Swedish speech and language pathologists reflect on how their clinical practises align to everyday language and communication skills of children with developmental language disorder

Klatte I.S., Ketelaar M., de Groot A., Bloemen M., Gerrits E.

AbstractBackgroundCollaboration between therapists and parents of children with developmental disabilities is a key element of family‐centred care. In practice, collaboration appears to be challenging for both parents and therapists. This systematic review aims to make explicit how therapists can optimise their collaboration with parents of young children with developmental disabilities, according to the perspectives of parents and therapists.MethodsA systematic review was conducted using the following databases: Medline (PubMed), CINAHL (OVID) and PsychINFO (OVID). Those papers were selected, which focused on collaboration using a two‐way interaction between therapists and parents, exploring the perspectives of therapists and/or parents of children between 2 and 6 years. Papers needed to be published in English or Dutch between 1998 and July 2021. Included papers were synthesised using a qualitative analysis approach by two researchers independently. Results sections were analysed line‐by‐line, and codes were formulated and discussed by all authors. Codes were aggregated, resulting in a synthesis of specific collaboration strategies in combined strategy clusters.ResultsThe search generated 3439 records. In total, 24 papers were selected. Data synthesis resulted in an overview of specific strategies organised into five clusters: (1) continuously invest time in your collaboration with parents, (2) be aware of your important role in the collaboration with parents, (3) tailor your approach, (4) get to know the family and (5) empower parents to become a collaborative partner.ConclusionsThis systematic review resulted in an overview of concrete strategies for therapists to use in their collaboration with parents of children with developmental disabilities. The strategies formulated enable therapists to consciously decide how to optimise their collaboration with each individual parent. Making these strategies explicit facilitates change of practice from therapist‐led and child‐centred towards family‐centred care.

Klatte I.S., Bloemen M., de Groot A., Mantel T.C., Ketelaar M., Gerrits E.

AbstractBackgroundCollaborative practice between therapists and parents is a key element of family‐centred care and is essential if we want to address family priorities and needs in interventions. However, collaborative practice is challenging for speech and language therapists (SLTs) and parents. To facilitate collaboration, collaborative practices need to be implemented into speech and language therapy for young children with developmental language disorders (DLD) and their families. Actual change and implementation of collaboration in practice will be successful only when it corresponds with patients’ needs, in our case the needs of parents of young children with DLD.AimsTo explore parents’ needs in their collaboration with SLTs during therapy for their young child with DLD.Methods & ProceduresParents of children with (a risk of) DLD in the age of 2–6 years were eligible for participation. We recruited parents via SLTs. Twelve parents of children with DLD participated in semi‐structured interviews about their needs in collaboration with SLTs. We used a phenomenological approach focusing on parents’ lived experiences. We transcribed the interviews verbatim. All interviews were read/listened to and discussed by our parent panel, multiple researchers and the interviewer. Two researchers independently analysed the data using the reflective thematic analysis of Braun and Clarke.Outcomes & ResultsThe analysis of the interviews resulted in six themes: (1) knowing what to expect, (2) knowing how to contribute, (3) feeling capable of supporting the child, (4) trusting the therapist, (5) alignment with parents and children's needs, preferences and priorities and (6) time and space for asking questions and sharing information.Conclusions & ImplicationsParents want SLTs to invest time in collaborating with them. Parents need SLTs to empower them to become a collaborative partner and enable them to support their child in daily life. Parents need knowledge about the therapy process and diagnosis and skills in how to support their child's language development. Also, they need emotional support to feel secure enough to support their child, to ask questions to therapists and to bring up their own thoughts and opinions in therapy. Parents’ needs are in line with collaborative working as described in literature, which underlines the importance of implementing collaborative working in speech and language therapy for young children with DLD.WHAT THIS PAPER ADDSWhat is already known on the subject Several reviews have explored parents’ perspectives on speech and language therapy. Results reveal parents’ experiences with speech and language therapy in general, and parents’ perspectives on specific topics such as shared decision‐making and parents/therapists roles in therapy.What this study adds This study adds insights into parents’ needs to ensure collaboration with speech and language therapists (SLTs). Parents of young children with developmental language disorders (DLD) need SLTs to invest time to create optimal collaboration. It is important for parents to have enough knowledge about DLD and the SLT process, skills and confidence in how to support their child and opportunities to share thoughts and questions with SLTs. Our results underline the importance of parents being empowered by SLTs to become a collaborative partner.What are the clinical implications of this work? When children are referred to speech and language therapy, parents often venture into an unknown journey. They need support from SLTs to become a collaborative partner in speech and language therapy. Parents need SLTs to invest time in sharing knowledge, skills and power and align therapy to parents’ and child's needs, preferences, priorities and expectations.

McGregor K.K., Ohlmann N., Eden N., Arbisi-Kelm T., Young A.

Purpose: The aim of this study was to situate developmental language disorder (DLD) within the impairment and disability framework of the International Classification of Functioning, Disability, and Health (ICF); describe the functional strengths and weaknesses of a cohort of first-grade children with DLD and their peers; and explore the ways that language-related disabilities relate to language impairment, developmental risk, and receipt of language services. Method: We queried the caregivers of 35 children with DLD and 44 peers with typical language development about their children's language-related functions, developmental risks, and language services using mixed quantitative and qualitative methods. Results: The children with DLD presented with weaknesses in domains that are highly dependent upon language skill, including communication, community function, interpersonal relationships, and academics. They presented with strengths in domestic and personal aspects of daily living, play and coping aspects of socialization, and gross motor function. Caregivers of children with DLD expressed pride in their children's agentive and prosocial qualities. Consistent with the ICF, what distinguished children with DLD who had functional weaknesses and disabilities from those who had healthy function was not the severity of language impairment as measured by decontextualized tests of language skill, but the presence of cumulative developmental risks. Compared to those with healthy function, a larger portion of children with weaknesses and disabilities were receiving language services; however, two girls who had disabilities despite mild levels of impairment were without services. Conclusions: Children with DLD present with predictable strengths and weaknesses in everyday language-related functioning. For some children, the weaknesses are mild, but for others, they limit function to a greater extent and should be considered disabilities. The severity of language impairment is not a strong indicator of language-related function and, therefore, is not a good metric for determining service qualification.

TM H., S Q., A G., LJ H., GP B., P S., M K.

Abstract Background Risk of being diagnosed with different developmental disorders is found to vary with immigrant background. Knowledge about such differences in Norway are a starting point for equity in health services quality, and for early identification and prevention. Our objective was to assess the risk of receiving diagnoses of developmental disorders among children born in Norway (2006–2017) to two or one immigrant parent compared to children with two Norwegian-born parents. Methods Information on developmental disorders was from the Norwegian Patient Register (NPR) and information on immigrant background, parental country of origin, parental education, and household income from Statistics Norway. We estimated hazard ratios (HR) with Cox proportional hazard regressions. With children with Norwegian background as reference category, we estimated HRs for immigration background and region of origin. All analyses were adjusted for sex, year of birth, parental education, and household income. Results Children with two immigrant parents had a lower risk of receiving any developmental disorder diagnosis [HR 0.80 (95% CI 0.77, 0.82)] than children with Norwegian background, and lower risk of being diagnosed with attention deficit hyperactivity disorder (ADHD) diagnosis [HR 0.24 (95% CI 0.22, 0.27)], learning difficulties diagnosis [HR 0.39 (95% CI 0.33, 0.47)], and behavioral and emotional disorders [HR 0.52 (95% CI 0.49, 0.55)]. Children with immigrant parents had higher hazard than Norwegian background children of autism spectrum disorder (ASD) [HR 2.21 (95% CI 2.04, 2.39)], mental retardation [HR 1.84 (95% CI 1.64, 2.07)], language disorders [HR 1.30 (95% CI 1.20, 1.40)], and unspecified developmental disorders [HR 1.22 (95% CI 1.17, 1.28)]. Children with only one immigrant parent had lower risk of diagnoses than children of two immigrants. Conclusion Risk of receiving a diagnosis of various developmental disorders varied substantially by immigrant background. Understanding the underlying mechanisms of these differences is warranted to ensure equity in health services and timely intervention.

