In order to optimize collaboration between Speech and Language Therapists (SLTs) and parents of children with Developmental Language Disorders (DLD), our aim was to study what is needed for SLTs to transition from the parent-as-therapist aide model to the FCC model and optimal collaborate with parents. Chapter 2 discusses the significance of demystifying collaborative working by making explicit how collaboration works. Chapter 3 examines SLTs’ perspectives on engaging parents in parent-child interaction therapy, utilizing a secondary analysis of interview data. Chapter 4 presents a systematic review of specific strategies that therapists can employ to enhance their collaboration with parents of children with developmental disabilities. Chapter 5 explores the needs of parents in their collaborative interactions with SLTs during therapy for their children with DLD, based on semi-structured interviews. Chapter 6 reports the findings from a behavioral analysis of how SLTs currently engage with parents of children with DLD, using data from focus groups. Chapter 7 offers a general discussion on the findings of this thesis, synthesizing insights from previous chapters to propose recommendations for practice and future research.
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Background: Collaboration between Speech and Language Therapists (SLTs) and parents is considered best practice for children with developmental disorders. However, such collaborative approach is not yet implemented in therapy for children with developmental language disorders (DLD) in the Netherlands. Improving Dutch SLTs’ collaboration with parents requires insight in factors that influence the way SLTs work with parents. Aims: To explore the specific beliefs of Dutch SLTs that influence how they collaborate with parents of children with DLD. Methods and procedures: We conducted three online focus groups with 17 SLTs using a reflection tool and fictional examples of parents to prompt their thoughts, feelings and actions on specific scenarios. Data were organised using the Theoretical Domains Framework (TDF). Outcomes and results: We identified 34 specific beliefs across nine TDF domains on how SLTs collaborate with parents of children with DLD. The results indicate that SLTs hold beliefs on how to support SLTs in collaborating with parents but also conflicting specific beliefs regarding collaborative work with parents. The latter relate to SLTs’ perspectives on their professional role and identity, their approach towards parents, and their confidence and competence in working collaboratively with parents.
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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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Children with speech sound disorders (SSD) have speech disorders due to problems in articulation, phonology, execution (eg. dysarthria), planning (eg. apraxia), orofacial anomalies (eg. cleft palate) or hearing impairment (ASHA). How do children with speech sound disorders perform on language and motor (experimental) tests compared to typically developing children?
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Purpose:Our aim was to develop consensus on the definition and operationalization of communicative participation (CP)in 2- to 8-year-old children with language disorders (LDs).A clear definition and operationalization can facilitate the discussion about children’s communication problems in daily life between parents and professionals. Method: In an online Delphi study, anonymized thoughts and opinions were collected on the definition and operationalization of CP in young children with LD. The 47 Delphi panel members were Dutch parents, young adults with LDs, teachers and assistants, speech-language pathologists, clinical linguists,and clinical researchers. Thematic content analysis was used to develop a concept definition and items operationalizing CP.The Delphi panel rated the suitability of concept definitions using a 7-point Likert scale. Concept definitions were revised with feedback from the Delphi panel until consensus was achieved. The Delphi panel rated items on how well they operationalize CP, using the same Likert scale. Results: The majority (79%) of the Delphi panel indicated that the essence of CP was captured by the definition:“CP is understanding and being understood in a social context,by applying verbal and non-verbal communication skills.”In addition, 33 behavioral items were developed.Conclusion:This study resulted in strong consensus on the definition of CP between Dutch parents and professionals.Items were developed that can inform speech-language pathologists on the type of questions to ask a child’s parents or teacher when discussing CP. Further research is needed on how the items can best be used in clinical practice.
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Children with developmental language disorders (DLDs) may experience barriers to communicative participation. Communicative participation is defined as ‘participation in life situations in which knowledge, information, ideas or feelings are exchanged’. Barriers experienced in communicative participation cannot be explained by language competence alone and are thought to be influenced by contextual factors. A better understanding of these factors will contribute to tailored speech and language therapy services for children with DLD. We conducted a focus group study with 13 speech and language therapists’ (SLTs) to explore their perspectives on contextual (environmental and personal) factors in early childhood that are associated with communicative participation in children with DLD. The personal factor of child well-being, and the environmental factors of familial support and SLT service provision were developed through thematic analysis. The potential mediating role of these factors on communicative participation implies that it is important to address contextual barriers and facilitators in speech and language therapy services.
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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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In a class or group of twenty children, - statistically - one child has a developmental language disorder (DLD). For children with DLD it is very difficult to keep up at school. The problems in the language also easily lead to miscommunication, which can cause behavioral problems. The timely recognition of a DLD is of great importance for early treatment. This way you can prevent or reduce problems at school, at home and in the children's leisure time. At the moment, children with DLD are not always identified early.Problems in language development can be identified early, for example at the age of two by child health workers. Parents, kindergarten teachers and elementary school teachers can also identify problems in children's language development. This requires a language screening instrument that can easily determine whether a child's language is 'at risk' or 'not at risk'. Early identification of language problems is important, but until today children are still missed. In this dissertation I present a new instrument for the identification of problems in the language development of children from one to six years old, the Early Language Scale (ELS). I also describe the development of the milestones in the language development of children, how good the current screening at the age of two at the health care office is and what parents think of this language screening. The ELS appears to detect DLD in young children well and can therefore make an important contribution to the detection of these problems at the primary health care.
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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: 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.AIMS: 1) To develop a comprehensive, comprehensible item bank for measuring communicative participation in children, adolescents, and young adults with communication problems. 2) To assess the content validity of the item bank in a sample of these groups. 3) To define criteria for the minimal age at which children with communication difficulties can self-report their communicative participation.METHOD: Based on a literature review and two concept elicitation studies three initial versions of item pools were developed: one for children, one for adolescents and one for young adults. These pools were pilot tested, using cognitive debriefing interviews, on comprehensibility and comprehensiveness in a diverse group of participants with communication difficulties, whereafter a second version of the item pools were created. Hereafter, the content validity was assessed in the target population and in a group of speech and language therapists.RESULTS: Initially, three item pools were created for children (58 items), adolescents (78 items), and young adults (84 items). In the pilot test with 33 children adolescents and young adults with communication difficulties, items were revised for comprehensibility, some items were added for comprehensiveness, and some items were deleted because they appeared irrelevant, resulting in updated pools of 50, 69, and 72 items. In the content validity study, cognitive interviews with 27 participants and a focus group with 8 professionals identified additional revisions. Most items were comprehensible, but some were irrelevant for specific subpopulations of communication difficulties. Two new items were added after the input of professionals, whereafter the item bank was found comprehensive.CONCLUSIONS: MyCommunication-Youth is an item bank for measuring communicative participation in children, adolescents and young adults with various communication difficulties. Three versions of the instrument were created: MyCommunication-Children of 49 items, MyCommunication-Adolescents of 70 items and MyCommunication-YoungAdults of 73 items. The item bank is comprehensible, relevant and comprehensive according to the target population and target professionals.
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