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Parental interventions can help parents use strategies to support their child's language and communication development. The ComAlong courses are parental interventions that focus on responsive communication, enhanced milieu teaching, and augmentative and alternative communication. This interview study aimed to investigate the course leaders' perceptions of the three ComAlong courses, ComAlong Habilitation, ComAlong Developmental Language Disorder, and ComAlong Toddler, and to evaluate their experiences of the implementation of the courses. Qualitative content analysis was used to analyze the interview data. Thereafter, three categories resulted from the findings: Impact on the Family, A Great Course Concept, and Accessibility of the Courses. The results indicate that participants perceived that the courses had positive effects on both parents and themself. Furthermore, it was described that parents gained knowledge about communication and strategies in how to develop their child's communication; however, the courses were not accessible to all parents. The collaboration between the parents and course leaders improved, and course leaders viewed the courses as an important part of their work. The following factors had an impact on the implementation: several course leaders in the same workplace, support from colleagues and management, and recruitment of parents to the courses. [ABSTRACT FROM AUTHOR]

Background: Personal protective equipment (PPE) and infection prevention and control (IPC) measures are crucial to preventing the spread of coronavirus disease 2019 (COVID-19). This study used a scoping review to investigate the challenges that exist when speech–language therapists (SLTs) use IPC measures for providing early communication intervention (ECI). Objectives: To describe existing, recent literature on PPE and IPC measures used in early intervention through a scoping review (steps 1–5) and to consult local clinicians to investigate how SLTs who provide ECI in South Africa relate to these findings (step 6 of the scoping review). Method: A scoping review was performed which followed the PRISMA-ScR framework. Because of limited literature on PPE and IPC measures used by SLTs in providing ECI, the inclusion criteria were adjusted to include PPE and IPC measures used by healthcare workers (HCWs) who provide early intervention to the population of infants and toddlers up to 3 years old. At the time of the review, articles were not older than 10 years and were published between 2011 and 2020. The scoping review included a consultation with South African SLTs who provide ECI, including during the COVID-19 pandemic. A pilot study was conducted prior to the consultations. Seventeen clinicians were included in total. Data from both the pilot study and main consultation were transcribed and analysed in the results using thematic analysis. Results: Fourteen articles were included in the study. The scoping review of existing literature identified challenges to implementing IPC measures, namely the care and behaviour of young children, infrastructure and system challenges, poor compliance and lack of training and a lack of standard IPC protocols. Clinicians in the consultation phase confirmed these challenges and reported that IPC measures did not consider ECI populations nor the settings in which services were provided. Suggestions from the literature for improved infection control included hand hygiene, improved supplies and infrastructure and education and training. Clinicians in the consultation added practical suggestions for implementing IPC measures within ECI, which included an increase in parent-led intervention as well as cleaning and disinfection strategies. Conclusion: This study identified challenges and recommendations of SLTs who use PPE and IPC measures whilst providing ECI. Understanding these challenges can benefit ECI services and future research efforts focused on improving ECI services whilst maintaining IPC standards.

Using a mobile health application (i.e., app) to empower primary caregivers of young children with developmental disorders in low- and middle-income countries is opening up new avenues for early childhood intervention. Thirteen caregivers and 10 speech-language pathologists participated in 3 focus groups to explore their perspectives about the potential benefits and suitability of a mobile health app as part of intervention, its features, the likelihood of using and recommending it, as well as potential pitfalls to be avoided. Both participant groups were generally positive, although there was little overlap between their responses. Caregivers generally focused on increased knowledge and skills (of all family members), as well as on empowerment and reduced costs. Speech-language pathologists, on the other hand, focused on how current service delivery would be enriched by increasing the dosage of therapy and enhancing parental cooperation. They also expected that the reach of service delivery would be expanded as more children and caregivers could potentially benefit. Although technology (i.e., mobile apps) could open up new possibilities for service delivery in this population, the perspectives of all stakeholder groups should be considered to ensure successful adoption of such technologies. [ABSTRACT FROM AUTHOR]