Braun V., Clarke V.

Jensen de López K.M., Lyons R., Novogrodsky R., Baena S., Feilberg J., Harding S., Kelić M., Klatte I.S., Mantel T.C., Tomazin M.O., Ulfsdottir T.S., Zajdó K., Rodriguez-Ortiz I.R.

Purpose Although researchers have explored parental perspectives of childhood speech and language disorders, most studies have been conducted in English-speaking countries. Little is known about parental experiences across countries, where procedures of language screening and services for language disorders differ. The authors participated in the COST 1 Action network IS1406, “Enhancing Children's Oral Language Skills Across Europe and Beyond,” which provided an opportunity to conduct cross-country qualitative interviews with parents. The aim of this pilot study was to explore ways in which parents construed and described speech and language disorders across countries. Method Semistructured qualitative interviews were conducted with parents from 10 families in 10 different countries. The data were analyzed using thematic analysis. Findings The overall theme was “acknowledging parental expertise.” The parents described, in detail, ways in which their children's speech and language (dis)abilities had an impact on the children's everyday life. Three subthemes were identified: impairment, disability, and changes over time. Conclusions The findings suggest that, across a range of countries, parents demonstrated contextualized understandings of their children's speech and language (dis)abilities, along with the everyday functional implications of the disorders. Hence, despite not holding professional knowledge about language disorders, the voices, views, understandings, and personal experiences of parents in relation to their child's disorder should be listened to when planning therapy services. Supplemental Material https://doi.org/10.23641/asha.14109881

Melvin K., Meyer C., Scarinci N.

Despite being an important aspect of effective early intervention service delivery, 'engagement' has been inconsistently defined in paediatric healthcare. Previous research has identified that engagement in early speech-language pathology intervention is complex and multifaceted. However, more research is needed to understand the ways that different families may engage with intervention in different settings.To explore the complexity of engagement in early speech-language pathology intervention from the perspectives of both families and their speech-language pathologists (SLPs).Video-reflexive ethnography was used to explore engagement with 21 matched SLP-family dyads in early intervention services. Up to three intervention appointments for each participating family were video recorded. Short video segments were selected and played to participants during individual semi-structured interviews where participants were invited to reflect on the interactions captured (i.e., 'video-reflexive sessions'). Interview data were analysed using thematic analysis.Results from the interview data were organized into one overarching theme 'Families may have "different levels of engagement"', and four individual themes that reflected how families engage differently in various aspects of intervention, including (1) attending sessions and coming into the room; (2) actively participating in sessions; (3) continuing to actively participate outside sessions; and (4) having open and honest communication with their SLPs.Families may have different levels of engagement in various aspects of intervention, which contribute to their unique profile of engagement. Findings of this study prompt SLPs to move beyond using blanket statements about whether or not families are engaged, to instead describing in detail how families are uniquely engaged. What this paper adds What is already known on the subject In early speech-language pathology intervention, the term 'engagement' refers to (1) a complex, multifaceted state of families 'being engaged' in intervention both inside and outside sessions; and (2) a relational, co-constructed process where many families 'become engaged' in intervention as they work together with SLPs. Although research has acknowledged engagement may look different for each parent and family, little is known about how families are uniquely engaged in early speech pathology intervention in different settings. What this paper adds to existing knowledge This study is the first to explore engagement from the perspectives of both families and SLPs working together in intervention. Both groups of participants described the complexity of engagement in this setting and acknowledged that families engage differently in different aspects of intervention, which contribute to their unique profile of engagement. What are the potential or actual clinical implications of this work? Being able to identify potential indicators of engagement, such as the ones described in this study, provide opportunities for SLPs to take a reflexive approach to engaging with individual families, in line with principles of family-centred care. Findings of this study therefore prompt SLPs to reflect on how the families they work with are engaged in intervention, and to consider their own role in facilitating engagement. In addition, results highlight the importance of SLPs initiating open conversations with families themselves about how they would like to be engaged in intervention, and what support would be most beneficial to them.

