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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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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AimTo investigate: (a) language difficulties in children with developmental coordination disorder (DCD), and (b) motor difficulties in children with developmental language disorder (DLD).MethodIn this systematic review, PubMed, CINAHL, PsycINFO, and Embase were searched to identify peer-reviewed studies. Two researchers independently identified, screened and evaluated the methodological quality of the included studies following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). For objective (a), we combined the terms: “developmental coordination disorder” AND “language skills” AND “children”. For objective (b) we combined the terms: “developmental language disorder” AND “motor skills” AND “children”.ResultsTen studies on language skills in children with DCD and 34 studies on motor skills in children with DLD are included, most with relatively good methodological quality. The results for language comprehension and production in children with DCD are contradictory, but there is evidence that children with DCD have communication and phonological problems. Evidence for general motor problems in children with DLD is consistent. Studies report problems in balance, locomotor, and fine motor skills in children with DLD. Evidence for aiming and catching skills is inconsistent.InterpretationThe findings of this systematic review highlight the co-occurrence of language impairments in children with DCD and motor impairments in children with DLD. Healthcare professionals involved in the assessment and diagnosis of children with DCD or DLD should be attentive to this co-occurrence. In doing so, children with DCD and DLD can receive optimal interventions to minimize problems in their daily life.
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Background: Early and effective treatment for children with developmental language disorder (DLD) is important. Although a growing body of research shows the effects of interventions at the group level, clinicians observe large individual differences in language growth, and differences in outcomes across language domains. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking. Aims: To assess changes in the language domains: expressive morphosyntax; receptive and expressive vocabulary; and comprehension, in children in special needs education for DLD. To explore if differences in language gains between children are related to child characteristics: language profile; severity of the disorder; being raised mono- or multilingually; and cognitive ability. Methods & Procedures: We extracted data from school records of 154 children (4–6 years old) in special needs education offering a language and communication-stimulating educational environment, including speech and language therapy. Changes in language were measured by comparing the scores on standardized language tests at the beginning and the end of a school year. Next, we related language change to language profile (receptive–expressive versus expressive-only disorders), severity (initial scores), growing up mono- and multilingually, and children’s reported non-verbal IQ scores. Outcomes&Results: Overall, the children showed significant improvements in expressive morphosyntax, expressive vocabulary and language comprehension. Baseline scores and gains were lowest for expressive morphosyntax. Differences in language gains between children with receptive–expressive disorders and expressive-only disorders were not significant. There was more improvement in children with lower initial scores. There were no differences between mono- and multilingual children, except for expressive vocabulary. There was no evidence of a relation between non-verbal IQ scores and language growth. Conclusions & Implications: Children with DLD in special needs education showed gains in language performance during one school year. There was, however, little change in morphosyntactic scores, which supports previous studies concluding that poor morphosyntax is a persistent characteristic of DLD. Our results indicate that it is important to include all children with DLD in intervention: children with receptive–expressive and expressive disorders; monoand multilingual children, and children with high, average and low non-verbal IQ scores. We did not find negative relations between these child factors and changes in language skills.
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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 Variations in communicative participation of children with developmental language disorder (DLD) cannot be wholly explained by their language difficulties alone and may be influenced by contextual factors. Contextual factors may support or hinder communicative participation in children, which makes their identification clinically relevant. Aims To investigate which contextual (environmental and personal) factors in early childhood are protective, risk or neutral factors for communicative participation among school-aged children with DLD, and to identify possible gaps in knowledge about this subject. Methods & Procedures A scoping review was conducted based on a systematic search of studies published from January 2007 to March 2022 in Pubmed, Embase (without MEDLINE), CINAHL and PsycINFO. In total, 8802 studies were reviewed using predefined eligibility criteria, of which 32 studies were included for data extraction and critically appraised using the Critical Appraisal Skills Programme (2021) tools. Main Contribution The methodological quality of included studies was adequate to strong. Personal protective factors identified are being a preschool girl, reaching school age and being prosocial, while personal risk factors are becoming a teenager or adolescent, having low socio-cognitive skills and experiencing comorbid mobility impairment or behavioural problems. Gender after the preschool years and non-verbal abilities were not found to be of influence, and the role of socio-emotional skills is inconclusive. Receiving therapy is an environmental protective factor, while the association between socio-economical family characteristics with communicative participation is inconclusive. Conclusions & Implications Limited research has been conducted on which risk and protective factors present in early childhood are associated with later communicative participation of children with DLD. The influence of co-occurring health conditions, social background variables, individual psychological assets, interpersonal relationships and attitudes of other people represent knowledge gaps. In addition, knowledge about the comparative effectiveness of different types of interventions and service delivery models, and the impact of administrative control, organizational mechanisms and standards established by governments on children's communicative participation is lacking. More longitudinal research is needed focusing on the identification of relevant personal and environmental factors and the interactions between them in relation to communicative participation outcomes.
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Children with DLD in special education show improvement in language performance. No differences in improvement between: • Children with receptive expressive disorders and expressive disorders • Children with low and high IQs • Mono and multilingual children Intervention is important for all children with DLD. Contact: gerda.bruinsma@hu.nlThere is a paucity of information on the effects of special education provisions on the language skills of children with DLD. Specifically , it is unclear 1. if (and how ) school based intervention impacts various language domains 2. to what extent child characteristics modulate outcomes Method We traced the trajectory of 154 children with DLD at 18 schools for special education that provide systematic language oriented interventions . Mean age 4;10 at the start of the study; range 3;11 5;7 yrs
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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: This study explores limitations in communication in daily life of children with developmental language disorder (DLD) from their parents' perspective as well as communicative abilities and social functioning in the classroom from their teacher's perspective. Furthermore, differences between children with mixed receptive–expressive disorder and children with expressive-only disorder in communication in daily life and social functioning are studied. Method: Data were collected through questionnaires completed by parents and teachers of children (5–6 years old) who attended schools for special education for DLD. Language test scores were retrieved from school records. Parents of 60 children answered open-ended questions about situations and circumstances in which their child was most troubled by language difficulties. Teachers of 83 children rated communicative abilities, social competence, and student–teacher relationship. Results: Parents reported communication with strangers as most troublesome and mentioned the influence of the mental state of their child. Parents considered limitations in expressing oneself and being understood and not being intelligible as core difficulties. Teachers rated the children's communicative abilities in the school context as inadequate, but their scores concerning social competence and the quality of teacher–child relationships fell within the normal range. Children with receptive–expressive disorder experienced limitations in communication in almost all situations, whereas those with expressive disorder faced limitations in specific situations. Children with receptive–expressive disorder were also significantly more limited in their communicative abilities and social competence at school than children with expressive disorder. No differences were found between the two groups in the quality of the teacher–child relationship. Conclusions: The results confirm that children with DLD face significant challenges in a variety of communicative situations. We found indications that children with receptive–expressive disorder experience more severe limitations than children with expressive disorder. The involvement of parents and teachers in evaluating a child's communicative ability provides valuable and clinically relevant information.
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Background: Collaborative 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. Aims: To explore parents’ needs in their collaboration with SLTs during therapy for their young child with DLD. Methods & Procedures: Parents 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 & Results: The 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 & Implications: Parents 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.
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