Collaboration between parents and SLTs produces optimal outcomes forchildren attending speech and language therapy: Gathering the evidence

Background: Collaboration between parents and speech and language therapists is seen as a key element in family-centred models. Collaboration can have positive impacts on parental and children’s outcomes. However, collaborative practice has not been well described and researched in speech and language therapy for children and may not be easy to achieve. It is important that we gain a deeper understanding of collaborative practice with parents, how it can be achieved, and how it can impact on outcomes. This understanding could support practitioners in daily practice with regard to achieving collaborative practice with parents in different contexts. Aims: The aim of this paper was to set a research agenda on collaborative practice between parents and speech and language therapists, in order to generate evidence regarding what works, how, for whom, in what circumstances, and to what extent. Methods: A realist evaluation approach was used to make explicit what collaborative practice with parents entails. The steps suggested by the RAMESES II project were used to draft a preliminary programme theory about collaborative practice between parents and speech and language therapists. This process generates explicit hypotheses which form a potential research agenda. Discussion and conclusion: A preliminary programme theory of collaborative practice with parents was drafted using a realist approach. Potential contextual factors (C), mechanisms (M) and outcomes (O) were presented which could be configured into causal mechanisms to help explain what works for whom in what circumstances. CMO configurations were drafted, based on relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesised programme theory for collaborative practice with parents, further testing against a broader literature is required alongside research to explore the functionality of the configurations across contexts. This paper highlights the importance of further research on collaborative practice with parents and the potential value of realist evaluation methodology. What this paper adds: Current policy in education, health and social care advocates for family-centred care and collaborative practice with parents. Thereby, collaborative practice is the preferred practice for speech and language therapists and parents. In this paper, we explored collaborative practice and used a realist evaluation approach to achieve the aim of setting a research agenda in this area. Researchers use realist evaluation, a methodology originally developed by Pawson and Tilley in the 1990s (Pawson and Tilley, 1997), to explore the causal link between interventions and outcomes, summarised as “what works, how, for whom, in what circumstances and to what extent” (Wong et al., 2014, p1). Realist evaluation provides a framework to explore configurations between contexts (C), mechanisms (M) and outcomes (O). We used this methodology to take a first step in making explicit what collaborative practice is and how it might be achieved in different contexts. We did this by drafting a preliminary programme theory about collaborative practice, where we made explicit what context factors and mechanisms might influence outcomes in collaborative practice between parents and SLTs. Based on this programme theory, we argue for the need to develop a research agenda on collaborative practice with parents of children with speech, language and communication needs. The steps between a programme theory and a research agenda could entail exploring each CMO, or step in the programme theory, and evaluating it against the existing literature – both within and beyond speech and language therapy - to see how far it stands up. In this way, gaps could be identified that could be converted into research questions which would stimulate debate about a research agenda on collaborative practice. Understanding how collaborative practice can be achieved in different contexts could support SLTs to use mechanisms to optimise collaborative practice intentionally and tailor interventions to the specific needs of families, thereby enhancing collaborative practice between parents and SLTs

“So, I told him to look for friends!” Barriers and protecting factors that may facilitate inclusion for children with Language Disorder in everyday social settings:cross-cultural qualitative interviews with parents

Purpose: Although researchers have explored parental perspectives on childhood speech and language disorders, this work has mostly been conducted in English-speaking countries. Little is known about parental experiences across countries. Participation in the COST Action IS1406 ‘Enhancing children’s oral language skills across Europe and beyond’ provided an opportunity to conduct cross-cultural qualitative interviews. The aims were to explore how parents construe inclusion and/or exclusion of their child and how parents involve themselves in order to facilitate inclusion. Method: Parents from nine countries and with a child who had received services for speechlanguage disorder participated in semi-structured qualitative interviews. We used thematic analysis to analyze the data. Results: Two overarching themes were identified: ‘Language disabilities led to social exclusion’ and ‘Promoting pathways to social inclusion’. Two subthemes were identified Interpersonal relationships are important and Deliberate proactiveness as stepping stones for social inclusion. Conclusions: Across countries, parents report that their children’s hidden disability causes misunderstandings that can lead to social exclusion and that they are important advocates for their children. It is important that the voices and experiences of parents of children with developmental disabilities are understood and acknowledged. Parents’ recommendations about how to support social inclusion need to be addressed at all levels of society

The Language Profile of Preschool Children With 22q11.2 Deletion Syndrome and the Relationship With Speech Intelligibility

Purpose: Young children with 22q11.2 deletion syndrome (22q11DS) often have impaired language development and poor speech intelligibility. Here, we report a comprehensive overview of standardized language assessment in a relatively large sample of preschool-aged children with 22q11DS. We furthermore explored whether speech ability explained variability in language skills. Method: Forty-four monolingual Dutch preschoolers (3–6 years) with a confirmed genetic 22q11DS diagnosis participated in this prospective cohort study. Standardized tests (Clinical Evaluation of Language Fundamentals Preschool-2-NL and Peabody Picture Vocabulary Test-III-NL) were administered. Speech intelligibility was rated by two expert speech and language therapists using a standardized procedure. Results: Most children had impaired language skills across all tested domains. The composite score for expressive language was significantly lower than that for receptive language, but the two were strongly correlated. Only small differences between the mean scores on the various subtests were observed, with the lowest scores for expressive morphosyntactic skills. Language scores showed a moderate positive relation with speech intelligibility, but language abilities varied greatly among the children with intelligible speech. Conclusions: We show that the majority of preschool children with 22q11DS have a broad range of language problems. Other than the relatively larger impairment in expressive than in receptive language skills, our results do not show a clearly delineated language profile. As many of the children with intelligible speech still had below-average language scores, we highlight that language problems require a broad assessment and care in all young children with 22q11DS. Future research using spontaneous language and detailed speech analysis is recommended, to provide more in-depth understanding of children's language profile and the relationship between speech and language in 22q11DS

Patterns Bit by Bit. An Entropy Model for Rule Induction

From limited evidence, children track the regularities of their language impressively fast and they infer generalized rules that apply to novel instances. This study investigated what drives the inductive leap from memorizing specific items and statistical regularities to extracting abstract rules. We propose an innovative entropy model that offers one consistent information-theoretic account for both learning the regularities in the input and generalizing to new input. The model predicts that rule induction is an encoding mechanism gradually driven as a natural automatic reaction by the brain’s sensitivity to the input complexity (entropy) interacting with the finite encoding power of the human brain (channel capacity). In two artificial grammar experiments with adults we probed the effect of input complexity on rule induction. Results showed that as the input becomes more complex, the tendency to infer abstract rules increases gradually

Are Dutch posture verbs lexical or functional elements?

In Dutch, posture verbs like liggen ‘lie’ and staan ‘stand’ are obligatorily used in locative constructions with inanimate subjects, classifying the spatial Figure-Ground relation. Prima facie, in this use, posture verbs seem more like functional elements than like lexical verbs. This paper investigates processing of Dutch posture verbs in a reference resolution task in the visual world paradigm, to get more clarity on the nature of these verbs. We know that lexical verbs like rinkelen ‘ring’ cause anticipatory looks towards a matching target referent like telefoon ‘telephone’; and that they suppress looks to a phonological competitor like telescoop ‘telescope’. The functional property of grammatical gender on determiners (de vs. het) is less robust in directing looks. When it comes to anticipating the target referent, and suppressing looks to a phonological competitor, do posture verbs pattern with lexical verbs, or with functional elements like grammatical gender

Fast but Not Furious. When Sped Up Bit Rate of Information Drives Rule Induction

The language abilities of young and adult learners range from memorizing specific items to finding statistical regularities between them (item-bound generalization) and generalizing rules to novel instances (category-based generalization). Both external factors, such as input variability, and internal factors, such as cognitive limitations, have been shown to drive these abilities. However, the exact dynamics between these factors and circumstances under which rule induction emerges remain largely underspecified. Here, we extend our information-theoretic model (Radulescu et al., 2019), based on Shannon’s noisy-channel coding theory, which adds into the “formula” for rule induction the crucial dimension of time: the rate of encoding information by a time-sensitive mechanism. The goal of this study is to test the channel capacity-based hypothesis of our model: if the input entropy per second is higher than the maximum rate of information transmission (bits/second), which is determined by the channel capacity, the encoding method moves gradually from item-bound generalization to a more efficient category-based generalization, so as to avoid exceeding the channel capacity. We ran two artificial grammar experiments with adults, in which we sped up the bit rate of information transmission, crucially not by an arbitrary amount but by a factor calculated using the channel capacity formula on previous data. We found that increased bit rate of information transmission in a repetition-based XXY grammar drove the tendency of learners toward category-based generalization, as predicted by our model. Conversely, we found that increased bit rate of information transmission in complex non-adjacent dependency aXb grammar impeded the item-bound generalization of the specific a_b frames, and led to poorer learning, at least judging by our accuracy assessment method. This finding could show that, since increasing the bit rate of information precipitates a change from item-bound to category-based generalization, it impedes the item-bound generalization of the specific a_b frames, and that it facilitates category-based generalization both for the intervening Xs and possibly for a/b categories. Thus, sped up bit rate does not mean that an unrestrainedly increasing bit rate drives rule induction in any context, or grammar. Rather, it is the specific dynamics between the input entropy and the maximum rate of information transmission

Zipf's law in aphasic speech: An investigation of word frequency distributions

Word frequencies in a text follow a curious pattern. A few of them appear extremely frequently, while by far most of them appear only once or twice. This pattern is considered a law of word frequencies, and better known as Zipf’s law. Its universality renders Zipf’s law one of the very few true language universals. The existence of this law has been known for more than a century. It has extensively been studied in large corpora of written texts and in many different languages, but hardly so in more singular cases such as spoken language and speech from people with a language disorder such as aphasia. This dissertation aims to fill this gap, to gain more insight into the workings of word frequencies on the one hand, and in the organization of the mental lexicon in people with and without aphasia on the other. First, the process of speech production is discussed, both in people with and without aphasia. Next, a thorough discussion of the hypotheses for the existence of Zipf’s law is presented. These explanations fall into a number of categories: The Principle of Least Effort, intermittent silence, preferential attachment, new optimization models (present day versions of the Principle of Least Effort) and a variety of semantic explanations. It is argued that models based on preferential attachment are most plausible. Next, it is shown how the values of the parameters of Zipf’s law vary depending on medium (written or spoken) and text length. In addition, a text is created for which Zipf’s law does not hold, to test if this is possible and how readers respond to such a text. These insights are then used to study Zipf’s law in different types of aphasic speech: in long samples from Dutch non-fluent aphasic speakers at 2, 5 and 8 months post onset and in short samples from English, Greek and Hungarian fluent and non-fluent aphasic speakers in the chronic stage of aphasia. It is shown that aphasia influences the values of the parameters, as does the language under consideration. But in all cases, Zipf’s law continues to apply. This finding strengthens the hypothesis that the system for word retrieval in aphasia is still intact

Compensatory and adaptive responses to real-time formant shifts in adults and children

Auditory feedback plays an important role in speech motor learning, yet, little is known about the strength of motor learning and feedback control in speech development. This study investigated compensatory and adaptive responses to auditory feedback perturbation in children (aged 4–9 years old) and young adults (aged 18–29 years old). Auditory feedback was perturbed by near-real-time shifting F1 and F2 of the vowel /ɪː/ during the production of consonant-vowel-consonant words. Children were able to compensate and adapt in a similar or larger degree compared to young adults. Higher token-to-token variability was found in children compared to adults but not disproportionately higher during the perturbation phases compared to the unperturbed baseline. The added challenge to auditory-motor integration did not influence production variability in children, and compensation and adaptation effects were found to be strong and sustainable. Significant group differences were absent in the proportions of speakers displaying a compensatory or adaptive response, an amplifying response, or no consistent response. Within these categories, children produced significantly stronger compensatory, adaptive, or amplifying responses, which could be explained by less-ingrained existing representations. The results are interpreted as both auditory-motor integration and learning capacities are stronger in young children compared to adults

A psycholinguistic framework for diagnosis and treatment planning of developmental speech disorders.

Background: Differential diagnosis and treatment planning of developmental speech disorders (DSD) remains a major challenge in paediatric speech-language pathology. Different classification systems exist, in which subtypes are differentiated based on their theoretical cause and in which the definitions generally refer to speech production processes. Accordingly, various intervention methods have been developed aiming at different parts of the speech production process. Diagnostic classification in these systems, however, is primarily based on a description of behavioural speech symptoms rather than on underlying deficits. Purpose: In this paper, we present a process-oriented approach to diagnosis and treatment planning of DSD. Our framework comprises two general diagnostic categories: developmental delay and developmental disorder. Within these categories, treatment goals/targets and treatment methods are formulated at the level of processes and rules/representations. Conclusion: A process-oriented approach to diagnosis and treatment planning holds important advantages, offering direct leads for treatment aimed at the underlying impairment, tailored to the specific needs of the individual and adjusted to the developmental trajectory