Can a teacher improve speech clarity in children presenting with speech sound disorders using targeted interventions?

This action research was influenced by a past pupil who presented with a range of complex needs, including unclear speech which hampered his ability to communicate effectively. Although I tried to address this need, my lack of knowledge inhibited the effectiveness of strategies put in place, and I felt as though my practice was insufficient to meet the needs of all the children in my class. This study, which was carried out with four 2nd class children in a suburban DEIS 1 Junior School in Dublin, examines whether I as a primary school teacher can effectively implement a programme which improves speech clarity for children who present with speech difficulties. Using a mixed methods approach, and following the ethical standards laid down by Maynooth College, formal and informal pre- and post- interviews and discussions took place with the four children and their parents. Nineteen questionnaires were distributed to school staff, and two speech practitioners were also interviewed. A reflective journal was maintained. I designed and implemented an 11-week intervention focussed on improving a specific target sound (TS). The intervention took place in a learning support classroom three times weekly for each group, withdrawing them from their mainstream classroom. Evidence-based methodologies were put in place to address speech perception, phonological awareness, sound production and minimal pairs. For this study, the TS for group 1 was /r/ while /sh/ was the TS for Group 2. Although the improvement of the children’s speech clarity was not strikingly noticeable, unexpected positive developments were evident in regard to speech perception, phonological awareness and spelling. All children were more conscious of correct pronunciation of their TS and established self-awareness of their own sound production; however this did not transfer to their social engagement with their peers. School staff expressed concern about the rising number of children presenting with speech difficulties, and the impact of this in the classroom. This was echoed by the speech practitioners. The collected data contrasted the importance of informed intervention in addressing speech needs and potential difficulty in accessing these services. The lack of improvement in the children’s speech clarity and information gathered from interviews highlights the need for professional intervention for children presenting with SSD. While phonological awareness strategies can be implemented to improve children’s self-awareness of sound production, this research has found that this is a difficulty for teachers who are not sufficiently trained to assess, diagnose or treat. This study detailed the benefits of collaboration between various professionals in order to provide the highest standard of services. This research also exposed the challenges in accessing speech services which emphasises the need for improvements in how the system operates, with recommendations for improved on-site services for speech and language

Can a teacher improve speech clarity in children presenting with speech sound disorders using targeted interventions?

This action research was influenced by a past pupil who presented with a range of complex needs, including unclear speech which hampered his ability to communicate effectively. Although I tried to address this need, my lack of knowledge inhibited the effectiveness of strategies put in place, and I felt as though my practice was insufficient to meet the needs of all the children in my class. This study, which was carried out with four 2nd class children in a suburban DEIS 1 Junior School in Dublin, examines whether I as a primary school teacher can effectively implement a programme which improves speech clarity for children who present with speech difficulties. Using a mixed methods approach, and following the ethical standards laid down by Maynooth College, formal and informal pre- and post- interviews and discussions took place with the four children and their parents. Nineteen questionnaires were distributed to school staff, and two speech practitioners were also interviewed. A reflective journal was maintained. I designed and implemented an 11-week intervention focussed on improving a specific target sound (TS). The intervention took place in a learning support classroom three times weekly for each group, withdrawing them from their mainstream classroom. Evidence-based methodologies were put in place to address speech perception, phonological awareness, sound production and minimal pairs. For this study, the TS for group 1 was /r/ while /sh/ was the TS for Group 2. Although the improvement of the children’s speech clarity was not strikingly noticeable, unexpected positive developments were evident in regard to speech perception, phonological awareness and spelling. All children were more conscious of correct pronunciation of their TS and established self-awareness of their own sound production; however this did not transfer to their social engagement with their peers. School staff expressed concern about the rising number of children presenting with speech difficulties, and the impact of this in the classroom. This was echoed by the speech practitioners. The collected data contrasted the importance of informed intervention in addressing speech needs and potential difficulty in accessing these services. The lack of improvement in the children’s speech clarity and information gathered from interviews highlights the need for professional intervention for children presenting with SSD. While phonological awareness strategies can be implemented to improve children’s self-awareness of sound production, this research has found that this is a difficulty for teachers who are not sufficiently trained to assess, diagnose or treat. This study detailed the benefits of collaboration between various professionals in order to provide the highest standard of services. This research also exposed the challenges in accessing speech services which emphasises the need for improvements in how the system operates, with recommendations for improved on-site services for speech and language

Can a teacher improve speech clarity in children presenting with speech sound disorders using targeted interventions?

This action research was influenced by a past pupil who presented with a range of complex needs, including unclear speech which hampered his ability to communicate effectively. Although I tried to address this need, my lack of knowledge inhibited the effectiveness of strategies put in place, and I felt as though my practice was insufficient to meet the needs of all the children in my class. This study, which was carried out with four 2nd class children in a suburban DEIS 1 Junior School in Dublin, examines whether I as a primary school teacher can effectively implement a programme which improves speech clarity for children who present with speech difficulties. Using a mixed methods approach, and following the ethical standards laid down by Maynooth College, formal and informal pre- and post- interviews and discussions took place with the four children and their parents. Nineteen questionnaires were distributed to school staff, and two speech practitioners were also interviewed. A reflective journal was maintained. I designed and implemented an 11-week intervention focussed on improving a specific target sound (TS). The intervention took place in a learning support classroom three times weekly for each group, withdrawing them from their mainstream classroom. Evidence-based methodologies were put in place to address speech perception, phonological awareness, sound production and minimal pairs. For this study, the TS for group 1 was /r/ while /sh/ was the TS for Group 2. Although the improvement of the children’s speech clarity was not strikingly noticeable, unexpected positive developments were evident in regard to speech perception, phonological awareness and spelling. All children were more conscious of correct pronunciation of their TS and established self-awareness of their own sound production; however this did not transfer to their social engagement with their peers. School staff expressed concern about the rising number of children presenting with speech difficulties, and the impact of this in the classroom. This was echoed by the speech practitioners. The collected data contrasted the importance of informed intervention in addressing speech needs and potential difficulty in accessing these services. The lack of improvement in the children’s speech clarity and information gathered from interviews highlights the need for professional intervention for children presenting with SSD. While phonological awareness strategies can be implemented to improve children’s self-awareness of sound production, this research has found that this is a difficulty for teachers who are not sufficiently trained to assess, diagnose or treat. This study detailed the benefits of collaboration between various professionals in order to provide the highest standard of services. This research also exposed the challenges in accessing speech services which emphasises the need for improvements in how the system operates, with recommendations for improved on-site services for speech and language

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH