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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]

Purpose: The aim of this study was to map the use of implementation science frameworks, models, and theories in intervention research targeting learning needs in the classroom. Method: A scoping review was conducted. Electronic database and manual searches were conducted. Two reviewers independently completed screening, data extraction, and quality appraisal. Qualitative content analysis was undertaken using Nilsen's taxonomy and the domains of the Consolidated Framework for Implementation Research (CFIR). The data were further analyzed using the CFIR valence and strength rating scales. Results: Included papers (n = 22) used a diverse sample of implementation science frameworks and models. Most studies used determinant frameworks to guide data collection and analysis. Few studies used implementation science theory. Most studies were mixed methods (n = 11), published since 2019 (n = 20), and conducted in North America (n = 15). Over half of the interventions targeted social, emotional, and mental health (n = 13). A complex interplay of inner setting factors was identified as having a strong influence on implementation. Teachers' knowledge and beliefs, adaptability, and complexity of interventions were also identified as important considerations when conducting research in this context. Conclusions: Early engagement with stakeholders in education is recommended when designing universal level speech, language, and communication interventions for use in the ordinary classroom. Adaptive, hybrid designs that test both implementation strategies and effectiveness of interventions may be warranted given the influence of inner setting factors on implementation outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aims to compare treatment outcomes of a levonorgestrel-releasing intrauterine system (LNGIUS) or oral progestogens in women with non-atypical endometrial hyperplasia (EH). Additionally, the predictors for EH non-regression were determined. Methods: Medical records of women diagnosed with non-atypical EH between April 2016 and March 2022 at Tuen Mun Hospital were retrieved. These patients were offered LNG-IUS as the first-line option or oral progestogens if they refused or had LNG-IUS contraindications such as submucosal fibroid distorting endometrial cavity. The rate of EH non-regression at 12 months and the rate of EH relapse at 24 and 36 months between groups were compared. Univariate and multivariate analyses were conducted to identify predictors for EH non-regression. Results: The median follow-up duration was 24 months for the LNG-IUS group and 19 months for the oral progestogens group. The rate of EH regression at 12 months was higher in the LNG-IUS group (93.9% vs 71.2%, p<0.001). The rate of EH relapse was higher in the oral progestogens group at 24 months (21.1% vs 1.1%, p=0.003) and 36 months (33.3% vs 2.3%, p=0.014). The incidence of hysterectomy for treatment failure was higher in the oral progestogens group (13.7% vs 4.2%, p=0.005). No EH relapse occurred in either group after 36 months posttreatment. Predictors for EH non-regression were postmenopausal status (odds ratio=5.80, p=0.022) and oral progestogens treatment (odds ratio=7.51, p<0.001). Conclusion: In women with non-atypical EH, treatment with LNG-IUS leads to a higher regression rate at 12 months, a lower relapse rate within 36 months, and a lower rate of hysterectomy due to treatment failure, compared with treatment with oral progestogens. Postmenopausal status and treatment with oral progestogens are risk factors for treatment failure. Regular endometrial surveillance should be provided to women at risk. Hysterectomy is recommended for postmenopausal women. [ABSTRACT FROM AUTHOR]

Background Parental education is one of the best predictors of child school achievement. Higher parental education is not only associated with higher child intelligence, but children from highly educated parents also perform better in school due to other family related factors. This study evaluates the relation between parental education, child non-verbal intelligence and parenting practices with child school achievement. Methods Longitudinal data from a large population-based, multi-ethnic cohort of children in the Netherlands (63% Dutch origin) followed from birth to age 13 years (3547 children; 52.3% girls) were analyzed. School achievement was measured at the end of primary school (12 years of age) with a national Dutch academic test score. Parental education was assessed at age 3 years. The non-verbal intelligence of the child was measured at age 6 years and a full intelligence was measured at age 13 years. Maternal and paternal family routines, harsh parenting and corporal punishment were assessed in early and mid-childhood. Mediation analysis was performed with the G-formula and Structural Equation Models. Results Child intelligence partially mediated [B indirect effect =0.54 95% CI (0.46, 0.62) P  < 0.001] the association between parental education and child school achievement. Independent of intelligence, family routines [B indirect effect =0.04 95% CI (0.01, 0.07) P  < 0.01], but not harsh parenting mediated this association. Conclusions Higher parental education was associated with better school achievement through two independent mechanisms, through higher intelligence of the child and parenting practices. [ABSTRACT FROM AUTHOR]

