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There is still no consensus about the nature of auditory processing disorders (APD). One of the most frequently reported symptoms for APD is difficulties with hearing and listening, especially in the presence of background noise, despite having normal peripheral hearing (ASHA, 2005; Jerger & Musiek, 2000). It is unclear whether there is a behavioral characteristic or whole set of symptoms that is solely attributable to problems with auditory processing. Such a distinctive feature could help audiologists and speech-language pathologists to differentiate APD from other developmental disorders. The purpose of this systematic review is to evaluate the literature on characteristics of children with suspected APD and to determine whether there is a distinctive feature.
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OBJECTIVE: This study investigated the perspectives of professionals from the Dutch audiological centres on the definition and care pathways of children with suspected auditory processing disorders (susAPD).DESIGN: focus group interviews.STUDY SAMPLE: In total, 45 professionals from 6 disciplines, representing 22 different audiological centres and one ambulatory service, participated in five parallel focus group interviews. Participants had a variety of experience in diagnosing and advising children with suspected APD.RESULTS: Qualitative analysis (open and thematic) identified four themes ("Definition", "Causes", "Diagnostic Procedures" and "Clinical Reasoning") expressing a variety of perspectives. Differences in perspectives were mainly affected by two debates: (1) whether or not APD exists as a pure (auditory) disorder and (2) whether or not current AP-tests are suitable in diagnosing children with listening difficulties. They also expressed a need for more guidance from the literature in their clinical decision making process.CONCLUSIONS: Professionals from the Dutch audiological centres share a broad perspective on children with APD. The ICF framework supports this perspective, thereby diminishing the need for a clear definition. The use of AP-tests should be limited to children where broader developmental disorders are first ruled out; a possible "pure" APD could then be diagnosed in a limited number of 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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Background: Shared decision-making is one key element of interprofessional collaboration. Communication is often considered to be the main reason for inefficient or ineffective collaboration. Little is known about group dynamics in the process of shared decision-making in a team with professionals, including the patient or their parent. This study aimed to evaluate just that. Methods: Simulation-based training was provided for groups of medical and allied health profession students from universities across the globe. In an overt ethnographic research design, passive observations were made to ensure careful observations and accurate reporting. The training offered the context to directly experience the behaviors and interactions of a group of people. Results: Overall, 39 different goals were defined in different orders of prioritizing and with different time frames or intervention ideas. Shared decision-making was lacking, and groups chose to convince the parents when a conflict arose. Group dynamics made parents verbally agree with professionals, although their non-verbal communication was not in congruence with that. Conclusions: The outcome and goalsetting of an interprofessional meeting are highly influenced by group dynamics. The vision, structure, process, and results of the meeting are affected by multiple inter- or intrapersonal factors.
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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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De Nederlandse maatschappij staat voor een belangrijke uitdaging. In 2030 moet de CO2-uitstoot met minimaal 49% zijn teruggedrongen en de Nederlandse industrie dient veel meer circulair te werken dan nu het geval is. In 2050 is de industrie circulair en stoot vrijwel geen broeikasgas meer uit. Een hele opgave als je bedenkt dat Nederland volgens de Nieuwe Economie Index nu nog op een score zit van 12.1% wat betreft circulariteit (Van ‘t Klooster et al., 2020). Voor de topsector Logistiek betekent dit dat er kennis en nieuwe concepten ontwikkeld moeten worden om duurzame logistieke oplossingen te realiseren.
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Zelfkennis is van essentieel belang voor de kwaliteit van het leven. Met name in de loopbaanontwikkeling is dat duidelijk. Maar hoe komt een mens aan zelfkennis en hoe kan men daarbij helpen? Dit hoofdstuk biedt enkele verklaringen waarom zelfkennis problematisch is. Vier manieren worden beschreven waarmee mensen naar zichzelf en naar anderen kunnen kijken. Eén van die manieren leent zich het best voor zelfsturing. Wat is deze manier? En wat houdt dit in voor loopbaanbegeleiding in onderwijs, arbeidsorganisaties en bij (re-)integratie?
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Inter)nationally there is discussion about whether auditory processing disorders (APD) should be seen as a unique clinical diagnosis and what is the most appropriate diagnosis and referral of children in this target group. In this context, the Dutch Audiological Centres (AC) have different care pathways for children with so-called unexplained listening difficulties. The purpose of the current document is to provide professionals with tools to identify, diagnose and treat children with listening difficulties. The Dutch Position Statement Children with Listening Difficulties has been developed based on current scientific evidence of listening difficulties, and based on meetings held with professionals. Professionals in the Dutch Audiological Centres have reached a consensus with the following 9 statements: Definition: (1) The target group 'Children with listening difficulties' is not a unique and demonstrable clinical entity. (2) The problems of children with listening difficulties are multimodal. (3) The symptoms of children with listening difficulties may also occur in children with other developmental disorders such as AD(H)D, DLD, dyslexia and learning disorders. Detection and referral: (4) After detection of listening difficulties, children can be referred to a multidisciplinary centre. Diagnostics: (5) When diagnosing a child with listening difficulties, an audiologist, a speech language therapist and a behavioral scientist must be involved. (6) Listening difficulties are initially mapped using patient history (with client-centred focus) and, if available, a validated questionnaire. (7) In the case of children with listening difficulties, a speech-in-noise test is always carried out in addition to the pure tone and speech audiometry (8) The diagnostic procedure for listening difficulties starts from a broad perspective on development. Therapy: (9) For children with listening difficulties, intervention is focused on the client’s needs and focuses on action-oriented practice. This document informs professionals in the Netherlands, who are working with children who are referred because of listening difficulties in the absence of hearing loss, about the current evidence available and about the consensus in the Netherlands.
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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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