Levickis P., McKean C., Wiles A., Law J.

Background Parent-child interaction therapies are commonly used by speech and language therapists (SLTs) when providing services to young children with language learning difficulties. However, the way parents react to the demands of such interventions is clearly important, especially for those from socially disadvantaged backgrounds. Parents play a central role in the therapy process so to ensure parent engagement, and to maximize intervention effectiveness, parents' views must be considered. Aims To explore the expectations and experiences of parents from socially disadvantaged backgrounds who had taken part in a parent-child interaction programme aimed at promoting language development in 2-3 year olds with language difficulties. Methods & procedures The sample included parents who had a child aged 2-3 years and had attended a parent-child interaction programme to promote their child's language development. Parents were eligible to take part if they were living in the 30% most deprived areas in a city in the North of England that constituted the study site. Ten parents participated in a qualitative semi-structured face-to-face interview in the home. Framework analysis was used to analyse the interview transcripts. Outcomes & results Parents' expectations before taking part in parent-child interaction interventions contribute to how they may engage throughout the intervention process. Barriers include parents' uncertainty about the nature of the intervention and differing attitudes regarding intervention approaches and strategies. Facilitators during the intervention process include gaining support from other parents, reassurance from the SLT regarding their child's language development, and their own ability to support their child's language learning, as well as increased confidence in how they support their child's development. Conclusions & implications Parents respond very differently to parent-child interaction intervention for children with language difficulties, depending on their expectations and attitudes towards intervention. Thus, it is critical that these different perspectives are understood by practitioners before intervention commences to ensure successful engagement. What this paper adds What is already known on this subject Parent-child interaction interventions are widely used to promote child language development. Parents play a central role in the therapy process of such interventions, so to maximize effectiveness, parents must be appropriately 'engaged' in that intervention. This involves attending, fully participating and having appropriate attitudinal and/or emotional involvement. The reciprocal nature of engagement means that parents are more likely to become engaged in intervention over time when they are supported by their SLT. What this paper adds to existing knowledge Parental expectations about the intervention process vary considerably and often need to be negotiated before the start of intervention. Reassurance and supporting positive attitudes to co-working with their SLT may be particularly important for families living with social disadvantage. Supporting parent engagement in parent-child interaction programmes can contribute to the parents' capability to continue implementing language-promoting strategies outside the intervention context and beyond the end of therapy. What are the potential or actual clinical implications of this work? Parents have different expectations regarding programme involvement. Therefore, having a two-way, open dialogue between parents and SLTs from the beginning is clearly important, not only as a way of sharing information but also to build on parents' understanding of what the intervention will involve and trust that the SLT will be able to deliver the intervention in collaboration with the parent. SLTs can enhance parent engagement by supporting parents to feel confident and providing reassurance in terms of their child's development and how they can support their child's language learning.

Le H.N., Mensah F., Eadie P., McKean C., Sciberras E., Bavin E.L., Reilly S., Gold L.

Low language abilities are known to be associated with significant adverse long-term outcomes. However, associations between low language and health-related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children's trajectories of HRQoL and language and examine the association between language and HRQoL trajectories.Data were from an Australian community-based cohort of children. HRQoL was measured at ages 4-13 years using the parent-reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool 2nd edition at 4 years and the CELF-4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross-sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group-based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood.Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable-high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable-high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively.Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children's language ability but also address the wider functional impacts of low language.

