Speech-language Pathology Services Research Articles

Development and psychometric evaluation of a scale to measure telepractice among speech and language pathologists during COVID-19 pandemic

Purpose With the outbreak of the COVID-19 and the need for physical distancing, the provision of Speech-Language Pathology (SLP) services via telepractice has been essential. One of the first steps in this field is the need to study telepractice among Speech and Language Pathologists (SLPs). However, there is currently no specific instrument to measure telepractice in SLP to achieve this aim. The present study was conducted to develop and evaluate the psychometric properties of a questionnaire to investigate telepractice among SLPs during the COVID-19 pandemic. Materials and methods The study comprised of two stages: (1) development of the questionnaire according to an in-depth literature review and (2) evaluation of the validity and reliability of the questionnaire. The content validity of the instrument was determined by 10 experts in the field of SLP. To check the face validity of the questionnaire, 10 SLPs were interviewed and their opinions were incorporated in the questionnaire. A total of 221 SLPs completed the questionnaire to determine the construct validity and the internal consistency. To evaluate the test-retest reliability, 30 SLPs completed the questionnaire twice with two weeks of interval. Results The final version of the questionnaire comprised of three sections and 31 items. The Cronbach’s alpha coefficients for different sections of the questionnaire ranged between 0.902 and 0.92 and the Intra-class Correlation coefficients of the sections were found to be between 0.9 and 0.96 in the test-retest reliability. Conclusions The questionnaire developed in the study is a valid and reliable scale to measure telepractice among SLPs for educational or research purposes.

International Telepractice: Encouraging Equity, Partnership, and Sustainability

Purpose: The following commentary outlines the principles of international telepractice with regard to speech-language pathology and audiology services. Additionally, this commentary provides critical caveats and concerns surrounding international telepractice as well as a summary of principles to follow as telepractice programs encourage access to care and bidirectional, sustainable, and ethical practice development. Conclusions: Telepractice among communication disorders professionals has grown exponentially in recent years. With the rise in telepractice opportunities, easier access to digital practice platforms, and increased Internet access through mobile devices, telepractice is a popular therapeutic modality in the communication disorders field. Telepractice applications have extended beyond therapeutic services alone and into clinical education among speech-language pathologists (SLPs) and audiologists (AUDs). Telepractice has also extended beyond national borders called international telepractice. This practice has the potential to improve access to critical rehabilitative and therapeutic services, build capacity in allied rehabilitation systems, and encourage global bidirectional partnership among SLPs and AUDs. However, this practice should not proceed without caution, and the ethical implications should be carefully and critically considered.

Incidence and Referral for Management of Communication Complaints in Mild Traumatic Brain Injury

