Identification of phonological processes in preschool children's single-word productions

Speech and language therapists (SLTs) often refer to phonological data norms as part of their assessment protocols in evaluating the communication skills of the pre-school child. There is a variety of norms available and although broadly similar, differences are embedded within their definitions of mastery of the adult target system. Presence of velar fronting, stopping of affricates and [s] reduction in the dataset was found to mirror previous research. However, there was a lower than expected incidence by age groups of palato-alveolar fronting, stopping of fricatives and obstruent cluster reduction

The experiences and perspectives of overseas trained speech and language therapists working in the United Kingdom

There is a growing body of research which has investigated the experience of the migrant health worker. However, only one of these studies has included speech and language therapists thus far, and then only with extremely small numbers. The aim of this study was to explore the experiences and perspectives of migrant speech and language therapists living in the UK. Twenty-three overseas qualified speech and language therapists living in the UK completed an online survey consisting of 36 questions (31 closed question, 5 open-ended questions). The majority of participants came from Australia or the USA and moved to the UK early in their careers. Participants reported a range of benefits from working in another country and more specifically working in the UK. The findings were consistent with other research on migrant health workers regarding known pull factors of travel, finance, and career. This study suggests additional advantages to working in the UK were realised once participants had started working in the UK, such as the UK job lifestyle. Finally, the migrant speech and language therapists were similar in profile to other migrant health workers in terms of age and country of origin previously reported in the literature

A systematic scoping review of speech and language therapists’ public health practice for early language development

Background: There have been calls for speech and language therapists (SLTs) to work within a public-health framework to support language development. Innovative practice is reported, but the range of services remains unknown. Furthermore, the potential impact of public health practice in speech and language therapy on early child development is also currently unknown. A new method in SLT research, systematic scoping reviews enable greater breadth of focus than traditional systematic reviews when identifying innovative practice. Aim: To report scope and critically appraise evidence of family-focused health-promotion practice for early language development in this area. Methods & Procedures: Using the Cochrane Public Health Group scoping review framework, data from reports of health-promotion practice with families of children aged 0-3 years were extracted and critically appraised on service delivery, information, reach and evaluation. Main contribution: Group-based service delivery was the most popular form of service delivery. There were limited reports on the information given in services and on their reach. Questionnaires were the most popular reported evaluation method. Quality of evaluations was poor due to lack of replicability and experimental control in the studies reported. Conclusions & Implications: This method of systematic review has highlighted the scope of health-promotion practice in speech and language therapy and also demonstrated the lack of evidence for its effectiveness on child language development. It is argued that systematic scoping reviews are valuable for scoping innovative practice in areas where either there is a lack of robust evidence or there is a high level of heterogeneity in practice or evaluation. To support clinician appraisal of available evidence, recommendations are given for development of questionnaire appraisal and for categorization of evidence levels on summary databases

The Persistence and Functional Impact of English Language Difficulties Experienced by Children Learning English as an Additional Language and Monolingual Peers

Purpose This study explored whether a monolingual-normed English language battery could identify children with English as an additional language (EAL) who have persistent English language learning difficulties that affect functional academic attainment. Method Children with EAL (n = 43) and monolingual English-speaking children (n = 46) completed a comprehensive monolingual-normed English language battery in Year 1 (ages 5–6 years) and Year 3 (ages 7–8 years). Children with EAL and monolingual peers, who either met monolingual criteria for language impairment or typical development on the language battery in Year 1, were compared on language growth between Year 1 and Year 3 and on attainment in national curriculum assessments in Year 2 (ages 6–7 years). Results Children with EAL and monolingual peers who met monolingual criteria for language impairment in Year 1 continued to display comparably impaired overall language ability 2 years later in Year 3. Moreover, these groups displayed comparably low levels of academic attainment in Year 2, demonstrating comparable functional impact of their language difficulties. Conclusion Monolingual-normed language batteries in the majority language may have some practical value for identifying bilingual children who need support with language learning, regardless of the origin of their language difficulties

Aerosol generating procedures, dysphagia assessment and COVID‐19: A rapid review

In response to members’ significant concerns and their request for an examination of the evidence relating to oropharyngeal dysphagia assessment, aerosol‐generating procedures (AGPs) and associated risk of COVID‐19 infection, the Royal College of Speech and Language Therapists (RCSLT) established a COVID‐19 Advisory Group (see the appendix). The group aimed to review the evidence underpinning the current healthcare policies in relation to AGPs, dysphagia assessment, and risk of transmission of and infection with COVID‐19 in response to urgent clinical information needs

How much exposure to English is necessary for a bilingual toddler to perform like a monolingual peer in language tests?

