The involvement of individuals with speech and language impairments in research: insights from a co-creation process

The purpose of this paper was to profile the extent and accuracy of teacher identification of speech and language impairment within a kindergarten student population in Tasmania, Australia, using the Kindergarten Development Check (KDC). A total of 286 kindergarten students (aged 4–5 years and in their first year of formal schooling) were screened by teachers with the KDC on two separate occasions over their kindergarten year. In the following academic year, each of the same 286 students were assessed by a speech-language pathologist, and diagnosed with either typically developing or impaired speech and/or language skills. Review of KDC data determined the number of students identified by teachers with speech and language impairment at each occasion during their kindergarten year. Comparison of data from the later KDC administration and speech-language pathology assessment then determined the correspondence between identification of speech and language impairment by teachers and speech-language pathologists. Upon initial administration of the KDC, 51 (17.8%) students were identified by teachers with language impairment and 47 (16.4%) students with speech impairment. Following the second administration of the KDC 3 months later, 20 (7.0%) students continued to be identified with language impairment, and 39 (13.6%) with speech impairment. Comparison of speech-language pathology testing results and KDC data from the second administration found the overall validity of teacher identification was 86.4% and 71% for speech and language impairment respectively. Specificity rates were high, with 93% and 97% of students with typically developing speech and language skills respectively, correctly classified on the KDC. However, the sensitivity was only 50% for speech impairment and 15% for language impairment, indicating that 50% of students presenting with speech impairment and 85% of students with language impairment in their subsequent academic year were not recorded by teachers as having such a difficulty on the later KDC administration during their kindergarten year. The KDC appears to be ineffective in supporting kindergarten teachers to identify students with ongoing speech and to a greater extent, language impairment. Measures to improve the sensitivity of the KDC in particular need to be considered by speech-language pathologists and educational professionals in Tasmania.

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.

Despite the high prevalence of bilingualism in the United Kingdom, few speech and language therapists (SLTs) are bilingual themselves. Most SLT research on bilingualism has generated knowledge to inform service delivery for bilingual clients, but few studies have investigated how being a bilingual SLT influences one's professional experiences and practices. Better understanding the unique positionality of bilingual SLTs can yield critical insights to meaningfully address issues of diversity, inclusion and equity in the profession. To investigate the experiences and practices of bilingual paediatric SLTs in the United Kingdom through the lens of Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF), a new theoretical framework developed to conceptualise the activities of professionals working in the field of disability. In this qualitative study, 19 bilingual paediatric SLTs practising in the United Kingdom were interviewed individually. Participants were recruited through a snowball sampling strategy, and semi-structured interviews conducted online. The data were analysed using reflexive thematic analysis and following a hybrid inductive-deductive approach to map the results onto the CHAT-ICF framework. Six overarching components of the CHAT-ICF framework hosted the 12 sub-themes identified to capture the experiences and practices of bilingual SLTs: (1) Subject (intersectionality); (2) Tools (language skills, education, clinical resources); (3) Rules (systemic barriers, sense of responsibility); (4) Community (sense of inclusion); (5) Division of labour (parents, colleagues); and (6) Practice (empathy with children, holistic mindset, flexible approaches). The use of the CHAT-ICF theoretical lens revealed two fundamental structural phenomena: (1) the distribution of sub-themes across many components of CHAT-ICF demonstrated that being a bilingual SLT is a multifactorial experience; and (2) the chain reactions between sub-themes illustrated the dynamic nature of bilingual SLTs' experiences which can be harnessed to challenge marginalisation and promote equity in the profession. This is the first qualitative study to date to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. These insights can be mobilised to inform the meaningful inclusion of bilingual SLTs in workforce planning efforts and service development. Recommendations include using intersectional lenses, providing cultural and anti-racism awareness training to SLTs, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in recruitment processes and increasing accountability at the leadership level. Research giving voice to bilingual SLTs, and other underrepresented demographics in the SLT workforce, can catalyse action to promote a more diverse and inclusive profession in line with the Royal College of Speech and Language Therapists' strategic vision 2022-2027. What is already known on the subject Most research on bilingualism in speech and language therapy is focused on issues related to service provision and delivery for bilingual clients with little consideration for bilingual speech and language therapists' (SLTs) unique positionality. A few survey studies have shown that bilingual SLTs report significantly higher competency and greater confidence when working with clients who speak multiple languages, but there are significant gaps in understanding how bilingualism impacts other aspects of their professional experiences. What this paper adds to existing knowledge This is the first study to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. We show that being bilingual profoundly impacts many aspects of their professional experiences, including their clinical identity, skillset, sense of inclusion in the workplace, work relationships and clinical approaches. Bilingual SLTs expressed developing trust relationships with bilingual families and adopting flexible approaches to account for their clients' environmental factors, all of which can contribute to more equitable SLT services. This study also makes a novel contribution by proposing and using the Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF) framework to conceptualise and investigate SLTs' experiences and practices. What are the potential or actual clinical implications of this work? This study provides evidence-based recommendations to inform progress towards the Royal College of Speech and Language Therapists' strategic vision 2022-2027 and the diversification of the profession. Actions to support bilingual SLTs and diversify the profession include shifting a rigid mindset of linguistic and cultural `competence' to self-growth and awareness, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in SLT recruitment processes and career progression and increasing accountability and leadership around issues of diversity in the workplace. The novel CHAT-ICF framework has the potential to be used to support therapists' reflexivity in their practice or structure audits of rehabilitation services. Intersectionality theories and transformative processes can catalyse positive change in clinical services and research around bilingualism.

