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Background: Children with cleft palate with or without cleft lip (CP±L) are at high risk of problems with early speech sound production, and these difficulties can persist into later childhood. Early intervention could help to reduce the number of children whose problems become persistent. However, much research in the field to date has focused on older children. There is a need to determine if providing intervention during the phase of early typical speech development leads to better outcomes. Aims: To review the evidence for the effectiveness of interventions targeting speech, delivered in the first 3 years of life for children with CP±L, and discuss factors such as intervention type, facilitator, dosage, outcome measures and the age of the child. Methods & Procedures: The systematic review was registered with PROSPERO (CRD42019121964). Eight bibliographic databases including CINAHL and MEDLINE were searched in August 2018. Studies were included if participants received speech and language interventions before 37 months and if they reported outcomes for speech. Two reviewers independently completed inclusion reviews, quality analysis and data extraction. Outcome & Results: The review included seven papers: one pilot randomized controlled trial, one controlled trial, four cohort studies and one case series report. Interventions largely took a naturalistic approach, namely focused stimulation and milieu teaching. The findings provide preliminary support for naturalistic interventions and suggest that these interventions can be delivered by parents with suitable training. Studies included in the review provided low‐strength evidence with variation in both the type of intervention, the manner of delivery and in the risk of bias in the designs used. Conclusions & Implications: The papers included in this review suggest that early naturalistic interventions can have positive impacts on the speech development of children with CP±L. However, the reported methodological quality of the publications overall was weak, and the current evidence lacks clarity and specificity in terms of therapy technique, delivery and optimum age of delivery. Future research should use more robust methodological designs to determine whether early speech interventions are beneficial for children born with CP±L. What this paper adds: What is already known on the subject: Children with CP±L show difficulties with early speech development and often have restricted speech sound inventories. They may reach the canonical babbling stage later than children without CP±L and studies have shown that 20% of children with CP±L have speech which is considered unintelligible or barely intelligible at age 5. It has been proposed that early intervention can lessen the impact of CP±L on speech development. However, currently, the evidence for early interventions for children with CP±L is limited, with the majority of studies focusing on children aged 3 years and older. What this paper adds to existing knowledge: This paper reviews the evidence for different types of early interventions for speech provided to children born with CP±L and whether these interventions are effective in supporting speech sound development. In this review, early intervention is defined as intervention provided to children in the first 3 years of life. This review describes intervention approaches and how they are delivered for this population. What are the potential or actual clinical implications of this work?: In the UK, children born with CP±L and their families are supported by National Health Service (NHS) services over a 20‐year period and speech and language therapy sessions may take place over many weeks and months. If providing early intervention in the first 3 years of life is effective, there is the potential for improved speech outcomes in early childhood and a reduced burden of care on children, families and services. This review considers the evidence for early speech intervention for children with CP±L in the first 3 years of life and identifies areas for future research. [ABSTRACT FROM AUTHOR]

Background: There has been a significant uptake in the use of telepractice during the coronavirus SARS‐CoV‐2 (COVID‐19) pandemic. This study explored the experiences of speech and language therapists (SLTs), assistants (SLTAs) and parents with telepractice during the COVID‐19 pandemic. Aims: (1) To identify factors that influenced success of telepractice; and (2) to describe clinicians' and parents' preferences for the future mode of service delivery for preschoolers with communication disorders. Methods & Procedures: The study was conducted in partnership with one publicly funded programme in Ontario, Canada, that offered services to preschoolers with speech, language and communication needs at no cost. SLTs (N = 13), assistants (N = 3) and parents (N = 13) shared their experiences and perspectives during semi‐structured videoconference interviews. Outcomes & Results: Factors that influenced the success of telepractice were reported in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who was involved in telepractice). These factors were reported to interact with each other. As the needs for each child and family are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. Conclusions & Implications: The themes identified in this study can be used by clinicians and managers to consider factors that influence the success of telepractice for children and families. WHAT THIS PAPER ADDS: What is already known on the subject?: Studies conducted before the COVID‐19 pandemic showed that telepractice was an effective and acceptable service approach. However, some clinicians and parents reported wanting to resume in‐person visits. The provision of telepractice services to families with children with communication disorders increased significantly during COVID‐19. What this paper adds to existing knowledge?: Parents and clinicians shared factors that influenced the success of telepractice during semi‐structured interviews. Factors were identified in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who were involved in telepractice). As each child's and family's needs are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. What are the potential or actual clinical implications of this work?: SLTs and SLT managers can use the factors identified to discuss with parents and decide whether telepractice may be well suited to the needs of each child and family. [ABSTRACT FROM AUTHOR]