Augmentative and alternative communication (AAC) can enhance children's communication and is recommended to be introduced as soon as problems are identified. The aim of this interview study was to investigate how parents perceive the ComAlong Toddler intervention offered to parents of children with communication difficulties early in the diagnostic process. ComAlong Toddler consists of a 5-session, group-based, parental course, and two home visits that focus on responsive communication, enhanced milieu teaching, and multimodal AAC. Interviews were conducted 1 year after the intervention with 16 parents who had attended ComAlong Toddler. The data were analyzed through qualitative content analysis, resulting in four categories: (a) Development for us and the child, (b) acquiring useful tools, (c) useful learning strategies, and (d) benefits and challenges regarding intervention structure. Findings suggest that parents of toddlers with language or communication disorders learned and appreciated responsive communication and enhanced milieu teaching. All had used multimodal AAC and described its benefits. Parents emphasized the value of learning from other parents as well as from a speech-language pathologist who engaged with their child in the home environment. Parents suggest an enhanced family focus as a potential improvement. [ABSTRACT FROM AUTHOR]

Aims: This study design article aims to describe a research study focused on evaluating the use of the Infant-Toddler Checklist to identify children at 18 months with early communication difficulties, and to study the ComAlong Toddler intervention for parents to support their child's communication development. Background : Communication disorders are a common public health problem affecting up to 20% of children. Evidence points to the importance of early detection and intervention to improve young children's communicative abilities and decrease developmental delay. Early identification of communication difficulties is possible with instruments such as Infant-Toddler Checklist. The ComAlong Toddler intervention is tailored to the needs of parents of young children with communication delay before definitive diagnosis. The parents are provided with guidance in communication enhancing strategies during home visit and five group sessions. Methods : The study uses a prospective cohort design. Children were consecutively recruited during 2015–2017, and data will be collected 2015–2023. The screening was performed at the child health centre through use of the Infant-Toddler Checklist. An assessment and first consultation were then performed by a speech and language therapist for children with suspected communication delay according to the screen as well as for children referred for other reasons before the age of 2.5 years. Children with confirmed communication delay were randomised between two interventions: the ComAlong Toddler parental course or a telephone follow-up. Outcome measures include child communication and language skills and use of augmentative and alternative communication. To gain insight into the participants' perspectives, surveys have been collected from parents. Conclusion: The study will provide information regarding identification and intervention for 18-month old children with communication delay. Trial registration: ISRCTN13330627 [ABSTRACT FROM AUTHOR]

Background: South Africa presents with high preterm birth (PTB) and low birth weight (LBW) rates (14.17%). Numerous conditions characterised by language impairment are associated with LBW and/or PTB. Speech-language therapists may fail to identify older children whose language impairment may have originated from LBW and/or PTB. Objective: To describe the frequency of LBW and/or PTB, in comparison with full-term birth, and associated conditions in children at an early communication intervention (ECI) clinic. Methods: Retrospective data of 530 children aged 3–74 months were analysed, with 91.9% presenting with language impairment. Results: Almost 40% had LBW and/or PTB, and late PTB was the largest category. Factors associated with LBW and/or PTB were prenatal risks, including small-for-gestational age, perinatal risks, including caesarean section, and primary developmental conditions. Secondary language impairment was prevalent, associated with genetic conditions and global developmental delay. Conclusion: The frequency of LBW and/or PTB was unexpectedly high, drawing attention to the origins of language impairment in almost 40% of the caseload at the ECI clinic.

