The Engage with Developmental Language Disorder (E-DLD) project: Cohort profile.

Evidence of the effectiveness of therapy for older children with (developmental) language disorder (DLD), and particularly those with receptive language impairments, is very limited. The few existing studies have focused on particular target areas, but none has looked at a whole area of a service. To establish whether for students with (developmental) language disorder attending a specialist school, 1:1 intervention with an SLT during one school term improves performance on targeted areas, compared with untreated control areas. Also, to investigate whether gender, receptive language status, autism spectrum disorder (ASD) status, or educational Key Stage affected their response to this intervention. Seventy-two students (aged 9-17 years, 88% of whom had receptive language impairments) and all speech and language therapists (SLTs) in our specialist school for children with Language Disorder, most of whom have DLD participated in this study over one school term. During this term, the SLTs devised pre- and post-therapy measures for every student for each target they planned to treat 1:1. In addition, for each target area, a control measure was devised. The targets covered a wide range of speech, language and communication areas, both receptive and expressive. Post-therapy tests were administered 'blind'. During the term, SLTs and students worked 1:1 on 120 targets, the majority in the areas of expressive and receptive language. Targets and controls did not differ pre-therapy. Significant progress was seen both on targets (d = 1.33) and controls (d = 0.36), but the targeted areas improved significantly more than the controls with a large and clinically significant effect size (d = 1.06). There was no effect of language area targeted (targets improved more than their controls for all areas). Participants with versus those without receptive language difficulties, co-occurring ASD diagnosis or participants in different educational Key Stages did not differ significantly in terms of the progress they made on target areas. Direct 1:1 intervention with an SLT can be effective for all areas of language for older children with (D)LD, regardless of their gender, receptive language or ASD status, or age. This adds to the relatively limited evidence base regarding the effectiveness of direct SLT intervention for school-aged children with (D)LD and for children with receptive language impairments. If direct 1:1 intervention can be effective with this hard-to-treat group, it may well also be effective with younger children with (D)LD. Thus, direct SLT services should be available for school-aged children with (D)LD, including older children and adolescents with pervasive difficulties.

Collaborative practice between therapists and parents is a key element of family-centred care and is essential if we want to address family priorities and needs in interventions. However, collaborative practice is challenging for speech and language therapists (SLTs) and parents. To facilitate collaboration, collaborative practices need to be implemented into speech and language therapy for young children with developmental language disorders (DLD) and their families. Actual change and implementation of collaboration in practice will be successful only when it corresponds with patients' needs, in our case the needs of parents of young children with DLD. To explore parents' needs in their collaboration with SLTs during therapy for their young child with DLD. Parents of children with (a risk of) DLD in the age of 2-6 years were eligible for participation. We recruited parents via SLTs. Twelve parents of children with DLD participated in semi-structured interviews about their needs in collaboration with SLTs. We used a phenomenological approach focusing on parents' lived experiences. We transcribed the interviews verbatim. All interviews were read/listened to and discussed by our parent panel, multiple researchers and the interviewer. Two researchers independently analysed the data using the reflective thematic analysis of Braun and Clarke. The analysis of the interviews resulted in six themes: (1) knowing what to expect, (2) knowing how to contribute, (3) feeling capable of supporting the child, (4) trusting the therapist, (5) alignment with parents and children's needs, preferences and priorities and (6) time and space for asking questions and sharing information. Parents want SLTs to invest time in collaborating with them. Parents need SLTs to empower them to become a collaborative partner and enable them to support their child in daily life. Parents need knowledge about the therapy process and diagnosis and skills in how to support their child's language development. Also, they need emotional support to feel secure enough to support their child, to ask questions to therapists and to bring up their own thoughts and opinions in therapy. Parents' needs are in line with collaborative working as described in literature, which underlines the importance of implementing collaborative working in speech and language therapy for young children with DLD. What is already known on the subject Several reviews have explored parents' perspectives on speech and language therapy. Results reveal parents' experiences with speech and language therapy in general, and parents' perspectives on specific topics such as shared decision-making and parents/therapists roles in therapy. What this study adds This study adds insights into parents' needs to ensure collaboration with speech and language therapists (SLTs). Parents of young children with developmental language disorders (DLD) need SLTs to invest time to create optimal collaboration. It is important for parents to have enough knowledge about DLD and the SLT process, skills and confidence in how to support their child and opportunities to share thoughts and questions with SLTs. Our results underline the importance of parents being empowered by SLTs to become a collaborative partner. What are the clinical implications of this work? When children are referred to speech and language therapy, parents often venture into an unknown journey. They need support from SLTs to become a collaborative partner in speech and language therapy. Parents need SLTs to invest time in sharing knowledge, skills and power and align therapy to parents' and child's needs, preferences, priorities and expectations.

