Purpose: Most speech-language pathologists (SLPs) working with children with developmental language disorder (DLD) do not perform language sample analysis (LSA) on a regular basis, although they do regard LSA as highly informative for goal setting and evaluating grammatical therapy. The primary aim of this study was to identify facilitators, barriers, and needs related to performing LSA by Dutch SLPs working with children with DLD. The secondary aim was to investigate whether a training would change the actual performance of LSA. Method: A focus group with 11 SLPs working in Dutch speech-language pathology practices was conducted. Barriers, facilitators, and needs were identified using thematic analysis and categorized using the theoretical domain framework. To address the barriers, a training was developed using software program CLAN. Changes in barriers and use of LSA were evaluated with a survey sent to participants before, directly after, and 3 months posttraining. Results: The barriers reported in the focus group were SLPs’ lack of knowledge and skills, time investment, negative beliefs about their capabilities, differences in beliefs about their professional role, and no reimbursement from health insurance companies. Posttraining survey results revealed that LSA was not performed more often in daily practice. Using CLAN was not the solution according to participating SLPs. Time investment remained a huge barrier. Conclusions: A training in performing LSA did not resolve the time investment barrier experienced by SLPs. User-friendly software, developed in codesign with SLPs might provide a solution. For the short-term, shorter samples, preferably from narrative tasks, should be considered.
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Background: Collaboration between parents and speech and language therapists (SLTs) 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: To set a research agenda on collaborative practice between parents and SLTs in order to generate evidence regarding what works, how, for whom, in what circumstances and to what extent. Methods & Procedures: 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 SLTs. This process generates explicit hypotheses which form a potential research agenda. Discussion & Conclusions: 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 the relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesized 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
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Background: Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision. Aims: To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification. Methods & Procedures: A database of 11,450 children was analysed consisting of data on children, aged 2–7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono‐ and bilingualism, nature of the language delay, and language profile of the children. Outcomes & Results:Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems. Conclusions & Implications: This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children.
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Background: Goal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person-centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations. Aims: A first step in developing theory and practical interventions is to explore first-hand experiences of SLTs and clients about day-to-day goal-setting practice. This study was guided by the following research question:What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services? Methods & Procedures: The qualitative study was carried out in the setting of routine speech–language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video-reflexive ethnography, using video footage of goal-setting conversations to facilitate semi-structured, reflexive interviews.Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client–SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs. Outcomes & Results: Data analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes. Conclusions & Implications: SLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal-setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved.
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People with voice problems can seek advice and therapy from a speech-language pathologist. Besides having problems with the speaking voice, a number of them are also amateur choristers. In addition to her standard examination, the speech-language pathologist has to specifically describe the use of the singing voice during choral singing and to assess the amount of mutual influence of speaking and singing voice. In therapy, a healthy phonation is learned. In today's practice, the therapist tends to confine herself to training the sepaking voice. It is known that pitch variation influences phonation. As pitch is a complicating factor in singing, the therapist could make the client aware of this influence by using exercises that alternate speaking and singing voice. Reference to and cooperation with singing teachers is essential. A network of speech-language pathologists 'with an ear for singers' and singing teachers should be built up.
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Purpose: This case study is presented to inform the reader of potential speech, language, cognitive, and emotional characteristics in preadolescent cluttering. Method: This case study describes a 10-year-old boy who started to clutter during preadolescence. The case illustrates that, in some adolescents, cluttering can co-occur with temporary stuttering-like behavior. In this case, signs of disturbances in speech-language production associated with behavioral impulsiveness as a young child were noted. Speech, language, cognitive, and emotional results of the case are reported in detail. Results: The changes in fluency development are reported and discussed within the context of changes in the adolescent brain as well as adolescent cognitive and emotional development. While being unaware of their speech condition before adolescence, during preadolescence, the changes in brain organization lead to an increase in rate and a decrease in speech control. Given that the client had limited understanding of what was occurring, they were at risk of developing negative communication attitudes. Speech-language therapists are strongly advised to monitor children with cluttering signals in the early years of their adolescence.
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Dit onderzoek is bedoeld om de huidige labelvorming van kinderen met luisterproblemen te onderzoeken en om in samenwerking met logopedisten en audiologen in Nederland te komen tot een uniforme en hanteerbare definitie en om de kennis en ervaring op het gebied van signalering, diagnostiek en behandeling te bundelen. De aanleiding voor dit promotieonderzoek zijn de vragen vanuit het werkveld (logopedisten, audiologen, psychologen AC) over AVP die tijdens presentaties op diverse congressen, in logopedische kwaliteitskringen en dyslexiekringen in de periode 2008-2012 en tijdens de studiedag “Diagnostiek van auditieve verwerkingsproblemen” van de FENAC op 21 mei 2014 (http://www.fenac.nl/algemeen/opleiding/studiedag-avp/studiedag-diagnostiek-van-auditieve-verwerkingsproblemen-avp.html) gesteld werden.
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The adoption of tablets by young children has raised enthusiasm and concern among speech and language pathologists. This study investigated whether tablet games can be used as effectively as real play objects in vocabulary intervention for children with developmental language disorder (DLD). A randomized, controlled non-inferiority trial was conducted with 70 3-year-old children with DLD. The novel intervention group (n = 35) received 12 10-min scripted intervention sessions with symbolic play using a tablet game spread out over 8–9 weeks. The standard intervention group (n = 35) received the same amount of intervention with real objects using the same vocabulary scripts. In each session, children were exposed to 22 target words. The primary outcome was the number of new target words learned. This was measured using a picture selection task including 22 target words and 22 control words at 3 time intervals: before the intervention, immediately post-intervention, and 5 weeks later. In both intervention groups, the children learned significantly more target words than control words. No significant differences in gains between the two intervention conditions were found. This study provides evidence that vocabulary intervention for toddlers with DLD using a tablet game is equally as effective as an intervention using real objects.
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Communicative participation is the most important outcome of speech and language therapy, but there are no measurement instruments for children, adolescents, and young adults. This paper describes the development of MyCommunication-Youth: an item bank to measure self-reported communicative participation in children, adolescents and young adults with various communication disorders.
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