Research Objectives To identify commonly reported cognitive-communication problems after mild traumatic brain injury (mTBI), and to describe the relationship between cognitive-communication complaints and referral for speech-language pathology (SLP) services. Design Pre-post design. Setting Outpatient specialty clinic. Participants Participants were 41 English-speaking adults and adolescents between the ages of 14 and 65 (M=29.17, SD=13.66) with uncomplicated mTBI; 23 participants repeated measures at discharge. Interventions Survey completion at first visit and discharge. Main Outcome Measures LaTrobe Communication Questionnaire (LCQ), Post Concussion Symptom Scale (PCSS), and SLP referral were the main outcome measures. Demographic information and injury characteristics were also extracted from participants’ medical records. Results Participants reported more problems with speaking too slowly (M=1.68), participating in group conversations (M=2.20), and three other issues at their first visits than published norms. According to Wilcoxon Signed-Rank test results, communication complaints decreased significantly by discharge (V=165, p=.005). Regression analyses showed that LCQ scores were related to PCSS scores (b=0.25, p < .001). Although the total LCQ score was not related to SLP referral, seven LCQ items (e.g., “Leave out important details,” "Go over and over the same ground," "Need a long time to think") were found to be significant predictors (OR=2.42-4.87, p < .04). Besides LCQ items, PCSS scores were also predictive of SLP referral (OR=1.04, 95% CI=1.01-1.08, p < .01). Demographics variables and injury characteristics were not significantly associated with LCQ scores or SLP referral in the current sample. Conclusions A subset of individuals experiences communication problems post concussion. Those who reported communication problems were more likely to be referred to SLP rehabilitation. Future research should examine the usefulness of communication items in directing rehabilitation pathways. Author(s) Disclosures We have no conflict of interest to disclose. To identify commonly reported cognitive-communication problems after mild traumatic brain injury (mTBI), and to describe the relationship between cognitive-communication complaints and referral for speech-language pathology (SLP) services. Pre-post design. Outpatient specialty clinic. Participants were 41 English-speaking adults and adolescents between the ages of 14 and 65 (M=29.17, SD=13.66) with uncomplicated mTBI; 23 participants repeated measures at discharge. Survey completion at first visit and discharge. LaTrobe Communication Questionnaire (LCQ), Post Concussion Symptom Scale (PCSS), and SLP referral were the main outcome measures. Demographic information and injury characteristics were also extracted from participants’ medical records. Participants reported more problems with speaking too slowly (M=1.68), participating in group conversations (M=2.20), and three other issues at their first visits than published norms. According to Wilcoxon Signed-Rank test results, communication complaints decreased significantly by discharge (V=165, p=.005). Regression analyses showed that LCQ scores were related to PCSS scores (b=0.25, p < .001). Although the total LCQ score was not related to SLP referral, seven LCQ items (e.g., “Leave out important details,” "Go over and over the same ground," "Need a long time to think") were found to be significant predictors (OR=2.42-4.87, p < .04). Besides LCQ items, PCSS scores were also predictive of SLP referral (OR=1.04, 95% CI=1.01-1.08, p < .01). Demographics variables and injury characteristics were not significantly associated with LCQ scores or SLP referral in the current sample. A subset of individuals experiences communication problems post concussion. Those who reported communication problems were more likely to be referred to SLP rehabilitation. Future research should examine the usefulness of communication items in directing rehabilitation pathways.

A Retrospective Chart Review of Referrals for Speech-Language Pathology Services after Concussion

<h3>Research Objectives</h3> To preliminarily evaluate a screening tool developed to identify cognitive and communication complaints post-concussion and guide referrals to speech-language pathology (SLP) rehabilitation services. <h3>Design</h3> Retrospective Chart Review. <h3>Setting</h3> Specialty Outpatient Clinic. <h3>Participants</h3> 129 patients with concussion, mean age 28.02 (SD=15.19), who received care from Shepherd Center's Complex Concussion Clinic (CCC) between August 2019 and March 2020, completed the Cognitive Symptom Screening Tool (CSST) form on the first visit. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Demographics, injury characteristics, medical history, Post Concussion Symptom Scale (PCSS) results, CSST results, and rehabilitation referrals were extracted from the medical charts. A Chi-squared Test was used to examine relationships between patients' reporting of problems (i.e., cognition, communication, and emotion), demographics, and injury characteristics. Logistic regression analyses were used to explore the SLP referral pattern. <h3>Results</h3> The most frequently reported cognitive-communication problems were maintaining mental energy throughout the day (81%), staying focused (72%), and completing tasks or assignments (63%). Females reported more difficulties remembering things than males (x2=4.61, p=.03), and females were more likely to be referred to SLP services than males (OR=2.99, 95%CI:1.46-6.25, p=.003). Patients who sustained concussions from motor vehicle accidents (OR=3.01, 95%CI:1.17-9.08, p=.025) or who lost consciousness were also more likely to be referred to SLP services (OR=3.52, 95%CI:1.20-12.89, p=.033). Compared to patients who did not receive imaging services, patients who showed unremarkable imaging signs had a higher chance of receiving SLP rehabilitation (OR=4.15, 95%CI:1.78-10.63, p=.002). Moreover, PCSS scores (OR=1.06, 95%CI:1.04-1.08, p < .001) and CSST scores (OR=1.63, 95%CI:1.34-2.01, p < .001) were significant predictors for SLP services. <h3>Conclusions</h3> Cognitive and communication complaints are frequent post concussion. Sex, severity of injury, and reporting of cognitive and communication issues were related to the referral of SLP rehabilitation services. <h3>Author(s) Disclosures</h3> We have no conflict of interests to declare.

Genesis of a New Generation of Telepractitioners: The COVID-19 Pandemic and Pediatric Speech-Language Pathology Services.

Purpose In March 2020, the COVID-19 pandemic caused a worldwide shift from in-person care to synchronous videoconferencing or telehealth. Many barriers to remote service delivery were eliminated, effectively creating a new generation of telepractitioners. This study chronicles changes in speech-language pathology clinicians' use and perceptions of telehealth with pediatric populations. Method The Telehealth Services: Pediatric Provider Survey was created in multiple steps and then distributed broadly through social media and professional community sites. Respondents were speech-language pathologists and speech-language pathology assistants in a variety of employment settings from across the country and abroad who were serving primarily pediatric clients (n = 269). Survey questions sought to capture changes in speech-language pathology clinicians' experiences with and perceptions of telehealth before, during, and predictions after the COVID-19 pandemic. Analyses identified factors that influenced the use of telehealth services before and after March 2020 (COVID-19). Results Survey results documented the dramatic increase in telehealth use from before March 2020 to October 2020. The reasons pediatric speech-language pathology clinicians used telehealth during the pandemic were mostly a result of employer mandates or lowering infection risk for both client and clinician; however, over time, pediatric speech-language pathology clinicians increased their telehealth proficiency and discovered the benefits of telehealth. Conclusion The adoption of telehealth and the rapid improvement in proficiency is a testament to the resiliency of providers and has long-term effects on the use of telehealth into the future. Supplemental Material https://doi.org/10.23641/asha.15183690.

Perspectives from the patient: A content analysis of communication changes, impact, and strategies to facilitate communication in multiple sclerosis

Purpose: Communication changes in multiple sclerosis (MS) are under-explored and under-recognised. Persons with MS (PwMS) are experts in their condition and play a valuable role in informing clinicians and researchers of their condition. This study aimed to investigate the perspectives of PwMS on: (1) MS-related communication changes, (2) the impact of these communication changes across key aspects of a person’s life, including work/studies, relationships, and general quality of life, and (3) strategies used to facilitate communication in daily interactions. Method: Two-hundred and sixty PwMS were recruited internationally and completed an online questionnaire. Content analysis was used to analyse open-ended questionnaire responses. Result: One-hundred and ninety-seven (75.8%) participants reported communication changes, including language, cognitive, speech, voice, and fluency changes. Participants described a variety of personal and environmental factors that influence communication negatively, such as fatigue, stress, and heat. Communication changes were reported to impact on psychological wellbeing, interpersonal relationships, participation and identity in the workforce and career pathways, and tertiary studies. Around 40% of participants reported using a range of overt and covert strategies to manage communication changes. Only 11.2% (n = 22/197) of participants who reported communication changes accessed speech-language pathology (SLP) services. Conclusion: PwMS can experience a wide spectrum of communication changes. These communication changes can have a profound and far-reaching impact on psychological wellbeing and societal participation. Engagement with SLP services is limited compared to the reported prevalence of communication changes. There is a need to raise awareness of the role of SLP in service provision for PwMS to manage communication changes. This paper discusses and provides suggestions for SLP services for PwMS with communication changes. There is a timely need to develop evidence-based interventions to support PwMS manage communication changes and reduce their impact.

Do people with Myasthenia Gravis need speech-language pathology services? A national survey of consumers’ experiences and perspectives

Purpose: This study explored experiences of bulbar (speech, voice and swallowing) symptoms in Australian adults with Myasthenia Gravis (MG), and the relationship between these symptoms and community participation and quality-of-life. Further, it examined access to and experiences with speech-language pathology (SLP) services, and awareness and perceptions of the SLP’s role. Method: A cross-sectional mixed methods online survey collected data using researcher-designed questions and patient-reported outcome measures (PROMs) including the Dysarthria Impact Profile (DIP), Voice Handicap Index (VHI), Dysphagia Handicap Index (DHI), Community Integration Questionnaire–Revised (CIQ-R), and Myasthenia Gravis Quality of Life–Revised 15 (MG-QOL15r). Analyses included descriptive and non-parametric statistics, and content analysis. Result: Participants were 111 adults with MG living in Australia. 74% of respondents reported experiencing symptoms of speech difficulties but only 20% of those were referred to SLP services. Similarly, 85% of respondents reported experiencing swallowing difficulties, but only 26% were referred to SLP. Voice handicap (VHI) was strongly correlated with the psychosocial impact of dysarthria (DIP) and dysphagia handicap (DHI). Increased voice and dysphagia handicap were moderately correlated with worse quality-of-life. There was generally poor awareness of the SLP’s role and many were reluctant to attend SLP appointments. Conclusion: These findings highlight unmet consumer needs for MG-related bulbar symptoms, and a lack of awareness of SLP services. It is suggested that, in addition to other strategies, consumer education and increased awareness are required to address these unmet needs.