Key findings of emergent literacy research conclude that emergent literacy experiences correlate with later reading success and that emergent literacy intervention for children with special needs is essential. As a group with special needs, children with Down syndrome require emergent literacy intervention. They may attain functional literacy skills and their language development determines their reading ability. Speech-language therapists have an important role to play in emergent literacy programme development in South Africa. As a first step towards programme development and emergent literacy intervention goal selection, the aim of this study was to determine the applicability of a self-administered questionnaire to describe parental perceptions and practices regarding the emergent literacy development of their young children with Down syndrome. A quantitative research approach was used within a cross-sectional descriptive survey. Fifteen literate parents, with preschool children with Down syndrome aged between two and five years were selected as participants. Data were collected via email and/or facsimile. The results showed that all participants valued emergent literacy development. They appeared to have knowledge about book-reading but not about the broad spectrum of emergent literacy experiences to which they might expose their children. Participants were actively promoting emergent literacy development of their children, but they had certain needs that could potentially be addressed by speech-language therapists working in early communication intervention. The questionnaire proved to be applicable, but changes are required for application with illiterate parents and those with low literacy skills. Based on the results a framework with guidelines for emergent literacy goal selection is provided.

The early identification of infants with communication disorders or at risk for communication delays is still one of the biggest challenges of early communication intervention (ECI) and threatens to compromise its efficacy. Current approaches to the early identification of young children at risk for communication disorders involve strategies aimed at the identification of general developmental delays and may not be sufficiently sensitive and specific enough to detect the early stages of communication disorders. The risks for mortality and health are often identified early in life, but the concomitant risks for communication disorders in the same young children are frequently not identified at that opportune time. The current study involved a descriptive survey, describing the identification of communication disorders in 153 subjects, whose data was stored in and retrieved from a customized ECI database system. The findings revealed that the subjects were assessed at the average age of 18 months, but that identifications of risk conditions occurred prenatally, at birth, after the perinatal period and later in life. The time of identification related to the different communication disorders identified in the subjects and caregivers played a major role in detecting the first signs of communication disorders in their children. In order to provide a guideline for clinical practice, a transdisciplinary conceptual framework towards a coordinated effort for the early identification of risks for communication disorders in young children is proposed.

Infants and toddlers with special needs within the developing context in South Africa are not currently receiving adequate early communication intervention services. The development of a model for service delivery to this population is imperative for the successful implementation of early communication intervention in the developing context in South Africa. The basic model of early intervention service delivery provides a theoretical basis for early intervention service delivery but has certain limitations when applied to the developing context in South Africa. Community-based intervention is proposed as an avenue for the delivery of health care services within primary health care although constraints in the application of community-based intervention exist. An integrated model of early communication intervention service delivery within community-based intervention is proposed and illustrated by presenting a case example.

Young children with Pierre Robin sequence are at considerable risk to develop delayed or disordered communication development. This study investigated the effectiveness of early communication intervention with four young children with Pierre Robin sequence, aged 5 to 28 months. The Proportional Change Index (Wolery, 1983) was used to determine the amount of child progress that took place during the intervention period. The results indicated that regular early communication intervention sessions over an extended period of time produced positive results, especially for expressive language abilities. The presence of a slight hearing loss due to otitis media, seemed to have influenced the effectiveness of early communication intervention. One subject displayed an associated disorder and evidenced the slowest rate of development for receptive and expressive language abilities as well as a limited phonetic repertoire for consonants. All but one subject had limited phonetic repertoires possibly due to velopharyngeal incompetence. Early communication intervention services should be delivered regularly over an extended period of time and the hearing abilities and speech production skills of young children with Pierre Robin sequence should be followed closely during early communication intervention.

Based on clinical observations, case finding for early communication intervention service delivery in rural areas, such as Ditsobotla sub-district, is limited. The study described the identification process used for infants and young children at risk for communication delay and disorders as part of a proposed incremental implementation of early communication intervention services within the existing primary healthcare package. A descriptive survey design was followed. A rating scale was utilized and interviews were conducted with 20 randomly selected primary healthcare personnel and eight primary healthcare programme managers in Ditsobotla sub-district in North West province. The aims were to describe the early identification methods/processes, resources and limitations and provide guidelines to introduce early communication intervention services in a rural community. The results indicated that the identification process was limited. An incremental implementation of the different early communication intervention functions within the primary health care package appears feasible. Implications of the findings may be applied to initiate early communication intervention services, based on integrated teamwork, in a rural district in South Africa.

Objective: To determine the age-specific communication functioning of children with cleft lip and palate (CLP) in the age groups of 1 to 11 months, 12 to 23 months, and 24 to 48 months. Design: A retrospective, descriptive, cross-sectional survey design was employed. Participants: Purposive sampling was implemented as a nonrandomized sampling method. The data sets of 227 participants, between the ages of 1 month and 48 months, and their families were investigated. Setting: The assessment data were extracted from an early communication intervention database at the Clinic for High Risk Babies at the University of Pretoria. Results: The findings revealed that expressive and receptive language and listening skills presented as the most vulnerable communication areas across all three age groups. The cumulative effect of the risk factors was the greatest in the 12- to 23-month age group, as this group presented with the highest frequency of delayed communication development. Relative strengths were found across all age groups in three areas: average cognitive skills, gross motor development, and displaying an appropriate variety of communication functions. Conclusions: The findings are confirmed by other studies and suggest that young children with CLP in the 12- to 23-month age group may be the most vulnerable for the emergence of communication delays. The vulnerable areas of communication development should be integrated as goals in a focused early communication intervention approach to the treatment of the young population with CLP. [ABSTRACT FROM AUTHOR]

Background:  Personal protective equipment (PPE) and infection prevention and control (IPC) measures are crucial to preventing the spread of coronavirus disease 2019 (COVID-19). This study used a scoping review to investigate the challenges that exist when speech-language therapists (SLTs) use IPC measures for providing early communication intervention (ECI)., Objectives:  To describe existing, recent literature on PPE and IPC measures used in early intervention through a scoping review (steps 1-5) and to consult local clinicians to investigate how SLTs who provide ECI in South Africa relate to these findings (step 6 of the scoping review)., Method:  A scoping review was performed which followed the PRISMA-ScR framework. Because of limited literature on PPE and IPC measures used by SLTs in providing ECI, the inclusion criteria were adjusted to include PPE and IPC measures used by healthcare workers (HCWs) who provide early intervention to the population of infants and toddlers up to 3 years old. At the time of the review, articles were not older than 10 years and were published between 2011 and 2020. The scoping review included a consultation with South African SLTs who provide ECI, including during the COVID-19 pandemic. A pilot study was conducted prior to the consultations. Seventeen clinicians were included in total. Data from both the pilot study and main consultation were transcribed and analysed in the results using thematic analysis., Results:  Fourteen articles were included in the study. The scoping review of existing literature identified challenges to implementing IPC measures, namely the care and behaviour of young children, infrastructure and system challenges, poor compliance and lack of training and a lack of standard IPC protocols. Clinicians in the consultation phase confirmed these challenges and reported that IPC measures did not consider ECI populations nor the settings in which services were provided. Suggestions from the literature for improved infection control included hand hygiene, improved supplies and infrastructure and education and training. Clinicians in the consultation added practical suggestions for implementing IPC measures within ECI, which included an increase in parent-led intervention as well as cleaning and disinfection strategies., Conclusion:  This study identified challenges and recommendations of SLTs who use PPE and IPC measures whilst providing ECI. Understanding these challenges can benefit ECI services and future research efforts focused on improving ECI services whilst maintaining IPC standards.

The aim of the article is to describe the communication development of a child with Fetal Retinoid syndrome (FRS) from six months to seven years of age. Little is known about this rare acquired syndrome and its long-term implications, especially on a child's communication development. A descriptive, ex post facto research design was used to study the participant's communication development from 1996 when the family enrolled in an early communication intervention programme. Annual serial assessments of the participant and her family were conducted and the data were stored in a research database after each assessment. The results are described according to a 4-level assessment framework and indicated consistent, but moderate to minor delays in the participant's communication development with a mild hearing loss in the right ear, associated with ear anomalies. Although prenatal exposure to isotretinoin may have serious effects on the unborn fetus and even cause death, the participant did not display all the symptoms of FRS described in the literature. The favorable family circumstances, early commencement of intervention, and supporting early educational environments were protecting factors that could have contributed positively to the participant's communication development. The importance of knowledge accumulation about rare syndromes such as FRS in Communication Pathology and Audiology is discussed and guidelines for early identification, assessment and treatment applicable to the case are proposed as an intervention option.