BackgroundDespite the compelling case for engaging parents in speech and language therapy, research indicates that speech and language therapists (SLTs) currently have a leading role in the goal‐setting process of therapy for children with developmental language disorder (DLD). Therefore, we set out to develop a tool that aims to support the dialogue between SLTs and parents and enhance shared decision‐making about children's communicative participation goals. We used co‐design techniques with SLT–practitioners to include their perspectives throughout the design process. Although co‐design has been used for some years in healthcare research, it is still a relatively new research methodology in the field of speech and language therapy.AimsTo provide a detailed description of the co‐design process that led to the development of a physical artefact that can support SLTs to engage parents of children with DLD in collaborative goal‐setting.Methods & ProceduresThe Design Council's Double Diamond model was used to develop a tool in co‐design, together with eight SLTs, who participated in all stages of the development process. Usability was tested in actual goal‐setting conversations between four SLTs and 11 parents of a child with DLD resulting in stepwise improvements. In addition, usability of the first and final prototypes was tested with five usability criteria that were rated on a 10‐point scale by 64 SLTs.Outcomes & ResultsThe co‐design process resulted in the development of a physical prototype of the tool called ‘ENGAGE’, consisting of a metal ‘tree trunk’ on which parents can stick magnetic ‘leaves’ containing potential participation goals for their child. The ‘tree’ shape represents a child's development and opportunities for growth. This first prototype received marks between 7.0 and 8.0 out of 10 on attractiveness, user‐friendliness, safety, functionality and affordability. After several iterations, there were significantly higher marks for attractiveness, user‐friendliness and safety in favour for the final prototype. Marks for functionality and affordability did not change significantly.Conclusions & ImplicationsAs researchers we usually develop pen‐and‐paper tools, interview protocols, apps or questionnaires to support clinical practice. Including the SLTs’ perspectives in the design process resulted in a tree‐shaped physical artefact that, according to the SLTs, helps to order information and encourages and guides their dialogue with parents. We strongly advocate the inclusion of end‐users in developing innovative user‐centred tools for speech and language therapy and we hope that this will become widespread practice.WHAT THIS PAPER ADDSWhat is already known on the subjectCollaborative goal‐setting is at the heart of family‐centred speech and language therapy. However, research indicates that goal‐setting processes for children with DLD are currently predominantly therapist‐led, instead of family‐centred. Reasons for the lack of parental engagement are that effective communication with parents throughout the goal‐setting process appears to be complex, and parents are not always invited and supported to engage in this. We used co‐design to develop a tool that aims to support SLTs in their dialogue about therapy goals with parents.What this paper adds to existing knowledgeThis paper provides an example of applying a co‐design approach for the development of a shared goal‐setting tool for SLTs and parents of young children with DLD. The co‐design approach enabled us to incorporate needs, experiences and ideas of SLTs in the design process. We report the four stages in the co‐design process from (1) discovering the needs, wants and desires of the people involved, (2) defining the problem that SLTs experience, (3) developing several solutions and selecting the best solution, and (4) developing and testing the prototype. The detailed description of this process can add to an understanding of the advantages and disadvantages of a design process that includes the perspective of end‐users. The result is a physical artefact representing a tree, which aims to support the conversation between SLTs and parents about a child's communicative participation. Items describing facets of communicative participation are printed on ‘leaves’ that can be hung on a tree trunk by parents. The tree shape is a positive metaphor for the growth and development of a child.What are the potential or actual clinical implications of this work?This study describes how SLTs can be meaningfully involved as partners in a co‐design research approach. Incorporating experience from clinical practice was highly relevant since our study aimed to create a solution that would support goal‐setting and service delivery by SLTs. We want to show that it is inspiring and beneficial for SLTs to partner with researchers in innovation of their own clinical practice and provide examples of co‐design activities that illustrate the involvement and influence of end‐users in a design process. Including the perspective of SLTs in the development of a new tool to facilitate the dialogue between SLTs and parents of children with DLD regarding therapy goal‐setting is expected to add value and enhance its implementation in clinical practice.

Longitudinal perspective on nonverbal intelligence development in young children with developmental language disorder.