Outcomes from an extended scope of practice speech-language pathology service for low risk ENT outpatients: A 5-year service review

Purpose: Early evidence supports the safety and efficiency of extended scope speech-language pathology (SLP) clinics designed to manage low risk ear nose and throat (ENT) outpatient referrals, however long-term data is lacking. The aim of this study was to complete a 5-year audit of clinical outcomes, including rates of re-referral, for a SLP Allied Health Practitioner (SLP AHP) led dysphagia and dysphonia service within an Integrated Specialist ENT Service. Method: A retrospective audit was undertaken of all patients referred with non-urgent dysphonia and/or dysphagia symptoms over a 5-year period since establishment of the SLP AHP service. Clinical outcomes, rates and reasons for re-referral to the specialist ENT waiting list were investigated. Result: Of 616 patient referrals, 462 patients were seen by the SLP AHP service. Most (72%, n = 333) received all required management through the clinical model, with only 28% (n = 129) requiring additional ENT intervention, consistent with previously published data. Only 36 of the 616 (6%) were re-referred/re-presented within 12 months of first presentation, of which only 12 were referred for same condition as initial referral. No adverse outcomes were recorded on the clinical database during this 5-year period. Conclusion: Results provide further evidence that the SLP AHP service is a safe and efficient method for managing low risk ENT outpatient referrals.

Waiting lists and prioritization of children for services: Speech-language pathologists’ perspectives

BackgroundWaiting lists occur when the availability of speech-language pathology services does not meet the demand. Speech-language pathologists (SLPs) commonly manage waiting lists and their consequences using prioritization. AimsThe aims of this study were to: (1) describe speech-language pathology waiting lists for children and factors associated with their presence in workplaces throughout the world, and (2) describe factors considered in and influencing SLPs’ prioritization of children for services. MethodsA questionnaire about pediatric waiting lists and prioritization was completed by 267 SLPs from 10 countries working in health, disability, education, and private sectors. Valid responses to closed questions from 264 SLPs were analyzed quantitatively. ResultsMost (73.6 %) SLPs reported having a waiting list in their workplace. Waiting lists were most common in community health centres (97.4 %). Waiting times ranged from 0 to 42 months (M = 8.09, SD = 5.84). High priority was assigned to infants (77.4 %), toddlers (65.3 %), children with feeding difficulties (88.5 %), and children who stutter (47.4 %). Prioritization parameters ranked as most important were: severity (M = 4.34), availability of resources (M = 4.11), diagnosis (M = 4.04), and age (M = 3.91). ConclusionsMany workplaces have long waiting lists for speech-language pathology services. Young children, feeding, and stuttering were most often considered high priority; however, prioritization can be complex, implicit, and influenced by external factors. Collaborative development of explicit, transparent waiting list and prioritization guidelines within workplaces, and the development and evaluation of active waiting strategies for children and families are recommended.

Hearing Screening in Pediatric Primary Care.

1. Jordan K. Yoeli, MD*,† 2. Daniel Nicklas, MD*,† 1. *Children’s Hospital Colorado, Aurora, CO 2. †University of Colorado, Aurora, CO Screening for congenital and acquired deafness and hearing loss (HL) represents a significant responsibility for clinicians in all newborn units and medical homes. Approximately 1 to 3 infants of 1,000 born in a well infant nursery setting and 2 to 4 of 100 born in a NICU have significant bilateral HL. Outcomes in various developmental domains depend on the early recognition and subsequent intervention for HL. Developmental delay is present in 30% to 40% of children with HL; the goal of hearing screening (HS) and prompt intervention is to optimize a child’s language acquisition, cognitive development, literacy, social-emotional maturity and academic success. This article reviews the most up-to-date standards and practices to aid medical providers in the early detection and intervention for pediatric HL. In the United States, universal screening begins in the neonatal period. According to the American Academy of Pediatrics (AAP) Joint Commission on Infant Hearing (JCIH), all infants should be screened for congenital HL before 1 month of age. Most infants are screened in nursery or NICU settings, except for those born outside of a medical facility. For the latter population or for infants with no documented HS, screening should be completed by the medical home before 1 month of age. In a well nursery setting, most HSs are performed by otoacoustic emission (OAE) testing. During an OAE screen, a sensitive microphone in the ear canal records the cochlear responses (“acoustic emissions”) to acoustic stimuli, thereby testing the peripheral auditory system from the outer/middle ear (conduction zones) to the cochlear outer hair cells (sensory organ). A “pass” indicates that hearing is functional to the level of …

