Language Therapy Services Research Articles

Aspectos da comunicação na síndrome de Werdning-Hoffman: estudo de caso clínico

Resumo: A Síndrome de Werdnig-Hoffman é uma doença neuromuscular hereditária, caracterizada pela atrofia e fraqueza muscular progressiva, que inviabiliza o desenvolvimento de habilidades motoras. O desenvolvimento mental encontra-se preservado, vivacidade e inteligência destacam-se, em contraste à precária atividade motora. O sujeito acometido por essa síndrome tem limitações físicas para a efetiva interação com o outro, o que pode acarretar problemas de comunicação. Este estudo tem como objetivo analisar as possibilidades comunicativas de uma criança com Síndrome de Werdnig-Hoffman no decorrer do processo terapêutico fonoaudiológico. É um estudo de caso de uma criança com quatro anos de idade, gênero feminino, filha única (de casal jovem), atendida em terapia fonoaudiológica em centro de reabilitação de deficiências múltiplas no período de agosto de 2013 a abril de 2014. Na avaliação fonoaudiológica observou-se que a paciente comunica-se por expressões faciais e raras vocalizações. No decorrer do processo terapêutico, a interação foi sustentada dialogicamente por meio de perguntas da fonoaudióloga respondidas afirmativa ou negativamente pela paciente. Para "sim", elevava a sobrancelha concomitante à maior abertura dos olhos e um discreto sorriso. Para "não", contraia a sobrancelha e realizava leve movimento de negação com a cabeça. Embora predominantemente silente e corporalmente inerte, a paciente expressa sua subjetividade por meio de condutas comunicativas que, mesmo precárias, indicam atividade simbólica na inserção e interpretação da realidade.

Parents’ journey into the world of autism

Background. Autism Spectrum Disorder (ASD) is a developmental disability that results in an impairment in an individual’s social interaction and communication, as well as restricted, repetitive and stereotyped patterns of behaviour. Children with ASD display difficulties in the areas of social as well as communicative behaviour. Parents, caregivers and family members are the main communication partners of children with ASD. Living with a child with ASD can result in changes within a family system. Objective. To describe the challenges and experiences faced by families in their interaction with their child with ASD, caregiver coping strategies and the success of these strategies, and the generalisation and carryover of therapeutic strategies provided by a speech language pathologist (SLP). Methods. A qualitative descriptive research design was selected to explore the objectives of the study. Ten participants were recruited; all participants were parents of a child with ASD attending Learners with Special Educational Needs School in Gauteng, South Africa. Data were collected through a semistructured face-to-face interview survey comprising open- and closed-ended questions, and were analysed using thematic content analysis. Results. The results revealed five main themes, namely communicative challenges, family experiences, communicative coping strategies, speech and language therapy services and strategies provided by the SLPs. Communicative challenges were experienced by parents of one child with ASD. The communication and behaviour of children with ASD were found to affect the daily functioning of the family. The majority of parents reported not learning a new mode of communication, but rather adapting and adjusting to the communication of their child. Communicative coping strategies were required for novel social settings. There were mixed responses with respect to parent’s abilities to access and learn new communicative coping strategies. Speech and language therapy assisted in improving the child’s communication skills, while strategies provided by SLPs were explained to be effective even though generalisation of strategies was limited. Conclusion. This study concluded that parents and children with ASD experience challenges in communication and interaction. The family systems approach as well as the World Health Organization’s International Classification of Impairments, Disabilities and Handicaps are two functional frameworks that can assist SLPs to provide intervention to children with ASD.

Testing two screening instruments for autism spectrum disorder in UK community child health services.

