Environmental influences on communication development: Implications for children with neurodevelopmental communication impairments

At the intersection of clinical neuroscience and communication sciences and disorders, this dissertation provides a compilation of studies aimed at examining contextual influences on children's communication development and the implications of this work for children with neurodevelopmental communication impairments. As discussed in Chapter 1, the present work is grounded in dynamic systems theory of development and a distributed model of communication, which together emphasize development as a context-dependent dynamic multilevel system that unfolds over time and is shaped by a multitude of factors. Neurodevelopmental communication impairments such as speech sound disorder, language disorder, and autism spectrum disorder affect approximately 1.5 - 16% of children, and are associated with academic, socioemotional, and behavioral difficulties. The work in Chapter 2 directly examines a common form of environmental support for children with neurodevelopmental communication impairments, speech-language therapy. More specifically, it assesses the effectiveness of a multimodal, integrated speech-language intervention in facilitating multisyllabic productions in six children 2-4 years of age with various neurodevelopmental disabilities. It uses single-case and within-subject experimental designs to understand individual trajectories and shape clinical practice. As a complement to the behavioral intervention, Chapter 3 of this thesis explores the novel use of noninvasive biosensors to measure electrical conductance across the skin during speech-language and occupational therapy as a potential support for communication in eight children, ages 2-11, with neurodevelopmental disabilities. Skin conductance is mediated by sympathetic cholinergic sudomotor nerve fibers and has been used extensively in the study of psychological states and processes. However, traditionally its use has been limited to highly controlled laboratory settings, whereas the use of such technology within the context of daily activities remains a major challenge. Next, as a means to examine a broader range of environmental influences, Chapter 4 uses a longitudinal monozygotic (MZ) twin difference method, a genetically sensitive design, to examine four candidate nonshared environmental influences on children's language development: birthweight, breastfeeding, and home reading exposure and parenting (M age = 7). This study aims to identify nonshared environmental effects on later language development, at mean ages 10 (n = 115 pairs) and 12 years (n = 108 pairs), across two assessment contexts: standardized testing and narrative language sampling. Finally, Chapter 5 concludes this dissertation by highlighting the need to study a broader range of contextual factors influencing communication development and its associated mechanisms, incorporate diverse and complementary methodologies, and develop effective communication supports for children with neurodevelopmental communication impairments

Facilitating multisyllabic productions & assessing sympathetic arousal in children with developmental disorders

Speech-language impairments represent one of the most common developmental disorders, ranging from 1.3-14.3%. In particular the ability to combine syllables represents an important developmental milestone that is delayed or impaired in a variety of clinically-identified populations. However, evidence to support specific treatment practices in this area is relatively sparse. In addition, limited information is available regarding how children's sympathetic arousal is associated with interventions. Recent technological advances in electrodermal activity (EDA) interfaces, as seen in the Q sensor (Affectiva, 2012), provide the opportunity to conduct in situ EDA assessments. EDA is sensitive to both cognitive and emotional states and processes, thereby offering the potential to derive information regarding children’s internal states during intervention. The present study 1) examined the effectiveness of an integrated speech-language intervention in increasing children's multisyllabic productions, 2) assessed the associations between in situ EDA and off-line behavioral coding of emotional valence, and 3) examined the association among different EDA measures.Ope

COVID-19 healthcare and social-related needs from the perspective of Spanish patients and healthcare providers: a qualitative analysis of responses to open-ended questions

