Abstract
BackgroundChildren with Social (Pragmatic) Communication Disorder (SPCD) have long-term needs in using and processing social language and have a high risk of later mental health difficulties. A manualised speech and language therapy programme, the Social Communication Intervention Programme (SCIP) provides therapy content for SPCD. A feasibility study is required to derive more precise estimates of key parameters for a future trial of SCIP.AimsTo assess the feasibility of conducting a substantive randomized controlled trial of SCIP for children with SPCD.MethodsA questionnaire was distributed to paediatric speech and language therapists in England. Survey questions addressed number of eligible children, routine intervention provision and trial recruitment factors. In the second phase, a single-arm intervention feasibility study was completed. Fifteen speech and language practitioners identified 24 children aged 5–11 years with SPCD. Practitioners received training/supervision to deliver 20 SCIP therapy sessions to each child. At time 1, parents of participating children provided three communication goals; expected steps in each goal were defined. After intervention, parents and practitioners independently rated each goal compared to baseline ability. Two research practitioners compared parent post-intervention commentaries with outcome scores to derive guidance about clinical significance. All practitioners recorded audio commentaries on therapy experiences. Post-intervention interviews were conducted with 6 practitioners and 6 parents. An expert panel completed a Delphi consultation on trial design.ResultsRoutine practice for SPCD varies widely. Children tend to be embedded in autism provision. Participation in a future trial was well supported provided resources are available to services. Outcomes analysis indicated all children except one made some progress on parent ratings; all children made progress on practitioner ratings. A power analysis for a future trial was carried out using current outcome measure as putative primary endpoint. Practitioners’ audio-diaries provided suggestions for training and adaption in a future trial. Outcomes and therapy methods were acceptable to practitioners and parents.ConclusionsThe feasibility study evaluated a novel outcome measure of social communication skills in SPCD. A power calculation indicated a feasible framework for a trial within a realistic period of time. Recommendations for recruitment methods, adaptation of manual and training were supported by practitioners and an expert panel.Trial registrationTitle: Speech-language therapy for child social communication disorderTrial ID: ISRCTN48030419. Date registered: January 1, 2017. Registered retrospectively.
Highlights
Children with Social (Pragmatic) Communication Disorder (SPCD) have long-term needs in using and processing social language and have a high risk of later mental health difficulties
A large majority of respondents to the survey would be willing to be randomised in a future trial but time available would be a major barrier to participation
The distinctive nature of the Social Communication Intervention Programme (SCIP) intervention approach was affirmed by all the participants, with the recognition that this approach may provide an impact for children who have complex needs and who have not benefitted from standard therapy
Summary
Children with Social (Pragmatic) Communication Disorder (SPCD) have long-term needs in using and processing social language and have a high risk of later mental health difficulties. The presence of significant and persistent social communication difficulties in middle childhood is associated with adverse outcomes such as behavioural difficulties in adolescence [1], in sustaining peer relations [2], successful employment [3] and with later mental health conditions [4]. This type of communication impairment comprises disproportionate difficulty with pragmatics (the social use of language) [5] and some structural language impairments [6, 7]. Known potential issues are the identification of children with social communication difficulties, consensus on what treatment as usual (TAU) is, whether a novel complex social communication intervention is acceptable and can be implemented by SLT practitioners in schools and clinics, and how changes in social communication and pragmatics can be measured
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