Background: Engagement of the child, parent and professional may facilitate positive outcomes for young children with communication disorders receiving early intervention (EI) via telepractice. Despite reported positive outcomes of engagement in a family‐centred model of EI, there is limited research exploring the nature engagement in the telepractice environment and guiding professionals on how to best interact with young children and their families. Aim: To identify a set of critical behaviours for building engagement in telepractice EI. Methods & Procedures: A two‐round modified e‐Delphi study was conducted. Participants were international experts in the field of paediatric communication disorders and telepractice EI from diverse allied health and education backgrounds. The experts used a nine‐point Likert scale to rate the importance of a predetermined set of critical behaviours for building engagement in telepractice EI across three different aspects of the telepractice interaction: (1) getting to know each other; (2) family‐centred telepractice; and (3) telepractice specific considerations. Outcomes & Results: A total of 30 experts completed round 1, with 21 participants from round 1 completing round 2 (70% response rate). Across the two rounds, a total of 64 of the 109 items presented (58.71%) achieved consensus as critical behaviours for building engagement in telepractice EI. Conclusions & Implications: The present study identified a set of individual aspects of the telepractice interaction that participants, particularly professionals, may need to intentionally address to engage with families of young children with communication disorders receiving EI via telepractice. The results from this study will contribute to the development of an observational tool to measure engagement in the telepractice EI environment. What this paper adds: What is already known on the subject: A growing body of research suggests telepractice is a feasible alternative for families of young children with communication disorders who lack access to high‐quality EI. The engagement of families through family‐centred care has long been recommended for children enrolled in EI. Although there is growing uptake of telepractice EI, limited research is available guiding professionals on how to engage with families of young children with communication disorders via telepractice. What this paper adds to existing knowledge: This study provides a set of 64 telepractice‐specific behaviours deemed critical to engagement for all participants of the telepractice interaction. The display of these behaviours could assist professionals to better engage with families of young children within the telepractice environment. What are the potential or actual clinical implications of this work?: The findings of this study provide a set of telepractice‐specific behaviours that professionals may need to deliberately display and encourage while interacting with young children with communication disorders and their families. Professionals displaying these behaviours could potentially enhance the engagement of families receiving EI services via telepractice. This set of critical behaviours will be refined with the aim of developing an evidence‐based observational tool to measure engagement in the context of telepractice EI. [ABSTRACT FROM AUTHOR]

Background: Despite being an important aspect of effective early intervention service delivery, 'engagement' has been inconsistently defined in paediatric healthcare. Previous research has identified that engagement in early speech–language pathology intervention is complex and multifaceted. However, more research is needed to understand the ways that different families may engage with intervention in different settings. Aims: To explore the complexity of engagement in early speech–language pathology intervention from the perspectives of both families and their speech–language pathologists (SLPs). Method & Procedures: Video‐reflexive ethnography was used to explore engagement with 21 matched SLP–family dyads in early intervention services. Up to three intervention appointments for each participating family were video recorded. Short video segments were selected and played to participants during individual semi‐structured interviews where participants were invited to reflect on the interactions captured (i.e., 'video‐reflexive sessions'). Interview data were analysed using thematic analysis. Outcomes & Results: Results from the interview data were organized into one overarching theme 'Families may have "different levels of engagement"', and four individual themes that reflected how families engage differently in various aspects of intervention, including (1) attending sessions and coming into the room; (2) actively participating in sessions; (3) continuing to actively participate outside sessions; and (4) having open and honest communication with their SLPs. Conclusions & Implications: Families may have different levels of engagement in various aspects of intervention, which contribute to their unique profile of engagement. Findings of this study prompt SLPs to move beyond using blanket statements about whether or not families are engaged, to instead describing in detail how families are uniquely engaged. What this paper addsWhat is already known on the subjectIn early speech–language pathology intervention, the term 'engagement' refers to (1) a complex, multifaceted state of families 'being engaged' in intervention both inside and outside sessions; and (2) a relational, co‐constructed process where many families 'become engaged' in intervention as they work together with SLPs. Although research has acknowledged engagement may look different for each parent and family, little is known about how families are uniquely engaged in early speech pathology intervention in different settings.What this paper adds to existing knowledgeThis study is the first to explore engagement from the perspectives of both families and SLPs working together in intervention. Both groups of participants described the complexity of engagement in this setting and acknowledged that families engage differently in different aspects of intervention, which contribute to their unique profile of engagement.What are the potential or actual clinical implications of this work?Being able to identify potential indicators of engagement, such as the ones described in this study, provide opportunities for SLPs to take a reflexive approach to engaging with individual families, in line with principles of family‐centred care. Findings of this study therefore prompt SLPs to reflect on how the families they work with are engaged in intervention, and to consider their own role in facilitating engagement. In addition, results highlight the importance of SLPs initiating open conversations with families themselves about how they would like to be engaged in intervention, and what support would be most beneficial to them. [ABSTRACT FROM AUTHOR]