This study explores the views and perspectives of adolescents with a speech, language and communication impairment (SLCI). With over a million children suffering from SLCI in the UK today it is more than ever necessary to unravel the mechanics of what many in the field refer to as the hidden disability. Whilst there is a wealth of research, evaluating the effectiveness of speech and language therapy, there is a paucity of data and analysis directly exploring the views of adolescents with an SLCI. This oversight must be addressed if researchers and practitioners are to work together to improve the wellbeing of young people with a speech and language impairment. This is particularly important for the adolescent age group as SLCIs act as a double burden at a transitional stage of physical and psychological development. With this in mind, this study aims to link the adolescents’ perspective on their impairment with their educational experiences and to highlight the key factors that promote their wellbeing. Embedded within a broad social-constructionist framework, this study devises a qualitative, interview-based approach to elicit the views of seven adolescents (five males and two females). The aim of this approach is to consolidate rich data on their world-views and perspectives which can then be analysed thematically. The focus of this approach will be their self-awareness, their perception of being included, and the role of their Speech and Language Centre (SLC –a specialist provision within their secondary school) in addressing their needs. Upon completion of the interviewing process and the thematic analysis, this study results in a total of nine key findings that (a) link adolescents’ perception of their impairment with their general sense of inclusion and wellbeing, and (b) demonstrate how those adolescents develop resiliency skills to cope in their mainstream environment. If anything, the findings underscore the importance of listening to young people’s ‘voices’ and of engaging directly with this vulnerable and under-represented age group. The researcher believes her own experience with living with a hearing impairment and her work in different school contexts gave her a privileged relationship with the adolescents interviewed and a broad perspective on SLCI. Whilst the study is small-scale and purely qualitative, precluding any broad generalisations, the researcher hopes that it will be a springboard for further research in the field and recommendations for practice.

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.