Retrospective study demonstrating therapy time impact on inpatient rehabilitation functional gains

Purpose The purpose of this retrospective study is to evaluate the association of total therapy time during inpatient rehabilitation and gain in functional independence for patients admitted to an inpatient rehabilitation facility (IRF). Materials and methods The study utilized a retrospective design that included all IRF patients from three IRFs in California from January 1, 2012 to December 31, 2013. Patient data collected as part of usual, routine medical, and rehabilitation care were used and includes demographics, medical variables, and functional outcomes data. Results There were 3212 patients discharged from the three IRFs, with 2,777 patients having received speech language pathology (SLP) therapy along with occupational therapy and physical therapy. Speech language pathology services were not provided for 435 patients in the database. Our results support that among all types of patients, increased therapy hours were associated with increased functional gains. For total functional independence measure (FIM) gain, an additional hour of PT therapy per day was associated with an increase of 7.55 FIM gain points (p < 0.001) and an additional hour of OT therapy per day was associated with an increase of 1.16 FIM gain points (p = 0.045), when adjusted for other variables in the model. SLP hours per day did not remain in the FIM gain model. Conclusions The findings of this study add to the understanding of therapy time and functional gain in an inpatient rehabilitation program. There is a positive relationship between total therapy time and functional gain. In the future determining the intensity and the related therapy activities provided will be needed to impact functional change. This has implications for shaping rehabilitation practice in the future. Implications for rehabilitation Increased number of therapy hours were associated with functional gains in an inpatient rehabilitation program for all types of patients. An additional hour of physical therapy per day was associated with an increase of 7.55 functional independence measure (FIM) point gain. An additional hour of occupational therapy per day was associated with an increase of 1.16 FIM point gain. Determining the intensity and related activities are needed to impact functional change which has implications for shaping rehabilitation practice.

Telerehabilitation for Communication and Swallowing Disorders in Parkinson’s Disease

Communication and swallowing disorders are highly prevalent in people with Parkinson’s disease (PD). The negative impact of these disorders on the quality of life of the person with PD and their families cannot be underestimated. Despite a demand for speech-language pathology services to support people with PD, many barriers to services exist. Telerehabilitation provides an alternate and complementary approach to in-person therapy that is patient-centered, enables timely assessment and intervention, and facilitates continuity of care throughout the course of the disease. This review explores the telerehabilitation applications designed for the management of the communication and swallowing disorders in PD, addresses the benefits and challenges of telerehabilitation, identifies future research directions, and highlights the potential of new technologies to enhance the management of communication and swallowing disorders and quality of life for people with PD.

Enhancing Language Services to Native American Children: A Look From the Inside

Enhancing Language Services to Native American Children: A Look From the Inside

Top 10: Responsive Speech-Language Pathology Services during COVID-19 and Beyond

Top 10: Responsive Speech-Language Pathology Services during COVID-19 and Beyond

Speech therapists’ perspectives about using tele-speech therapy: a qualitative study

