Supporting early communication skills of children with developmental disorders in South Africa : caregiver and clinician perspectives about mobile health applications

Using a mobile health application (i.e., app) to empower primary caregivers of young children with developmental disorders in low- and middle-income countries is opening up new avenues for early childhood intervention. Thirteen caregivers and 10 speech-language pathologists participated in 3 focus groups to explore their perspectives about the potential benefits and suitability of a mobile health app as part of intervention, its features, the likelihood of using and recommending it, as well as potential pitfalls to be avoided. Both participant groups were generally positive, although there was little overlap between their responses. Caregivers generally focused on increased knowledge and skills (of all family members), as well as on empowerment and reduced costs. Speech-language pathologists, on the other hand, focused on how current service delivery would be enriched by increasing the dosage of therapy and enhancing parental cooperation. They also expected that the reach of service delivery would be expanded as more children and caregivers could potentially benefit. Although technology (i.e., mobile apps) could open up new possibilities for service delivery in this population, the perspectives of all stakeholder groups should be considered to ensure successful adoption of such technologies.The United States National Institute of Deafness and Other Communication Disorders (NIDCD) through the National Institutes of Health (NIH) Fogarty International Center (FIC) mhealth initiative to Georgia State University.http://www.iycjournal.com2021-10-01hj2020Centre for Augmentative and Alternative Communication (CAAC

A mHealth application for the training of caregivers of children with developmental disorders in South Africa : rationale and initial piloting

BACKGROUND : Evidence-based mobile health (mHealth) interventions have been successful for an array of physical and mental health conditions. Children with developmental disorders (DD) often have secondary speech and language disorders. The lack of high-quality medical and educational services in low- and middle-income countries limits the opportunities for children with DD to succeed in life. South Africa currently offers limited access to education, social, and health services. METHODS : Twelve caregivers of twelve children with DD between the ages of 3 and 6 years who already received monthly early childhood therapy participated in this study. A mHealth app, called Nna’Le’wena, a Setswana phrase meaning “Me and You”, was designed, developed, installed, and tested on tablets. The app provided a systematic framework and guidance to the caregivers in order to use evidence-based communication interaction strategies with the children over a twelve-week period. The app could be used offline and provided audio instructions in English and Setswana, two dominant languages in South Africa. The app automatically generated log files and collected answers to weekly surveys. At the end of the study, caregivers were asked to evaluate the app by using relevant portions of the Mobile App Rating Scale (MARS). RESULTS : Caregivers were able to successfully interact and use the app. The app was well-received and liked by the caregivers. Caregivers listened to the instructional audios in English and Setswana during the 12-week period. They were able to provide communication opportunities to their children during daily living activities, especially during play- and mealtime activities. CONCLUSIONS : The Nna’Le’wena app was successfully deployed and used by caregivers of children with DD. mHealth solutions can be effective and are relatively affordable solutions that can enhance health care and educational delivery in different settings, including in low-and middle-income countries with limited Internet capabilities.National Institute of Deafness and Other Communication Disorders, National Institutes of Health.https://mhealth.amegroups.orghj2024Centre for Augmentative and Alternative Communication (CAAC)SDG-03:Good heatlh and well-beingSDG-04:Quality Educatio

Using a self-guided app to provide communication strategies for caregivers of young children with developmental disorders

One important evidence-based component of early communication interventions in high-income countries is teaching parents and other primary caregivers to provide communication opportunities in daily activities to stimulate the development of beginning communication skills. To address some of the barriers to communication interventions for children with developmental disorders (DD) in rural South Africa, we developed a prototype Web-based selfguided app for caregivers to use at home with their children with DD who were at the beginning stages of communication development. The purpose of this study is to examine how this app intervention functioned for caregivers and its secondary effects on their children. Fifty-one caregiver-child dyads were randomly assigned to either a typical care intervention group (a 30- minute hospital-based intervention once a month) or the self-guided mobile health technology (MHT) app plus the typical care intervention. We assessed both the caregivers and their children. The majority of the 27 caregiver-child dyads (81%) assigned to the app group used the app and completed a mean of 35.8 sessions across the 48 sessions (mean range = 5.08–15.75). Eighty percent of these caregivers employed the “help” function of the app (M per caregiver = 9.89). The caregivers who completed 44–48 sessions reported that more than half of the children moved from pre-symbolic forms of communication (e.g., crying) to symbolic forms of communication (e.g., words) by the end of the intervention. Compared to the typical care group, the caregivers perceived that their children's success increased even though their difficulties remained stable. The app group showed a very modest gain in expressive language while the typical care group did not. The findings suggest that the self-guided app framework shows promise as a supplement to traditional monthly speechlanguage intervention in South Africa.The National Institute of Deafness and Other Communication Disorders and the NIH Fogarty International Center.https://onlinelibrary.wiley.com/journal/17411130am2024Centre for Augmentative and Alternative Communication (CAAC)SDG-03:Good heatlh and well-bein

Adapting and translating the Mullen Scales of Early Learning for the South African context

BACKGROUND : South African speech-language therapists have identified the need for culturally valid and sensitive assessment tools that can accommodate multiple languages and cover a reasonable age range. The Mullen Scales of Early Learning (MSEL) extend from birth to 68 months, contain five separate subscales including receptive language, expressive language, gross motor, fine motor and visual reception scale, are straightforward to administer and have been successfully used in other African countries, such as Uganda. It also identifies a child’s strengths and weaknesses and provides a solid foundation for intervention planning. OBJECTIVES : This research aimed to demonstrate the appropriateness and usefulness of the translated and culturally and linguistically adapted MSEL across four South African languages (Afrikaans, isiZulu, Setswana and South African English) through two sub-aims: (1) to describe differences, if any, in MSEL performance across language groups and (2) to describe differences, if any, in MSEL performance between age groups. METHOD : A total of 198 typically developing children between the ages of 21 and 68 months spread across the four language groups were individually assessed with the culturally and linguistically adapted and translated MSEL. RESULTS : A one-way analysis of variance (ANOVA) showed no statistically significant differences between the four language groups for total MSEL scores. A Welch’s one-way ANOVA showed that the total MSEL scores were significantly different between age groups. CONCLUSION : The translation and adaptation of the MSEL was successful and did not advantage or disadvantage children based on their home language, implying that linguistic equivalence was achieved. The MSEL results differed between age groups, suggesting that the measure was also successful in differentiating the performance of children at different developmental levels.Funding for the study was provided by the National Institutes of Health’s Fogarty International Center through grant number TW-008999 to MaryAnn Romski. This research was supported by the United States National Institutes of Health’s Fogarty International Center (grant number TW-008999) to MaryAnn Romski.https://sajcd.org.za/index.php/sajcdam2018Centre for Augmentative and Alternative Communication (CAAC

Parent-implemented augmented communication intervention and young children with Down syndrome: an exploratory report

IntroductionYoung children with Down syndrome (DS) present with speech and language impairments very early in childhood. Historically, early language intervention for children with DS included manual signs, though recently there has been an interest in the use of speech-generating devices (SGDs). This paper examines the language and communication performance of young children with DS who participated in parent-implemented communication interventions that included SGDs. Specifically, we compared the functional vocabulary usage and communication interaction skills of children with DS who received augmented communication interventions (AC) that included an SGD with those children with DS who received spoken communication intervention (SC).MethodsTwenty-nine children with DS participated in this secondary data analysis. These children were part of one of two longitudinal RCT studies investigating the effectiveness of parent-implemented augmented communication interventions in a larger sample of 109 children with severe communication and language impairments.ResultsThere were significant differences between children with DS in the AC and SC groups in terms of the number and proportion of functional vocabulary targets used and the total vocabulary targets provided during the intervention at sessions 18 (lab)and 24 (home).DiscussionOverall, the AC interventions provided the children with a way to communicate via an SGD with visual-graphic symbols and speech output, while the children in the SC intervention were focused on producing spoken words. The AC interventions did not hinder the children’s spoken vocabulary development. Augmented communication intervention can facilitate the communication abilities of young children with DS as they are emerging spoken communicators

Language assessment for children with a range of neurodevelopmental disorders across four languages in South Africa

PURPOSE : The purpose of this study is (a) to examine the applicability of a culturally and linguistically adapted measure to assess the receptive and expressive language skills of children with neurodevelopmental disorders (NDDs) in South Africa and then (b) to explore the contributions of 2 additional language measures. METHOD : In Part 1, 100 children with NDD who spoke Afrikaans, isiZulu, Setswana, or South African English were assessed on the culturally and linguistically adapted Mullen Scales of Early Learning (MSEL). Clinicians independently rated the children's language skills on a 3-point scale. In Part 2, the final 20 children to be recruited participated in a caregiver-led interaction, after which the caregiver completed a rating scale about their perceptions of their children's language. RESULTS : Performance on the MSEL was consistent with clinician-rated child language skills. The 2 additional measures confirmed and enriched the description of the child's performance on the MSEL. CONCLUSIONS : The translated MSEL and the supplemental measures successfully characterize the language profiles and related skills in children with NDD in multilingual South Africa. Together, these assessment tools can serve a valuable function in guiding the choice of intervention and also may serve as a way to monitor progress.The National Institutes of Health Fogarty International Center grant number TW-008999 to MaryAnn Romski.http://ajslp.asha.orghj2018Centre for Augmentative and Alternative Communication (CAAC

THE IMPACT OF CONVERSATIONAL TURN-TAKING ON VOCABULARY SIZE IN CHILDREN WITH DEVELOPMENTAL DISABILITIES USING AUGMENTATIVE AND ALTERNATIVE COMMUNICATION

Conversational turn-taking in families with children who are typically developing has been shown to positively impact their child’s receptive and expressive vocabulary scores. However, limited research analyzes whether this relationship exists in children with developmental disabilities and limited functional speech. Research suggests that augmentative and alternative communication (AAC) facilitates a greater vocabulary size in children with developmental disabilities, but it is unknown if conversational turn-taking impacts its success. This study reduces the gap in the literature by examining the impact of conversational turn-taking on the effectiveness of AAC exposure throughout a 12-week language intervention. Additionally, it examines the growth trajectory of conversational turn-taking throughout the AAC language intervention. The results indicated that AAC exposure moderates the relationship between conversational turns and vocabulary size at the end of the intervention, such that increases in total conversational turns between parent-child dyads predicted greater vocabulary size at the end of the intervention, but only in children exposed to AAC. Moreover, throughout the AAC intervention parents and children exhibited similar quadratic growth curves in conversational turns suggesting that parents are meeting the engagement of their children while participating in the intervention. Clinically, these results imply that language interventions using AAC would benefit from increasing opportunities for more conversational turns, but such techniques would be ineffective in the spoken communication interventions. Additionally, when parents take on the role of interventionist, they should be informed of the importance of conversational turns to match the input of their child and maximize vocabulary growth by the end of the intervention

Parent Stress and Perceptions of Language Development: Comparing Down Syndrome and Other Developmental Disabilities

This study extended research on the Down syndrome advantage by examining differences in parent stress and parent perceptions of language development between 29 parents of young children with Down syndrome and 82 parents of children with other developmental disabilities. Parents of children with Down syndrome reported lower levels of total stress, child-related stress, and stress surrounding the parent–child interaction. Parents of children in both groups reported that they felt successful in their ability to affect their children\u27s communication development but did differ on perceptions of difficulty such that parents of children with Down syndrome perceived their children\u27s communication difficulties as less severe despite the children exhibiting similar language skills. Finally, after accounting for potential explanatory confounding variables, child diagnosis remained a significant predictor of parent stress and perceptions of language development. Results highlight the importance of considering etiology when assisting families raising a child with a disability

Adapting and translating the Mullen Scales of Early Learning for the South African context

Background: South African speech-language therapists have identified the need for culturally valid and sensitive assessment tools that can accommodate multiple languages and cover a reasonable age range. The Mullen Scales of Early Learning (MSEL) extend from birth to 68 months, contain five separate subscales including receptive language, expressive language, gross motor, fine motor and visual reception scale, are straightforward to administer and have been successfully used in other African countries, such as Uganda. It also identifies a child’s strengths and weaknesses and provides a solid foundation for intervention planning. Objectives: This research aimed to demonstrate the appropriateness and usefulness of the translated and culturally and linguistically adapted MSEL across four South African languages (Afrikaans, isiZulu, Setswana and South African English) through two sub-aims: (1) to describe differences, if any, in MSEL performance across language groups and (2) to describe differences, if any, in MSEL performance between age groups. Method: A total of 198 typically developing children between the ages of 21 and 68 months spread across the four language groups were individually assessed with the culturally and linguistically adapted and translated MSEL. Results: A one-way analysis of variance (ANOVA) showed no statistically significant differences between the four language groups for total MSEL scores. A Welch’s one-way ANOVA showed that the total MSEL scores were significantly different between age groups. Conclusion: The translation and adaptation of the MSEL was successful and did not advantage or disadvantage children based on their home language, implying that linguistic equivalence was achieved. The MSEL results differed between age groups, suggesting that the measure was also successful in differentiating the performance of children at different developmental levels