The aim of this study was to test the accuracy of two screening instruments in UK Community health services: Modified Checklist for Autism in Toddlers (M-CHAT) and Social Communication Questionnaire (SCQ) for autism spectrum disorder (ASD). A two-stage screening and in-depth assessment procedure, combined with sampling stratification and statistical weighting, allowed the accuracy of the screens to be estimated in the entire population of referred children. The study included all referrals of children aged 18 to 48months to community paediatric and speech and language therapy services in two London districts over a 12-month period between September 2004 and September 2005. Parents of 808 children were approached; screen data were obtained on 543 children (67.2%). A stratified subsample of 120 children received an in-depth assessment for ASD as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th edition. Community clinician judgement of likely ASD was available for 98 out of the 120 children. The sensitivity and specificity were 64% (95% confidence intervals; range 51-80%) and 75% (63-85%) for the SCQ, and 82% (72-92%) and 50% (33-64%) for M-CHAT. There was no evidence that the area under the curve differed between the two screening instruments. There was also no evidence that clinician judgement of likely ASD differed from either of the screening tests. The screening tests did not perform well to confirm preliminary clinical judgement to refer (in series), nor as an alternative indicator for referral (in parallel). While screening tests may provide useful information, their accuracy is moderate. Screening information in isolation should not be used to make referral decisions regarding specialized ASD assessment.

Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study

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.

The importance of natural change in planning school-based intervention for children with Developmental Language Impairment (DLI)

Some reports suggest that there is an increase in the number of children identified as having developmental language impairment (Bercow, 2008). yet resource issues have meant that many speech and language therapy services have compromised provision in some way. Thus, efficient ways of identifying need and prioritizing intervention are required. Despite this, children’s natural change is rarely formally considered when intervention planning. The role of age, gender and non-verbal IQ in predicting change has also not always been considered. A longitudinal baseline period is important because it may guide teachers and language therapists towards different therapeutic aims/methods for different groups of children. This study reports on 22 children aged 4–7 identified by teachers as having language difficulties. All children took part in a classroom-based semantic language intervention in two phases, the first led by speech and language therapists (SLTs), followed by a phase led by trained learning support assistants (LSAs). Two Natural Change subgroups were compared: One group showed natural change in language over a six-week period before the intervention ran ( n = 11; Baseline Improvers) whilst the other group did not show language change in this non-intervention period ( n = 12; Baseline Non-Improvers). The groups were well matched on skills at study entry and differed only on score change without intervention. Language skills were assessed at three subsequent time points: pre-therapy, post-SLT-therapy and post-LSA-therapy. In the group as a whole, significant changes were seen across all language measures except expressive vocabulary. Non-verbal cognitive ability showed no change over time, and did not predict language change. There were important differences in the patterns shown by each subgroup depending on natural change without intervention. Notably, Baseline Non-Improvers changed during intervention more than Baseline Improvers. The results suggest that use of a longitudinal baseline may be useful when planning interventions and deciding where to focus limited resources.

“Teleswallowing”: a case study of remote swallowing assessment

Purpose – Telemedicine has enabled speech and language therapists (SLTs) to remotely assess swallowing difficulties (dysphagia) experienced by nursing home residents. The new technique, “teleswallowing”, was designed by the Speech and Language Therapy Service at Blackpool Teaching Hospitals NHS Foundation Trust. It allows prompt assessment, avoiding potential risks of aspiration pneumonia, malnutrition, poor rehabilitation, increased hospital stays and reduced quality of life (Hinchey et al., 2005; Langmore et al., 1998). The purpose of this paper is to report on a second pilot of teleswallowing and the concomitant adoption study. Design/methodology/approach – The adoption study employed qualitative methods, including consultations with senior managers, semi-structured interviews with nursing home matrons/managers and nurses, two focus groups and semi-structured interviews with SLTs. The project clinical lead kept an activity log, which was used to estimate resource savings. Findings – Over a three-month period, six SLTs and 17 patients in five nursing homes participated in teleswallowing assessments. Teleswallowing benefited both patients and participating nursing homes. Better use of therapist time and cost savings were demonstrated and evidence showed that the service could be successfully scaled up. Despite this, a number of barriers to service transformation were identified. Originality/value – This is the first implementation of teleswallowing in the UK, but it has been used in Australia (Ward et al., 2012). The approach to engaging stakeholders to understand and address barriers to adoption is novel. The value lies in the lessons learned for future innovations.

A weekly speech and language therapy service for head and neck radiotherapy patients during treatment: maximizing accessibility and efficiency.

