Identity and meaning-making in children with primary speech/language impairments

Primary speech and language impairment (PSLI) is a term used to describe children with a range of significant speech and language impairments, in the context of normal cognitive abilities. The aims of this thesis were firstly to explore identity construction in children with PSLI, and secondly to explore how these children made sense of their experiences. Narrative inquiry was used to conduct this study. The participants were 11 children aged 9-12 years-old, presenting with PSLI. The aim was to generate storied accounts of events and happenings in their lives using interviews, supplemented with visual methods. An innovative analytical framework was designed, drawing on a range of narrative analytical methods, including an analysis of verbal and nonverbal evaluation markers, cohesion markers, as well as an analysis of agency and identities presented in the children’s narratives. The key findings were four interrelated themes, which were conceptualised in a working model comprising facilitators and potential barriers to well-being and belonging. The four themes which contributed to well-being and belonging included: relationships; autonomy, agency, and competence; identities of belonging and difference; and hope and concern for the future. Facilitators of well-being and belonging were life events and experiences that the children evaluated in positive ways, whereas potential barriers were life events and experiences which they evaluated in negative ways. Although some children evaluated their experiences in mixed and sometimes contradictory ways, their evaluations were predominantly positive. This thesis contributes to the field in four ways. Firstly, it provides new insights into identity construction in children with PSLI. Secondly, it adds to understandings of ways in which children conceptualise communication impairment. Thirdly, it deepens understandings of the determinants of well-being and belonging in children with PSLI. Finally, this thesis highlights the value of narrative inquiry as a means for listening to the voices of children with communication impairments

Exploring the Utility of the Simple View of Reading in Irish Children Attending Schools in Areas Designated as Socially Disadvantaged

Evidence suggests that children living in areas designated as socially disadvantaged may be at risk for literacy difficulties. The Simple View of Reading (Gough & Tunmer, 1986; Hoover &Gough, 1986) is a theoretical model that sets out to describe the processes that children need to develop to become proficient readers, that is word recognition or decoding processes and language comprehension processes. The overall aim of this study was to investigate the utility of the Simple View of Reading in a cohort of Irish children attending schools designated as socially disadvantaged. The objectives were twofold. The first objective was to investigate predictors of reading accuracy, spelling and reading comprehension skills in this sample. The second objective was to investigate whether or not these predictors varied with age. The sample comprised fifty-nine children attending two schools. Inclusion criteria were: children between the ages of 5-8 years; a sample of children within three ranges of reading abilities as rated by their teachers (teachers were asked to rate the children’s reading ability as above average, average or below average); and a minimum score of 80 on the British Picture Vocabulary Scales (BPVS) (Dunn et al., 1997) to be included. Reading accuracy (single word reading and passage reading), reading comprehension, and spelling were measured using three standardised tests i.e., Weschler Individual Attainment Test 11UK, Teachers Version (WIAT, 11UK-T) (Weschler, 2006), the York Assessment of Reading for Comprehension (YARC) (Snowling et al., 2009), and the Single Word Spelling Test (SWST), (Sacre & Masterson, 2000). Potential predictors of literacy skills, such as phonemic awareness and phonic knowledge skills, were measured using criterion-referenced tests. Vocabulary was also a potential predictor and was measured using the BPVS. There was mixed evidence for the Simple View of Reading. While phonic knowledge, phonemic knowledge and non-word reading were predictors of reading, other factors such as vocabulary were also predictors. Although vocabulary was a predictor of reading comprehension for the total sample, the picture was less clear when the effect of age was explored. To conclude, there was mixed evidence to support the Simple View of Reading.  Nonetheless, the findings were encouraging in that children were acquiring literacy skills

Establishment of an Innovative Telehealth Speech and Language Therapy Placement as a Rapid Response to COVID-19: Sharing the Learning

The aim of this evaluation was to explore practice educators’ and speech and language therapy (SLT) students’ experiences of a rapid response telehealth placement in response to the COVID-19 pandemic in order to inform quality improvement. In March 2020, public health restrictions were imposed across Ireland in efforts to ‘flatten the curve’ in response to the COVID-19 pandemic. All placements were cancelled. According to an Irish Association of Speech and Language Therapists survey in April 2020, 47% of SLTs were redeployed to swabbing and contact tracing roles, and many remain redeployed seven months later. This redeployment, along with strict public health measures in clinical sites, significantly reduced the availability of clinical placements. A rapid response was required to enable students to develop clinical competencies. Although telehealth has been used to deliver speech and language therapy in other countries, it had not been used routinely in service provision in Ireland. In this article, we outline how we built on existing partnerships with practice educators, both on- and off-site, to design a much-needed telehealth placement. We explored educators’ and students’ experiences using an online focus group and online survey respectively. The evaluations of practice educators were positive in that despite their initial apprehension, they reported that this placement provided valuable learning opportunities for students while also providing benefits for clients. They also reported some technological and sustainability challenges. The students also evaluated this placement positively with 83.3% of respondents rating the placement as ‘excellent ‘and 16.7% rating it as ‘good’. All stakeholders valued this learning experience

Stage 1 Registered Report: The experiences and perceptions of parent-child interaction therapy for parents of young children with communication difficulties: A qualitative evidence synthesis protocol.