Event Abstract Back to Event High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder. Hannah M. Hobson1* and Geoffrey Bird2, 3 1 University of Greenwich, United Kingdom 2 University of Oxford, United Kingdom 3 Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom Developmental Language Disorder (DLD) is a neurodevelopmental condition in which children do not achieve typical levels of language skill. These children may experience difficulties with structural aspects (i.e. syntactic, lexical and phonological problems) as well as pragmatic aspects of language. The prevalence rate of DLD is approximately 7.5% (Norbury et al., 2016). Thus, in a typical UK classroom of 30 students, we can expect on average two children to have DLD. Despite its relative prevalence compared to more widely known conditions such as autism (which has an estimated prevalence of around 1%; Baird et al., 2006), DLD is not well known. This is partly due to a historic lack of agreement on the criteria and terminology for DLD; recent efforts have been made to reach consensus on these issues (Bishop et al., 2016). However, the goal of increased awareness of DLD is not yet reached, and in the meantime, poor awareness of DLD has implications for children’s wellbeing and long-term outcomes. It is unsurprising, given the oral language and literacy demands of most education systems, that children with DLD show poorer academic outcomes compared to typically developing children (Johnson, Beitchman, & Brownlie, 2010). However, children with DLD may also face problems with their attendance: children who are school-refusers have poorer language skills overall, and a higher incidence of language impairments (Naylor, Staskowsi, Kenney & King, 1994). Language problems are also associated with exclusions from school; excluded children show higher rates of expressive language difficulties (Ripley & Yuill, 2005), and studies of mainstream secondary school pupils facing exclusion suggest that two thirds have language problems, with one third showing severe language problems (Clegg, Stackhouse, Finch, Murphy, & Nicholls, 2009). Of the 15 children assessed for this study, only one had received speech and language therapy (for a stammer); none of the other children had been assessed by a speech and language therapist. All children had been excluded three or more times, and were at risk of being permanently excluded from school. Language impairment is also elevated in mental health services. The high rate of language problems in children and adolescents accessing support for emotional and behavioural problems has been summarised in a meta-analysis of 22 studies (Hollo, Wehby, & Oliver, 2014): approximately 81% of children accessing help for an emotional-behavioural disorder have below-average language proficiency, and that 47% of children show moderate to severe language problems. None of the children in the studies had previously been assessed for speech or language problems. As yet, there is no data to indicate whether the high rate of language problems in these services has an impact on progress in psychological therapy. Language problems also show relationships to involvement with the criminal justice system. Language-impaired youth have higher rates of arrests and convictions (Brownlie et al., 2004), and the rate of language impairment in young offender institutions is elevated (see Anderson, Hawes, & Snow, 2016 for a systematic review). A recent study found that 47% of the 93 young offenders assessed showed language skills significantly below what would be expected for their age, and 20% would have met the criteria for language impairment (Hughes et al., 2017). The majority of those identified as having a language impairment had not previously worked with a speech and language therapist. It is thus clear that in a variety of different vulnerable populations we see higher rates of language impairment than would be expected given the prevalence in the general population, and that many of these cases go undetected. It is important to emphasise that many children with DLD go on to have good outcomes, and that language impairment is not deterministic of the problems discussed here (see Johnson et al, 2010). This is important, as it suggests firstly that there are factors that moderate the relationship between language problems and wellbeing, and secondly because it offers hope that, with appropriate identification and support, children with DLD can have good outcomes. Nonetheless, a pertinent question is why are rates of DLD increased across these different settings? There are number of plausible reasons. Firstly, some of the risk factors for poor language development and emotional and behavioural problems are overlapping, such as social disadvantage (Horwitz et al., 2003; Olak et al., 2009; Singh & Ghandour, 2012). Secondly, language problems themselves may contribute to social and psychological difficulties that increase the risk of emotional and behaviour problems. Specifically, language problems may lead children to experience social isolation, reducing opportunities for acquiring good social skills and increasing the risk of poor self-esteem and poor emotional outcomes (Craig, 1993; Redmound & Rice, 1998; Wadman, Durkin, & Conti-Ramsden, 2008). Children with language problems are also at increased risk of being