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Background: Competent clinical reasoning forms the foundation for effective and efficient clinical swallowing examination (CSE) and consequent dysphagia management decisions. While the nature of initial CSEs has been evaluated, it remains unclear how new information gathered by speech–language therapists (SLTs) throughout a patient's acute‐care journey is integrated into their initial clinical reasoning and management processes and used to review and revise initial management recommendations. Aims: To understand how SLTs' clinical reasoning and decision‐making regarding dysphagia assessment and management evolve as patients transition through acute hospital care from referral to discharge. Methods & Procedures: A longitudinal, qualitative approach was employed to gather information from two SLTs who managed six patients at a metropolitan acute‐care hospital. A retrospective 'think‐aloud' protocol was utilized to prompt SLTs regarding their clinical reasoning and decision‐making processes during initial and subsequent CSEs and patient interactions. Three types of concept maps were created based on these interviews: a descriptive concept map, a reasoning map and a hypothesis map. All concept maps were evaluated regarding their overall structure, facts gathered, types of reasoning engaged in (inductive versus deductive), types of hypotheses generated, and the diagnosis and management recommendations made following initial CSE and during subsequent dysphagia management. Outcomes & Results: Initial CSEs involved a rich process of fact‐gathering, that was predominantly led by inductive reasoning (hypothesis generation) and some application of deductive reasoning (hypothesis testing), with the primary aims of determining the presence of dysphagia and identifying the safest diet and fluid recommendations. During follow‐up assessments, SLTs engaged in increasingly more deductive testing of initial hypotheses, including fact‐gathering aimed at determining the tolerance of current diet and fluid recommendations or the suitability for diet and/or fluid upgrade and less inductive reasoning. Consistent with this aim, SLTs' hypotheses were focused primarily on airway protection and medical status during the follow‐up phase. Overall, both initial and follow‐up swallowing assessments were targeted primarily at identifying suitable management recommendations, and less so on identifying and formulating diagnoses. None of the patients presented with adverse respiratory and/or swallowing outcomes during admission and following discharge from speech pathology. Conclusions & Implications: Swallowing assessment and management across the acute‐care journey was observed as a high‐quality, patient‐centred process characterized by iterative cycles of inductive and deductive reasoning. This approach appears to maximize efficiency without compromising the quality of care. The outcomes of this research encourage further investigation and translation to tertiary and post‐professional education contexts as a clear understanding of the processes involved in reaching diagnoses and management recommendations can inform career‐long refinement of clinical skills. WHAT THIS PAPER ADDS: What is already known on the subject: SLTs' clinical reasoning processes during initial CSE employ iterative cycles of inductive and deductive reasoning, reflecting a patient‐centred assessment process. To date it is unknown how SLTs engage in clinical reasoning during follow‐up assessments of swallowing function, how they assess the appropriateness of initial management recommendations and how this relates to patient outcomes. What this paper adds to the existing knowledge: Our longitudinal evaluation of clinical reasoning and decision‐making patterns related to swallowing management in acute care demonstrated that SLTs tailored their processes to each patient's presentation. There was an emphasis on monitoring the suitability of the initial management recommendations and the potential for upgrade of diet or compensatory swallowing strategies. The iterative cycles of inductive and deductive reasoning reflect efficient decision‐making processes that maintain high‐quality clinical care within the acute environment. What are the potential or actual clinical implications of this work?: Employing efficient and high‐quality clinical reasoning is a hallmark of good dysphagia practice in maximizing positive patient outcomes. Developing approaches to understanding and making explicit clinical reasoning processes of experienced clinicians may assist SLTs of all developmental stages to provide high standards of care. [ABSTRACT FROM AUTHOR]

Introduction: Speech Language Therapy First Point of Contact Clinic (SLT‐FPOCC) models can assist assessment of low‐risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best‐practice care, consideration of other low‐risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT‐FPOCC model and examine consumer perceptions. Methods & Procedures: The service followed existing SLT‐FPOCC procedures, with ENT triaging referrals, then SLT completing pre‐ and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post‐service satisfaction survey. Results: Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty‐three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre‐/postoperative VCCs were completed with no adverse events. Conclusion & Implications: The current data support SLT‐FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre‐ and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services. WHAT THIS PAPER ADDS: What is already known: Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well‐recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech‐language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre‐ and postsurgical assessments of such low‐risk populations. What this study adds: This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT‐led FPOCC model, the trained SLT completes the pre‐ and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study: Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre‐and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management. [ABSTRACT FROM AUTHOR]

Background: Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID‐19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face‐to‐face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real‐world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. Methods: An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Results: Four hundred and thirty‐eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost‐effectiveness compared to face‐to‐face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Conclusions: Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. WHAT THIS PAPER ADDS: What is already known on this subject: The COVID‐19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre‐COVID‐19, evidence for the use of telehealth in this field included small‐scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face‐to‐face delivery. The realities of at‐scale clinical practice were not well‐represented, and critical elements of service such as cost‐effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long‐term and future use of telehealth remains unclear. What this paper adds to existing knowledge: The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer‐term and at‐scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face‐to‐face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work?: UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co‐ordinated leadership at the local, national and international levels and the development of policy and clinical guidance. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) use videofluoroscopic swallow study (VFSS) results to manage dysphagia. Yet, in some services only doctors can directly request a VFSS, potentially creating workflow inefficiencies and delaying patient access to VFSS. An alternative model, where SLTs directly refer patients for VFSS, is used in many services in the UK and Australia. However, processes for implementing and sustaining this model have not been reported. Aims: To evaluate the implementation of an SLT‐led inpatient VFSS referring model using the Consolidated Framework for Implementation Research (CFIR) to ascertain implementation barriers, facilitators and critical sustainability factors. Methods & Procedures: This implementation evaluation examined stakeholder perceptions of implementing the SLT‐led VFSS referring model via interviews of (1) SLTs who treat and refer inpatients for VFSS; (2) doctors who manage and refer inpatients for VFSS; (3) radiologists; and (4) trained VFSS referring SLTs. The CFIR was used to prospectively guide implementation planning, evaluation and outcome reporting, regarding barriers, facilitators and sustainability factors. Outcomes & Results: Implementation facilitators were (1) the advantage of SLT‐led VFSS referring over the standard model (doctors referring), in promoting high‐quality VFSS referrals; (2) compatibility of the model with the SLT skill set; (3) supportive communication networks between staff groups; and (4) engaging stakeholders throughout implementation. Adequate availability of trained VFSS referring SLTs was both a barrier and a facilitator of implementation. It was also a critical sustainability factor, along with ongoing staff education and outcome monitoring. Conclusions & Implications: The CFIR supported systematic evaluation of implementation facilitators and barriers, and adjustment of factors critical for implementing and sustaining the new model. Findings may assist other organizations to establish the SLT‐led VFSS referring model. What this paper adds: What is already known on the subject: Models where SLTs directly refer patients for VFSS have been described in the literature, with evidence of appropriate referrals and adherence to radiation safety standards. However, the process for establishing and sustaining this referring model has not been published. What this paper adds to existing knowledge: This study describes the process and outcomes of implementing an SLT‐led VFSS referring model, using the CFIR. A key advantage of the new model that facilitated implementation was the improved quality of VFSS referrals compared with the standard referring model. Important facilitating factors in the environment were the compatibility of the model with SLTs' skillset and supportive communication network between doctors and SLTs. Initially, an implementation barrier was the inadequate availability of trained SLT referrers. Using proactive implementation strategies, more referrers were trained (which was a facilitating factor for implementing and sustaining the model). What are the potential or actual clinical implications of this work?: This study highlights that successful implementation requires more than just an effective model. Features of the environment require consideration to minimize barriers and optimize facilitating factors, supported by proactive implementation strategies. Planning and evaluating implementation processes and outcomes using a standardized implementation framework such as CFIR aided understanding of barriers and facilitators for introducing the SLT‐led VFSS referring model. This process may assist other services to implement the model. [ABSTRACT FROM AUTHOR]