Our hospital did not provide a weekly speech and language therapy (SLT) service for head and neck cancer patients during radiotherapy treatment. SLT is recommended in the international guidelines, but many centers do not offer this service. In the case of our hospital, SLT was not provided because there were no funds to cover the costs of additional staff. To create a new service model within a multidisciplinary setting to comply with the international SLT guidelines and without increasing staff. We aimed to measure the accessibility and efficiency of a new model of service delivery at our center both for patients and for the service. 79 patients were recruited for the study. We followed 1 group of patients (n = 29; observation group) throughout their treatment for 6 weeks to establish if there was a clinical need to offer SLT at the treatment center. A second group of patients (n = 50; intervention group) received a weekly SLT review at the treatment center throughout their radiotherapy. Data collected at the tertiary cancer center for 6 months included: age, gender, tumor site and size, treatment modality, swallowing outcomes, communication outcomes, patient satisfaction, multidisciplinary team feedback, and time efficiency. The observation group did not participate in the intervention group because the data was collected between 2 different groups of participants. However, all participants were referred to their local SLT service at the end of their treatment if that was clinically indicated, regardless of the group they had been in. The proportion of patients accessing SLT services during treatment and the time efficiency of the service were both improved with this model of delivery. The service's compliance with international guidelines was met. More patients continued with oral intake during their treatment at our center with the new service. Improvements were also reported in communication clarity and communication confidence in the same group. Offering head and neck cancer patients SLT at the same time and place as their radiotherapy treatment improves patient outcomes and increases SLT efficiencies. As this was not a treatment study, further clinical trials are required with regards to functional outcomes.

Using different methods to communicate: how adults with severe acquired communication difficulties make decisions about the communication methods they use and how they experience them

Purpose: This study aimed to explore how adults with severe acquired communication difficulties experience and make decisions about the communication methods they use. The primary objectives were to explore their perceptions of different communication methods, how they choose communication methods to use in different situations and with different communication partners, and what facilitates their decision-making. Method: A qualitative phenomenological approach was used. Data collection methods were face-to-face video-recorded interviews using each participant’s choice of communication method and e-mail interviews. The methodological challenges of involving participants with severe acquired communication disorders in research were addressed in the study design. Seven participants, all men, were recruited from a long-term care setting in a rehabilitation hospital. The data analysis process was guided by Colaizzi’s (1978) analytic framework. Results: Four main themes were identified: communicating in the digital age – e-mail and social media, encountering frustrations in using communication technologies, role and identity changes and the influences of communication technology and seeking a functional interaction using communication technologies. Conclusion: Adults with acquired communication difficulties find digital communication, such as e-mail and social media, and mainstream technologies, such as iPads, beneficial in communicating with others. Current communication technologies present a number of challenges for adults with disabilities and are limited in their communicative functions to support desired interactions. The implications for AAC technology development and speech and language therapy service delivery are addressed.Implications for RehabilitationAdults with severe acquired communication difficulties can make significant contributions to AAC research through the use of multi-modal methods to express themselves.Adults with acquired communication difficulties find mainstream technologies and digital communications, such as social media, beneficial, and sometimes preferred when communicating with others.Current AAC technologies limit functional interactions for those with communication difficulties and technology development is needed.Speech and Language Therapists need to work in partnership with adults with acquired communication difficulties in AAC decision-making and tailor interventions to clients’ specific goals and needs.

“He'll Grow out of it Soon—Won't He?”—The Characteristics of Older Children's Speech When They Do—and Don't—Grow out of it

Speech sound disorder is a common reason for referral to speech and language therapy services in the early years. While for some children, their difficulties are transitory and they either respond to intervention or their difficulties resolve, for others, their speech sound difficulties evolve into persistent speech disorder (PSD). The purpose of this article is to provide information on the features of PSD and how to assess children with PSD in order to identify the full range and limits of their speech sound system. Reference is made to ALSPAC, a large longitudinal population study, regarding prevalence, possible subtypes, and risk factors for PSD.

Non-attendance and utilization of a speech and language therapy service: a retrospective pilot study of school-aged referrals.