bullied (Redmond, 2011), and of having poorer emotion regulation (Fujiki, Brinton & Clarke, 2002). Finally, and of relevance to an array of different professions, when their language problems are not recognised, the behaviours of children and young people with DLD may be interpreted by the adults in their environment in a way that increases the likelihood of poor outcomes. In the context of forensic interviewing, Snow and Powell (2012) argue that the presentation of language problems in young offenders may lead professionals to assume that the young person is rude, or incoherent with their account of events (and therefore likely guilty). One account given by a young person in prison stated that when asked by a judge if he was remorseful of his crime, he said no: he had never heard the word “remorseful” before, and had no idea what it meant (Talbot, 2007). If such an experience is representative of young people with communication disorders’ interactions with the criminal justice system, it is perhaps not surprising that the rate of language problems is so high in young offender institutions. Extrapolating this to the headteacher’s office or the psychiatrist’s chair, we may predict that children with DLD are similarly judged as being uncooperative, unapologetic or reticent. It would be naïve to assume that untrained professionals will readily detect language problems in their cohorts. Rather, language impairments will not always be obvious to people interacting with a person with DLD; adults have a tendency to assume that children understand more of what is being said to them than is actually the case (Sattler, Feldman, & Bohanan, 1985), and children may engage in masking behaviours that cover their language problems (Evans & Macwhinney, 1999). Indeed, teachers have quite poor sensitivity and specificity to children’s oral language impairments (Antoniazzi, Snow & Dickson-Swift, 2010). Even in settings where we might expect educational staff to have a higher level of knowledge regarding language problems, this is not necessarily the case: in a special school for children with emotional and behavioural difficulties in which the prevalence of language impairment was 74%, less than half of these children had been identified as impaired (Stringer & Lozano, 2007). Speech problems may be the most detectable issue, but children with pure speech problems actually do not show adverse outcomes, compared to typical children (Johnson et al., 2010). Possibly this is because speech problems do not affect children’s social and emotional development in the same way that a language problem does. Alternatively, perhaps a child with a speech problem is far more likely to be identified and supported than a child who has a language impairment but whose speech does not sound unusual. What happens to these children and young people if their language problems are not recognised? The increased rates of language impairment in children facing exclusion from school and in the criminal justice system paint a gloomy picture. DLD is considered a lifelong condition, and while children’s language skills may improve, they require input from specialists to help them acquire skills and strategies to compensate for their language problems (Perkins, 2001). Clearly there are many children who finish schooling and enter services aiming to remediate mental health problems or criminal behaviours without their language problems having been detected. It is therefore important that awareness of DLD is sufficient in professions that are very likely to interact with children with DLD, including mental health and forensic professionals. Acknowledgements Geoff Bird was supported by the Baily Thomas Charitable Trust. References Anderson, S. A. S., Hawes, D. J., & Snow, P. C. (2016). Language impairments among youth offenders: A systematic review. Children and Youth Services Review, 65(April), 195–203. http://doi.org/10.1016/j.childyouth.2016.04.004 Antoniazzi, D., Snow, P., & Dickson-Swift, V. (2010). Teacher identification of children at risk for language impairment in the first year of school. International journal of speech-language pathology, 12(3), 244-252. Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., & Charman, T. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet, 368(9531), 210–215. http://doi.org/10.1016/S0140-6736(06)69041-7 Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., Adams, C., Archibald, L., … Whitehouse, A. (2016). CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children. PLoS ONE, 11(7), 1–26. http://doi.org/10.1371/journal.pone.0158753 Brownlie, E. B., Beitchman, J. H., Escobar, M., Young, A., Atkinson, L., Johnson, C., ... & Douglas, L. (2004). Early language impairment and young adult delinquent and aggressive behavior. Journal of abnormal child psychology, 32(4), 453-467. Clegg, J., Stackhouse, J., Finch, K., Murphy, C., & Nicholls, S. (2009). Language abilities of secondary age pupils at risk of schoolClegg, J., Stackhouse, J., Finch, K., Murphy, C., & Nicholls, S. (2009). Language abilities of secondary age pupils at risk of school exclusion: A preliminary report. Child Language Teaching and Therapy, 25(1), 123–139. http://doi.org/10.1177/0265659008098664 Craig, H. K. (1993). Social skills of children with specific language impairment: Peer relationships. Language, Speech, and