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Background: Effective co-practice is essential to deliver services for children with speech, language and communication needs (SLCN). The necessary skills, knowledge and resources are distributed amongst professionals and agencies. Co-practice is complex and a number of barriers, such as 'border disputes' and poor awareness of respective priorities, have been identified. However social-relational aspects of co-practice have not been explored in sufficient depth to make recommendations for improvements in policy and practice. Here we apply social capital theory to data from practitioners: an analytical framework with the potential to move beyond descriptions of socio-cultural phenomena to inform change., Aims: Co-practice in a local authority site was examined to understand: (1) the range of social capital relations extant in the site's co-practice; (2) how these relations affected the abilities of the network to collaborate; (3) whether previously identified barriers to co-practice remain; (4) the nature of any new complexities that may have emerged; and (5) how inter-professional social capital might be fostered., Methods & Procedures: A qualitative case study of SLCN provision within one local authority in England and its linked NHS partner was completed through face-to-face semi-structured interviews with professionals working with children with SLCN across the authority. Interviews, exploring barriers and facilitators to interagency working and social capital themes, were transcribed, subjected to thematic analysis using iterative methods and a thematic framework derived., Outcomes & Results: We identified a number of characteristics important for the effective development of trust, reciprocity and negotiated co-practice at different levels of social capital networks: macro-service governance and policy; meso-school sites; and micro-intra-practitioner knowledge and skills. Barriers to co-practice differed from those found in earlier studies. Some negative aspects of complexity were evident, but only where networked professionalism and trust was absent between professions. Where practitioners embraced and services and systems enabled more fluid forms of collaboration, then trust and reciprocity developed., Conclusions & Implications: Highly collaborative forms of co-practice, inherently more complex at the service governance, macro-level, bring benefits. At the meso-level of the school and support team network there was greater capacity to individualize co-practice to the needs of the child. Capacity was increased at the micro-level of knowledge and skills to harness the overall resource distributed amongst members of the inter-professional team. The development of social capital, networks of trust across SLCN support teams, should be a priority at all levels-for practitioners, services, commissioners and schools., (© 2016 Royal College of Speech and Language Therapists.)

Aim: The aim of the study was to develop an ecologically valid synthesis of the evidence underpinning interventions for children with speech, language, and communication needs (SLCN), integrating a range of different data sources., Method: Three sources of information were integrated: the Cochrane Review of interventions for children with primary speech and language delays/disorder; current practice from an online survey of 534 speech and language therapists and other professionals working with children with SLCN; and parent reports of preferred outcomes. Evidence was ranked as strong, moderate, or indicative., Results: Of the 58 interventions identified, three (5%) were found to have a strong level of evidence, 32 (56%) had moderate evidence, and 23 (39%) had indicative evidence. Five were universal interventions, the remainder targeted and universal. The integrated findings were then turned into an online interactive database, which is moderated and updated at regular intervals., Interpretation: There are a number of interventions that have a moderate or strong level of evidence underpinning them but they tend not to be those used by practitioners who often favour well-established familiar programmes even if they have only indicative evidence. There is a degree of complementarity between professional and parent views about outcomes, albeit with different emphases., (© 2014 Mac Keith Press.)

Although Warren, Fey and Yoder (2007) have described the key components of "dosage", one needs to go beyond description if one is to understand "optimal" dosage, specifically one needs to relate the characteristics of the intervention to the size of the intervention effect. This study examines the association between dose, intensity, and effect size in 20 randomized controlled studies taken from a few systematic reviews focusing on interventions aiming to ameliorate vocabulary, phonology, and syntax. Reporting of dosage characteristics is an important issue. Our analysis shows that "teaching episodes" and "dose form" are rarely reported in the included studies. The other dosage characteristics are present but not always reported in a transparent fashion. Session length and cumulative intervention intensity is lower for phonology interventions than it is for vocabulary intervention. Dosage, however defined, is not directly associated with outcome, although the level of association varies across the three interventions, for example appearing stronger for vocabulary and phonology than syntax. Taking the three interventions together the dosage components are related to the intervention effects size, but the sample is small and the association is not statistically significant. This study concludes that, while the framework suggested by Baker (2012) and adapted from Warren et al. (2007) is useful but without reference to the effect size of a study, it can only ever tell half the story. One needs to be able to relate dosage to outcome, asking questions about the relationship between the different dosage characteristics and the intervention effect size. Given the available data, it is not, at this stage, possible to make recommendations about optimal dosage.

Studies indicate that language impairment that cannot be accounted for by factors such as below-average non-verbal ability, hearing impairment, behaviour or emotional problems, or neurological impairments affects some 6% of school-age children. Language impairment with a receptive language component is more resistant to intervention than specific expressive or phonological delays, and carries a greater risk of comorbid behavioural difficulties as well as adverse outcomes for language development and academic progress. This paper considers underlying explanations that may account for receptive-expressive language impairment. It also reviews evidence for the effectiveness of intervention from theory and recent systematic reviews, trials, and speech and language therapy practice., (© The Authors. Journal compilation © Mac Keith Press 2010.)