Purpose Tele-speech therapy refers to the application of telecommunication technologies to provide speech-language pathology services at a distance and establishes communication between a specialist and a patient for assessment, intervention, or consultation. Due to the shortage of speech therapists, the use of tele-speech therapy services can be helpful, especially for those who do not have access to speech-language therapists. The aim of this study was to investigate speech therapists' perspectives about using tele-speech therapy. Methods This was a qualitative study conducted in 2020. Data were collected through conducting in-depth semi-structured interviews with 12 faculty members who worked in three different medical universities. The interviews were recorded digitally and transcribed verbatim. The data were analysed by using framework analysis method and MAXQDA version 10. Results Having analysed the data, four themes, 10 categories, and 26 subcategories emerged. The main findings included necessary requirements for implementing and using tele-speech therapy in terms of developing academic courses, guidelines, and necessary technical infrastructure, advantages of using tele-speech therapy for specialists and patients, challenges of, and opportunities for, using tele-speech therapy. Conclusion Although tele-speech therapy has several benefits for specialists and patients, challenges of using this technology should not be underestimated. There are also a number of research opportunities in this field and their results can be helpful for successful implementation of this technology in the future. Implications for rehabilitation The clinical assessment and treatment of patients with speech-language disorders are sometimes difficult mainly due to the limited healthcare resources or the patient heath condition. Tele-speech therapy can be regarded as an alternative approach or a complementary method for face-to-face visits, especially for patients who are not able to attend clinics. Despite the advantages, the challenges of providing special groups of patients with tele-speech therapy should be taken into account. Telerehabiliation and rehabilitation research centres can support future research in the field of tele-speech therapy to present more evidence regarding the strengths and weaknesses of this technology. Implications for practice Technical and non-technical infrastructures should be taken into account before implementing tele-speech therapy services. Tele-speech therapy has a number of advantages for patients and specialists. Challenges of providing tele-speech therapy services, such as risk of inaccurate evaluation and difficulty in interaction with patients should not be underestimated. There are a number of research opportunities in the field of tele-speech therapy and tele-rehabilitation centres can support further research in this area. The findings of this study can facilitate utilisation of tele-speech therapy in different settings.

Clinical practices of speech-language pathologists working with 12- to 16-year olds in Australia

Purpose: The current landscape of speech-language pathology (SLP) services for 12- to 16-year olds in Australia remains largely unchartered. Implementing the Speech Pathology 2030 vision necessitates mapping current services, and gaps in services, provided by speech-language pathologists (SLPs). However, the last survey of Australian SLPs’ practices with young people was conducted in 2005. The aim of this study was to bridge the service delivery information gap. Method: Ninety-six SLPs working with 12- to 16-year olds in Australia completed an anonymous online survey consisting of binary choice, multiple choice, and Likert scale questions. A theoretical approach to service delivery based on response to intervention models underpinned question design. Result: SLP clinical practices remain traditional, following an impairment/diagnostic model. Additionally, there is an inequitable provision of SLP services across states/territories of Australia, according to whether or not there is government provision for SLP services in public schools. Conclusion: The results suggest a need for standard government provision of SLP services across Australia to ensure equity of access. These findings inform our understanding of contemporary assessment and intervention practices of SLPs working with 12- to 16-year olds in Australia.

The relationship between language difficulties, psychosocial difficulties and speech-language pathology service access in the community.

A range of factors may impact whether children access speech-language pathology (SLP) services, beyond their communication difficulties. For instance, co-occurring psychosocial difficulties may amplify children's observable difficulties, leading to greater access. It is important to examine such associations because they may reflect inherent differences between children with language difficulties who access services and those who do not, indicating under-servicing for subgroups in the community. The first aim was to examine possible differences in psychosocial difficulties between children with language difficulties who did versus did not access SLP services in the past 12 months. The second aim was to examine the unique contribution of psychosocial difficulties to service access, over and above language difficulties and other common predictors of service access. Analyses were carried out on data gathered from 808 eleven-year-old children who took part in the Early Language in Victoria Study (ELVS). Children were categorized as having language difficulties based on their CELF-4 Core Language Score with a cut-point of > 1.25 SD below the mean. The primary outcome measure was access to SLP services in the past 12 months. Comparison and predictor variables included children's psychosocial difficulties, language skills, relevant demographic variables (gender, caregiver education) and prior SLP access. A total of 42 children with language difficulties who had accessed SLP services had significantly greater psychosocial difficulties than those who had not (SDQ Total Difficulties, U = 53.00, z = -4.080, p < 0.001). Using binary logistic regression, a model examining child gender, caregiver education, psychosocial difficulties (internalizing and externalizing behaviours), language difficulties and prior SLP access (in earlier years) was significant χ2 (8) = 137.285, p< 0.001, with increased externalizing difficulties (OR = 1.213, p < 0.001), increased communication difficulties (OR = 0.949, p < 0.001), and prior SLP access (OR = 7.430, p < 0.001) identified as unique predictors of service access. The results indicate that children with language difficulties who have comorbid psychosocial difficulties are more likely to access services than those who do not. Accordingly, children with language difficulties who access clinical services may require interdisciplinary support, while children without co-morbid psychosocial difficulties may be under-referred for SLP services. What this paper adds What is already known on this subject There is evidence that a range of personal and contextual factors impact the likelihood of a person accessing healthcare services beyond the specific issue of concern. What this paper adds to existing knowledge In this population-based study, we provide statistical evidence that children with language difficulties who had higher levels of psychosocial difficulties were more likely to access SLP services than those who had lower levels. What are the potential or actual clinical implications of this work? Children with language difficulties who access SLP services may require support for psychosocial difficulties, while children who do not have comorbid difficulties may be underserviced in the community.