Non-attendance and inappropriate referrals affect the effective and efficient running of healthcare services. Non-engagement with speech and language therapy (SLT) services may lead to negative long-term consequences for children in need of SLT intervention. Currently there is a dearth of research on non-attendance and non-engagement with SLT services. To identify factors associated with (1) non-attendance and (2) parents' non-engagement with SLT services. Demographic data were collected from 140 case files of children (aged 5;0-17;11 years) discharged from a public community SLT service (November 2011-October 2013) with no intervention provided. Logistic regression analyses explored relationships between demographic data and (1) non-attendance and (2) non-engagement with the SLT service. There was an increased probability of non-attendance during winter (i.e. September-February inclusive; OR = 3.14; p = 0.028) relative to summer, and with each month a child waited for SLT assessment (OR = 1.19; p = 0.066). There was decreased probability of non-attendance with children referred for speech (OR = 0.08; p = 0.011) or language difficulties (OR = 0.15; p = 0.050) relative to dysfluency. The probability of non-engagement with the SLT service increased in each of the following conditions: with each month a child waited for assessment (OR = 1.27; p = 0.004); in urban (OR = 2.40; p = 0.066) relative to rural locations; during winter (OR = 2.65; p = 0.021) relative to summer; and with referrals made by occupational therapists, physiotherapists, psychologists and social workers (OR = 18.65; p = 0.016) relative to doctor referrals. Non-attendance is influenced by wait times, season and the reason for referral. Location (urban versus rural), referral source, wait times and season are factors related to non-engagement with SLT services. Targeted policies to improve efficiency and effectiveness of SLT services could be designed around these study findings.

Serving the Underserved: Language Intervention to Children with Disorders of the Autism Spectrum in Brazil

Language disorders are considered part of the symptoms of the autism spectrum disorders (ASD) since the first descriptions by Kanner. Providing language therapy services to children with ASD is a challenge in countries such as Brazil, where besides geographic and social-cultural diversity there is a lack of enough professionals with adequate training. Therefore university-related services have a fundamental role in filling this gap. This presentation will describe the various initiatives by such a service is Sao Paulo, one of the world's largest metropolitan areas. This specialized service provides language assessment, diagnosis and weekly therapy to children with ASD since 1986. During this period ASD's complexity became clear and demanded the inclusion of other activities such as: multiprofessional colaboration; interdisciplinary research; out-reaching and mentoring of teachers with children and adolescents with ASD in their classes; systematic meetings with parents; use of tele-health resources to increase the number of services provided to this population; editing and distribution of brochures to improve the awareness about ASD and development of assessment tools adapted to the Brazilian reality. These initiatives were conducted whithin the context of scientific research, therefore providing elements to evidence-based-practice. Many of the researches were associated to 37 Master and Doctorate projetcs and were published in scientific journals (115 papers). Also, during this period many professionals had their specialized training and are now teaching in other universities. Today 80 children and adolescents attend to weekly language therapy sessions and 12 undergraduate, 8 graduate students, 3 post-doctorate and 2 researches comprise the team.

Payment and Delivery of Case Management for Individuals With Intellectual and Developmental Disabilities

In the United States, Medicaid is the primary source of funding for many services on which individuals with intellectual and developmental disabilities depend. Case management, one such service, links individuals with intellectual and developmental disabilities to community-based speech and language therapy, adaptive technology, medical care, and other support services. Case management can facilitate navigation in a complex system of care. State and federal concerns about the rising cost of Medicaid and case management have led to changes in payment methodologies. This analysis of one state's case management expenditure during 2007 and 2008 found payment changes were associated with a decrease in the average annual cost per person. Comparing these two years, the largest decrease in cost was found among children and youth, those individuals with less severe disabilities, and persons from ethnic/racial minorities. As such changes could delay early intervention, over time, they could have a negative effect on both cost and outcomes. While this is a case study of a single service in a large urban area of one state, the results may apply to other health and human services and to other locales where fee-for-service arrangements are used.

Perspectives on the past and the future: Clients' views for adult stammering

Background: Client opinions are appropriate contributions to the design and evaluation of health care services. Adults who stammer (AWS) have previously informed discussion regarding speech and language therapy (SLT) services; however, contemporary UK perspectives are lacking. Aim: This study aimed to identify features of helpful and unhelpful SLT services for AWS from the client and potential user perspective. Highlighting preferred components of therapy from this standpoint can help to ensure that SLT services are client-centred. Methods: An online survey was conducted using questions largely derived from UK professional guidelines of minimum best practice. Responses were subjected to quantitative and qualitative analysis. Results: Both positive and negative aspects of individual and group therapy for AWS were identified. Ideal service characteristics related to ‘therapy and therapist’ and ‘service delivery’ issues. Results were generally consistent with previous similar studies. In addition, consideration of the place of remote communication methods within therapy highlighted an appetite for such practice. Conclusions: SLT facilitated long-term benefits for the majority of respondents, but future service design could incorporate greater flexibility in the: timing of therapy; therapeutic format; choice of therapist; and use of technology. The relevance of these findings for allied health services is acknowledged.

