Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study (original) (raw)
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Issues to consider in the evaluation of speech and language therapy for preschool children
Child: Care, Health and Development, 1999
This paper reviews some of the methodological issues involved in the design of a randomized controlled trial currently underway in Bristol. The trial compares the progress of preschool children randomly allocated to a`watching±waiting' control group with the experimental group who have immediate access to therapy. This paper reviews a number of relevant studies, which have either followed up preschool children with early language delays or have investigated the effects of therapy with this age group. The basic design of the trial is outlined along with a discussion of the sample, the measurements used and the therapy given.
Child: Care, Health and Development, 2020
Background: The existing evidence is limited in terms of perspectives of preschool children with speech and language needs and their views on activities used to support their needs. This paper discusses a stream of work from the interdisciplinary research programme known as "Child Talk," based in England, UK. The overall purpose of this work stream was to gain the perspectives of preschool children aged 2 to 5 years and 11 months, with speech and language needs, to use in the development of an evidence-based framework of activities. Methods: Twenty-four preschool children with a variety of needs from diverse backgrounds took part. An observational methodology was used to capture children's experiences. Children were filmed during a series of sessions, with innovative headmounted cameras worn by the children and supported by researcher field notes. Framework analysis was used to analyse the data based on the body movement, vocalization, and visual attention of the children during these sessions. Results and Conclusions: Results included that children expressed enjoyment and engagement in the activities. The children expressed themselves and demonstrated their focus "multimodally" through combinations of body language, vocalization, and visual attention. These modalities were present across all contexts and children. It highlights the importance of encouraging participation in preschool children and consequently this innovative piece of work has national and international importance. K E Y W O R D S child development, qualitative research methods, speech and language activities, young children 1 | INTRODUCTION AND BACKGROUND This article discusses one stream of work, the Children's Groups, drawn from "Child Talk" an inter-disciplinary research programme based in England, UK. "Child Talk" aimed to develop an evidencebased framework to support the decision-making of speech and language therapists in England as they design and plan interventions appropriate to the needs of individual preschool children aged 2 to
International Journal of Language & Communication Disorders
Background: Several studies have suggested that practitioners hold speech and language therapy (SLT) practice as tacit and consequently it is difficult for the therapist to describe. The current study uses a range of knowledge elicitation (KE) approaches, a technique not used before in SLT, as a way of accessing this tacit knowledge. There is currently no agreed framework that establishes key factors underpinning practice for preschool children with speech and language disorders. This paper attempts to address that gap. Aims: To develop a framework of SLTs' practice when working with preschool children with developmental speech and language disorders (DS&LD). Methods & Procedures: A mixed-methods approach was adopted for this study. Data were collected iteratively, from 245 SLTs with experience of working with preschool children with DS&LD across sites in England, by means of focus groups and national events. There were three stages of data collection: local sites, specific-interest groups and two national events. KE techniques were used to gather data, with initial data being collected in local site focus groups. Findings from groups were taken to subsequent larger groups where a combination of concept mapping, teach-back and sorting exercises generated a more detailed description of practice, using discussion of consensus and disagreement to stimulate further exploration and definition and provide validatory evidence. Outcomes & Results: This paper provides a high-level framework of therapy for preschool children with DS&LD that makes practice explicit in this area. The framework proposes that therapists' aims for this group of children fall into three categories: addressing children's areas of impairment and skills; achieving functionally meaningful skills and carryover; and supporting adults to provide a supportive communication environment. The exact configuration is shaped by the child's context and needs. Conclusions & Implications: The framework highlights themes that are well researched in the literature (e.g., speech) and others that have been little studied (e.g., adult understanding), indicating a disconnect between research evidence and practice. The research also highlights the complex nature of interventions for preschool children with DS&LD and the importance therapists attribute to tailoring therapy to individual needs. The framework provides a scaffold upon which SLTs can focus their clinical practice and encourages the profession to understand and explore better the gaps between research evidence and clinical practice for preschool children with DS&LD.
Child Language Teaching and Therapy, 2012
This article reports a series of interviews with education and health practitioners. The aims were to identify interventions used in practice with children with speech, language and communication needs, to explore explanations for the choice of intervention and to identify the ways that outcomes were measured. Participants ( n = 61) included educational psychologists, speech and language therapists and education advisory staff. They talked about interventions in terms of published programmes, principles and activities, strategies, resources and training programmes. There was evidence of local adaptation of interventions and wide development of local programmes. The choice of intervention was governed by a desire to meet identified service gaps and with reference to the evidential and/or theoretical basis of the intervention and the practicalities of the intervention. Outcomes were typically measured at the level of the individual rather than a service level. The study provided insig...
International Journal of Language & Communication Disorders, 2011
Background: A randomized controlled trial was conducted of a whole-service cohort of children referred to the Paediatric Speech and Language Therapy Service of Middlesbrough Primary Care Trust between January 1999 and April 2000. The 730 children involved, aged up to 16 years, were diagnosed with primary speech and/or language impairment in the absence of any learning, physical or sensory difficulty. Aims: The study considered outcomes of treatment versus no treatment. Methods & Procedures: Treatment involved clinic-based interventions, provided according to local departmental criteria and care pathways, averaging 5.5 h (range 0-24 h) of contact during the 6-month period immediately following initial assessment. Assessments occurred within 8 weeks of referral and intervention began immediately thereafter. Outcomes & Results: Treatment was significantly more effective than no treatment, over 6 months, both overall (p < 0.001) and for each of the three diagnostic categories (comprehension, expression and speech, each p < 0.001). Conclusions: An average of 6 h of speech and language therapy in a 6-month period can produce significant improvement in performance, and it has been shown to be more effective than no treatment over the same 6-month period for children with primary speech and/or language impairment.
Journal of communication disorders
Parents of 210 preschool children (age 2–5.7) and their clinicians were asked to describe their expectations for therapy and the changes they observed following treatment. Based on content analysis of the parents’ and clinicians’ responses, it was apparent that the comments aligned with the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health—Child and Youth version (ICF-CY) framework. Parents and clinicians observed positive changes across the ICF-CY domains of Body Functions, Activities and Participation and Personal Factors following therapy. Parents noted twice as many changes in the Participation and Personal Factors domains as clinicians. Parents described improvements in play, socialization, confidence and behaviour at home, school and in the community—changes not typically captured by other preschool speech and language outcome measures. New outcome measures need to be based on actual observations of change by both parents and clinicians to ensure that they measure a sufficiently broad-based range of skills.Learning outcomes: The reader will better understand (1) the parents’ expectations for therapy (2) the types of changes that can be associated with speech and language therapy and (3) the need for broad-based outcome measures that can evaluate speech and language outcomes.
Developmental medicine and child neurology, 2014
The aim of the study was to develop an ecologically valid synthesis of the evidence underpinning interventions for children with speech, language, and communication needs (SLCN), integrating a range of different data sources. Three sources of information were integrated: the Cochrane Review of interventions for children with primary speech and language delays/disorder; current practice from an online survey of 534 speech and language therapists and other professionals working with children with SLCN; and parent reports of preferred outcomes. Evidence was ranked as strong, moderate, or indicative. Of the 58 interventions identified, three (5%) were found to have a strong level of evidence, 32 (56%) had moderate evidence, and 23 (39%) had indicative evidence. Five were universal interventions, the remainder targeted and universal. The integrated findings were then turned into an online interactive database, which is moderated and updated at regular intervals. There are a number of int...