Since preterm and low birth weight infants display a high-risk for communication disorders or delays, the Neonatal Intensive Care (NICU) provides the earliest opportunity where family-centered early communication intervention (ECI) services can be initiated. Extensive knowledge about high-risk neonates exists, but there appears to be limited knowledge about the emergence of early communication skills in these neonates. The aim of the study was to provide a systematic description of the successive communication developmental steps of a high-risk neonate on a weekly basis, from birth to discharge from a NICU, in order to guide further research on a larger scale. An Α-type single case study design was used to collect prospective data over 14 sessions during the participant's 51-day stay in the NICU. Using a comprehensive data-collection protocol, rich data sets were gleaned over time. The results are described as a chronology of events contributing to the participant's risk status and influencing his early communication development. The successive emergence the different components of language skills in the participant provided new insights into the communication development of a preterm neonate and should be further investigated. An ECI programme and guidelines for implementation in the NICU are discussed as a treatment option.

Purpose: This article presents current information on recommended practices related to the delivery of early intervention (El) supports and services to infants and toddlers with, or at risk for, communication deficits and their families. Method: The focus is on presenting the changing paradigm for speech-language pathologists (SLPs) working in El based on the best available research evidence and expert opinion. The article includes a brief review of the recommended and promising practices for early communication intervention and applies the content to the role of the SLP as a consultant to caregivers. It provides strategies for "how to" join into the everyday activities/routines and places with the caregiver and child in order to facilitate caregiver-implemented intervention that will enhance caregiver-child interactions and promote the child's participation and learning. The importance of, and strategies for, collaborative consultation with diverse caregivers within a family-centered approach is presented. Implications: This article provides important and timely information for professionals and families related to family-centered El practices, caregiver-implemented interventions, adult teaching strategies, and collaborative consultation with families of infants and toddlers with, or at risk for, communication deficits. SLPs can use the information presented to inform their practices when working with these young children and their families. [ABSTRACT FROM AUTHOR]

Traditional models of service delivery prevent speech-language therapists and audiologists from identifying and implementing early communication intervention(ECI) in South Africa. This study utilized the framework of the transdisciplinary team approach to develop a collaborative partnership between community nurses and speech-language therapists and audiologists. An interdisciplinary in-service training programme was implemented with 24 community nurses employed at family health clinics in KwaZulu-Natal; with the aim of enhancing their knowledge and attitudes toward the early identification and referral of at-risk children to speech-language therapists and audiologists. Three questionnaires were used to evaluate the nurses' knowledge and attitudes. Results indicated that the training programme significantly improved the nurses' knowledge regarding ECI but not their attitudes. Implications of these findings are discussed in terms of service delivery for ECI, and the education and training of early interventionists in the South African context.

Background:  South Africa presents with high preterm birth (PTB) and low birth weight (LBW) rates (14.17%). Numerous conditions characterised by language impairment are associated with LBW and/or PTB. Speech-language therapists may fail to identify older children whose language impairment may have originated from LBW and/or PTB., Objective:  To describe the frequency of LBW and/or PTB, in comparison with full-term birth, and associated conditions in children at an early communication intervention (ECI) clinic., Methods:  Retrospective data of 530 children aged 3-74 months were analysed, with 91.9% presenting with language impairment., Results:  Almost 40% had LBW and/or PTB, and late PTB was the largest category. Factors associated with LBW and/or PTB were prenatal risks, including small-for-gestational age, perinatal risks, including caesarean section, and primary developmental conditions. Secondary language impairment was prevalent, associated with genetic conditions and global developmental delay., Conclusion:  The frequency of LBW and/or PTB was unexpectedly high, drawing attention to the origins of language impairment in almost 40% of the caseload at the ECI clinic.