La comunicación preverbal en niños con ausencia del lenguaje

Young children consulting due to an absence of language usually show deficits in the construction of preverbal communicative mechanisms, not necessarily a sign of broader developmental disorders. AimTo analyse the presence/absence of preverbal abilities in non-autistic children with language absence. PopulationA subset of 77 2-3.5year-old children was analysed. These children attended consultation at the Speech-Language Pathology Service of the Hospital Universitario Austral and private consultation due to an absence of language. Materials and methodologyThe population of children under study went through an audiological evaluation to rule out hearing loss. Their parents were asked to answer the M-CHAT Questionnaire to rule out children with high and medium risk of autism; and an assessment of the general development parameters was made with the Vineland, VABS scale, seeking to identify the presence of specific delays in language acquisition and global developmental disorders. The preverbal abilities studied were: visual contact, joint attention, the ability to interact, simple imitation, and the use of protoimperative gestures. ResultsChildren with global developmental delays showed more issues in the above mechanisms than the patients with specific language delays. The items that showed a higher level of impairment were the development of imitation and the use of protoimperative gestures related to development during the last quarter of the first year of life.

The oral and written narrative language skills of adolescent students in youth detention and the impact of language disorder

BackgroundUnmet language and literacy needs are common among young people who are involved with youth justice systems. However, there is limited research regarding the functional text-level language skills of this population with regard to narrative macrostructure (story grammar) and microstructure (semantics and syntax) elements. MethodsIn this study, we examined macrostructure and microstructure elements in the oral and written narrative texts of 24 adolescent students of a youth detention centre. The students, who were aged 14- to 17- years, were all speakers of Standard Australian English, and 11 (46%) students met criteria for language disorder (LD). FindingsWhen we compared the narratives according to modality of language, the students demonstrated stronger narrative language skills in the written modality compared to the oral. However, when we compared the narratives according to language ability, we found that the impact of LD on inclusion of macrostructure elements was greater in the oral modality, and for microstructure elements, was greater in the written modality. Errors in written conventions were common among both students with and without LD. ConclusionsOur results indicate that both the modality of language as well as the presence of LD should be considered when young people are required to participate in forensic contexts including programs that address educational and rehabilitation needs. Our results indicate a need for consistent text-level language assessment to better identify and respond to functional difficulties within language and literacy. There is potential for speech-language pathology services to enhance comprehensive assessment as well as inform educational and rehabilitation programs for young people who are involved with youth justice systems.

Are we meeting the needs of vulnerable children? Distribution of speech-language pathology services on the Gold Coast, Australia.

Compared to national averages, the Gold Coast, Australia, has a proportionately higher number of children entering their first year of primary school with 'at risk' or 'vulnerable' language skills. This paper investigates the distribution of paediatric speech-language pathology (SLP) services on the Gold Coast, relative to children's language and cognitive skills, and socioeconomic status (SES). SLP service locations were identified through national association data and a manual search and mapped against SES and Australian Early Development Census data, for language and cognitive skills. Data for 7595 children was included, with 943 (12.4%) at risk and 780 (12.6%) vulnerable for language and cognitive skills. A total of 75 SLPs were identified (85.3% private, 14.6% public), which is 1 SLP to every 23 children who might have current or impending speech, language and communication needs. Fewer services were available in areas where vulnerable children were located and most were private providers, leading to further potential barriers to service access. The number of SLP services located on the Gold Coast is inadequate to meet the needs of children with language and cognitive skill vulnerabilities. Consideration of how services might be distributed is explored and warrants further consideration.