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Aim: Evidence shows that 20%–30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration. Materials and methods: We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 – neurological diseases (n = 93), G2 – head and neck surgery (n = 200), G3 – gastroenterological diseases (n = 94) and G4 – other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered. Results: There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX–X). Conclusions: Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery. WHAT THIS PAPER ADDS: What is already known on the subject: Clinical signs of penetration or aspiration include coughing, throat clearing and voice changes, while silent penetration or aspiration patients aspirate without demonstrating any clinical symptoms. The most common consequences of silent aspiration include aspiration pneumonia, recurrent lower respiratory tract infections and respiratory failure. Additionally, malnutrition and dehydration can be indicators of silent aspiration. Patients may unknowingly reduce their oral intake and lose weight. Retrospective studies have shown that 20%–30% of patients aspirate silently (e.g. patients after stroke, acquired brain injury, head and neck cancer treatment, prolonged intubation). Clinical examination of swallowing can miss up to 50% of cases of silent aspiration. What this paper adds to existing knowledge: Currently, silent aspiration is often discussed in neurological literature, but its applications to head and neck surgery are limited. In this study, we identify head and neck surgery patients who should be prioritised or considered to be in higher need of instrumental swallowing evaluation due to a higher risk of silent aspiration. What are the potential or actual clinical implications of this work?: Post‐treatment structural changes can result in lower cranial nerve paresis (IX, X, XII) and face injury, in which vagus and glossopharyngeal nerves are injured. After tracheostomy and radiotherapy, patients with problems swallowing saliva need careful clinical examination, particularly cranial nerve examination. [ABSTRACT FROM AUTHOR]

Background: When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non‐attendance or non‐adherence that are multifactorial and variable dependent on, for example, population and intervention. Aims: To identify rates of non‐attendance and non‐adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. Methods: Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self‐efficacy), personal circumstances (socio‐demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non‐attendance rates were identified via local health records and non‐adherence ascertained using a specific parent‐reported measure within the treatment experience domain. Results: Participants (N = 199) were predominantly mothers, and were ethnically and socio‐economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non‐attendance was 25% and the main predictors of non‐attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non‐adherence in this cohort was 26% with parental rating of the importance of a recommendation and self‐efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. Conclusions & Implications: Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS: What is already known on the subject: It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge: This study identified rates of parental non‐attendance and non‐adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non‐attendance. What are the potential or actual clinical implications of this work?: This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN. [ABSTRACT FROM AUTHOR]

Background: As delays or disorders in early language and communication are the most prevalent symptom in children with disabilities, early screening is crucial to promote prevention, early diagnosis, and intervention. However, to the best of our knowledge, no screening tool is available for the joint assessment of early language and social communication skills in European Portuguese (EP)‐learning children, which is critical for screening, monitoring and enrolment in appropriate early intervention services. Aims: (1) To adapt and validate the EP version of the Communication and Symbolic Behaviour Scales Developmental Profile™ (CSBS DP™) Infant–Toddler Checklist, a parental report for the screening of early language and social communication skills. (2) To conduct a cross‐cultural comparison between the EP adaptation and the original US version. Methods & Procedures: A total of 611 EP‐learning children (ages 6–24 months) were assessed on the CSBS DP Infant–Toddler Checklist. Normative data, psychometric characteristics (i.e., internal consistency and test–retest reliability), and cross‐cultural comparison between the EP and the original version were explored. Outcomes & Results: Internal consistency ranged from good to excellent and the test–retest reliability was excellent. The performance of the EP and US samples matched on almost all scores. However, EP children performed significantly better than their American peers in the Social compositive at 22 months and in the Symbolic composite at 20 months. No further differences were found. Conclusions & Implications: These findings showed that the EP CSBS DP Infant–Toddler Checklist seems to be a reliable screening tool of communicative and symbolic behaviours for EP‐learning children, which can be particularly relevant for decision‐making in clinical practice. WHAT THIS PAPER ADDS: What is already known on the subject: Early communication skills are known to be related to later language outcomes. Thus, screening tools for the early identification of children at risk for language and communication impairments, which may lead to monitoring and early intervention, have the potential to promote better outcomes. However, to the best of our knowledge, no screening tool is available for the assessment of early communication abilities in EP‐learning children. What this paper adds to existing knowledge: This study adapted and validated the EP CSBS DP Infant–Toddler Checklist, the first published parental report checklist for the assessment of early communication skills in EP. It described the psychometric characteristics of the adapted checklist, summarized the newly available normative data for EP‐learning infants and toddlers, and compared the performance of EP‐learning children with the original standardization sample reported for American English. The results demonstrated that this tool is a reliable instrument for the early screening of language, communicative and symbolic behaviours for EP‐learning children between 6 and 24 months of age. What are the potential or actual clinical implications of this work?: Given that early screening is crucial to promote prevention, early diagnosis and intervention, the availability of this tool is particularly relevant for children monitoring and their enrolment in appropriate early intervention services, helping decision‐making in clinical practice, in line with current guidelines regarding early monitoring and intervention to promote and support better outcomes. Thus, the tool and related normative data will be useful for paediatricians, family doctors, primary healthcare providers, developmental psychologists and speech–language therapists, among other professionals in the healthcare and educational fields, concerned with speech, language, and communication development and impairments. [ABSTRACT FROM AUTHOR]

Background: Down syndrome (DS) is a neurodevelopmental disorder of genetic origin with a cognitive‐behavioural profile that distinguishes it from other syndromes. Within this profile, language difficulties are particularly marked, having been more studied in childhood than in adulthood. More generally, there is a paucity of research on the prosodic skills of individuals with DS, despite the relevance of this linguistic component for effective communication. Aims: This study aimed to analyse, for the first time, the prosodic profile of Spanish‐speaking teenagers and young adults with DS. We hypothesized that participants with DS would show significantly lower skills for the perception and production of prosodic functions and forms when compared to peers with intellectual disability (ID) of unknown origin. We also hypothesized that teenagers and young adults with DS would have better prosody perception than prosody production. Methods & Procedures: The final sample included in the study comprised 28 Spanish‐speaking teenagers and young adults with DS and 29 teenagers and young adults with other ID matched on chronological age and nonverbal cognition. Their prosodic skills were tested by means of the Profiling Elements of Prosody for Speech and Communication battery. This battery allows for the separate evaluation of the comprehension and expression of the communicative functions of prosody and the discrimination and production of the forms that carry out such functions. Outcomes & Results: In the prosody function tasks, which are the most adaptive tasks for the communicative process, we found, as expected, significantly lower scores on the turn‐end, chunking, and focus tasks in the group with DS. However, no significant between‐group differences were found for the affect tasks. Participants with DS also had significantly lower scores on the prosodic form tasks than participants with other ID. The results of the comparison between prosodic perception and production skills showed that a generalization about a better profile in comprehension versus production is not possible and that there is a dependence on the demands of the prosodic task undertaken. Conclusions & Implications: The findings contribute to the ongoing development of the language profile of teenagers and young adults with DS and imply the need to design prosodic intervention programs based on their specific profile. WHAT THIS PAPER ADDS: What is already known on the subject: Prosody is a fundamental element of language, and its mastery affects the effectiveness of communication. However, research on prosody in Down syndrome (DS) that offers a holistic view from a psycholinguistic approach is still scarce. To date, studies focused on providing a detailed profile of prosodic skills in individuals with DS have been mainly conducted with a few English‐speaking children. These studies have shown that the comprehension and production of prosody is severely impaired, especially when considering affect and focus production, as well as the perception and production of prosodic forms. During childhood, greater efficacy is found in prosody comprehension than in prosody expression. What this study adds: This is the first study analysing the prosodic profile of a large group of Spanish‐speaking teenagers and young adults with DS. Poorer performance in the perception and production of both prosodic functions and forms was observed in participants with DS compared to participants with intellectual disability of unknown origin matched on chronological age and nonverbal cognition. Unlike what has been previously found in children, teenagers and young adults with DS performed at the same level as the control group on the understanding and expression of affect through prosodic cues. Results also showed that a generalization about a better prosody profile in comprehension versus production is not possible. What are the clinical implications of this work?: This study provides new data on the prosodic skills of Spanish‐speaking teenagers and young adults with DS. Given the impact of prosody on effective communication and the pattern of difficulties found in this study, speech and language therapists working with individuals with DS should consider including prosodic skills in interventions not only in childhood but also in adolescence and adulthood. Therefore, the prosodic profile of strengths and weaknesses in individuals with DS found in this research has direct implications for clinical practice. [ABSTRACT FROM AUTHOR]

Background: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. Aims: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. Methods and Procedures: In total, 43 UK families of 2–4‐year‐olds were recruited to the study, half of whom completed an 8‐week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait‐list controls. Results and Outcomes: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait‐list controls. Conclusions and Implications: We conclude that pre‐verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. What This Paper Adds: What is already known on the subject: Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds: This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work?: Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need. [ABSTRACT FROM AUTHOR]