Background: Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis. Aims: To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277). Methods & Procedures: A total of 32 variables were used as predictors in regression analyses of short‐ and medium‐term Lidcombe Program outcome, and of treatment dropout. Outcomes & Results: Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity. Conclusions & Implications: Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop‐out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions. What this paper addsWhat is already known on the subjectInformation is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts Lidcombe Program treatment outcome.What this paper adds to existing knowledgeThere are predictors of Lidcombe Program treatment outcome that are statistically significant, but none are clinically significant.What are the potential or actual clinical implications of this work?Clinicians can tell parents that nothing has been found that can assist with making prognostic indications about treatment outcome for their children. [ABSTRACT FROM AUTHOR]

Background: There is a clear predominance of programmes aimed at improving aspects related to language production in pupils with developmental language disorder (DLD). However, programmes aimed at improving their receptive skills are limited. Aims: The main aim was to assess the effectiveness of an intervention programme for oral language comprehension skills in preschoolers with typical development (TD) and pupils with DLD. Methods & Procedures: Participants were 99 five‐year‐old pupils, with and without DLD, divided into four groups: two control groups (TD‐C = 25; DLD‐C = 25) and two experimental groups (TD‐T = 24; DLD‐T = 25), from schools on the Spanish island of Tenerife. The study used, as pre‐ and post‐measures, the receptive language subtests of the CELF‐4‐Spanish: Concepts and Following Directions, Word Classes—Receptive and Sentence Structure, as well as two tasks assessing comprehension of paragraphs and narratives. Due to the strong link between oral comprehension skills and executive functions, working memory and semantic fluency are included in this research. The Backward Digit Span subtest of the Wechsler Intelligence Scale for Children (WISC‐IV) and Semantic Fluency subtest of the Controlled Oral Word Association Test (COWAT) were used to assess working memory and semantic fluency, respectively. The intervention programme followed a multitiered system of support (MTSS) model, with 95 sessions lasting 60 min each delivered jointly by teachers and speech and language therapists, and focused on lexical–semantic, morphological, syntactic and narrative skills; inferences; verbal working memory; and semantic fluency. Outcomes & Results: The results showed, as expected, that pupils diagnosed with DLD initially performed worse on oral language comprehension and executive functions than pupils with TD. Further, the DLD‐T and TD‐T groups showed greater gains following the programme, especially in word classes—receptive, sentence structure, verbal working memory and semantic fluency. Finally, a significant positive correlation was found between the gains obtained by the participants in verbal working memory and semantic fluency, with the gains obtained in the three CELF‐4‐Spanish subtests. Conclusions & Implications: An intervention programme applied at an early age fosters oral language comprehension skills and executive functions in pupils with DLD and TD. The intervention organized at different levels of support, following an MTSS model, showed clear progress of the DLD and TD groups in oral language comprehension and executive functions. What this paper adds: Pupils with DLD present deficits in linguistic comprehension and executive functions. There are many intervention programs focused on improving language production skills. It is also necessary to consider the skills underlying language problems in pupils with DLD. Oral language, inference, working memory and semantic fluency activities improve comprehension. A collaborative and inclusive intervention of teachers and speech language therapists. Psycholinguistic and neuropsychological skills training should become part of the academic curriculum as early as preschool age. What is already known on the subject: Pupils with DLD show problems related to both comprehension and production language. However, there is a clear predominance of programs just aimed at improving aspects related to language production. Clinical implications of this study: An intervention program applied at an early age fosters oral language comprehension skills and executive function in pupils with DLD. The intervention organized at different levels of support, following an adaptation of the Response Tier Intervention models, showed clear progress of the DLD in comprehension oral language and executive functions. [ABSTRACT FROM AUTHOR]

Background: The Rotterdam Evaluation Study of Stuttering Therapy randomized trial (RESTART) was seminal, comparing the Lidcombe Program with RESTART Demands and Capacities Model‐based treatment (RESTART‐DCM) for pre‐school age children who stutter. Aims: To critique the methods of the RESTART trial to develop guidelines for its systematic replication and extension. Beyond that, to contribute to the refinement of existing methodological guidelines for early stuttering intervention. Method: The discussion is organized around methodological issues of primary outcomes, treatment completion, clinician allegiance, treatment fidelity, age exclusions and no‐treatment control reasoning. Main Contribution: We recommend six methodological guidelines to guide future clinical trials comparing the Lidcombe Program with RESTART‐DCM, which can be applied to clinical trials of other early stuttering intervention methods: (1) incorporate a continuous measure of primary outcome; (2) ensure that all children in clinical trials have completed treatment; (3) eliminate potential bias due to clinician allegiance; (4) establish treatment fidelity within and beyond the clinic; (5) include children younger than 3 years in clinical trials; and (6) establish an estimate of treatment effect size at some stage of treatment development. Conclusion: In addition to guiding future clinical research comparing RESTART‐DCM and Lidcombe Program treatment, these recommendations may extend to influence positively other treatment developments for early stuttering. [ABSTRACT FROM AUTHOR]

Background: Communication training for parents of young children with neurodisability is often delivered in groups and includes video coaching. Group teaching is problematic when there is wide variation in the characteristics and needs amongst participants. Aims: To assess the potential feasibility and acceptability of delivering one‐to‐one parent training supported by remote coaching using smartphone apps and of conducting further trials of the intervention. Methods & Procedures: We aimed to recruit eight children aged 12–48 months with motor disorders and communication difficulties and to provide families with individual parent training in six weekly home visits supplemented by remote coaching via smartphone apps. For outcome measurement, parents recorded their interaction with their child thrice weekly during baseline (3 weeks), intervention, post‐intervention (3 weeks) and follow‐up (1 week). Measures comprised parent responsiveness and counts of children's communication and vocalization. Research design feasibility was measured through rates of recruitment, attrition, outcome measure completion and agreement between raters on outcome measurement. Intervention feasibility was assessed through the proportion of therapy sessions received, the number of videos and text messages shared using the apps in remote coaching, and message content. Parents were interviewed about the acceptability of the intervention and trial design. Interviews were transcribed and analyzed using inductive thematic analysis. Outcomes & Results: Nine children were recruited over 16 weeks. All fitted the inclusion criteria. Four families withdrew from the study. Five families completed the intervention. No family submitted the target number of video recordings for outcome measurement. Interrater agreement was moderate for child communication (K = 0.46) and vocalization (K = 0.60) and high for The Responsive Augmentative and Alternative Communication Style scale (RAACS) (rs = 0.96). Parents who completed the intervention reported positive experiences of the programme and remote coaching via the apps. Therapist messages via the app contained comments on parent and child behaviour and requests for parental reflection/action; parental messages contained reflections on children's communication. Conclusions & Implications: The intervention and study design demanded high levels of parental involvement and was not suitable for all families. Recording shorter periods of interaction via mobile phones or using alternative methods of data collection may increase feasibility of outcome measurement. [ABSTRACT FROM AUTHOR]

Background In attempting to evaluate an intervention programme designed to improve English literacy outcomes in children in a remote indigenous community in Australia, the need for valid and culturally appropriate measures of the factors likely to impact on literacy development became apparent. One factor considered likely to be of importance was the precision of the children's phonological representations. Aims To develop a measure of phonological representations that was culturally relevant for Anindilyakwa children and to evaluate its reliability and concurrent validity against English measures that are known to be predictive of literacy outcomes. Methods & Procedures Starting from the Quality of Phonological Representations test (QPR), the authors developed an Anindilyakwa Quality of Phonological Representations test (AQPR) and examined its reliability and concurrent validity. Outcomes & Results The AQPR was found to have acceptable reliability and to correlate significantly with three well-established measures of phonological awareness and phonics in English. Conclusions The AQPR would thus seem an appropriate screening test for use by teachers to identify Anindilyakwa children in need of interventions to improve phonological representations before exposing them to an English literacy programme for which they may not yet be ready. The process involved in its development could be used by others working with indigenous students. [ABSTRACT FROM AUTHOR]

Background: Parents and professionals can both play a role in improving children's expressive language development and a number of alternative models of delivery exist that involve different levels of input by these two groups. However, these alternative treatments have not been subject to rigorous comparative analysis in terms of both cost and clinical effectiveness. Aims: To compare, from the viewpoint of the healthcare provider, parent-based intervention (PBI) for preschool children presenting with expressive language delay with current practice observed in an actual healthcare setting where parents of the child follow a professional's advice on a review basis. Methods & Procedures: Two groups of children were compared on a variety of expressive and receptive language assessment measures. One group ( n =10) received standard individual general care. The comparison group ( n =12) received PBI. Outcomes & Results: After the 6-month study, the results indicated that children who received PBI made significantly greater language gains that children who received current practice. In addition, a cost-effective analysis was conducted. This showed that although the language gains delivered by PBI did incur some additional costs for the healthcare provider, there was no significant increase in cost per outcome gain over general care. Conclusions: Options in the implementation of PBI are discussed that could potentially save costs for the healthcare providers and increase the value of a PBI-based approach. [ABSTRACT FROM AUTHOR]