At least 25% of autistic children worldwide have the potential to grow up in a bilingual environment. However, many autistic children are being denied opportunities to access additional languages and the cultural, familial and community connections that come with this. There is little evidence identifying the barriers to language learning and access, and no research addressing the perspectives of speech and language therapists (SLTs), who are crucial in supporting parents to make informed choices about bilingualism with their child. The aim of this research was to understand the experiences of SLTs working with autistic bilingual children, to understand the main considerations when working with families, and the opportunities and barriers for training, including the sources of information that current practice is based on. Twelve SLTs from across the United Kingdom were recruited for this study. All participants were experienced in working with autistic bilingual children and their families (M = 7 years, range 4-23 years). Semi-structured interviews were conducted and focused on the experiences of SLTs regarding familial bilingual experiences, the effect of sociocultural factors of practice, and the extent to which practice is based on current research. Data were analysed using reflexive thematic analysis. Three central themes were identified from the interviews: (1) participants discussed parental uncertainties as to whether they were doing the right thing for their child, (2) while participants were in support of bilingualism, they were not always confident that they were providing the right advice and found it difficult to in keep up to date with relevant, evidence-based research, and (3) participants highlighted a need to shift towards a more inclusive and culturally diverse practice. This is the first qualitative study to understand the perspectives of SLTs working with autistic bilingual children. We identify several key difficulties in supporting access to language learning, and these findings have immediate and longer-term implications for supporting SLTs, and in turn, the children and families they support. What is already known on the subject Research suggests that autistic children currently have fewer opportunities to maintain bilingualism compared to neurotypical peers. Despite the lack of evidence, many families remain concerned that bilingualism will have a negative impact on their child's development. To date, little is known about the perspectives of speech and language therapists (SLTs) who play a significant role in supporting the development of autistic bilingual children. This is the first study to provide an in-depth qualitative analysis of the experiences of SLTs working with autistic bilingual children and their families in the United Kingdom. What this study adds The results highlight a number of reoccurring barriers in providing optimal support: first, frequently cited concerns about bilingualism from parents that link to a lack of understanding about autism and the role of SLTs more generally. Second, SLTs do not have confidence in the assessments and tools available and described a lack of emphasis on cultural factors in practice. Many SLTs were concerned about the limited options for resources and interventions available in other languages, which could be challenging for parents who were less proficient or confident communicating in English. Third, SLTs reported having limited opportunities to keep up to date with relevant research to support their decision-making processes. What are the clinical implications of this work? These results have several important implications for practice-they highlight the need for more inclusive practices where possible, a need for more diversity within the profession and further opportunities to be provided with evidence-based advice around good practice. The results also suggest a benefit of providing accessible, evidence-based resources for parents about autism and bilingualism, to ensure that research key findings are reaching families.

Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID-19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face-to-face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real-world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Four hundred and thirty-eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost-effectiveness compared to face-to-face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. What is already known on this subject The COVID-19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre-COVID-19, evidence for the use of telehealth in this field included small-scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face-to-face delivery. The realities of at-scale clinical practice were not well-represented, and critical elements of service such as cost-effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long-term and future use of telehealth remains unclear. What this paper adds to existing knowledge The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer-term and at-scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face-to-face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work? UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co-ordinated leadership at the local, national and international levels and the development of policy and clinical guidance.

Purpose We sought to estimate the prevalence of isolated epileptiform activity (IEA) in children with speech and language impairments and discuss the utility of an electroencephalogram (EEG) in assessing these children. Method We conducted a systematic review and searched for eligible studies in 8 databases. All languages were included, and meta-analyses were performed. Results We found 55 prevalence estimates (8 with control group). The odds of having IEA were 6 times greater for children with speech and language impairments than for typically developing children. The overall pooled prevalence of IEA was 27.3%. A wide variation between the prevalence estimates was, to a certain degree, explained by type of impairment (8.1% in speech impairments, 25.8% in language impairments, and 51.5% in language regression). Sleep EEGs detected a significantly higher prevalence than awake EEGs. Although the presence of epilepsy gave a significantly higher prevalence than if epilepsy was not present, 33.5% of children with language impairment but without epilepsy were found to have IEA in sleep EEGs. Conclusions This systematic review shows that IEA is 6 times more prevalent in children with speech and language impairment than in typically developing children. However, the prevalence rates vary to a great extent. Uncovering IEA will, in addition to information from other clinical assessments, provide a more comprehensive understanding of the child's impairments. We argue that, although EEG is of questionable value when assessing children with speech impairments, sleep EEG could be valuable when assessing children with language impairments and, in particular, children who experience language regression.

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.

This longitudinal study used piece-wise growth curve analyses to examine growth patterns in oral reading fluency for 1,991 students with speech impairments (SI) or language impairments (LI) from first through third grade. The main finding of this study was that a diagnosis of SI or LI can have a detrimental and persistent effect on early reading skills. Results indicated differences between subgroups in growth trajectories that were evident in first grade. A large proportion of students with SI or LI did not meet grade-level reading fluency benchmarks. Overall students with SI showed better performance than students with LI. Reading fluency performance was negatively related to the persistence of the SI or LI; the lowest performing students were those originally identified with SI or LI whose diagnosis changed to a learning disability. The results underscore the need to identify, monitor, and address reading fluency difficulties early among students with SI or LI.

Background: Medical and allied health professionals and educators are often the first point of contact for parents who are concerned with their child’s communication abilities. Because there are few speech-language pathologists in Nigeria, it becomes imperative for medical and educational professionals to provide practical steps and suggestions to parents to help facilitate their child’s speech and language development. Objective: To provide an overview of speech and language development and impairment and ultimately empower professionals with the practical steps to guide parents on ways to facilitate their child’s communication development. Method: Review of studies that have investigated methods of treating speech and language impairments was performed. Results: The practical steps and suggestions presented have been proven to be effective at facilitating children’s speech and language development. Conclusion: Medical and allied health professionals and educators should avail the parents with appropriate and effective information that would enable them to address their child’s speech and language impairment.

Background For many years research and practice have noted the impact of the heterogeneous nature of Developmental Language Disorder (also known as language impairment or specific language impairment) on diagnosis and assessment. Recent research suggests the disorder is not restricted to the language domain and against this background, the challenge for the practitioner is to provide accurate assessment and effective therapy. The speech and language therapist aims to support the child and their carers to achieve the best outcomes. However, little is known about the experiences of the speech and language therapist in the assessment process, in contrast to other childhood disorders, yet their expertise is central in the assessment and diagnosis of children with language disorder. Aims This study aimed to gain an in-depth understanding of the experiences of speech and language therapists involved in the assessment and diagnosis of children with Developmental Language Disorder including the linguistic and non-linguistic aspects of the disorder. Methods and procedures The qualitative study included three focus groups to provide a credible and rich description of the experiences of speech and language therapists involved in the assessment of Developmental Language Disorder. The speech and language therapists who participated in the study were recruited from different types of institution in three NHS trusts across the UK and all were directly involved in the assessment and diagnosis procedures. The lengths of speech and language therapist experience ranged from 2 years to 38 years. The data were analysed using inductive thematic analysis within a phenomenological approach. Outcomes and results The analysis of the data showed three main themes relating to the speech and language therapists’ experience in assessment and diagnosis of Developmental Language Disorder. These themes were the participants’ experiences of the barriers to early referral (subthemes – parents’ misunderstanding and misconceptions of Developmental Language Disorder, bilingualism can mask Developmental Language Disorder and public lack of knowledge of support services), factors in assessment (subthemes – individual nature of impairments, choosing appropriate assessments, key indicators and identifying non-language difficulties) and the concerns over continued future support (subthemes – disadvantages with academic curriculum, disadvantages for employment, impact of Developmental Language Disorder on general life chances). Conclusions and implications This study provides first-hand evidence from speech and language therapists in the assessment of children with Developmental Language Disorder, drawing together experiences from speech and language therapists from different regions. The implications are that support for early referral and improved assessment tools are needed together with greater public awareness of Developmental Language Disorder. The implications are discussed in relation to the provision of early and effective assessment and the use of current research in these procedures.

BackgroundGoal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person‐centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations.AimsA first step in developing theory and practical interventions is to explore first‐hand experiences of SLTs and clients about day‐to‐day goal‐setting practice. This study was guided by the following research question: What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services?Methods & ProceduresThe qualitative study was carried out in the setting of routine speech–language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video‐reflexive ethnography, using video footage of goal‐setting conversations to facilitate semi‐structured, reflexive interviews. Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client–SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs.Outcomes & ResultsData analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes.Conclusions & ImplicationsSLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal‐setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved.WHAT THIS PAPER ADDSWhat is already known on the subjectSLTs want to set meaningful goals together with their patients but lack theory and resources to effectively shape the goal‐setting process. Few studies have directly reported on the perspectives and needs of SLTs and patients regarding goal setting. Patients generally perceive goal setting as a vague activity in which they minimally participate. SLTs want to involve patients in the goal‐setting process and describe the potential benefits, but they also want to report barriers on the systemic and professional competence level.What this paper adds to the existing knowledgeSLTs and patients perceive shared goal setting as a multifaceted process, rather than a one‐off conversation. This process holds potential vulnerabilities for SLTs and patients alike, and the themes in this study propose potentially helpful ingredients to mediate this vulnerability and shape the goal‐setting process.What are the potential or clinical implications of this work?To take the first steps towards effective shared goal setting, SLTs should embrace the element of discovery in goal setting and apply their expert knowledge in supporting communication. To develop practical interventions for SLTs, shared goal setting needs to be further conceptualized and embedded in policy and clinical guidelines.

