Allocation and funding of speech and language therapy for children with developmental language disorders across Europe and beyond

Background: Children with Developmental Language Disorder (DLD) have a significant deficit in spoken language ability which affects their communication skills, education, mental health, employment and social inclusion. Aim: The present study reports findings from a survey by EU network COST ACTION 1406 and aims to explore differences in service delivery and funding of SLT services for children with DLD across Europe and beyond. Methods and procedures: The survey was completed by 5024 European professionals. COST countries were grouped into Nordic, Anglo-Saxon, Continental, Mediterranean, Central/Eastern and Non-European categories. The use of direct, indirect and mixed interventions, and their relationship to funding available (public, private or mixed) were considered for further analysis. Outcomes and results: The results revealed that for direct therapy, there were more cases than expected receiving private funding. For indirect therapy, fewer than expected received private and more than expected public funding. For mixed therapy, fewer cases than expected received private funding. Conclusions and implications: The results implies that other factors than evidence-based practices, practitioners experience, and patient preferences, drive choices in therapy. More research is needed to gain a better understanding of factors affecting the choice of therapy

Allocation and funding of Speech and Language Therapy for children with Developmental Language Disorders across Europe and beyond

Background: Children with Developmental Language Disorder (DLD) have a significant deficit in spoken language ability which affects their communication skills, education, mental health, employment and social inclusion. Aim: The present study reports findings from a survey by EU network COST ACTION 1406 and aims to explore differences in service delivery and funding of SLT services for children with DLD across Europe and beyond. Methods and procedures: The survey was completed by 5024 European professionals. COST countries were grouped into Nordic, Anglo-Saxon, Continental, Mediterranean, Central/Eastern and Non-European categories. The use of direct, indirect and mixed interventions, and their relationship to funding available (public, private or mixed) were considered for further analysis. Outcomes and results: The results revealed that for direct therapy, there were more cases than expected receiving private funding. For indirect therapy, fewer than expected received private and more than expected public funding. For mixed therapy, fewer cases than expected received private funding. Conclusions and implications: The results implies that other factors than evidence-based practices, practitioners experience, and patient preferences, drive choices in therapy. More research is needed to gain a better understanding of factors affecting the choice of therapy

How aware is the public of the existence, characteristics and causes of language impairment in childhood and where have they heard about it? A European survey

Public awareness of language impairment in childhood (Developmental Language Disorder (DLD)) has been identified as an important determiner of research and clinical service delivery, yet studies directly assessing public awareness are lacking. This study surveyed awareness across 18 countries of Europe.Method: A questionnaire developed by an international team asked whether respondents had heard of language impairment affecting children, what they thought its manifestations and causes were and where they had heard of it. Respondents were also asked whether they had heard of autism, dyslexia, ADD/ADHD and speech disorder. The questionnaire was administered to members of the public in 18 European countries. A total of 1519 responses were obtained, spanning 6 age groups, 4 educational level groups and 3 income level groups.Results: Across all but one country, significantly fewer people had heard of language impairment than any of the other disorders (or 60 % compared to over 90 % for autism). Awareness tended to be lowest in Eastern Europe and greatest in North-Western Europe, and was influenced by education level, age and income level. People in countries with overall low and overall high awareness differed in their views on manifestations and causes. People had heard of language impairment and autism the same way - most frequently through the media, including Internet, and less frequently through their child’s school or a medical professional.Discussion: The study confirms that awareness of language impairment and knowledge of the breadth of its manifestations are low. It also suggests opportunities for how to increase awareness, including greater media coverage of language impairment and more efficient use of venues such as schools and healthcare. Ways in which cultural and linguistic differences may influence public awareness efforts are discussed, including the translatability of clinical labels and scientific terms. These may impact the acceptance of a common term and definition across all countries. As awareness campaigns are gaining momentum, the findings of this study can serve as a baseline against which to compare future findings.peer-reviewe

Childhood Bilingualism and Reading Difficulties : Insights from Cognition and Pedagogy

We are living in a world in which bi/multilingualism has become commonplace within everyday life for a great number of people. Research has shown that bilingualism produces various cognitive consequences. These effects are generally seen as positive and contributing to an enhanced level of cognitive processing. Bilingualism functions selectively to produce outcome performances depending on the areas that are the subject of investigation. Furthermore, the patterns of results may vary if second-language reading occurs in a dyslexic context. Thus, many children may struggle with this situation, suggesting the need for the provision of a special education agenda in schools. The intention of this dissertation is to address the abovementioned topics. In study I, the effect of bilingualism on lexical vs. non-lexical reading tasks is examined. This study finds that the pattern of the effect might vary based on the type of reading task (e.g., semantic or phonological origins for information processing). In studies II and III, the combined effect of bilingualism and reading difficulties on executive functions (working memory, inhibitory control and flexibility) and on longterm memory (episodic and semantic) is examined. These studies find that, in line with primary expectations, bilingualism in typically developed reading is associated with enhanced overall cognitive performance in either executive functioning or episodic and semantic memory. Interestingly, the combination of second-language reading and reading difficulties is associated with lower performance (longer processing time) for executive functioning and long-term memory (specifically episodic memory). It is suggested that this pattern of performance is produced by a general delayed processing profile in the context of bilingualism and reading difficulties. The findings are discussed in light of the notion of inefficient and difficult learning of new input in terms of dyslexic problems. Study IV explores special education teachers’ assumptions with respect to the type of special education services in Swedish schools with a high proportion of (bilingual) pupils with reading difficulties. The findings of this study underscore the importance of the provision of special bi-literacy education for bilingual dyslexic children in schools and the current shortcomings regarding time and knowledge resources in this regard