Hearing Services in Schools, 24(4), 206-215. Evans, J. L., & MacWhinney, B. (1999). Sentence processing strategies in children with expressive and expressive-receptive specific language impairments. International Journal of Language & Communication Disorders, 34(2), 117-134. Fujiki, M., Brinton, B., & Clarke, D. (2002). Emotion regulation in children with specific language impairment. Language, Speech, and Hearing Services in Schools, 33(2), 102-111. Hollo, A., Wehby, J. H., & Oliver, R. M. (2014). Unidentified language deficits in children with emotional and behavioral disorders: A meta-analysis. Exceptional Children, 80(2), 169–186. http://doi.org/10.1177/001440291408000203 Horwitz, S. M. C., Irwin, J. R., Briggs-Gowan, M. J., Bosson Heenan, J. M., Mendoza, J., & Carter, A. S. (2003). Language delay in a community cohort of young children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(8), 932–940. http://doi.org/10.1097/01.CHI.0000046889.27264.5E Hughes, N., Chitsabesan, P., Bryan, K., Borschmann, R., Swain, N., Lennox, C., & Shaw, J. (2017). Language impairment and comorbid vulnerabilities among young people in custody. Journal of Child Psychology and Psychiatry and Allied Disciplines, 58(10), 1106–1113. http://doi.org/10.1111/jcpp.12791 Johnson, C. J., Beitchman, J. H., & Brownlie, E. B. (2010). Twenty-year follow-up of children with and without speech-language impairments: Family, educational, occupational, and quality of life outcomes. American Journal of Speech-Language Pathology, 19(1), 51–65. http://doi.org/10.1044/1058-0360(2009/08-0083) Naylor, M. W., Staskowski, M., Kenney, M. C., & King, C. A. (1994). Language disorders and learning disabilities in school-refusing adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 33(9), 1331-1337. Norbury, C. F., Gooch, D., Wray, C., Baird, G., Charman, T., Simonoff, E., … Pickles, A. (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 57(11), 1247–1257. http://doi.org/10.1111/jcpp.12573 Amone-P’Olak, K., Burger, H., Ormel, J., Huisman, M., Verhulst, F. C., & Oldehinkel, A. J. (2009). Socioeconomic position and mental health problems in pre-and early-adolescents. Social psychiatry and psychiatric epidemiology, 44(3), 231-238. Perkins, M. R. (2001). Compensatory strategies in SLI. Clinical Linguistics and Phonetics, 15(1–2), 67–71. http://doi.org/10.1080/026992001461334 Redmond, S. M. (2011). Peer victimization among students with specific language impairment, attention-deficit/hyperactivity disorder, and typical development. Language, Speech, and Hearing Services in Schools, 42(4), 520-535. Redmond, S. M., & Rice, M. L. (1998). The socioemotional behaviors of children with SLI: Social adaptation or social deviance?. Journal of Speech, Language, and Hearing Research, 41(3), 688-700. Ripley, K., & Yuill, N. (2005). Patterns of language impairment and behaviour in boys excluded from school. The British Journal of Educational Psychology, 75(Pt 1), 37–50. http://doi.org/10.1348/000709905X27696 Sattler, J. M., Feldman, J., & Bohanan, A. L. (1985). Parental estimates of children’s receptive vocabulary. Psychology in the Schools, 22(3), 303–307. http://doi.org/10.1002/1520-6807(198507)22:3<303::AID-PITS2310220312>3.0.CO;2-J Singh, G. K., & Ghandour, R. M. (2012). Impact of neighborhood social conditions and household socioeconomic status on behavioral problems among US children. Maternal and Child Health Journal, 16(SUPPL. 1), 158–169. http://doi.org/10.1007/s10995-012-1005-z Snow, P., & Powell, M. (2012). Youth (in) justice: Oral language competence in early life and risk for engagement in antisocial behaviour in adolescence. Trends and Issues in Crime and Criminal Justice, 435, 1-6. Stringer, H., & Lozano, S. (2007). Under identification of speech and language impairment in children attending a special school for children with emotional and behavioural disorders. Educational & Child Psychology, 24(4), 9–19. Talbot, J. (2007) No One Knows: Identifying and Supporting Prisoners with Learning Difficulties and Learning Disabilities. The Views of Prison Staff. London: Prison Reform Trust Wadman, R., Durkin, K., & Conti-Ramsden, G. (2008). Self-esteem, shyness, and sociability in adolescents with specific language impairment (SLI). Journal of Speech, Language, and Hearing Research, 51(4), 938-952. Keywords: developmental language disorder (DLD), Language, vulnerable population group, Mental Health, Policy & disabilities Conference: 4th International Conference on Educational Neuroscience, Abu Dhabi, United Arab Emirates, 10 Mar - 11 Mar, 2019. Presentation Type: Oral Presentation (invited speakers only) Topic: Educational Neuroscience Citation: Hobson HM and Bird G (2019). High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.. Conference Abstract: 4th International Conference on Educational Neuroscience. doi: 10.3389/conf.fnhum.2019.229.00002 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 08 Feb 2019; Published Online: 27 Sep 2019. * Correspondence: Dr. Hannah M Hobson, University of Greenwich, Greenwich, London, SE10 9LS, United Kingdom, H.Hobson@greenwich.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Hannah M Hobson Geoffrey Bird Google Hannah M Hobson Geoffrey Bird Google Scholar Hannah M Hobson Geoffrey Bird PubMed Hannah M Hobson Geoffrey Bird Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

