play activities, book reading, naturalistic routines, media and methodological implications. Challenges for future research are discussed, including ways to ensure the ecological validity of findings by coupling naturalistic language recordings with data collected during diverse everyday activity contexts.

Background: A number of studies have suggested that practitioners hold speech and language therapy (SLT) practice as tacit and consequently it is difficult for the therapist to describe. The current study uses a range of knowledge elicitation (KE) approaches, a technique not used before in SLT, as a way of accessing this tacit knowledge. There is currently no agreed framework that establishes key factors underpinning practice for preschool children with speech and language disorders. This paper attempts to address that gap. Aims: The aim of this study was to develop a framework of speech and language therapists’ practice when working with preschool children with developmental speech and language disorders (DS&LD). Methods and Procedures: A mixed methods approach was adopted for this study. Data were collected iteratively, from 245 speech and language therapists with experience of working with preschool children with DS&LD across sites in England, by means of focus groups and national events. There were three stages of data collection; local sites, specific interest groups and two national events. KE techniques were used to gather data, with initial data being collected in local site focus groups. Findings from groups were taken to subsequent larger groups where a combination of concept mapping, teach-back and sorting exercises, generated a more detailed description of practice, using discussion of consensus and disagreement to stimulate further exploration and definition and provide validatory evidence. Outcomes and Results: This paper provides a high-level framework of therapy for preschool children with DS&LD that makes practice explicit in this area. The framework proposes that therapists’ aims for this group of children fall into three categories: addressing children’s areas of impairment and skills; achieving functionally meaningful skills and carryover; supporting adults to provide a supportive communication environment. The exact configuration is shaped by the child’s context and needs. Conclusions and Implications: The framework highlights themes that are well researched in the literature (e.g. speech) and others that have been little studied (e.g. adult understanding), indicating a disconnect between research evidence and practice. The research also highlights the complex nature of interventions for preschool children with DS&LD and the importance therapists attribute to tailoring therapy to individual needs. The framework provides a scaffold for speech and language therapists to focus their clinical practice and encourages us as a profession to better understand and explore the gaps between research evidence and clinical practice, for preschool children with DS&LD.

Purpose: This study explores perceptions of Quality of Life (QOL) of people with a dual diagnosis of learning disability and autism to facilitate a better understanding for clinical practice and service provision. Design/methodology/approach: Mixed methods were used to gain perceptions of QOL from 20 individuals referred to their local diagnostic service. Individuals completed questionnaires and participated in in-depth interviews which were thematically analysed. Findings: Subjective wellbeing scores were lower than those found in previous research. Social interaction was raised extensively with participants describing both positive and negative perceptions. The need for tailored social support and the value of individual control over environment were raised. Research Limitations/Implications: The study was small in scale and limited to subjects who had been referred for a diagnostic service. The study identified the need for further study, particularly in relation to the social relationships domain of QoL, and the impact of stress and anxiety. Practical Implications: Social Implications: Originality/Value: This study demonstrated that it is possible to access views from this group and that these views are nuanced. It suggests differences between reported QoL in people with learning disabilities who are and who are not autistic. Service design and individual approaches could be improved by a better understanding of these differences.

Background: Early interventions to support young children’s language development through responsive parent-child interaction have proven efficacy but are not currently delivered universally. A potential universal delivery platform is the Health Visitor (HV) led 2-2½ year old review in England’s Healthy Child Programme. It is unclear if it is feasible to offer such interventions through this platform. We report an intervention development process, including extensive stakeholder consultation and co-design to develop an acceptable, feasible and equitable early language intervention for delivery in this context.Methods:The study involved five phases including 13 stakeholder co-design workshops with 7 parents and 39 practitioners (HVs, early years practitioners and speech and language therapists). 1) Identification of existing intervention evidence. 2) Qualitative review of intervention studies extracting candidate target behaviours for intervention and intervention techniques. 3) Co-design workshops with parents and practitioners examining acceptability, barriers and enablers to those behaviours and techniques. Particular attention was paid to diverse family circumstances and the range of barriers which might exist. 4) Findings were analysed using COM-B and theoretical domains frameworks and a prototype intervention model designed. 5) Co-design workshops iteratively refined the proposed model. Results:Practitioners were committed to offering language intervention at the 2-2½ year old review but were not sure precisely how to do so. Parents/caregivers wanted to be proactive and to have agency in supporting their own children, and to do this as soon as possible. For equitable intervention it must be proportionate, with higher ‘intensity’ for higher levels of disadvantage, and tailored, offering differing approaches considering the specific barriers and enablers, assets and challenges in each family. The importance and potential fragility of alliances between parent/caregiver and practitioner were identified as key and so strategies to engender successful collaborative partnership are also embedded intervention design. Conclusion: It is possible to develop an acceptable, feasible and equitable universal intervention for use at the 2-2 ½ year review to promote children’s language development. The result is one of the most explicitly developed universal interventions to promote children’s language development. Further development and piloting is required to develop materials to support successful widespread implementation.