Background: Evidence‐based practice involves the synthesis of multiple forms of evidence to inform clinical decision‐making and treatment evaluation. Practice‐ and patient‐based evidence are two forms of evidence that are under‐represented in the stuttering literature. The collection of such knowledge is essential to support the design and delivery of effective stuttering interventions for adults. Aims: To build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence‐based interventions for adults who stutter. Methods & Procedures: Adults who stutter and speech and language therapists (SLTs) with experience in providing stuttering intervention participated in the three‐round e‐Delphi Survey focused on: (1) identifying key stuttering intervention components, including principles, practices, and structural and contextual elements; and (2) obtaining group consensus on stuttering intervention components. Statements were categorized using the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering. Outcomes & Results: A total of 48 individuals agreed to participate: 48/48 (100%) completed the Round 1 questionnaire, 40/48 (83%) responded to Round 2 and 36/40 (90%) participated in Round 3. Following content analysis of Round 1, 101 statements were developed, and consensus was achieved on 89 statements perceived as representing the core components of stuttering intervention for adults. Categorization of these statements reflected the key stuttering intervention components relating to personal reactions to stuttering, limitations in life participation and environmental factors. Conclusions & Implications: Consensus on the core components of stuttering intervention was reached through engagement with key stakeholders. The evidence‐based framework presented highlights the range of key intervention components a clinician should consider when designing interventions for adults who stutter. What this paper adds: What is already known on the subject: Evidence‐based practice endorses the synthesis of multiple knowledge forms including research, practice and patient evidence to support clinical decision‐making and treatment evaluation. The stuttering literature is characterized by an over‐representation of efficacy evidence, with significantly less practice and patient evidence to guide clinical practice. What this paper adds to existing knowledge: This study adds valuable practice‐ and patient‐based evidence for effective stuttering intervention components for adults who stutter. These relate to personal reactions to stuttering, limitations in life participation and environmental factors. What are the potential or actual clinical implications of this work?: This research presents a stakeholder‐informed framework for stuttering intervention to guide SLTs working with adults who stutter in designing evidence‐based interventions. The framework supports the adoption of a person‐centred approach to intervention to ensure each client's unique needs, preferences, values and desired outcomes are explored and integrated into therapy. [ABSTRACT FROM AUTHOR]

Background: There is an increasing number of technological resources available to speech and language therapists (SLTs) for use in clinical practice, but the factors that influence SLTs' selection and use of such resources are not well understood. In related fields, technology acceptance models have been employed to explain users' adoption of technology and to inform the advancement of empirically supported technological resources. Aims: To determine the factors that influence SLTs' use of technology for clinical practice by testing a model of their technology acceptance and use. Methods & Procedures: We surveyed 209 practising SLTs in the United States representative of the speech and language membership of the American Speech–Language–Hearing Association (ASHA). Participants completed a 38‐item electronic survey representing four categories: (1) technology use, (2) technology attitudes and factors influencing technology use, (3) employment information and (4) demographics. Items measuring technology attitudes served as indicators of the research model, which mapped the primary relationships of a technology acceptance model. Survey data were collected before the Covid‐19 pandemic. Outcomes & Results: The research model accounted for 66% of the variance in SLTs' behavioural intention to use technology, which significantly and positively predicted the amount of time they reportedly spent using technology in the workplace. Subjective norms and attitudes towards technology use directly predicted the intention to use technology. Perceived usefulness and ease of use indirectly predicted intention to use technology. Survey respondents reported using technology during 48% (SD = 24%) of their overall weekly work hours on average, with a large majority reporting using technology at least once per week for planning (89% of respondents), assessment (66% of respondents) or intervention (90% of respondents). Conclusions & Implications: These findings statistically explain the relationships between SLTs' attitudes and their intention to use technology for clinical practice, contributing to our understanding of why SLTs adopt certain technologies. We also detail the nature and frequency of technology use in the clinical practice of SLTs. Future directions for this work include further exploring use categories, employing direct measurements of technology use and exploring the impact of recent changes in SLT service delivery due to the Covid‐19 pandemic on SLTs' technology attitudes. What this paper addsWhat is already known on the subjectExisting research about the adoption and use of technological resources by SLTs indicates that they select tools based on convenience, cost and recommendations by others.What this paper adds to existing knowledgeThis study is the first to develop and test a research model of SLTs' technology attitudes. The findings from model testing demonstrate the significant predictors of SLTs' behavioural intention to use technology for clinical purposes. Intent of use is related to how much SLTs use technology in the workplace.What are the potential or actual clinical implications of this work?The present findings can inform interventions targeting the design and adoption of electronic SLT resources that are empirically supported. [ABSTRACT FROM AUTHOR]

Abstract: Background: Multiple interventions have been developed to address speech sound disorder (SSD) in children. Many of these have been evaluated but the evidence for these has not been considered within a model which categorizes types of intervention. The opportunity to carry out a systematic review of interventions for SSD arose as part of a larger scale study of interventions for primary speech and language impairment in preschool children. Aims: To review systematically the evidence for interventions for SSD in preschool children and to categorize them within a classification of interventions for SSD. Methods & Procedures: Relevant search terms were used to identify intervention studies published up to 2012, with the following inclusion criteria: participants were aged between 2 years and 5 years, 11 months; they exhibited speech, language and communication needs; and a primary outcome measure of speech was used. Studies that met inclusion criteria were quality appraised using the single case experimental design (SCED) or PEDro‐P, depending on their methodology. Those judged to be high quality were classified according to the primary focus of intervention. Outcomes & Results: The final review included 26 studies. Case series was the most common research design. Categorization to the classification system for interventions showed that cognitive–linguistic and production approaches to intervention were the most frequently reported. The highest graded evidence was for three studies within the auditory–perceptual and integrated categories. Conclusions & Implications: The evidence for intervention for preschool children with SSD is focused on seven out of 11 subcategories of interventions. Although all the studies included in the review were good quality as defined by quality appraisal checklists, they mostly represented lower‐graded evidence. Higher‐graded studies are needed to understand clearly the strength of evidence for different interventions. [ABSTRACT FROM AUTHOR]