While previous research has suggested that lowering athletes' heart rates can enhance sports performance, it is unknown whether slow-paced music might induce a lower heart rate and thereby improve some types of motor performance. In this study, we investigated the effects of different types of music during dart-throw training on both heart rate and dart-throwing performance in 45 (M age = 19.7, SD = 0.31 years) novice dart throwers who were randomly assigned to either a Slow Music Group (SMG), a Fast Music Group (FMG), or a Control Group (CG). All participants completed three dart-throwing blocks - Pre-Test, Practice, and Post-Test. During the Practice block, participants practiced dart-throwing with either slow-paced, fast-paced or no music according to their assigned group. We recorded the participants' heart rates and total dart-throwing accuracy scores during Pre-Test and Post-Test. Music-assisted dart-throw training with slow-paced music was effective in significantly inhibiting a performance-related increase in heart rate and was associated with the greatest dart throwing improvement after training. [ABSTRACT FROM AUTHOR]

Background: The cultural and language diversity across many European countries presents a range of challenges and opportunities for speech and language therapists and other practitioners working with children with developmental language disorders (DLD) and their families. Objective: The aim of this study was to explore practitioners' perceptions of cultural and linguistic differences in response to children with DLD across different countries. Methods: A survey was developed by practitioners and researchers working with children with DLD across Europe and beyond as part of the work of Cost Action IS1406. Data from 1,358 practitioners from 8 European countries – Ireland, UK, Bulgaria, Poland, Croatia, Spain, Norway and Sweden – and 2 neighbour countries – Turkey and Lebanon – were included in the present analyses, which address two groups of questions. The first focuses on practitioners' perceptions of the way that parents think about cultural differences and their relationship to language development in their children. The second concerns the extent to which practitioners consider themselves to have the skills to work with children from other cultures and using different languages. Results/Conclusions: Most countries present a similar profile with intermediate results about their perception of cultural issues, but Lebanon and Turkey are the group with the most positive responses. In terms of bilingual issues most practitioners indicated that they only worked in their country's primary language. The only country where this was not the case was Lebanon. Professionals from Spain and Lebanon form a subgroup in terms of their confidence to work with different cultural/language groups. The paper highlights both the universal importance of cultural and linguistic competence in managing young children's needs and indicates that in most cases professionals do not think they have the necessary expertise to work with cultural and linguistic diversity. [ABSTRACT FROM AUTHOR]

Background: Many healthcare and educational services providers have undergone a rapid transition from a face‐to‐face to a tele‐practice mode of service delivery in the context of the COVID‐19 outbreak. This, in turn, has led to a need to understand better the evidence underpinning such moves. Based on a review of existing reviews, this paper critically analyses the relevant literature related to intervention with children with communication disabilities drawing on the COM‐B model. Methods & Procedures: Ten reviews were identified following a systematic searching of electronic databases. These were then coded according to both PRISMA criteria and the components of the COM‐B model. Based on these findings, a critical analysis of the state of the tele‐practice intervention literature is discussed and fed into evidence‐based advice for practitioners transitioning to this mode of service delivery. Outcomes & Results: The COM‐B mapping suggests that the existing literature has provided primary evidence for physical opportunity and reflective motivation (e.g., participants have the time to take part and the necessary materials, as well as a desire to do it). It has also focused on elements of social opportunity (e.g., having support and prompts from others to take part). However, there are significant gaps in the description and analysis of both physical and psychological capability components. Conclusions & Implications: Whilst the evidence for tele‐practice interventions for children and young people with communication disabilities is growing, it is also lacking a comprehensive framework to support its implementation. In times of rapid transitions, researchers and practitioners alike need to understand how to evaluate comprehensively the impact of changing the mode of intervention delivery. The COM‐B model provides a powerful tool to reflect on the key elements for the successful design and implementation of tele‐practice interventions. What this paper addsWhat is already known on this subjectTele‐practice has been a feature of service delivery for speech and language therapists working with children and young people with speech and language disorders for many years, as it has in other areas of practice. This came into sharp focus during 2020 during the 'lock‐down' following the start of the COVID‐19 pandemic when most practice went online.What this paper adds to existing knowledgeThis study set out to provide a framework for understanding service delivery, drawing on the COM‐B behaviour change model. This is applied using a rapid review methodology to 10 systematic and narrative reviews of the existing literature published since 2005. The findings suggest that while most studies demonstrated efficacy, there was a lack of information regarding specific aspects of the model which would affect their implementation.What are the potential or actual clinical implications of this work?It is anticipated that the paper has the potential to have a direct bearing on how tele‐practice services for children and young people with speech and language disorders will be delivered in the future. The paper concludes with a series of recommendations for practice and research in terms of the application of the COM‐B model to tele‐practice in speech and language therapy. [ABSTRACT FROM AUTHOR]