BackgroundCollaboration between Speech and Language Therapists (SLTs) and parents is considered best practice for children with developmental disorders. However, such collaborative approach is not yet implemented in therapy for children with developmental language disorders (DLD) in the Netherlands. Improving Dutch SLTs’ collaboration with parents requires insight in factors that influence the way SLTs work with parents. AimsTo explore the specific beliefs of Dutch SLTs that influence how they collaborate with parents of children with DLD. Methods and proceduresWe conducted three online focus groups with 17 SLTs using a reflection tool and fictional examples of parents to prompt their thoughts, feelings and actions on specific scenarios. Data were organised using the Theoretical Domains Framework (TDF). Outcomes and resultsWe identified 34 specific beliefs across nine TDF domains on how SLTs collaborate with parents of children with DLD. The results indicate that SLTs hold beliefs on how to support SLTs in collaborating with parents but also conflicting specific beliefs regarding collaborative work with parents. The latter relate to SLTs’ perspectives on their professional role and identity, their approach towards parents, and their confidence and competence in working collaboratively with parents. Conclusions and implicationsSLTs hold specific beliefs that potentially hinder them from working collaboratively with parents. Appropriate interventions should be developed by combining implementation science and behaviour change science.

A Brain Marker for Developmental Speech Disorders

Purpose: Data mining algorithms using electronic health records (EHRs) are useful in large-scale population-wide studies to classify etiology and comorbidities (Casey et al., 2016). Here, we apply this approach to developmental language disorder (DLD), a prevalent communication disorder whose risk factors and epidemiology remain largely undiscovered.Method: We first created a reliable system for manually identifying DLD in EHRs based on speech-language pathologist (SLP) diagnostic expertise. We then developed and validated an automated algorithmic procedure, called, Automated Phenotyping Tool for identifying DLD cases in health systems data (APT-DLD), that classifies a DLD status for patients within EHRs on the basis of ICD (International Statistical Classification of Diseases and Related Health Problems) codes. APT-DLD was validated in a discovery sample (N = 973) using expert SLP manual phenotype coding as a gold-standard comparison and then applied and further validated in a replication sample of N = 13,652 EHRs.Results: In the discovery sample, the APT-DLD algorithm correctly classified 98% (concordance) of DLD cases in concordance with manually coded records in the training set, indicating that APT-DLD successfully mimics a comprehensive chart review. The output of APT-DLD was also validated in relation to independently conducted SLP clinician coding in a subset of records, with a positive predictive value of 95% of cases correctly classified as DLD. We also applied APT-DLD to the replication sample, where it achieved a positive predictive value of 90% in relation to SLP clinician classification of DLD.Conclusions: APT-DLD is a reliable, valid, and scalable tool for identifying DLD cohorts in EHRs. This new method has promising public health implications for future large-scale epidemiological investigations of DLD and may inform EHR data mining algorithms for other communication disorders.Supplemental Material S1. Developmental language disorder (DLD) manual chart review rubric.Supplemental Material S2. Intercoder reliability for research assistant coders and SLP coders for 10% of the discovery sample.Supplemental Material S3. Determining the DLD phenotype among EHRs retrieved from a broad search for LD symptoms. Walters, C. E., Jr., Nitin, R., Margulis, K., Boorom, O., Gustavson, D. E., Bush, C. T., Davis, L. K., Below, J. E., Cox, N. J., Camarata, S. M., & Gordon, R. L. (2020). Automated Phenotyping Tool for identifying developmental language disorder cases in health systems data (APT-DLD): A new research algorithm for deployment in large-scale electronic health record systems. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2020_JSLHR-19-00397

Approximately 9.9 % of children present with difficulties in language development (DLD), 7.6 % without serious additional impairments and 2.3 % associated with languagerelevant comorbidities, e.g., hearing loss. Notably, in a consensus statement by experts in German-speaking countries, in the guideline presented here, and further in this article, all of these disorders are referred to as "developmental language disorders" (DLD), whereas the international consortium CATALISE only refers to those without comorbidities as DLD. DLDs are among the most commonly treated childhood disorders and, if persistent, often reduce educational and socio-economic outcome. Children in their third year of life with developmental language delay (late talkers, LT) are at risk of a later DLD. This German interdisciplinary clinical practice guideline reflects current knowledge regarding evidence-based interventions for developmental language delay and disorders. A systematic literature review was conducted on the effectiveness of interventions for DLD. The guideline recommends parent training (Hedges g = 0.38 to 0.82) for LTs with expressive language delay, language therapy (Cohen's d = -0.20 to 0.90) for LTs with additional receptive language delay or further DLD risk factors, phonological or integrated phonological treatment methods (Cohen's d = 0.89 to 1.04) for phonological speech sound disorders (SSDs), a motor approach for isolated phonetic SSDs (non-DLD), and for lexical-semantic and morpho-syntactic impairments combinations of implicit and explicit intervention approaches (including input enrichment, modeling techniques, elicitation methods, creation of production opportunities, metalinguistic- approaches, visualizations; Cohen's d = 0.89-1.04). Recom mendations were also made for DLD associated with pragmatic-communicative impairment, bi-/ multilingualism, hearing loss, intellectual disability, autism-spectrum disorders, selective mutism, language- relevant syndromes or multiple disabilities, and for intensive inpatient language rehabilitation. Early parent- and child-centered speech and language intervention implementing evidence-based intervention approaches, frequency, and settings, combined with educational language support, can improve the effectiveness of management of developmental language delay and disorders.