Background Bilingual children are under-referred due to an ostensible expectation that they lag behind their monolingual peers in their English acquisition. The recommendations of the Royal College of Speech and Language Therapists (RCSLT) state that bilingual children should be assessed in both the languages known by the children. However, despite these recommendations, a majority of speech and language professionals report that they assess bilingual children only in English as bilingual children come from a wide array of language backgrounds and standardized language measures are not available for the majority of these. Moreover, even when such measures do exist, they are not tailored for bilingual children. Aims It was asked whether a cut-off exists in the proportion of exposure to English at which one should expect a bilingual toddler to perform as well as a monolingual on a test standardized for monolingual English-speaking children. Methods & Procedures Thirty-five bilingual 2;6-year-olds exposed to British English plus an additional language and 36 British monolingual toddlers were assessed on the auditory component of the Preschool Language Scale, British Picture Vocabulary Scale and an object-naming measure. All parents completed the Oxford Communicative Development Inventory (Oxford CDI) and an exposure questionnaire that assessed the proportion of English in the language input. Where the CDI existed in the bilingual's additional language, these data were also collected. Outcomes & Results Hierarchical regression analyses found the proportion of exposure to English to be the main predictor of the performance of bilingual toddlers. Bilingual toddlers who received 60% exposure to English or more performed like their monolingual peers on all measures. K-means cluster analyses and Levene variance tests confirmed the estimated English exposure cut-off at 60% for all language measures. Finally, for one additional language for which we had multiple participants, additional language CDI production scores were significantly inversely related to the amount of exposure to English. Conclusions & Implications Typically developing 2;6-year-olds who are bilingual in English and an additional language and who hear English 60% of the time or more, perform equivalently to their typically developing monolingual peers

Discriminating disorder from difference using dynamic assessment with bilingual children

The DAPPLE (Dynamic Assessment of Preschoolers’ Proficiency in Learning English) is currently being developed in response to a clinical need. Children exposed to English as an additional language may be referred to speech and language therapy because their proficiency in English is not the same as their monolingual peers. Some, but not all, of these children are likely to have a core language learning difficulty. Clinicians need to be able to distinguish disorder from difference due to a child’s language learning context. The assessment used a test–teach–test format to examine children’s ability to learn vocabulary, sentence structure and phonology. The assessment, which takes less than 60 minutes to administer, was given to 26 children who were bilingual: 12 currently on a speech and language therapy caseload and 14 children matched for age and socio-economic status who had never been referred to speech and language therapy. The DAPPLE data clearly discriminated the two groups. The caseload group required a greater amount of prompting to identify targeted words in the receptive vocabulary assessment and performed less well in the post-teaching expressive component. For sentence structure, the caseload group required more cues to acquire the targeted clause elements in the teaching phase. The caseload group made more phoneme errors at the initial and final assessments than the controls, and the type of errors made differed. Teaching resulted in greater positive change in percent phonemes correct for the caseload participants. Qualitative analyses of individual children’s performance on the DAPPLE suggested that it has the potential to discriminate core language deficits from difference due to a bilingual language learning context. Future directions for development of the test are considered

Screening adult patients with a tracheostomy tube for dysphagia: a mixed-methods study of practice in the UK

Background: Patients with tracheostomy tubes are at risk of aspiration and swallowing problems (dysphagia) and because of their medical acuity, complications in this patient population can be severe. It is well recognised that swallow screening in stroke significantly reduces potential complications by allowing early identification and appropriate management of patients at risk (by health professionals), thereby reducing delays in commencing oral intake and preventing unnecessary, costly interventions by speech and language therapists (SLTs). However, there is no standardised swallow screen for the tracheostomised population and there is a paucity of literature regarding either current or best practice in this area. Aims: The aim of this study was therefore to investigate current United Kingdom (UK) practice for swallow (dysphagia) screening for adult patients with tracheostomy tubes and to explore and describe health professionals’ perceptions of their current practice/current systems used. Methods and Procedures: A mixed methods approach was adopted, comprising a semi-structured online questionnaire and recorded follow-up telephone interviews. Participants were SLTs, nurses and physiotherapists working with patients with tracheostomies. Responses were analysed to determine current practice with regard to swallow screening. Thematic analysis of interviews allowed further exploration and clarification of the questionnaire findings. Outcomes and Results: Two-hundred and twenty one questionnaires were completed. Approximately half (45%) of the participants worked in trusts with formal swallow screens, whilst the remainder used a variety of other approaches to identify patients at risk, often relying on informal links with multidisciplinary teams (MDT). In line with current evidence, patients with neurological diagnoses and a tracheostomy were consistently referred directly to speech and language therapy. Only a quarter of questionnaire participants thought their current system was effective at identifying patients at risk of swallowing problems. Eleven questionnaire participants were interviewed. They highlighted the important role of MDT team working here, emphasising both its strengths and weaknesses when working with these patients. Conclusions and Implications: Current practice in the UK for screening patients with a tracheostomy for swallow problems is varied and often sub-optimal. Despite the evidence base for enhancing outcomes, MDT working is still perceived as problematic. A swallow screening tool for use with this population, to enhance MDT working and ensuring that practice fits in line with current evidence, may improve patient safety and care

Balancing safety and enjoyment: current practice when recommending tastes for people with intellectual disabilities who are non-orally fed

Eating and drinking problems are common among people with intellectual disabilities. Having a compromised swallow or being at risk of inadequate nutrition are two reasons for introducing non-oral feeding. Such procedures involve the creation of an external opening for food and drink to be delivered directly into the stomach through a tube. In recent years maintenance of the swallow and quality of life issues have led to introduction of small amounts of food and drink (oral tastes) for people who are non-orally fed. Little evidence exists about the reasoning used to inform this decision or the types of oral tastes offered. This study aims to address these omissions. An exploratory survey, distributed via email, was used to gather information from speech and language therapists and dietitians about their current practice and their decision-making processes when offering oral tastes to people who are non-orally fed. Data presented here reflect the responses from respondents working primarily with people with intellectual disabilities (55 out of 158 respondents). Oral tastes were being offered and clinical decision-making around this centred on balancing the wellbeing and wishes of the person with intellectual disabilities and their carers with the risks to wellbeing inherent in implementing and supporting an oral taste programme