Improving communication outcomes for young offenders: a proposed response to intervention framework.

Speech, language and communication needs (SLCN) are strongly overrepresented in young offender populations, and there is growing commitment internationally to ensuring access to speech-language therapy services for such young people. However there is currently no framework in which such interventions might be conceptualized, delivered and evaluated. This is significant given the role of language competence in the development of prosocial skills and also in the transition to literacy. To present Response to Intervention (RTI) as a framework in which SLCN of young offenders might be systematically addressed and evaluated within youth justice settings, led by speech-language therapists, in conjunction with other education and welfare team members. Literature regarding prevalence rates of SLCN in young offenders is reviewed, together with the limited extant evidence on interventions for this group. The importance of applying evidence-based interventions is argued, and a framework for adapting RTI for SLCN in custodial settings is outlined. A framework for adapting RTI to design, deliver and evaluate speech-language therapy interventions in youth custodial settings is presented. Speech-language therapy interventions for young offenders will be better addressed at policy, practice and research levels if a framework such as an RTI adaptation is employed. It is expected, however, that this model will evolve over time, as intervention evidence pertaining to the youth offender population emerges.

Child speech, language and communication need re‐examined in a public health context: a new direction for the speech and language therapy profession

Historically speech and language therapy services for children have been framed within a rehabilitative framework with explicit assumptions made about providing therapy to individuals. While this is clearly important in many cases, we argue that this model needs revisiting for a number of reasons. First, our understanding of the nature of disability, and therefore communication disabilities, has changed over the past century. Second, there is an increasing understanding of the impact that the social gradient has on early communication difficulties. Finally, understanding how these factors interact with one other and have an impact across the life course remains poorly understood. To describe the public health paradigm and explore its implications for speech and language therapy with children. We test the application of public health methodologies to speech and language therapy services by looking at four dimensions of service delivery: (1) the uptake of services and whether those children who need services receive them; (2) the development of universal prevention services in relation to social disadvantage; (3) the risk of over-interpreting co-morbidity from clinical samples; and (4) the overlap between communicative competence and mental health. It is concluded that there is a strong case for speech and language therapy services to be reconceptualized to respond to the needs of the whole population and according to socially determined needs, focusing on primary prevention. This is not to disregard individual need, but to highlight the needs of the population as a whole. Although the socio-political context is different between countries, we maintain that this is relevant wherever speech and language therapists have a responsibility for covering whole populations. Finally, we recommend that speech and language therapy services be conceptualized within the framework laid down in The Ottawa Charter for Health Promotion.

Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia

Objective: The aim was to evaluate behavioural therapy as a treatment for low mood in people with aphasia. Design: A randomized controlled trial comparing behavioural therapy plus usual care with a usual care control. Potential participants with aphasia after stroke were screened for the presence of low mood. Those who met the criteria and gave consent were randomly allocated. Setting: Participants were recruited from hospital wards, community rehabilitation, speech and language therapy services and stroke groups. Subjects: Of 511 people with aphasia identified, 105 had low mood and were recruited. Interventions: Behavioural therapy was offered for up to three months. Outcomes were assessed three and six months after random allocation. Main measures: Stroke Aphasic Depression Questionnaire, Visual Analog Mood Scales ‘sad’ item, and Visual Analogue Self-Esteem Scale. Results: Participants were aged 29 to 94 years (mean 67.0, SD 13.5) and 66 (63%) were men. Regression analysis showed that at three months, when baseline values and communication impairment were controlled for, group allocation was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), visual analogue ‘sad’ (P = 0.03), and Visual Analogue Self-Esteem Scale (P < 0.01). At six months, group alone was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), and remained significant when baseline values were controlled for (P = 0.02). Mean Stroke Aphasic Depression Questionnaire 10-item hospital version scores decreased from baseline to six months by six points in the intervention group as compared with an increase of 1.9 points in the control group. Conclusions: Behavioural therapy seemed to improve the mood of people with aphasia.