BackgroundWhile the relationship between speech, language and communication needs (SLCN) and mental health difficulties has been recognized, speech and language therapists (SLTs), and mental health professionals face challenges in assessing and treating children with these co‐occurring needs. There exists a gap in the evidence base for best practice for professionals working with children and young people (CYP) who experience difficulties in both areas.AimsTo explore the views of SLTs and mental health clinicians about their experiences of working with CYP exhibiting co‐occurring SLCN and mental health difficulties.Methods & ProceduresSemi‐structured interviews were conducted with eight SLTs and six mental health professionals, including psychotherapists, clinical psychologists, play therapists and counsellors, with experience working with CYP with SLCN. Interviews were analysed using reflexive thematic analysis and themes were identified from the data.Outcomes & ResultsParticipants felt that SLCN and mental health difficulties frequently co‐occur. Participants described how CYP with SLCN and mental health issues commonly experience difficulties across and between the domains of language and cognition, emotional well‐being and challenging behaviour. Findings suggest that there are organizational limitations in the fields of SLT and mental health that have implications for the efficacy of assessment and treatment of CYP with SLCN and mental health difficulties. Traditional talking therapies were perceived to be inaccessible and ineffective for CYP with SLCN and mental health difficulties. Interventions blending behaviour and emotion programmes with language and communication interventions were considered potentially beneficial.Conclusions & ImplicationsFuture research should explore and evaluate current services and service set‐up in SLT and mental health. The findings from this study have important implications for the efficacy of treatments provided to this population suggesting that more research needs to be done into effective diagnosis and interventions for this population.WHAT THIS PAPER ADDSWhat is already known on the subjectResearch suggests that CYP with SLCN, such as developmental language disorder (DLD), are likely to experience mental health difficulties including depression, anxiety and poor emotional well‐being. CYP who experience difficulties with SLCN and poor mental health are not well understood and this area remains under‐researched. This has implications for clinician knowledge and therefore the effective diagnosis and treatment of children and adolescents experiencing SLCN and mental health difficulties. In addition, little is known about the accessibility of talking therapies to CYP presenting with SLCN and mental health difficulties.What this paper adds to existing knowledgeSLCN issues are understood by SLTs and mental health issues are understood by mental health professionals, but where these co‐occur difficulties exist for the diagnostic process, with professionals perceiving that CYP in this category are often undiagnosed or misdiagnosed. Organizational boundaries between SLT and mental health were perceived to contribute to a lack of understanding of SLCN and mental health needs, which has implications for effective diagnosis and treatment. Traditional talking therapies were thought to be inaccessible for CYP with SLCN and mental health difficulties. Interventions used in both SLT and psychotherapy were perceived as clinically useful if combined.What are the potential or actual clinical implications of this work?This paper highlights implications for the accessibility and efficacy of the assessment and treatment provided to this population and to the organization of services currently treating this group of CYP. A direction for future research would be to undertake service evaluations and intervention‐based studies.

Diagnosing specific language impairment (SLI) in monolingual children is a complex task, with some controversy regarding criteria. Diagnosis of SLI in bilinguals is made more complex by the lack of standardized assessments and poor understanding of clinical markers in languages other than English. There is an added complexity when one of the languages being acquired is an endangered one, where the domains of use and input are restricted, and where input is affected by convergence with the majority language. This article explores the challenge facing speech and language therapists and psychologists in diagnosing SLI in bilingual children acquiring Irish and English. Six speech and language therapists and four psychologists took part in semi-structured interviews exploring the impact of the bilingual environment, the nature of bilingual language impairment, current practices and the needs of these children. Thematic analysis was carried out and here three of the main themes emerging in the areas of assessment, the bilingual environment and characteristics of language impairment in this population are discussed. For assessment, an overriding theme was the requirement of standardized testing to secure additional educational and therapy resources for these children. However, because there are no standardized tests available in Irish, both professions end up translating existing English-based language and psychological assessments, using the norms provided to achieve standard scores. Both professions expressed strong dissatisfaction with this practice but saw little choice, given the Department of Education’s approach to allocation of supports. Language impairment in Irish was characterized by lexical difficulties, particularly with verbs and prepositions, tense errors, and significant borrowing and code-switching with English. Other themes that emerged were the growing influence of English as the children became older, which affected both attitudes to the minority Irish language as well as the content and structure of the language itself. The implications for service provision for bilingual populations in general are outlined.