Background The Preschool Speech and Language Program (PSLP) in Ontario, Canada, is a publically funded intervention service for children from birth to 5 years with communication disorders. It has begun a population-level programme evaluation of children's communicative participation outcomes following therapy. Data are currently being collected for all children who access this service-over 50 000 children each year. Aims To understand and evaluate how therapeutic interventions in speech-language therapy impact the everyday lives of children and families by applying a theoretical framework. Main Contribution This discussion paper critically examines how the Bioecological Model of Development can be applied to the study of communicative participation outcomes following speech and language therapy. This model will be used in future analyses of communicative participation outcomes data in Ontario's PSLP. The strengths and challenges of this approach are reviewed. [ABSTRACT FROM AUTHOR]

Background Understandings of 'communicative competency' (CC) have an important influence on the ways that researchers and practitioners in augmentative and alternative communication (AAC) work toward achieving positive outcomes with AAC users. Yet, very little literature has critically examined conceptualizations of CC in AAC. Following an overview of the emergence of the concept of CC and of the field of AAC, we review seven conceptualizations of CC identified in the literature. Aims To consider the contributions and potential shortcomings of conceptualizations of CC in AAC. Methods & Procedures We use a critical theoretical approach to review, critique and synthesize conceptualizations of CC in AAC, with a particular focus on uncovering 'taken for granted' assumptions. By historically situating the reviewed literature, we examine the shifting boundaries and tensions among theoretical conceptualizations of CC in AAC and their potential impacts on practice. Main contributions We suggest ways that revisiting past scholarly work, alongside emergent, innovative conceptualizations of CC might shift ways of thinking about CC in AAC which tend to focus on the individual who communicates differently, toward (re)location of CC as a shared, socially incorporated and performed communication construct. Conclusion & Implications We propose that emerging critical perspectives drawn from AAC and other interdisciplinary literatures offer innovative ways of theorizing communication difference, which might inform evolving conceptualizations of CC in AAC. [ABSTRACT FROM AUTHOR]

Background: Prior research has described the prevalence and utility of questions in children's language learning environment. However, there has been little empirical investigation of the interaction sequences that ensue following caregiver questions. Understanding these interactions may be especially important for children with autism spectrum disorder (ASD), who may have difficulty engaging in reciprocal interactions. Question–response–evaluation sequences (QRE) are a particular type of interaction sequence launched by questions that have been examined primarily in classroom contexts. Less research has been devoted to understanding how caregivers and children with ASD leverage this interactional format in the context of home interactions. Aims: We focus on QRE sequences within interactions between a 5‐year‐old bilingual child with ASD and his parents. In these sequences, the adult poses known‐answer questions, the child responds and the adult evaluates the response. QRE sequences are primarily structured by the questioner (i.e., the parents in our context), and we examine the interactive work done by parents to initiate, maintain and close these sequences. We also examine the child's contributions to these sequences. Methods & Procedures: We applied conversation analysis (CA) to video recordings of home routines, such as play, book‐reading and schoolwork. Videos were fully transcribed using CA conventions, and 55 QRE segments were isolated from the data corpus for further analysis. Outcomes & Results: Q‐word questions (i.e., where, what, why, when, how questions) were the most prevalent question format, and repetition of the child's response was the most prevalent form of evaluation. We found that QRE sequences were embedded within a variety of action trajectories that extend beyond pedagogical functions. These included repairing a prior utterance, extending collaborative play routines and engaging in topically connected labelling rituals. Conclusions & Implications: QRE sequences appeared to strike a balance in terms of the level of constraint they placed on the child's contributions to interactions, and the affordances they provide for participating in and progressing through interactions. This study can help clinicians understand the types of interactions that can be pursued with QRE sequences in their work with children with ASD. The findings may also aid intervention researchers' efforts to leverage caregivers' existing strengths for adapting their interactional overtures to maximize children's engagement. Finally, this study provides an illustration of caregiver–child interactions in a population that is currently under‐represented in the literature. [ABSTRACT FROM AUTHOR]