Identifying stakeholders’ needs is crucial to informing decisions and policy development. This study aims to identify healthcare and social-related needs and effective strategies associated with COVID-19 from the first-person perspectives of patients and healthcare providers. Methods: Cross-sectional online survey design including qualitative open-ended questions, conducted in primary care and hospital settings across Spain, with 12 out of 19 regions represented. Adults aged 18 years and older, who (a) resided in Spain and had a history of COVID-19 or (b) worked as healthcare providers delivering direct or indirect care for people with COVID-19 in Spanish primary care or hospitals during 2020 were eligible to participate. Recruitment was conducted via social-media networks (Twitter, LinkedIn, and WhatsApp) and communication channels of key organizations including patient and professional associations and groups. A total of 182 people were invited to complete the surveys and 76 people completed the surveys (71% women), of which 33 were home-isolated patients, 14 were hospitalized patients, 16 were primary care professionals, and 13 were hospital care professionals. Results: A total of 327 needs and 86 effective strategies and positive aspects were identified across surveys and classified into the following overarching themes: (i) Accessibility, (ii) Basic needs, (iii) Clinical care, (iv) Person-and-family centered care, (v) Caring for the healthcare professional, (vi) Protocolization, information, health campaigns, and education, (vii) Resource availability, (viii) and Organizational needs/strategies. Discussion: Findings indicate the Spanish health and social care systems were generally unprepared to combat COVID-19. Implications for research, practice, and policy focus on integrating first-person perspectives as best practice to identify, prioritize and address needs to increase health and social care systems capacity and preparedness, as well as providing well-co-coordinated responses across government, healthcare, and non-government sectors to promote and protect the physical and mental health of al

COVID-19 healthcare and social-related needs from the perspective of Spanish patients and healthcare providers: a qualitative analysis of responses to open-ended questions

IntroductionIdentifying stakeholders’ needs is crucial to informing decisions and policy development. This study aims to identify healthcare and social-related needs and effective strategies associated with COVID-19 from the first-person perspectives of patients and healthcare providers.MethodsCross-sectional online survey design including qualitative open-ended questions, conducted in primary care and hospital settings across Spain, with 12 out of 19 regions represented. Adults aged 18 years and older, who (a) resided in Spain and had a history of COVID-19 or (b) worked as healthcare providers delivering direct or indirect care for people with COVID-19 in Spanish primary care or hospitals during 2020 were eligible to participate. Recruitment was conducted via social-media networks (Twitter, LinkedIn, and WhatsApp) and communication channels of key organizations including patient and professional associations and groups. A total of 182 people were invited to complete the surveys and 76 people completed the surveys (71% women), of which 33 were home-isolated patients, 14 were hospitalized patients, 16 were primary care professionals, and 13 were hospital care professionals.ResultsA total of 327 needs and 86 effective strategies and positive aspects were identified across surveys and classified into the following overarching themes: (i) Accessibility, (ii) Basic needs, (iii) Clinical care, (iv) Person-and-family centered care, (v) Caring for the healthcare professional, (vi) Protocolization, information, health campaigns, and education, (vii) Resource availability, (viii) and Organizational needs/strategies.DiscussionFindings indicate the Spanish health and social care systems were generally unprepared to combat COVID-19. Implications for research, practice, and policy focus on integrating first-person perspectives as best practice to identify, prioritize and address needs to increase health and social care systems capacity and preparedness, as well as providing well-co-coordinated responses across government, healthcare, and non-government sectors to promote and protect the physical and mental health of all

Global Healthcare Needs Related to COVID-19 : An Evidence Map of the First Year of the Pandemic

FADQThis work was funded by the Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP) and the Regional Ministry of Health of the Community of Madrid through non-refundable grants from the credits awarded to the Community of Madrid by the Spanish Government Fund COVID-19, included in Order HAC/667/2020.The COVID-19 pandemic has exposed gaps and areas of need in health systems worldwide. This work aims to map the evidence on COVID-19-related healthcare needs of adult patients, their family members, and the professionals involved in their care during the first year of the pandemic. We searched the databases MEDLINE, Embase, and Web of Science. Two reviewers independently screened titles and abstracts and assessed full texts for eligibility. Disagreements were resolved by consensus. Descriptive data were extracted and inductive qualitative content analysis was used to generate codes and derive overarching themes. Thirty-six studies met inclusion criteria, with the majority reporting needs from the perspective of professionals (35/36). Professionals' needs were grouped into three main clusters (basic, occupational, and psycho-socio-emotional needs); patients' needs into four (basic, healthcare, psycho-socio-emotional, and other support needs); and family members' needs into two (psycho-socio-emotional and communication needs). Transversal needs across subgroups were also identified and grouped into three main clusters (public safety, information and communication, and coordination and support needs). This evidence map provides valuable insight on COVID-19-related healthcare needs. More research is needed to assess first-person perspectives of patients and their families, examine whether needs differ by country or region, and evaluate how needs have evolved over time