The nature of 'Teacher talk' is likely to have a considerable bearing on the child's learning but measuring the communication environment in the classroom can present challenges. One tool which does this is the Communication Supporting Classroom Observation Tool (CSCOT). Initial use suggested that it was valid and reliably used by specialists (psychologists and speech and language therapists) and special educational needs coordinators (SENCOs). A key question is whether it can be used routinely by classroom teachers and whether results coincide with those in earlier studies. CSCOT observations were carried out by teachers in 33 schools (32 Reception classrooms, 25 in Year 1 and 25 in Year 2) in two local authorities in the North East of England and teachers were asked afterwards to reflect on their experiences using the tool. Scores were in line with those in earlier studies and were consistently higher on all dimensions for reception compared to Year 2, but there was no difference between other year groups. Results were mostly consistent with the original studies. Language learning environment was higher relative to both language learning opportunities and interactions across all years (which again did not differ). There was a moderate interaction between language learning environment where scores were significantly higher in the Reception group and lower in the Year 2 group. Teachers supported the use of the CSCOT in their feedback, suggesting that CSCOT was easy to use and useful in informing practice. The CSCOT clearly has utility as a starting point in auditing classroom communication. It allows teachers to compare between classrooms and year groups and potentially fosters collaboration between teachers and specialist practitioners who focus on communication such as speech and language therapists. Further work could link the observation tool into an intervention program co-constructed with teachers. [ABSTRACT FROM AUTHOR]

There is an increasing emphasis on supporting the oral language needs of children in the classroom. A variety of different measures have been developed to assist this process but few have been derived systematically from the available research evidence. A Communication Supporting Classrooms Observation Tool (CsC Observation Tool) for children aged 4–7 years (that is, in Reception and Key Stage 1 classrooms) was devised following a review of the research literature. The evidence derived from 62 research papers was rated based on the studies’ research design following specific rating criteria. Based on the review of the literature and rating of the evidence, three main areas were identified and included as dimensions in the CsC Observation Tool: Language Learning Environment, Language Learning Opportunities and Language Learning Interactions. A feasibility study was carried out in 101 classrooms in 39 schools across 10 local authorities in England. The results suggested that the CsC Observation Tool discriminated well between different age groups within the sample and between different schools. In addition, significant differences were found across the three dimensions of the CsC Observation Tool. For all year groups, scores for the Language Learning Environment dimension were significantly higher than scores for Language Learning Interactions, and scores for the Language Learning Interactions dimension were significantly higher than those for the dimension of Language Learning Opportunities. The study provided evidence for using the CsC Observation Tool in schools to support training and development. The tool has the potential to be used as a key feature in universal intervention studies to promote oral language in the classroom. [ABSTRACT FROM AUTHOR]

Background An association between children's early language development and their emotional and behavioural functioning is reported in the literature. The nature of the association remains unclear and it has not been established if such an association is found in a population-based cohort in addition to clinical populations. Methods This study examines the reported association between language development and emotional and behavioural functioning in a population-based cohort. Data from 1,314 children in the Children in Focus (CiF) sample from the Avon Longitudinal Study of Parents and Children ( ALSPAC) were analysed. Regression models identified the extent to which early language ability at 2 years of age and later language ability at 4 years of age is associated with emotional and behavioural functioning at 6 years while accounting for biological and social risk and adjusting for age and performance intelligence ( PIQ). Results A series of univariable and multivariable analyses identified a strong influence of biological risk, social risk and early and later language ability to emotional and behavioural functioning. Interestingly, social risk dropped out of the multivariate analyses when age and PIQ were controlled for. Early expressive vocabulary at 2 years and receptive language at 4 years made a strong contribution to emotional and behavioural functioning at 6 years in addition to biological risk. The final model accounted for 11.6% of the variance in emotional and behavioural functioning at 6 years. Conclusions The study identified that early language ability at 2 years, specifically expressive vocabulary and later receptive language at 4 years both made a moderate, but important contribution to emotional and behavioural functioning at 6 years of age. Although children's language development is important in understanding children's emotional and behavioural functioning, the study shows that it is one of many developmental factors involved. [ABSTRACT FROM AUTHOR]

Dynamic assessment has been shown to have considerable theoretical and clinical significance in the assessment of socially disadvantaged and culturally and linguistically diverse children. In this study it is used to enhance assessment of pre-school children with primary language impairment. The purpose of the study was to determine whether a dynamic assessment (DA) has the potential to enhance the predictive capacity of a static measure of receptive vocabulary in pre-school children. Forty pre-school children were assessed using the static British Picture Vocabulary Scale (BPVS), a DA of word learning potential and an assessment of non-verbal cognitive ability. Thirty-seven children were followed up 6 months later and re-assessed using the BPVS. Although the predictive capacity of the static measure was found to be substantial, the DA increased this significantly especially for children with static scores below the 25th centile. The DA of children' s word learning has the potential to add value to the static assessment of the child with low language skills, to predict subsequent receptive vocabulary skills and to increase the chance of correctly identifying children in need of ongoing support. [ABSTRACT FROM AUTHOR]