Background Children with persistent speech disorder (PSD) are at higher risk of difficulties with literacy, with some evidence suggesting an association with poorer educational attainment. However, studies to date have either used small clinical samples, which exclude children who have not been referred to clinical services, or relied on parent–teacher report of children's speech development. There is a need for an inclusive study to investigate the impact of PSD on educational outcomes using a population‐based sample and robust measures of speech development. Aim Using a large prospective UK population‐based study—the Avon Longitudinal Study of Parents and Children (ALSPAC)—this study investigated: (1) how children identified with PSD at age 8 years perform on educational attainment tests at ages 10–11 and 13–14 years in comparison with children without PSD; and (2) whether children identified with PSD at age 8 years are more likely to receive a label of special educational needs (SEN) in secondary school. Methods & Procedures We examined the data for 263 children with PSD and 6399 controls who had speech assessed at age 8 years in a research clinic. Educational attainment was measured using data from English school standard attainment tests. Data on SEN categorization were obtained between 11 and 13 years of age. Children with PSD and controls were compared using regression analyses adjusted for biological sex, maternal age, verbal, performance and full‐scale IQ. Outcomes & Results Children with PSD at age 8 years were more likely to achieve lower attainment scores at ages 10–11 years in English and mathematics and across all three subjects of English, mathematics and science at ages 13–14 years after controlling for biological sex and maternal education; score below target levels for English at both time points after controlling for verbal IQ, and at ages 13–14 years after controlling for performance IQ; and receive a label of SEN (typically for the category of cognition and learning needs or communication and interaction needs) in secondary school. Conclusions & Implications PSD identified at age 8 years is associated with poor educational attainment at ages 10–11 and 13–14 years in the core subjects of English, mathematics and science. Children with PSD at age 8 years are more likely to be identified with SEN at ages 11–13 years, particularly cognition and learning needs, and communication and interaction needs. We need to be aware of the potential for the long‐term impact of PSD on educational attainment in providing appropriate and effective support throughout school. What this paper addsWhat is already known on the subject Speech‐sound disorder is associated with reading and spelling difficulties, with some evidence to suggest that PSD is associated with a higher risk of literacy difficulties. Limited evidence also suggests that speech‐sound disorder may be associated with poorer educational attainment. However, studies to date have used small clinical samples or parent–teacher report of speech development and there is a need to determine whether the association is observed in larger and more inclusive population‐based samples. What this paper adds to existing knowledge This prospective, longitudinal study of a large community‐based sample of English children has shown that PSD is associated with poorer educational attainment at the end of primary school and at ages 13–14 years. Children with PSD are also more likely to be identified as having SEN in secondary school, especially communication and interaction needs but also including cognition and learning needs. What are the potential or actual clinical implications of this work? Understanding the long‐term implications of PSD on educational attainment highlights the importance of ongoing monitoring and support to enable children to reach their potential throughout primary and secondary school. The identification of children with a history of PSD during transition to secondary school will enable effective support to be put in place. The intervention for children with PSD should involve close collaboration between speech and language therapists and education professionals.

Background: Collaboration between parents and speech and language therapists is seen as a key element in family-centred models. Collaboration can have positive impacts on parental and children’s outcomes. However, collaborative practice has not been well described and researched in speech and language therapy for children and may not be easy to achieve. It is important that we gain a deeper understanding of collaborative practice with parents, how it can be achieved, and how it can impact on outcomes. This understanding could support practitioners in daily practice with regard to achieving collaborative practice with parents in different contexts. Aims: The aim of this paper was to set a research agenda on collaborative practice between parents and speech and language therapists, in order to generate evidence regarding what works, how, for whom, in what circumstances, and to what extent. Methods: A realist evaluation approach was used to make explicit what collaborative practice with parents entails. The steps suggested by the RAMESES II project were used to draft a preliminary programme theory about collaborative practice between parents and speech and language therapists. This process generates explicit hypotheses which form a potential research agenda. Discussion and conclusion: A preliminary programme theory of collaborative practice with parents was drafted using a realist approach. Potential contextual factors (C), mechanisms (M) and outcomes (O) were presented which could be configured into causal mechanisms to help explain what works for whom in what circumstances. CMO configurations were drafted, based on relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesised programme theory for collaborative practice with parents, further testing against a broader literature is required alongside research to explore the functionality of the configurations across contexts. This paper highlights the importance of further research on collaborative practice with parents and the potential value of realist evaluation methodology. What this paper adds: Current policy in education, health and social care advocates for family-centred care and collaborative practice with parents. Thereby, collaborative practice is the preferred practice for speech and language therapists and parents. In this paper, we explored collaborative practice and used a realist evaluation approach to achieve the aim of setting a research agenda in this area. Researchers use realist evaluation, a methodology originally developed by Pawson and Tilley in the 1990s (Pawson and Tilley, 1997), to explore the causal link between interventions and outcomes, summarised as “what works, how, for whom, in what circumstances and to what extent” (Wong et al., 2014, p1). Realist evaluation provides a framework to explore configurations between contexts (C), mechanisms (M) and outcomes (O). We used this methodology to take a first step in making explicit what collaborative practice is and how it might be achieved in different contexts. We did this by drafting a preliminary programme theory about collaborative practice, where we made explicit what context factors and mechanisms might influence outcomes in collaborative practice between parents and SLTs. Based on this programme theory, we argue for the need to develop a research agenda on collaborative practice with parents of children with speech, language and communication needs. The steps between a programme theory and a research agenda could entail exploring each CMO, or step in the programme theory, and evaluating it against the existing literature – both within and beyond speech and language therapy - to see how far it stands up. In this way, gaps could be identified that could be converted into research questions which would stimulate debate about a research agenda on collaborative practice. Understanding how collaborative practice can be achieved in different contexts could support SLTs to use mechanisms to optimise collaborative practice intentionally and tailor interventions to the specific needs of families, thereby enhancing collaborative practice between parents and SLTs.