Eighty-five percent of medical research goes to waste, partly because it is not appropriately communicated to stakeholders. This represents a critical issue for the research community, especially because individuals who are impacted by research should be able to readily access that research. Making research findings accessible to key stakeholders is an important step in implementation science and in enabling research to have meaningful impacts. Plain language summaries are a tool to make research more accessible to individuals with communication disorders. While guidelines exist to support researchers to develop plain language summaries for some populations, no such guidelines exist for the developmental language disorder (DLD) community. We aimed to develop evidence-informed guidelines to support researchers to create plain language summaries that are accessible for individuals with DLD, their families, and the broader community. This discussion paper describes the development of these guidelines and how they may be implemented by researchers who conduct research on the topic of DLD. We drew from existing plain language summary guidelines for other populations and knowledge of various barriers that may impact the DLD community's ability to access scientific research. We used this knowledge to create guidelines for researchers to develop plain language summaries of their research relating to the DLD population. This includes guidelines for creating written, visual, audio and video summaries. We consulted with an adult with DLD, an implementation scientist, and a speech-language pathologist regarding the suitability of the guidelines. The plain language summary guidelines are publicly available via https://osf.io/ydkw9. They include templates and examples, as well as suggestions for writing and visual styles. We encourage strengths-based language, seeking feedback from non-experts, and sharing the summaries on social media. We have also developed an online repository for researchers to disseminate their plain language summaries via DLD advocacy groups. The written, audio and video plain language summaries that researchers create using our guidelines can be used to disseminate research to the DLD community. This can facilitate science implementation and maximise the impact of DLD research. The plain language summaries may also help individuals with DLD better understand the research that has been conducted about them. This may in turn support their engagement with services and empower them to make evidence-informed choices for themselves and partner in co-designing new research. Future research could explore the perspectives of the DLD community and researchers regarding the implementation of these guidelines. A lot of research goes to waste. This is partly because researchers rarely share their results with the non-scientific community. People with communication disorders might find it hard to understand research papers. We made guidelines to help researchers explain their research to people with developmental language disorder (DLD. We brought together existing advice on how to explain research in a clear way. We sought advice from people with different experiences and perspectives, including an adult with DLD. The guidelines are at https://osf.io/ydkw9. The guidelines include advice on how to add pictures to research summaries. We also explain how to make a video or podcast summarising research. We encourage researchers to share their research summaries on social media. This means their research can reach more people and can make a difference. It is important that people with DLD understand DLD research. This might help them to understand their diagnosis and take part in future research. What is already known on the subject For research to make a difference, it must be appropriately communicated to its stakeholders; however, only 1.5% of academic journals require authors to write plain language summaries. What this paper adds to existing knowledge This paper presents publicly available guidelines for researchers to create written, visual, audio and video plain language summaries aimed to be accessible for individuals with developmental language disorder (DLD) and their families. What are the potential or actual clinical implications of this work? Researchers can use plain language summaries to disseminate research to the wider community. This can help individuals with DLD better understand the research that has been conducted about them and may empower them to meaningfully partner in co-designing new research.

Erratum: Involving Individuals with Developmental Language Disorder and their Parents/Carers in Research Priority Setting.

Adjectives are essential for communication, conceptual development and academic success. However, they are semantically and syntactically complex and can be particularly challenging for children with Developmental Language Disorder (DLD). Surprisingly, language interventions have not typically focused on this important word class. (1) To provide a supportive and accessible primer on adjectives for practitioners; (2) to explore how the SHAPE CODINGTM system can be adapted to support adjective learning in DLD; and (3) to provide practical recommendations on how to support adjective learning in clinical practice and education. We synthesise linguistic and psychological research on adjective semantics, clinical insights into DLD and pedagogical practice supporting this population. We address the lack of specific training in the nature and acquisition of adjectives for speech and language therapists (SLTs) by providing an accessible primer. We also provide an innovative guide detailing how an established metalinguistic intervention might be adapted to support adjective learning. Without targeted support for adjective learning, the communicative potential of children with DLD is compromised. Our recommendations can be used across a range of therapeutic and educational contexts to guide SLTs and teaching staff in developing practice in this area. What is already known on the subject Adjectives are an essential word class needed for effective communication. They are also vital to successfully achieve academic objectives across all curriculum areas. For example, most subjects require children to be able to describe, evaluate, compare and discriminate different events, objects or techniques. Children with Developmental Language Disorder (DLD) have deficits in various domains of language that can affect adjective learning and use. What this paper adds to existing knowledge Despite the importance of adjectives, speech and language therapists (SLTs) and other professionals supporting language development rarely receive specific training regarding their structure and meanings, and how to teach and support their use. This article provides an accessible primer on the many subtypes of adjectives and how these behave syntactically and semantically. It explores how adjective teaching could be enhanced for children with DLD by adapting an established metalinguistic technique and provides practical recommendations for implementing this approach. What are the potential or actual clinical implications of this work? By raising awareness of the complexities of adjectives and providing strategies to support their acquisition by children with DLD, this article will enable SLTs and teaching staff to improve their understanding and practice in this area and, with further research, to develop robust, effective interventions for children with DLD. This will contribute to enhancing the long-term academic, social and employment success of children with DLD.