Background: Parent-child interaction therapy refers to a group of interventions mediated by trained parents to address areas of developmental difficulties in children. In the field of speech and language therapy it is used in early intervention for children with speech, language and communication difficulties. The intervention involves training parents and caregivers on the importance of responsivity and language input in daily interactions and coaches them on strategies to implement these with the children. As the success of the intervention is heavily influenced by caregiver engagement, understanding and acceptance, it is important to consider their views. However, to date there has been limited work on synthesising parental views of this intervention. Methods: This is a protocol for a qualitative evidence synthesis of peer-reviewed qualitative papers addressing the experiences and perceptions of parent-child interaction therapy for parents of children with communication difficulties. We will complete a systematic search of 11 databases, review the reference lists and complete a cited reference search of all included studies. Two authors will independently screen tests for inclusion, initially by title and abstract, with full-text screening as necessary. Thematic synthesis will be used for all included studies. We will appraise the quality of included studies using CASP and confidence in the review findings using GRADE CERQual. Discussion: As the views of parents are pivotal in the success of this intervention, the findings from this synthesis should help to guide best practice and policy for the future implementation of parent child interaction therapy for children with communication difficulties

Working with the parents and families of children with developmental language disorders: An international perspective

Background The relationship between parental input and child language development has had a complex history. It has become clear that indirect parent training for the parents of children with delayed language development is an important feature of interventions offered by speech and language therapists in the anglophone countries. Yet we know less about how this type of approach is realised in other countries. Methods In this paper we report the results of a survey of practice undertaken as part of the work of COST Action IS1406, a European Union (EU) funded research network. The focus of this paper is specifically on parent-related questions and responses referring to children under the age of twelve. The survey was devised by members of the Action and circulated electronically during the summer of 2017. In all, 4024 practitioners responded from 60 countries, the majority of whom came from EU member countries. Findings Respondents to the survey indicated that indirect therapy is commonly carried out via the parent in the early years and via teachers later. A range of professional groups, in addition to speech and language therapists, is likely to adopt this approach; including teachers, pedagogues and psychologists. A variety of interventions is reported, some of which have a reasonable evidence-base underpinning them. It is interesting to see the widespread involvement of fathers and other family members in interventions. Finally, the fact that practitioner characteristics (age, experience, location of practice etc.) are not related to the use of indirect techniques points to the universal recognition of the value of these approaches. Conclusions Despite the very different traditions in the practice of intervention across countries, there is clearly a widespread recognition of the importance of indirect approaches to intervention and specifically those focusing on parents. The mixture of family members being involved in interventions is a very promising indication of the role sharing commonly associated with the contemporary family. Yet the number of specific intervention approaches identified is relatively small given the number of respondents. There is a need for a better understanding of what exactly practitioners are doing when they involve parents in intervention or carry out parent-child interaction interventions and how well these interventions work in routine practice. This also has implications for the application of evidence-based practice and the precise nature of the interventions concerned (advice to parents, video interaction training etc.).COST (European Cooperation in Science and Technology)Unión Europea Horizonte 2020 Marie Sklodowska-Curie grant agreement No. 70504

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

Impact of Parenchymal Tuberculosis Sequelae on Mediastinal Lymph Node Staging in Patients with Lung Cancer

Because tuberculous (TB) involvement of mediastinal lymph nodes (LN) could cause false positive results in nodal staging of lung cancer, we examined the accuracy of nodal staging in lung cancer patients with radiographic sequelae of healed TB. A total of 54 lung cancer patients with radiographic TB sequelae in the lung parenchyma ipsilateral to the resected lung, who had undergone at least ipsilateral 4- and 7-lymph node dissection after both chest computed tomography (CT) and fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT were included for the analysis. The median age of 54 subjects was 66 yr and 48 were males. Calcified nodules and fibrotic changes were the most common forms of healed parenchymal pulmonary TB. Enlarged mediastinal lymph nodes (short diameter > 1 cm) were identified in 21 patients and positive mediastinal lymph nodes were identified using FDG-PET/CT in 19 patients. The overall sensitivity and specificity for mediastinal node metastasis were 60.0% and 69.2% with CT and 46.7% and 69.2% with FDG-PET/CT, respectively. In conclusion, the accuracy of nodal staging using CT or FDG-PET/CT might be low in lung cancer patients with parenchymal TB sequelae, because of inactive TB lymph nodes without viable TB bacilli

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

Alien Registration- Lyons, Rena M. (Lubec, Washington County)

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