Purpose Children with speech and language disorders are at risk in relation to psychological and social well-being. The aim of this study was to understand the experiences of these children from their own perspectives focusing on risks to their well-being and protective indicators that may promote resilience. Method Eleven 9- to 12-year-old children (4 boys and 7 girls) were recruited using purposeful sampling. One participant presented with a speech sound disorder, 1 presented with both a speech and language disorder, and 9 with language disorders. All were receiving additional educational supports. Narrative inquiry, a qualitative design, was employed. Data were generated in home and school settings using multiple semi-structured interviews with each child over a 6-month period. A total of 59 interviews were conducted. The data were analyzed to identify themes in relation to potential risk factors to well-being and protective strategies. Results Potential risk factors in relation to well-being were communication impairment and disability, difficulties with relationships, and concern about academic achievement. Potential protective strategies were hope, agency, and positive relationships. Conclusion This study highlights the importance of listening to children's narratives so that those at risk in relation to well-being can be identified. Conceptualization of well-being and resilience within an ecological framework may enable identification of protective strategies at both individual and environmental levels that can be strengthened to mitigate negative experiences.

Background: Multiple interventions have been developed to address speech sound disorder (SSD) in children.Many of these have been evaluated but the evidence for these has not been considered within a model whichcategorizes types of intervention. The opportunity to carry out a systematic review of interventions for SSD aroseas part of a larger scale study of interventions for primary speech and language impairment in preschool children.Aims: To review systematically the evidence for interventions for SSD in preschool children and to categorize themwithin a classification of interventions for SSD.Methods & Procedures: Relevant search terms were used to identify intervention studies published up to 2012, withthe following inclusion criteria: participants were aged between 2 years and 5 years, 11 months; they exhibitedspeech, language and communication needs; and a primary outcome measure of speech was used. Studies thatmet inclusion criteria were quality appraised using the single case experimental design (SCED) or PEDro-P,depending on their methodology. Those judged to be high quality were classified according to the primary focusof intervention.Outcomes & Results: The final review included 26 studies. Case series was the most common research design.Categorization to the classification system for interventions showed that cognitive–linguistic and productionapproaches to intervention were the most frequently reported. The highest graded evidence was for three studieswithin the auditory–perceptual and integrated categories.Conclusions & Implications: The evidence for intervention for preschool children with SSD is focused on seven outof 11 subcategories of interventions. Although all the studies included in the review were good quality as definedby quality appraisal checklists, they mostly represented lower-graded evidence. Higher-graded studies are neededto understand clearly the strength of evidence for different interventions.

BACKGROUND: Linguistic comprehension and narrative skills encapsulate a complex array of grammatical and semantic skills that underpin complex reading comprehension processes. However, most research in this area has focused on children with reading difficulties and not on typically developing children. Also the research has mostly focused on short-term effects of these skills on reading during the primary school years. Therefore, it remains unclear what specific role linguistic comprehension and narrative skills play in typically developing children's reading beyond the primary school years.AIMS: With this 9-year prospective longitudinal study, we sought to clarify the independent effects of linguistic comprehension and narrative skill (at 5 years of age) on children's reading ability at 10 and 14 years of age.SAMPLE: We examined the data from 716 children (MAge = 67 months, SD = 2.13 months), which were drawn from a major population cohort study, the Avon Longitudinal Study of Parents and Children.METHODS: Children's language skills were assessed at 5 and word reading and reading comprehension skills at 10 years of age. The reading achievement scores at 14 years of age were based on national curriculum test results.RESULTS: Linguistic comprehension and narrative skills at 5 years of age made unique and direct contributions to reading comprehension skills and reading achievement after accounting for general cognitive ability, memory, phonological skills, and mother's education. Moreover, listening comprehension predicted reading achievement even when prior reading skills were taken into account.CONCLUSIONS: Linguistic comprehension and narrative skills are related but distinct oral language skills that continue to influence children's reading development beyond the primary school years.

Evidence-based practice includes research evidence, clinical expertise and stakeholder perspectives. Stakeholder perspectives are important and include parental ethno-theories, which embrace views about many aspects of speech, language and communication, language development, and interventions. The Developmental Niche Framework provides a useful theory to understand parental beliefs. Ethnotheories, including those about language development, delay and interventions, may vary cross culturally and are less well understood in relation to families who may be considered ‘under-served’ or ‘hard-to-reach’ by speech and language therapy services. Who is considered to be under-served and the reasons why some families are under-served are complex.

A common early intervention approach for preschool children with language problems is parent–child interaction therapy (PCIT). PCIT has positive effects for children with expressive language problems. It appears that speech and language therapists (SLTs) conduct this therapy in many different ways. This might be because of the variety of approaches available, the diverse set of families SLTs work with or the different organizational structures. Understanding the critical components of PCIT would enable SLTs to map the variations that are implemented and researchers to evaluate the effects of such variation. This study aimed to identify the potentially critical components of PCIT based on the practical experience of SLTs and to identify SLTs’ rationales for the way they structure PCIT. Both parameters are important for the long term goal, that is, to develop a framework that can be used to support practice. Semi-structured interviews were conducted with 10 SLTs who had at least one year experience in delivering PCIT with preschool children with language impairment. The interviews were transcribed and analysed, using thematic analysis. Analysis of the SLT interview data identified four potentially critical components that underpin the teaching of strategies to parents: parents’ engagement, parents’ understanding, parents’ reflection and therapists’ skills. SLTs suggested that all four components are needed for the successful delivery of PCIT. The reasons that SLTs give for the way in which they structure PCIT are mainly based on organizational constraints, family needs and practicalities. SLTs consider PCIT to be valuable but challenging to implement. A framework that makes explicit these components may be beneficial to support practice.