Remote Speech and Language Therapy services in Buckinghamshire

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Measuring word complexity in speech screening: single‐word sampling to identify phonological delay/disorder in preschool children

Children's speech sound development is assessed by comparing speech production with the typical development of speech sounds based on a child's age and developmental profile. One widely used method of sampling is to elicit a single-word sample along with connected speech. Words produced spontaneously rather than imitated may give a more accurate indication of a child's speech development. A published word complexity measure can be used to score later-developing speech sounds and more complex word patterns. There is a need for a screening word list that is quick to administer and reliably differentiates children with typically developing speech from children with patterns of delayed/disordered speech. To identify a short word list based on word complexity that could be spontaneously named by most typically developing children aged 3;00-5;05 years. One hundred and five children aged between 3;00 and 5;05 years from three local authority nursery schools took part in the study. Items from a published speech assessment were modified and extended to include a range of phonemic targets in different word positions in 78 monosyllabic and polysyllabic words. The 78 words were ranked both by phonemic/phonetic complexity as measured by word complexity and by ease of spontaneous production. The ten most complex words (hereafter Triage 10) were named spontaneously by more than 90% of the children. There was no significant difference between the complexity measures for five identified age groups when the data were examined in 6-month groups. A qualitative analysis revealed eight children with profiles of phonological delay or disorder. When these children were considered separately, there was a statistically significant difference (p < 0.005) between the mean word complexity measure of the group compared with the mean for the remaining children in all other age groups. The Triage 10 words reliably differentiated children with typically developing speech from those with delayed or disordered speech patterns. The Triage 10 words can be used as a screening tool for triage and general assessment and have the potential to monitor progress during intervention. Further testing is being undertaken to establish reliability with children referred to speech and language therapy services.

Perda auditiva sensorioneural unilateral e distúrbios da comunicação

Este estudo objetiva verificar a associação entre distúrbios da comunicação oral e perda auditiva sensorioneural unilateral. A partir de dados preliminares de estudo transversal com 20 sujeitos de ambos os sexos com idades entre 7 e 19 anos (média 10,8) com graus variados de perda auditiva sensorioneural unilateral atendidos em serviço de referência em avaliação de distúrbios da linguagem e da audição em São Paulo, Brasil. Todos os pacientes foram submetidos a anamnese, avaliação auditiva e entrevista estruturada para levantamento de informações sobre habilidades de linguagem, comunicação e audição. A média de idade do diagnóstico da perda auditiva foi de 6,3 anos. Cinco (25%) destes sujeitos tinham histórico de repetência escolar e perda auditiva da orelha esquerda. A comunicação oral foi a alteração comunicativa mais referida entre os pacientes estudados. As habilidades linguísticas, comunicativas e auditivas são afetadas de forma variada pela ocorrência da perda auditiva unilateral e comorbidades como deficit de atenção, irritabilidade e agitação parecem estar associados a esta na população estudada.

The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school‐age children who have pragmatic and social communication problems with or without autism spectrum disorder

Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment (PLI) or social communication disorder (SCD). Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder (ASD). There is little robust evidence of effectiveness of speech-language interventions which target the language, pragmatic or social communication needs of these children. To evaluate the effectiveness of an intensive manualized social communication intervention (SCIP) for children who have PLI with or without features of ASD. In a single-blind RCT design, 88 children with pragmatic and social communication needs aged 5;11-10;8, recruited from UK speech and language therapy services, were randomly assigned in a 2:1 ratio to SCIP or to treatment-as-usual. Children in the SCIP condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants. All therapy content and methodology was derived from an intervention manual. A primary outcome measure of structural language and secondary outcome measures of narrative, parent-reported pragmatic functioning and social communication, blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention, immediately post-intervention and at 6-month follow-up. Analysis was by intention to treat. No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability. Significant treatment effects were found for blind-rated perceptions of conversational competence, for parent-reported measures of pragmatic functioning and social communication, and for teacher-reported ratings of classroom learning skills. There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes, but not standardized language assessment outcomes, for 6-11-year-old children who have pragmatic and social communication needs. These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention. The substantial overlap between the presence of PLI and ASD (75%) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs.