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 to the problem Dutch society demonstrates a development which is apparent in many societies in the 21st century; it is becoming ethnically heterogeneous. This means that children who are secondlanguage speakers of Dutch are learning English, a core curriculum subject, through the medium of the Dutch language. Research questions What are the consequences of this for the individual learner and the class situation?Is a bi-lingual background a help or a hindrance when acquiring further language competences. Does the home situation facilitate or impede the learner? Additionally, how should the TEFL professional respond to this situation in terms of methodology, use of the Dutch language, subject matter and assessment? Method of approach A group of ethnic minority students at Fontys University of Professional Education was interviewed. The interviews were subjected to qualitative analysis. To ensure triangulation lecturers involved in teaching English at F.U.P.E. were asked to fill in a questionnaire on their teaching approach to Dutch second language English learners. Thier response was quantitatively and qualitatively analysed. Findings and conclusions The students encountered surprisingly few problems. Their bi-lingualism and home situation were not a constraint in their English language development. TEFL professionals should bear the heterogeneous classroom in mind when developing courses and lesson material. The introduction to English at primary school level and the assessment of DL2 learners require further research.
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Purpose: This article summarizes the shared principles and evidence underpinning methods employed in the three sentence-level (syntactic) grammatical intervention approaches developed by the authors. We discuss associated clinical resources and map a way forward for clinically useful research in this area. Method: We provide an overview of the principles and perspectives that are common across our three syntactic intervention approaches: MetaTaal (Zwitserlood, 2015; Zwitserlood, Wijnen, et al., 2015), the SHAPE CODING™ system (Ebbels, 2007; Ebbels et al., 2014, 2007), and Complex Sentence Intervention (Balthazar & Scott, 2017, 2018). A description of each approach provides examples and summarizes current evidence supporting effectiveness for children with developmental language disorder ranging in age from 5 to 16 years. We suggest promising directions for future research that will advance our understanding of effective practices and support more widespread adoption of syntactic interventions with school-age children. Conclusion: In each approach to syntactic intervention, careful and detailed analysis of grammatical knowledge is used to support target selection. Intervention targets are explicitly described and presented systematically using multimodal representations within engaging and functional activities. Treatment stimuli are varied within a target pattern in order to maximize learning. Similar intervention intervals and intensities have been studied and proven clinically feasible and have produced measurable effects. We identify a need for more research evidence to maximize the effectiveness of our grammatical interventions, encompassing languages other than English, as well as practical clinical tools to guide target selection, measurement of outcomes, and decisions about how to tailor interventions to individual needs.
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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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Purpose: Applying evidence-based grammar intervention can be challenging for speech and language therapists (SLTs). Language in Interaction Therapy (LIT) is a focused stimulation intervention for children with weak morphosyntactic skills, which was developed to support SLTs in incorporating results from effect studies in daily practice. The aims of this Clinical Focus are (a) to explain the principles and elements of LIT and stimulate use in daily SLT practice and (b) to describe the effects of LIT on morphosyntactic skills of 4- to 5-year-olds in special education, compared to usual care. Method: With a description of LIT, we provide guidance to implement evidence-based intervention. Important elements are as follows: proper selection of therapy goals, language facilitating techniques, child-centered and clinician-directed elements, and the use of scripts. Our focus in the description is on the support and practical solutions LIT tries to provide to SLTs. We also explored the implementation of LIT in special education, to improve morphosyntax in 4- and 5-year-old children. We provided SLTs with training and designed protocols for each therapy session. The effects of LIT were measured in a single-case A-B design, repeated in five children with developmental language disorders (ages 4;2-5;7 [years;months]). Conclusion: We conclude that implementation of LIT is possible if LIT is enriched with support in goal selection, protocols to guide therapy sessions, and training and coaching. In the single-case study, four children showed more growth in mean length of utterance during and directly following the LIT intervention phase, compared to the baseline phase with usual care, and in two of them, this difference was significant. The grammatical complexity measure "TARSP-P" showed an overall significantly higher score at group level during LIT, but limited effects on an individual level.
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The aim of this study was to assess the criterion validity of a new screening instrument, the Early Language Scale (ELS), for the identification of young children at risk for developmental language disorder (DLD), and to determine optimal age-adjusted cut-off scores. We recruited a community-based sample of 265 children aged 1 to 6 years of age. Parents of these children responded on the ELS, a 26-item "yes-no" questionnaire. The children were assessed with extended language tests (language comprehension, word production, sentence production, communication). A composite score out of these tests (two tests below - 1 SD or one below - 1.5 SD) was used as reference standard. We assessed the validity of the ELS, measured by sensitivity, specificity, predictive values, and AUC. The optimal sensitivity/specificity age-dependent cut-off ELS score was at 15th percentile. Sensitivity and specificity were 0.62 and 0.93, respectively. Positive predictive value was moderate (0.53), negative predictive value was high (0.95), the positive likelihood ratio was 9.16, and negative likelihood ratio was 0.41. The area under the ROC curve was 0.88. The items covered the increasing language development for the ages from 1 to 6.Conclusion: The ELS is a valid instrument to identify children with DLD covering an age range of 1 to 6 years in community-based settings.What is Known:• Early identification and treatment of developmental language disorders can reduce negative effects on children's emotional functioning, academic success, and social relationships.• Short, validated language screening instruments that cover the full age range of early childhood language development lack.What is New:• The 26-item Early Language Scale (ELS) is a valid instrument to identify children at risk for developmental language disorder in well-child care and early educational settings among Dutch children aged 1-6 years.
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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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Bipolar disorder is a severe mental illness with serious consequences for daily living of patients and their caregivers. Care as usual primarily consists of pharmacotherapy and supportive treatment. However, a substantial number of patients show a suboptimal response to treatment and still suffer from frequent episodes, persistent interepisodic symptoms and poor social functioning. Both psychiatric and somatic comorbid disorders are frequent, especially personality disorders, substance abuse, cardiovascular diseases and diabetes. Multidisciplinary collaboration of professionals is needed to combine all expertise in order to achieve high-quality integrated treatment. 'Collaborative Care' is a treatment method that could meet these needs. Several studies have shown promising effects of these integrated treatment programs for patients with bipolar disorder. In this article we describe a research protocol concerning a study on the effects of Collaborative Care for patients with bipolar disorder in the Netherlands.
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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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