Purpose The aim was to evaluate the effectiveness of computer-assisted input-based intervention for children with speech sound disorders (SSD). Method The Sound Start Study was a cluster-randomized controlled trial. Seventy-nine early childhood centers were invited to participate, 45 were recruited, and 1,205 parents and educators of 4- and 5-year-old children returned questionnaires. Children whose parents and educators had concerns about speech were assessed ( n = 275); 132 children who were identified with phonological pattern-based errors underwent additional assessment. Children with SSD and no difficulties with receptive language or hearing, typical nonverbal intelligence, and English as their primary language were eligible; 123 were randomized into two groups (intervention n = 65; control n = 58), and 3 withdrew. The intervention group involved Phoneme Factory Sound Sorter software (Wren & Roulstone, 2013) administered by educators over 9 weeks; the control group involved typical classroom practices. Participants were reassessed twice by a speech-language pathologist who was unaware of the initial assessment and intervention conditions. Results For the primary outcome variable (percentage of consonants correct), the significant mean change from pre- to postintervention for the intervention group (mean change = +6.15, p < .001) was comparable in magnitude to the significant change for the control group (mean change = +5.43, p < .001) with a small between-groups effect size for change (Cohen's d = 0.08). Similar results occurred for measures of emergent literacy, phonological processing, participation, and well-being. Conclusion Computer-assisted input-based intervention administered by educators did not result in greater improvement than typical classroom practices.

BackgroundAn association between social disadvantage and early language development is commonly reported in the literature, but less attention has been paid to the way that different aspects of social disadvantage affect both expressive and receptive language in the first two years of life.AimThis study examines the contributions of gender, parental report of early language skills, and proximal social variables (the amount of stimulation in the home, resources available to the child and the attitudes/emotional status of the primary carer and the support available to him/her) controlling for distal social variables (family income and maternal education) to children’s expressive and receptive language development at two years in a community ascertained population cohort.Methods and ProceduresData from 1,314 children in the Children in Focus (CiF) sample from the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Multivariable regression models identified the contribution of proximal (what parents do with their children) measures of social disadvantage adjusting for more distal (e.g., family income and material wealth) measures as well as early language development at 15 months to the development of verbal comprehension, expressive vocabulary and expressive grammar (word combinations) at 2 years of age.Outcome and ResultsIn the final multivariable models gender, earlier language and proximal social factors, covarying for distal factors predicted 36% of the variance for expressive vocabulary, 22% for receptive language and 27% for word combinations at two years. Language development at 15 months remained a significant predictor of outcomes at 24 months. Environmental factors were associated with both expressive scales but the picture was rather more mixed for receptive language suggesting that there may be different mechanisms underlying the different processes.Conclusions and ImplicationsThis study supports the argument that social advantage makes a strong contribution to children’s language development in the early years. The results suggest that what parents/carers do with their children is critical even when structural aspects of social disadvantage such as family income and housing have been taken into consideration although this relationship varies for different aspects of language. This has the potential to inform the targeting of public health interventions focusing on early language and preliteracy skills on the one hand and home learning environments on the other and, potentially, the two in combination.

Multiple interventions have been developed to address speech sound disorder (SSD) in children. Many of these have been evaluated but the evidence for these has not been considered within a model which categorizes types of intervention. The opportunity to carry out a systematic review of interventions for SSD arose as part of a larger scale study of interventions for primary speech and language impairment in preschool children.To review systematically the evidence for interventions for SSD in preschool children and to categorize them within a classification of interventions for SSD.Relevant search terms were used to identify intervention studies published up to 2012, with the following inclusion criteria: participants were aged between 2 years and 5 years, 11 months; they exhibited speech, language and communication needs; and a primary outcome measure of speech was used. Studies that met inclusion criteria were quality appraised using the single case experimental design (SCED) or PEDro-P, depending on their methodology. Those judged to be high quality were classified according to the primary focus of intervention.The final review included 26 studies. Case series was the most common research design. Categorization to the classification system for interventions showed that cognitive-linguistic and production approaches to intervention were the most frequently reported. The highest graded evidence was for three studies within the auditory-perceptual and integrated categories.The evidence for intervention for preschool children with SSD is focused on seven out of 11 subcategories of interventions. Although all the studies included in the review were good quality as defined by quality appraisal checklists, they mostly represented lower-graded evidence. Higher-graded studies are needed to understand clearly the strength of evidence for different interventions.

© 2017, © 2017 The Speech Pathology Association of Australia Limited. Purpose: During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents’ and educators’ concerns, (2) examine inter-rater reliability between parents’ and educators’ concerns and (3) determine the group difference between level of concern and children’s performance on clinical testing. Method: Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents’ Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n = 275), receptive vocabulary (n = 131) and language (n = 274). Result: More parents/educators were concerned about children’s speech and expressive language, than behaviour, social–emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents’ and educators’ responses were significantly correlated (except gross motor). Parents’ and educators’ level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators’ level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without. Conclusion: Children’s communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.

Aim The aim of the study was to develop an ecologically valid synthesis of the evidence underpinning interventions for children with speech, language, and communication needs (SLCN), integrating a range of different data sources. Method Three sources of information were integrated: the Cochrane Review of interventions for children with primary speech and language delays/disorder; current practice from an online survey of 534 speech and language therapists and other professionals working with children with SLCN; and parent reports of preferred outcomes. Evidence was ranked as strong, moderate, or indicative. Results Of the 58 interventions identified, three (5%) were found to have a strong level of evidence, 32 (56%) had moderate evidence, and 23 (39%) had indicative evidence. Five were universal interventions, the remainder targeted and universal. The integrated findings were then turned into an online interactive database, which is moderated and updated at regular intervals. Interpretation There are a number of interventions that have a moderate or strong level of evidence underpinning them but they tend not to be those used by practitioners who often favour well-established familiar programmes even if they have only indicative evidence. There is a degree of complementarity between professional and parent views about outcomes, albeit with different emphases.

The importance of parent–child interaction (PCI) for language development has been well established. This has led many speech and language therapy (SLT) interventions to focus on modifying PCI as a means to improving children’s early language delay. However, the success of such programs is mixed. The current review compares PCI, observed in naturally occurring contexts, with preschool children with language delay and age- or language-matched typically developing (TD) controls. A systematic review of the literature searched 10 databases for studies using a case-control design and extracted data concerning participants, matching, selection, design, assessments, measures, findings, statistics, and bias. Quality appraisal used the Critical Appraisal Skills Programme case-control checklist. The search identified 17,824 articles, which were reviewed against exclusion criteria. The final review included 9 studies, which were diverse in terms of matching, delay criteria, and PCI measure. A narrative synthesis was conducted. The evidence for PCI differences between children with language delay and TD peers was limited and any suggestion that parents were less responsive could be attributed to limited language skills of children with language delay. The findings question the assumption that communicative environments of children with language delay are different, although the evidence is from a small sample of children from middle-class families. Children with language delay may instead be less able to learn from their environment. The review highlights the gap in understanding the relationship between parent and child language use during PCI. The need for further, longitudinal research is emphasized, including children ranging in type and severity of delay, across diverse socioeconomic backgrounds.

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.

There are policy and theoretical drivers for listening directly to children’s perspectives. These perspectives can provide insights to children’s experiences of their daily lives and ways in which they construct their multiple identities. Qualitative methodology is a useful research paradigm with regard to exploring children’s experiences. However, listening to the perspectives of children with speech and language disorders is a relatively new field of research. Therefore, it is important that researchers share their experiences of using methods and reflect on the strengths and limitations of these methods. The authors have used narrative inquiry with children with speech and language disorders to explore ways in which these children make sense of their experiences and construct their identities. In this paper, the authors reflect on methodological considerations when using narrative inquiry with children with speech and language disorders. They critically discuss three methodological considerations: narrative inquiry as a methodological choice, methods for data generation, limitations, and rigour.

Speech sound disorders are a common communication difficulty in preschool children. Teachers indicate difficulty identifying and supporting these children. The aim of this research was to describe speech and language characteristics of children identified by their parents and/or teachers as having possible communication concerns. 275 Australian 4- to 5-year-old children from 45 preschools whose parents and teachers were concerned about their talking participated in speech-language pathology assessments to examine speech, language, literacy, non-verbal intelligence, oromotor skills and hearing. The majority (71.3%) of children demonstrated lower consonant accuracy than expected for their age, 63.9% did not pass the language-screening task, 65.5% had not been assessed and 72.4% had not received intervention from a speech-language pathologist. The 132 children who were identified with speech sound disorder (phonological impairment) were more likely to be male (62.9%) who were unintelligible to unfamiliar listeners, and had poor emergent literacy and phonological processing skills, despite having typical hearing, oral structures, and intelligence. Children identified by parents and teachers with concerns may have a range of speech, language and communication needs requiring professional support.

Background: Implementation fidelity refers to the degree to which an intervention or programme adheres to its original design. This paper examines implementation fidelity in the Sound Start Study, a clustered randomised controlled trial of computer-assisted support for children with speech sound disorders (SSD). Method: Sixty-three children with SSD in 19 early childhood centres received computer-assisted support (Phoneme Factory Sound Sorter [PFSS] – Australian version). Educators facilitated the delivery of PFSS targeting phonological error patterns identified by a speech-language pathologist. Implementation data were gathered via (1) the computer software, which recorded when and how much intervention was completed over 9 weeks; (2) educators’ records of practice sessions; and (3) scoring of fidelity (intervention procedure, competence and quality of delivery) from videos of intervention sessions. Result: Less than one-third of children received the prescribed number of days of intervention, while approximately one-half participated in the prescribed number of intervention plays. Computer data differed from educators’ data for total number of days and plays in which children participated; the degree of match was lower as data became more specific. Fidelity to intervention procedures, competency and quality of delivery was high. Conclusion: Implementation fidelity may impact intervention outcomes and so needs to be measured in intervention research; however, the way in which it is measured may impact on data.

Early childhood educators are frequently called on to support preschool-aged children with speech sound disorders and to engage these children in activities that target their speech production. This study explored factors that acted as facilitators and/or barriers to the provision of computer-based support for children with speech sound disorders (SSD) in early childhood centres. Participants were 23 early childhood educators at 13 centres who participated in the Sound Start Study, a randomized controlled trial that examined the effectiveness of the Phoneme Factory Sound Sorter® (PFSS) computer program (Wren and Roulstone, 2013). Following the trial, participants completed a telephone interview discussing their experiences implementing the program. Transcripts from the interviews were analysed and three categories emerged as factors that influenced the provision of support: (1) personal factors that related to the children (engagement with PFSS, inclusion/exclusion experience), peers, and educators (service provision, educator engagement, support of child PFSS use); (2) environmental factors that related to policies and philosophies (child-centred practice, technology), the physical environment (inclusion/exclusion), and logistics (time, technology); and (3) program factors that related specifically to PFSS (program format, specific games, game duration). In order to best meet the needs of children, parents, educators, and clinicians, these factors need to be taken into consideration in the provision of speech and language therapy services in early childhood centres.

The World Report on Disability takes a broad emphasis on disability. In their paper on the implications of this report for speech-language pathology and for people with communication disabilities, Wylie, McAllister, Davidson, and Marshall (2013) emphasize the importance of promoting a broader view of communication disability. This commentary explores the challenges of investigating the epidemiology of communication disability, in particular, the difficulties defining the disability and then measuring it in a valid and reliable manner. The two interpretations are discussed of the concept medically under-served as it relates to speech-language pathology: service availability and service accessibility. Bourdieu's forms of capital were then explored as a way of understanding an individual's perception of capital and how service provision can enhance perceived capital and minimize loss of capital. It is important services are mindful of the variations of capital and engage with communities to facilitat...

Over time, the labels used for various speech and language impairments change. For example, language impairment in children has been called developmental dysphasia/aphasia, language impairment/ disorder/delay/difficulties (Bishop, 2013). Changes in labels reflect our evolving understanding of the nature of a disorder but also the changing social context and mores. Currently a number of terms are in use for speech and language impairments which may be used differently by practitioners and researchers in education and health contexts. For example, the phrase ‘speech, language, and communication needs’ (SLCN) was coined in the UK by the Bercow review to encompass the widest range of these impairments. However the term is used and understood in a variety of ways by different professionals and not used at all by parents (Dockrell, Lindsay, Roulstone, & Law, 2014; Roulstone & Lindsay, 2012). The use of other labels such as specific language impairment or language delay is by no means straightforward as recent debates have illustrated (Bishop, 2014; Reilly et al., 2014). That debate reflected the views of academics, clinicians, educators, and parents (Bishop, 2014; Huneke & Lascelles, 2014; Lauchlan & Boyle, 2014). While professionals debate the best label to describe language impairments, it is evident that language impairments are not well understood in the public domain when compared with other diagnostic categories such as Autism, and ADHD (Kamhi, 2004).

This review investigated what is known about the impact of bilingualism on children’s phonemic awareness. Studies of bilingual children where one language was English were identified by searching electronic databases and bibliographies from the last 50 years. Thirteen studies were analysed thematically and summarized in terms of methods and key findings. Findings suggest a variable pattern of performance, with some studies showing no difference between bilingual and monolingual performance on tasks. However, there was also evidence for advanced acquisition of phonemic awareness skills in some bilingual children, mediated by characteristics of languages spoken.

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 children's 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.

As part of a large-scale study of children's 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.

Children have the right to express their views and influence decisions in matters that affect them. Yet decisions regarding speech-language pathology are often made on their behalf, and research into the perspectives of children who receive speech-language pathology intervention is currently limited. This paper reports a qualitative study which explored experiences of communication and of speech-language pathology from the perspectives of children with speech, language, and communication needs (SLCN). The aim was to explore their perspectives of communication, communication impairment, and assistance. Eleven school-children participated in the study, aged between 7-10 years. They were recruited through a speech-language pathology service in south west England, to include a range of ages and severity of difficulties. The study used open-ended interviews within which non-verbal activities such as drawing, taking photographs, and compiling a scrapbook were used to create a context for supported conversations. Findings were analysed according to the principles of grounded theory. Three ways of talking about communication emerged. These were in terms of impairment, learning, and behaviour. Findings offer insight into dialogue between children with SLCN and adults; the way communication is talked about has implications for children's view of themselves, their skills, and their participation.

Background: Systematic reviews are increasingly being carried out in speech-and-language therapy and are used by practitioners, service commissioners, policy-makers and researchers to inform decisi...

A consideration of evidence-based practice has led many to debate the nature of evidence. Rejecting the idea that randomized controlled trials should be the only legitimate source of evidence, writers have argued that other types of research and knowledge should be considered legitimate sources of evidence. This paper suggests that one should draw on systematic research, including qualitative research, for evidence, and that other types of knowledge such as craft and practice knowledge are part of the profession's expertise. This paper argues that evidence and expertise are both required for evidence-based practice to occur. Finally, a consideration of patients' values and expectations is explored as a third component of evidence-based practice. The paper argues that all three components are necessary for evidence-based practice.

This paper expands on the lead article by Hersh (2010) regarding a number of challenges that face speech-language pathologists (SLPs) when ending therapy, in this case focusing on children's speech and language impairment. Children's speech and language impairments are often long-term with impacts on other aspects of their functioning; there is little clarity about the notion of resolution and there is little research about optimum points of discharge or ending therapy. In the lead article, Hersh (2010) reports the personal concerns experienced by SLPs working with people with aphasia. Similar findings are highlighted here from the child speech and language impairment context; in particular that SLPs' thresholds of concern vary. The paper notes the resource pressures that lead to prioritization decisions related to the point of discharge and argues that clarity in goal planning and the explicit discussion of goals and the purpose of intervention, in partnership with clients and their families goes some way to reducing pressure faced by SLPs.

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 stro...

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 children's 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.

This article reports an investigation in further education colleges in the north west of England into the language and communication content of courses for students with severe learning difficulties. The inquiry was undertaken for the M.Ed degree of Liverpool University. Sue Roulstone is currently the chief speech therapist at Bristol Royal Hospital for Sick Children and teaches part time at Bristol Polytechnic.

Evidence-based practice includes research evidence, clinical expertise and stakeholder perspectives. Stakeholder perspectives are important and include parental ethno-theories, which embrace views about many aspects of speech, language and communication, language development, and interventions. The Developmental Niche Framework provides a useful theory to understand parental beliefs. Ethnotheories, including those about language development, delay and interventions, may vary cross culturally and are less well understood in relation to families who may be considered 'under-served' or 'hard-to-reach' by speech and language therapy services. Who is considered to be under-served and the reasons why some families are under-served are complex.To describe beliefs and reported practices, in relation to speech and language development, delay and intervention, of parents and carers from a small number of groups in England who were perceived to be under-served in relation to SLT services.As part of a wider National Institute for Health Research (NIHR)-funded study (Child Talk), seven focus groups (with a total of 52 participants) were held with parents from three communities in England. Topics addressed included beliefs about language development, language delay and parents' reported responses to language delay. Data were transcribed and analysed using adapted framework analysis, which also drew on directed content analysis.Four themes resulted that broadly matched the topics addressed in the focus groups: language development and the environment; causes and signs of speech and language delay; responses to concerns about speech, language and communication; and improving SLT. These produced some previously unreported ideas, e.g., about how language develops and the causes of delay.The findings are discussed in relation to previous literature and the Developmental Niche Framework. Clinical implications include ideas about issues for SLTs to discuss with families and the need to recognize that parents may see themselves as competent facilitators of language. Suggestions are made for future research, including: expanded investigation of a wider range of under-served groups, an exploration of who parents consult when concerned about their child's language, and how key community figures advise parents in relation to language delay.

BackgroundThe Child Talk study aimed to develop an evidence-based framework to support the decision-making of speech and language therapists (SLTs) as they design and plan interventions appropriate to the needs of individual children with primary speech and language impairments and their families. The need for early identification and effective intervention for these children continues to be a government policy priority because of the link between children’s early speech and language skills and their broader well-being and outcomes in later life. The first phase of Child Talk sought to map and describe current SLT practice for these children; identify and summarise the existing research evidence relating to practice; and investigate the perspectives of parents, early years practitioners, preschool children and ‘underserved’ communities on speech and language therapy. The second phase of Child Talk focused on the development of a toolkit – assessment tools, outcome measures and a data set – to support future service and economic evaluations of the framework.MethodsChild Talk adopted a mixed-methods design. Quantitative methods included surveys and investigated the prevalence and patterns of intervention usage; qualitative data collection methods included focus groups, interviews and reflection to investigate participants’ perspectives and understandings of interventions. Data analysis methods included descriptive and inferential statistics, thematic and content analysis and framework analysis. Participants were recruited nationally through six NHS sites, professional bodies, parent groups and advertising. Participants included SLTs (n = 677), parents (n = 84), preschool children (n = 24), early years practitioners (n = 31) and ‘underserved’ communities (n = 52).Key findingsSpeech and language therapy interventions were characterised in terms of nine themes, viewed as comprehensive and inclusive by practitioners. Relevant assessments, interventions and outcome domains were identified for the nine themes. Areas of tacit knowledge and underspecified processes contributed to variability in the detail of the framework. Systematic reviews identified 58 relevant and robust studies (from 55,271 papers retrieved from the initial literature search). The number of studies relevant to each theme varied from 1 to 33. Observational data on preschool children’s perspectives on speech and language therapy interventions revealed the dynamic nature of their interaction with different activities and people within therapy sessions. Parents’ experiences of speech and language therapy were generally positive although some reported that the rationale for therapy was not always clear. Parental perspectives in underserved communities suggested that, although parents were confident about how to support children’s language development, they were less informed about the nature of language impairments and the function of speech and language therapy. The availability of information regarding resources directed towards speech and language therapy services was poor. In particular, services lacked both a culture of collecting outcome data routinely and measures of professional input and costs associated with their activities.ConclusionA descriptive framework of SLT practice has been developed to support the discussions between therapists and families when making decisions regarding the selection of interventions and outcome measures. Further research is needed to address gaps in the intervention framework and evaluate its effectiveness and cost-effectiveness in improving outcomes for preschool children with primary speech and language impairments.Study registrationThis study is registered as PROSPERO CRD42013006369.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Objective: The relationship between social disadvantage, behavior, and communication in childhood is well established. Less is known about how these 3 interact across childhood and specifically whether pragmatic language skills act as a mediator between early social disadvantage and adolescent behavior.Method: The sample was the Avon Longitudinal Study of Parents and Children, a representative birth cohort initially recruited in England in 1991/1992 and followed through to adolescence and beyond. Of the original 13,992 live births, data were available for 2926 children at 13 years. Univariable analysis was first used to identify sociodemographic and other predictors of the Strengths and Difficulties Questionnaire (SDQ) at 13 years. The mediational role of the pragmatics scale of the Children's Communication Checklist (CCC) at 9 years was then tested, controlling for age, gender, and IQ. Results: There was evidence of both a direct effect from social disadvantage (path C′) to SDQ Total Behavior Score at 13 years (-.205; p p Conclusion: The results provide evidence to suggest that there maybe a causal relationship between these variables, suggesting that interventions targeting pragmatic skills have the potential to reduce adolescent behavioral symptoms.