Previous studies have highlighted a high level of language impairment (LI) and pragmatic language disorder (PLD) amongst children with social, emotional and behavioural difficulties (SEBD). However, little is known regarding the impact of LI in the severity of PLD in this group. This study investigates the language and pragmatic language skills of a group of boys with externalising behaviour (EB), making comparisons with a control group matched for age and socio-economic status. Specifically, the study asks whether there is a difference in pragmatic language presentation between those with and without significant LI. In this study, 35 boys aged between 7 and 12 years identified at high risk of an EB diagnosis and 42 controls participated in assessment of structural and pragmatic language skills. Comparisons were made between these two groups and then within the EB group between those with and without LI. The EB and Control groups were well matched for age and SES but the EB group scored significantly lower than the Control group in measures of language and pragmatic language. Within the EB group the presence of LI was not found to differentiate participants with regard to teacher rating of pragmatic language skills. Furthermore, despite considerable differences in structural language skills within the EB group, teachers rated all participants with EB very similarly in this area. This raises questions about their functional communication skills and teacher perception of these pupils which are discussed along with implications for practice. [ABSTRACT FROM AUTHOR]

There is evidence for co-occurrence of social, emotional and behavioural difficulties (SEBD) and communication/language difficulties in children. Our research investigated the feasibility of vocalisation technology, its combination with observational software and the efficacy of a novel coding scheme and assessment technique. It aimed to investigate children’s online verbal and non-verbal communicative behaviours. Two techniques were employed: Language Environment Analysis (LENA) and behaviour coding (Noldus Observer). These were trialled with children during an interactive task developed for the study: ‘The Story in a Box’. The participants were 14 children, aged 4–7 years; 7 typically developing (TD), 7 with SEBD. There was a statistically significant difference between counts of child vocalisations and conversational turns from children with SEBD and trends in the nature of verbal and non-verbal behaviour used by TD and SEBD children. The research concluded that LENA and Observer can be used effectively with children with SEBD. TD and SEBD children present differences in communicative ability. [ABSTRACT FROM PUBLISHER]

Children with a diagnosis of reactive attachment disorder (RAD) appear to show difficulties in social understanding. We aimed to compare the pragmatic language functioning of children with (RAD) and autism spectrum disorder (ASD). Assessments were made in three groups of children aged 5-8 years, with verbal IQ estimates in the normal range: 35 with a RAD diagnosis, 52 with an ASD diagnosis and 39 with typical development. The Children's Communication Checklist (CCC) was used to compare their pragmatic language skills, and ADI-R algorithms were used to compare autistic symptomatology, according to parent report. According to the CCC, the RAD group demonstrated significant problems in their use of context, rapport and social relationships with a degree of severity equivalent to children in the ASD comparison group. More than 60% of the group with RAD met ADI-R clinical criteria on the Use of Language and Other Social Communication Skills subscale, 46% on the Reciprocal Social Interaction subscale, and 20% had significant repetitive and stereotyped behaviours. Children with RAD appear to be at least as impaired as children with ASD in certain domains of social relatedness, particularly in their pragmatic language skills. [ABSTRACT FROM AUTHOR]

Background: Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment (PLI) or social communication disorder (SCD). Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder (ASD). There is little robust evidence of effectiveness of speech-language interventions which target the language, pragmatic or social communication needs of these children. Aims: To evaluate the effectiveness of an intensive manualized social communication intervention (SCIP) for children who have PLI with or without features of ASD. Methods & Procedures: In a single-blind RCT design, 88 children with pragmatic and social communication needs aged 5;11-10;8, recruited from UK speech and language therapy services, were randomly assigned in a 2:1 ratio to SCIP or to treatment-as-usual. Children in the SCIP condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants. All therapy content and methodology was derived from an intervention manual. A primary outcome measure of structural language and secondary outcome measures of narrative, parent-reported pragmatic functioning and social communication, blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention, immediately post-intervention and at 6-month follow-up. Analysis was by intention to treat. Outcomes & Results: No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability. Significant treatment effects were found for blind-rated perceptions of conversational competence, for parent-reported measures of pragmatic functioning and social communication, and for teacher-reported ratings of classroom learning skills. Conclusions & Implications: There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes, but not standardized language assessment outcomes, for 6-11-year-old children who have pragmatic and social communication needs. These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention. The substantial overlap between the presence of PLI and ASD (75%) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs. [ABSTRACT FROM AUTHOR]