Larson A.L., Cycyk L.M., Carta J.J., Hammer C.S., Baralt M., Uchikoshi Y., An Z.G., Wood C.

As the population of young children from culturally and linguistically diverse (CLD) backgrounds grows in the U.S., so too does awareness of the need for interventions to promote their language development and reduce the “word gap.” This synthesis described and analyzed studies examining interventions for improving language outcomes for young, CLD children (birth through age 5). The purpose was to discuss how cultural and linguistic factors were addressed in the interventions, examine the methodological rigor of the studies, identify the outcomes and measures used, determine the efficacy of the interventions on language skills in English and in children’s home language(s), and describe the reported social validity of the interventions. Forty articles reporting on 41 studies met inclusionary criteria. Interventions focused on four areas: explicit instruction on targeted skills; classroom curriculum interventions; interactive book reading and/or book making interventions; and naturalistic, routines-based interventions. Most interventions were delivered to children above age 3 who were from Latino and/or Spanish-speaking backgrounds. Also, linguistic adaptations (primarily in Spanish) were more common in interventions as compared to cultural adaptations. Vocabulary was the most common outcome targeted, with a wide variety of measures used across studies. Most interventions had positive effects in English and/or a language other than English particularly when the interventions were linguistically- and culturally-responsive. Several cultural or linguistic factors were also identified as variables affecting intervention fidelity, engagement, and effects. Limitations of the current research base and implications for practice are discussed.

Morgan L., Marshall J., Harding S., Powell G., Wren Y., Coad J., Roulstone S.

Background: A number of studies have suggested that practitioners hold speech and language therapy (SLT) practice as tacit and consequently it is difficult for the therapist to describe. The current study uses a range of knowledge elicitation (KE) approaches, a technique not used before in SLT, as a way of accessing this tacit knowledge. There is currently no agreed framework that establishes key factors underpinning practice for preschool children with speech and language disorders. This paper attempts to address that gap. Aims: The aim of this study was to develop a framework of speech and language therapists’ practice when working with preschool children with developmental speech and language disorders (DSL local sites, specific interest groups and two national events. KE techniques were used to gather data, with initial data being collected in local site focus groups. Findings from groups were taken to subsequent larger groups where a combination of concept mapping, teach-back and sorting exercises, generated a more detailed description of practice, using discussion of consensus and disagreement to stimulate further exploration and definition and provide validatory evidence. Outcomes and Results: This paper provides a high-level framework of therapy for preschool children with DSL achieving functionally meaningful skills and carryover; supporting adults to provide a supportive communication environment. The exact configuration is shaped by the child’s context and needs. Conclusions and Implications: The framework highlights themes that are well researched in the literature (e.g. speech) and others that have been little studied (e.g. adult understanding), indicating a disconnect between research evidence and practice. The research also highlights the complex nature of interventions for preschool children with DS&LD and the importance therapists attribute to tailoring therapy to individual needs. The framework provides a scaffold for speech and language therapists to focus their clinical practice and encourages us as a profession to better understand and explore the gaps between research evidence and clinical practice, for preschool children with DS&LD.

Hansson K., Håkansson G., Ringblom N., Jalali-Moghadam N.

Gallagher A.L., Murphy C., Conway P., Perry A.