This paper examines the relationship between components of evidence-based practice (clinical expertise, patient perspective and research evidence).Findings are examined from two research programs: the Better Communication Research Program and Child Talk, including exploratory studies of the views of parents and children regarding speech-language pathology and studies of current practice by SLPs in England. Systematic reviews of the research literature were also undertaken. The paper analyses relationships between outcomes valued by children and parents and those reported in the literature and in practice, parents' perspectives regarding intervention in comparison with clinicians' reports of practice and the extent to which research evidence underpins current practice is examined.Parents and children value functional outcomes and positive experiences; these are not routinely measured in research or practice. Therapy is perceived positively by most parents; however, some are ambivalent and less clear about the rationale. Commonly used interventions are supported by evidence, but there are gaps regarding some critical therapy components.The paper discusses four challenges to evidence-based practice: the consistency and clarity of descriptions of interventions; consensus based models of practice; understanding of the mechanisms of change; and, finally, the operationalization of client preferences within an evidence-based practice framework.

In 2000, 25 speech and language therapy projects were established in schools in England, funded through the Standards Fund. An evaluation commissioned by the Government reported positive results and gave an overview of all the projects at a point approximately six months after their inception. Although there were common themes, it was quite clear that the projects differed widely in their structure and interpretation of the original brief. In this article, Sue Roulstone, Professor of Speech and Language Therapy at the University of the West of England, and Rosalind Owen and Lucy French, both specialist speech and language therapists working for the United Bristol Healthcare NHS Trust, provide an in-depth report of one of the projects and its evaluation after 18 months. The project, based on a systems analysis approach, targeted its interventions at the individual child, the parents, the teachers and therapists, the classrooms and schools, and more strategic levels in the health and education services. The article gives details of the 'interventions' for each component. An independent evaluation gathered qualitative and quantitative data that suggest that the new service had a positive impact on all aspects of the system. Children made gains in their speech and language; parents were informed and involved; therapists and teachers were more satisfied about their knowledge base; and systems changed within the schools to reflect and support the collaboration. The outcomes of the project led to a rolling out of the model to two more cluster groups of schools. A number of organisational structures were identified which support the ongoing collaboration. Details given in this article will enable others to identify whether or not this model might suit their local circumstances and be replicable in their context. © NASEN 2005.

This article examines data from a multimethod study of speech and language therapy for pre-school children. The study compares the impact of intervention offered immediately following assessment with a control condition of monitoring over a 12-month period. A randomized controlled trial, a survey and in-depth interviews with parents are used. Data from the component studies were reviewed in order to draw out implications for good practice. These cluster into four areas: caseload selection, eclecticism, targeting and acceptability of therapy. Therapists were found to individualize therapy for their heterogenous caseloads. Parents generally valued therapy but wanted more specific activities. The article concludes that the heterogeneity of therapists’ caseloads creates challenges for evidence-based practice. In order to increase therapists’ understanding of factors that are critical to success, therapy should be systematically varied within a well-documented hypothesis testing approach.

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 children's 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 children's participation in planning and reviewing therapy.

This paper explores the construct validity of a measure of clinical outcomes, the Therapy Outcomes Measures (TOM). The work took place within a randomized controlled trial of pre-school ch...

Aim The aim of this paper is to examine the natural history of early speech and language delay in preschool children over a 12-month period. Methods The study reports data on 69 children under the age of 3.5 years who were referred for speech and language therapy because of early speech and language delay. The children were monitored over a 12-month period but received no direct intervention during that time. Assessment of their comprehension, expressive language and their phonology took place at baseline and again at 6 and 12 months after baseline. Results The results show a general picture of improvement, although there was considerable individual variation. By the end of the 12 months, two-thirds of the children were still eligible on the study intake criteria. Therapist's rating of a child's functional communication at the outset was a significant predictor of the child's outcome at the end of the 12-month period. Discussion The paper discusses the appropriateness of a ‘monitoring’ approach to the management of early language delay and highlights the need to consider the social issues and views of parents as well as the severity of a child's difficulties.

Objectives The paper presents a research study investigating the effectiveness and acceptability of community speech and language therapy provision for preschool children with early speech/language delays. As a ‘worked example’, it demonstrates the value of a multimethod approach to evaluation. Methods The paper examines how the research findings of a pragmatic randomized controlled trial (RCT), a survey questionnaire and qualitative in-depth interviews, which were the methods used in the evaluation, overlap and complement each other. Results There was little evidence to establish the effectiveness of the speech and language therapy provided in the trial. This lack of difference was reflected in responses of parents to items on the questionnaire. The findings of the RCT, questionnaire and interviews all cast considerable doubt on the prospect of spontaneous resolution of the children's difficulties. Although the RCT showed few differences between the children allocated to immediate therapy or ‘watchful waiting’, the questionnaire and interviews revealed the circumstances in which the parents felt that these intervention strategies had been acceptable and unacceptable. Conclusions Although the trial provided information about the progress of the children, the questionnaire and interview components highlighted the advantages and limitations of the intervention from the viewpoint of parents, thereby helping to explain the RCT findings. Thus, the study demonstrates how a multimethod approach to evaluation can yield useful information to explain the findings of RCTs.