Background and Aim.Children with Developmental Language Disorder (DLD) are at an increased risk to develop behaviors associated with Autism Spectrum Disorder (ASD). The relationship between early language difficulties and the occurrence of ASD-related behaviors in DLD is poorly understood. One factor that may hinder progress in understanding this relationship is the etiological heterogeneity of DLD. We therefore study this relationship in an etiologically homogeneous group of children, who share phenotypic characteristics with children with DLD: children with the 22q11.2 Deletion Syndrome (22q11DS). We compare children with 22q11DS, to children with DLD and age-matched typically developing children (TD).Method44 children with 22q11DS, 65 children with DLD and 81 TD children, between 3.0–6.5 years old, participated in a longitudinal cohort study that included a baseline measure and a follow-up measure with a 1-year interval. A parental questionnaire (SRS-2) was used to measure the incidence of behaviors in two key behavioral domains associated with ASD: Social Communication and Interaction and Restricted Repetitive Behaviors and Interests. At baseline, we assessed children's expressive and receptive language abilities as well as their intellectual functioning with standardized tests. We compared the distribution of ASD-related behaviors between the three groups. We used regression analyses to investigate whether language abilities at baseline predict ASD-related behavior at follow-up, accounting for ASD-related behavior at baseline, demographic variables and intellectual functioning.ResultsBoth the children with 22q11DS and the children with DLD displayed significantly more ASD-related behaviors than the TD children. Over 30% of children in both clinical groups had scores exceeding the subclinical threshold for ASD in both behavioral domains. Both in 22q11DS and DLD, baseline receptive language scores were negatively correlated with ASD-related behaviors 1 year later, when controlling for baseline SRS-scores. However, this association was statistically significant only in children with 22q11DS, even when controlled for IQ-scores, and it was significantly stronger as than in the TD group. The strength of the association did not differ significantly between 22q11DS and DLD.ConclusionBoth children with 22q11DS and children with DLD present with elevated rates of ASD-related behaviors at a preschool-age. Only in children with 22q11DS we observed that weaker receptive language skills were related to increased behavioral problems in the domain of social communication and interaction one year later.ImplicationsOur findings indicate that relations between early language impairment and other behavioral phenotypes may be more feasible to detect in a subgroup of children with a homogeneous etiology, than in a group of children with a heterogeneous etiology (such as children with DLD). Our results in 22q11DS reveal that receptive language is especially important in predicting the occurrence of ASD-related behaviors. Future research is needed to determine to what extent receptive language predicts the occurrence of ASD-related behaviors in children with DLD, especially among those children with DLD with the weakest receptive language. Clinically, screening for ASD-related behaviors in children with developmental language difficulties is recommended from a young age, especially among children with receptive language difficulties.

Children with developmental language disorder (DLD) frequently have difficulties with word learning and understanding vocabulary. For these children, this can significantly impact on social interactions, daily activities and academic progress. Although there is literature providing a rationale for targeting word learning in such children, there is little evidence for the effectiveness of specific interventions in this area for children with identified DLD. To establish whether direct one-to-one intervention for children with DLD over 9 years of age leads to improved abilities to identify, comprehend, define, and use nouns and verbs targeted in intervention as compared with non-targeted control items and whether or not the participants' rating of their own knowledge of the words changes with intervention. Twenty-five children and young people with language disorder (aged 9;4-16;1) participated in the study: 18 with DLD and seven with a language disorder associated with autism spectrum disorder (ASD). Two assessments of different levels were created: a higher ability (less frequent words) and a lower ability (more frequent words). Participants' speech and language therapists (SLTs) decided which level would be the most appropriate for each participant. Four tasks were carried out as part of the assessment and the scores were used to identify which words each participant worked on. Participants received one 30-min session per week one-to-one with their own SLT for 7 weeks, plus a 5-min revision session in between each main session. During each of the first five sessions, participants learned two new words; the two final sessions were spent revising the 10 words which had been targeted. Post-intervention assessment showed an increase in scores for both treated and control words. However, progress on treated words was significantly greater than on control words (d = 1.07), indicating effectiveness of intervention. The difference between progress on targeted and control words was found both for nouns (d = 1.29) and verbs (d = 0.64), but the effect size was larger for nouns. Whether or not the participants had an associated ASD did not affect the results. The children's self-rating of their knowledge of the targeted words was also significantly higher than for control words post-intervention. The intervention delivered one-to-one by the participants' usual SLT was effective in teaching new vocabulary to older children with language disorders. This shows that older children with language disorders can make progress with direct one-to-one intervention focused on vocabulary.

Purpose: For over two decades, we have known that children with developmental language disorder (DLD) are underserved. We have also known that DLD does not attract the research attention that it merits given its prevalence and impact. The purposes of this clinical focus article are to present evidence that these failures continue, explore the reasons behind these failures, and propose solutions. Method: I reviewed the literature and applied bibliometric analysis procedures from Bishop (2010) to quantify research efforts aimed at DLD compared to other neurodevelopmental disorders.Results: The percentage of children who are deemed eligible for clinical services because of DLD continues to fall well short of estimates based on the prevalence of DLD in community samples. The amount of research conducted on DLD relative to other neurodevelopmental disorders remains low. Contributing factors include a lack of awareness of DLD, the hidden nature of DLD, entrenched policies, and the dissonance created when speech-language pathologists must diagnose DLD in school settings.Conclusions: Expanded approaches to supporting children with DLD are required. These might include engagement in advocacy and awareness campaigns; clearer communication with the families we serve and enhanced collaborations with classroom teachers; the implementation of school-based language screenings; participation in policymaking; and the development of service delivery models that operate alongside those that exist in our schools and complement their function.Supplemental Material S1. Search terms. McGregor, K. K. (2020). How we fail children with developmental language disorder. Language, Speech, and Hearing Services in Schools. Advance online publication. https://doi.org/10.1044/2020_LSHSS-20-00003