Childhood Bilingualism and Reading Difficulties : Insights from Cognition and Pedagogy

We are living in a world in which bi/multilingualism has become commonplace within everyday life for a great number of people. Research has shown that bilingualism produces various cognitive consequences. These effects are generally seen as positive and contributing to an enhanced level of cognitive processing. Bilingualism functions selectively to produce outcome performances depending on the areas that are the subject of investigation. Furthermore, the patterns of results may vary if second-language reading occurs in a dyslexic context. Thus, many children may struggle with this situation, suggesting the need for the provision of a special education agenda in schools. The intention of this dissertation is to address the abovementioned topics. In study I, the effect of bilingualism on lexical vs. non-lexical reading tasks is examined. This study finds that the pattern of the effect might vary based on the type of reading task (e.g., semantic or phonological origins for information processing). In studies II and III, the combined effect of bilingualism and reading difficulties on executive functions (working memory, inhibitory control and flexibility) and on longterm memory (episodic and semantic) is examined. These studies find that, in line with primary expectations, bilingualism in typically developed reading is associated with enhanced overall cognitive performance in either executive functioning or episodic and semantic memory. Interestingly, the combination of second-language reading and reading difficulties is associated with lower performance (longer processing time) for executive functioning and long-term memory (specifically episodic memory). It is suggested that this pattern of performance is produced by a general delayed processing profile in the context of bilingualism and reading difficulties. The findings are discussed in light of the notion of inefficient and difficult learning of new input in terms of dyslexic problems. Study IV explores special education teachers’ assumptions with respect to the type of special education services in Swedish schools with a high proportion of (bilingual) pupils with reading difficulties. The findings of this study underscore the importance of the provision of special bi-literacy education for bilingual dyslexic children in schools and the current shortcomings regarding time and knowledge resources in this regard

Special Education Teachers’ Narratives on Literacy Support for Bilingual Students with Dyslexia in Swedish Compulsory Schools

The aim of the study is to investigate how special education teachers talk about their teaching in relation to bilingual students with dyslexia within Swedish compulsory schools. Data consist of transcripts from in-depth interviews with 15 special education teachers. According to the teacher narratives, the special education services appeared to be biased against bilingual students, as the support provided to bilingual students with dyslexia was revealed to be more or less the same as that provided to monolingual Swedish-speaking students with dyslexia. This bias is discussed in relation to the notion of difference blindness as well as in relation to practical constraints. Nevertheless, the teachers strongly advocated collaborative work with mother tongue teachers in order to facilitate dyslexia identification in bilingual students and to gain a more comprehensive picture of their language and literacy competencies, which is a desire that contrasts and contests a pedagogical monolingual master model within special education services

Sweden

Developments in the understanding of language disorders and the progression of clinical practice for children with developmental language disorder (DLD) in Sweden started with a focus on speech, with a gradual widening of focus towards other aspects of language skills – grammar, semantics, comprehension and pragmatics. Alfhild Tamm (1876–1959) was a pioneer in the field, who brought attention to the phenomenon of speech disorder (sw. talrubbning). She was a medical doctor specialised in psychiatry and neurology (Nettelbladt and Samuelsson, 1998). In her special task to assess children in classes for under-achievers in schools in the Stockholm area she noticed that many children with speech difficulties (as well as children with reading and writing difficulties) had non-verbal skills within the normal range (Nettelbladt, 2007; Nettelbladt and Samuelsson, 1998). During the second decade of the twentieth century she started a special clinic for those children and she also wrote a textbook on the topic (Talrubbningar och deras behandling, 1916). Alfhild Tamm’s view on speech disorders as a phenomenon was based in medical science, whereas her view on intervention was based in pedagogy. Although the focus was on speech difficulties, she was also aware of comprehension difficulties and she described agrammatism. Furthermore, she found it relevant to distinguish between general developmental delay and a specific language disorder (Nettelbladt, 2007; Nettelbladt and Samuelsson, 1998). However, it was phoniatrician Gunnar Bjuggren who established modern phoniatric-logopedic care in Sweden by opening a phoniatric clinic at Sabbatsbergs hospital (Lindström, 2008)