Evidence based pathways to intervention for children with language disorders

Background: Paediatric SLT roles often involve planning individualised intervention for specific children (provided directly by SLTs or indirectly through non-SLTs), working collaboratively with families and education staff and providing advice and training. A tiered approach to service delivery is currently recommended, whereby services become increasingly specialised and individualised for children with greater needs.  Aims: To examine 1) evidence of intervention effectiveness for children with language disorders at different tiers and 2) evidence regarding SLT roles; and to propose an evidence-based model of SLT service delivery.  Methods: Controlled, peer-reviewed studies, meta-analyses and systematic reviews of interventions for children with language disorders are reviewed and their outcomes discussed, alongside the differing roles SLTs play in these interventions. We indicate where gaps in the evidence base exist and present a possible model of service delivery consistent with current evidence, and a flowchart to aid clinical decision making.  Main Contribution: The service delivery model presented resembles the tiered model commonly used in education services, but divides individualised (Tier 3) services into Tier3A: indirect intervention delivered by non-SLTs, and Tier 3B: direct intervention by an SLT. We report the evidence for intervention effectiveness and which children might best be served by each tier, the role SLTs could take within each, and the evidence of effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well-supported. There is currently limited evidence regarding additional benefit of SLT-specific roles at Tiers 1 and 2. With regard to individualised intervention (Tier 3): children with complex or pervasive language disorders progress significantly following direct individualised intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well-trained, -supported and -monitored.  Conclusions: SLTs have a contribution to make at all tiers, but where prioritisation for clinical services is a necessity, we need to establish the benefits and cost-effectiveness of each contribution. Good evidence exists for SLTs delivering direct individualised intervention, and we should ensure that this is available to those children with pervasive and/or complex language impairments. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches

Evidence-based pathways to intervention for children with language disorders

Background  Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs.  Aims  To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence‐based model of SLT service delivery and a flowchart to aid clinical decision‐making.  Methods & Procedures  Meta‐analyses and systematic reviews, together with controlled, peer‐reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted.  Main Contribution  The service‐delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non‐SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT‐specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored.  Conclusions & Implications  SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost‐effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches

Public health approaches still have room for individualized services: response to commentaries on 'Evidence-based pathways to intervention for children with language disorders'

First paragraph: We welcome these commentaries and an open discussion about SLT roles in improving the lives of children with language disorder. Our motivation comes in part from our lived experiences of situations like those above, where there is a perception from schools and indeed families (cf. Bercow 10 Years On) that the needs of children with language disorder are not being met. We focus our response on three key issues that arise from these thought-provoking comments

Production of change-of-state, change-of-location and alternating verbs: A comparison of children with specific language impairment and typically developing children

Correct use of verb argument structure relies on accurate verb semantic representations whose formation depends partly on use of reverse linking. We predicted that children with Specific Language Impairment (SLI), who have difficulties with reverse linking, would have inaccurate semantic representations for verbs and hence difficulties with verb argument structure. Fifteen participants with SLI (mean age: 13;1), grammar-matched (GM) (8;3), vocabulary-matched (VM) (8;8), and chronological age-matched (CAM) controls (13;1) described 24 video scenes involving four change-of-state, four change-of-location, and four alternating verbs. All groups performed worse on change-of-state than change-of-location verbs. The participants with SLI performed significantly worse than VM and CAM but not GM controls on change-of-state verbs. However, they did not differ from any group on alternating or change-of-location verbs. We concluded young people with persistent SLI have difficulties with aspects of verb argument structure into their teenage years. © 2012 Copyright Psychology Press Ltd