Inter-professional collaboration (IPC) has been recommended for many years as a means by which the needs of children with developmental language disorders (DLD) can be met at school. However, effective IPC remains difficult to achieve and our knowledge of how to support it is limited. A shared understanding between those involved has been identified as critical to IPC.To examine the literature, as one source of data, for evidence of a shared understanding between the fields of speech and language therapy (SLT) and education about children with DLD and how such needs can best be met at school.An integrative review of the literature was undertaken. A systematic search of the published, peer-reviewed literature (between 2006 and 2016) was conducted for empirical and theoretical papers and a manual search was undertaken to obtain a representative sample of policy/professional guidelines. A total of 81 papers across SLT and education were included in the review. The papers were scrutinized using a qualitative content analysis.Although some commonality between perspectives in the literature was identified, differences between the fields dominated. These differences related to how DLD is conceptualized; how children's needs are assessed; which outcomes are prioritized and how best these outcomes can be achieved. We also found differences about what constitutes useful knowledge to guide practice. We suggest that the nature of the differences we identified in the literature may have negative implications for practitioners wishing to collaborate to meet the needs of children with DLD in school. The perspectives of practising SLTs and teachers need to be sought to determine whether the findings from the literature reflect dilemmas in practice.Effective IPC is essential to meet the needs of children with DLD in school; yet, it remains difficult to achieve. Our review of the literature across SLT and education indicates evidence of a lack of shared understanding about DLD. If these differences are also evident in practice, then a conceptual model to support IPC may be warranted.

Davies K.E., Marshall J., Brown L.J., Goldbart J.

Current research investigating collaboration between parents and speech and language therapists (SLTs) indicates that the SLT role is characterized by therapist-led practice. Co-working with parents of children with speech and language difficulties is less frequently described. In order to embrace co-working during intervention, the SLT role may need to be reframed, focusing on acquiring skills in the role of coach as well as the role of planning intervention and treating children.To report (1) SLTs' conceptions about their own roles during intervention for pre-school children with speech and language difficulties; and (2) SLTs' conceptions of parents' roles during intervention.A qualitative study used individual, semi-structured interviews with 12 SLTs working with pre-school children. Open-ended questions investigated SLTs' expectation of parents, experience of working with families, and the SLTs' conception of their roles during assessment, intervention and decision-making. Thematic network analysis was used to identify basic, organizational and global themes.SLTs had three conceptions about their own role during intervention: treating, planning and coaching. The roles of treating and planning were clearly formulated, but the conception of their role as coach was more implicit in their discourse. SLTs' conception of parents' roles focused on parents as implementers of activities and only occasionally as change agents.Collaboration that reflects co-working may necessitate changes in the conception about the role for both SLTs and parents. SLTs and parents may need to negotiate roles, with parents assuming learner and adaptor roles and SLTs adopting a coaching role to activate greater involvement of parents. Applying conceptual change theory offers new possibilities for understanding and enabling changes in SLTs' conception of roles, potentially initiating a deeper understanding of how to achieve co-working during speech and language intervention.

Klatte I.S., Harding S., Roulstone S.

Parents' play an essential role in Parent-Child Interaction Therapy (PCIT) as the primary agent of intervention with their child. Unfortunately, speech and language therapists (SLTs) report that parents' engagement is challenging when conducting PCIT. Although focusing on and stimulating the engagement of parents, when needed, can increase the success of PCIT, little is known about what factors influence parent engagement.To explore SLTs' views about the factors that facilitate or pose barriers to parents' engagement in PCIT.A secondary analysis of 10 interview transcripts about SLTs' views on delivering PCIT with parents of children with developmental language disorder (DLD) was conducted. Codes from the original analysis where checked for their relevance to parents' engagement by the first author. Potential themes were identified iteratively with all authors.Four themes were identified in the SLTs' description of their experiences with the engagement of parents: mutual understanding, creating a constructive relationship between the SLT and parent, parental empowerment, and barriers. It became clear that SLTs were focusing on different aspects of engagement.This study makes an initial contribution to our understanding of SLTs' view of parents' engagement and about what stimulates parent engagement or effects disengagement. SLTs play an important role in supporting parents to engage and stay engaged with therapy. Training SLTs on how best to engage parents, focusing on mutual understanding, creating constructive relationships between the SLT and parent, parental empowerment, and barriers, is necessary. However, more research is needed on how to train relevant skills in SLTs. Clearer definitions of engagement would improve understanding and judgements about how best to support parents.