Background: There is considerable variability in the presentation of developmental language disorder (DLD). Disagreement amongst professionals about how to characterize and interpret the variability complicates both the research on understanding the nature of DLD and the best clinical framework for diagnosing and treating children with DLD. We describe and statistically examine three primary possible models for characterizing the variability in presentation in DLD: predictable subtypes; individual differences; and continuum/spectrum. Aims: To test these three models of DLD in a population‐based sample using two distinct types of cluster analyses. Methods & Procedures: This study included children with DLD (n = 505) from the US Epidemiological Study of Language Impairment database. All available language and cognitive measures were included. Two cluster methods were used: Ward's method and K‐means. Optimal cluster sizes were selected using Bayesian information criteria (BIC). Bootstrapping and permutation methods were used to evaluate randomness of clustering. Outcomes & Results: Both clustering analyses yielded more than 10 clusters, and the clusters did not have spatial distinction: many of these clusters were not clinically interpretable. However, tests of random clustering revealed that the cluster solutions obtained did not arise from random aggregation. Conclusions & Implications: Non‐random clustering coupled with a large number of non‐interpretable subtypes provides empirical support for the continuum/spectrum and individual differences models. Although there was substantial support for the continuum/spectrum model and weaker support for the individual differences model, additional research testing these models should be completed. Based on these results, clinicians working with children with DLD should focus on creating treatment plans that address the severity of functioning rather than seeking to identify and treat distinct subtypes. Additional consideration should be given to reconceptualizing DLD as a spectrum condition. [ABSTRACT FROM AUTHOR]

Abstract: Background: Children with developmental language disorders (DLDs) often struggle with classroom behaviour. No study has examined whether positive teacher–child relationships may act as a protective factor for children with DLDs in that these serve to enhance children's important classroom‐learning behaviours. Aims: To examine the association between the quality of teacher–child relationships and teacher‐rated classroom‐learning behaviours of children with DLDs in both preschool and kindergarten. Methods & Procedures: Longitudinal data were collected on 191 preschoolers (mean = 42.4 months of age, SD = 11.6 months) with DLDs in special education classrooms during preschool and in kindergarten. Teacher–child relationship quality was assessed in preschool, and children's classroom‐learning behaviours were measured in preschool and kindergarten. Regression models were used to examine the relationship between teacher–child relationship quality and children's concurrent and future classroom‐learning behaviours. Outcomes & Results: Positive teacher–child relationship quality in preschool was associated with better classroom‐learning behaviours in preschool and kindergarten for children with DLDs. Preschool teacher–child relationship quality characterized by low levels of conflict and high levels of closeness was associated with positive classroom‐learning behaviours during preschool. Teacher–child conflict but not closeness was predictive of children's classroom‐learning behaviours in kindergarten. Conclusions & Implications: These results suggest that the quality of the teacher–child relationship for children with DLDs during preschool is associated within their learning‐related behaviours in the classroom both concurrently and in the subsequent year. Findings suggest that teacher–child relationships should be explored as a mechanism for improving the learning‐related behaviours of children with DLDs. [ABSTRACT FROM AUTHOR]

Background More limited working memory capacity and slower processing for language and cognitive tasks are characteristics of many children with language difficulties. Individual differences in processing speed have not consistently been found to predict language ability or severity of language impairment. There are conflicting views on whether working memory and processing speed are integrated or separable abilities. Aims To evaluate four models for the relations of individual differences in children's processing speed and working memory capacity in sentence imitation. The models considered whether working memory and processing speed are integrated or separable, as well as the effect of the number of operations required per sentence. The role of working memory as a mediator of the effect of processing speed on sentence imitation was also evaluated. Methods & Procedures Forty-six children with varied language and reading abilities imitated sentences. Working memory was measured with the Competing Language Processing Task (CLPT), and processing speed was measured with a composite of truth-value judgment and rapid automatized naming tasks. Mixed-effects ordinal regression models evaluated the CLPT and processing speed as predictors of sentence imitation item scores. A single mediator model evaluated working memory as a mediator of the effect of processing speed on sentence imitation total scores. Outcomes & Results Working memory was a reliable predictor of sentence imitation accuracy, but processing speed predicted sentence imitation only as a component of a processing speed by number of operations interaction. Processing speed predicted working memory capacity, and there was evidence that working memory acted as a mediator of the effect of processing speed on sentence imitation accuracy. Conclusions & Implications The findings support a refined view of working memory and processing speed as separable factors in children's sentence imitation performance. Processing speed does not independently explain sentence imitation accuracy for all sentence types, but contributes when the task requires more mental operations. Processing speed also has an indirect effect on sentence imitation by contributing to working memory capacity. [ABSTRACT FROM AUTHOR]