Objective: To evaluate two methods for identifying speech and language problems in preschool children., Design: Prospective population based study., Setting: Inner London., Participants and Methods: 37 health visitors were randomly assigned to use a structured screening test (18) or a parent led method (19). Of 623 eligible children aged 30-36 months, the parents of 582 agreed to participate (353 using the structured test and 229 the parent led method)., Main Outcome Measures: Children were assessed by a speech and language therapist blinded to the test result, using the Reynell developmental language scales. Children were classified as having "severe language problems" if the Reynell score was below the third centile for receptive language and as "needing therapy" if the Reynell score was below the seventh centile for receptive or expressive language and clinical opinion., Results: Reference assessments and usable scores were obtained for 458 (97%) of the 474 children screened. 98 (21%) children had severe language problems and 131 (29%) needed therapy. The sensitivity and specificity for the structured screening test were 66% (95% confidence interval 53% to 76%) and 89% (85% to 93%) respectively for severe language problems and 54% (43% to 65%) and 90% (85% to 93%) for those needing therapy. The sensitivity and specificity for referral by the parent led method were 56% (40% to 71%) and 85% (78% to 90%) for severe language problems and 58% (44% to 71%) and 90% (83% to 94%) for those needing speech and language therapy., Conclusions: Both approaches failed to detect a substantial proportion of children with severe language problems and led to over-referral for diagnostic assessments. Screening is likely to be an ineffective approach to the management of speech and language problems in preschool children in this population.

The present study aimed to investigate 1) whether country categories and type of DLD predict the type of therapy (direct, indirect, and mixed) the child receives, and 2) whether there is an association between country categories, type of therapy, and type of DLD (receptive, expressive, and mixed). European countries were categorised based on Sapir's typology into Continental, AngloSaxon, Nordic and Mediterranean groups. A fifth group i.e. Central European (including Baltic countries) was added. The data to address these questions comes from an online survey, translated and adapted into 30 languages, and is based on reports by 4685 professionals delivering services for children with DLD. This survey was developed by the COST Action IS1406 members and distributed online among practitioners in the year 2017 across European countries. Results indicated that country categories and type of DLD predicted type of therapy. It was suggested that cultural and contextual factors might play a key role in driving clinical practice above and beyond language profiles, patient characteristics and evidence-based practice. [ABSTRACT FROM AUTHOR]

Background The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians. Aims To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term. Methods & Procedures We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term. Outcomes & Results and Conclusions & Implications We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process. [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]

Background: Previous studies have highlighted the level of communication difficulty experienced by children from socially disadvantaged backgrounds, but the pattern of difficulties remains unclear. Aims: The study asks whether the performance of a community sample of children from one of the most socially disadvantaged neighbourhoods in Scotland is best characterized by a general delay in all areas of development, by difficulties across the more formal structural aspects of language or in phonological skills. Methods & Procedures: The study included 138 monolingual English-speaking children: 63 (45.7%) boys and 75 (54.3%) girls aged between 5 and 12 years. All children were assessed blind to educational attainment in the school. Outcomes & Results: Nearly 40% of children had delayed language development with 10% having severe difficulties. The children presented with an uneven profile with much lower structural language scores than reading, general communication skills or non-verbal performance. Although service use was high in the group as a whole, the proportion who met criteria for specific language impairment on discrepancy criteria were not those who were being referred to speech and language therapy. Conclusions & Implications: Although many children were performing well within the normal range, a substantial proportion were not, having considerable implications for the way that services are delivered to these children. Given the high prevalence of delayed structural language difficulties in this group, there is a clear need for a more universal 'population'-based approaches to service delivery. [ABSTRACT FROM AUTHOR]

Using the 1970 British Cohort Study, this study examines factors promoting positive language development and subsequent successful education and employment transitions among children showing early receptive language problems (age 5). We find that 61 per cent of children with early receptive language problems develop into competent readers by age 10. Factors promoting positive language development include parental support and more importantly a good school environment, characterised by only few children receiving remedial help. Post-16 education and employment experiences indicated competent reading to be associated with a less challenging journey into adulthood. Findings are discussed in terms of their policy implications. [ABSTRACT FROM AUTHOR]

Background: It is widely accepted that service users should be actively involved in new service developments, but there remain issues about how best to consult with them and how to reconcile their views with those of service providers. Aims: This paper uses data from The Aphasia in Scotland study, set up by NHS Quality Improvement Scotland to identify the direction of the development of services for people with aphasia in Scotland. It examines the views both of those who provide and of those who receive those services. Methods & Procedures: The study integrated findings from a questionnaire to all speech and language therapists treating people with aphasia across Scotland with findings from focus groups with service users and aphasia practitioners. Outcomes & Results: Three themes were identified: (1) public and professional awareness of the impact of aphasia on the individual and their family; (2) current service provision and gaps in services; and (3) directions for the future development of services and barriers to change. Although the impact of aphasia is well recognized amongst most professionals (that is, not just speech and language therapists), considerable concern was expressed about the level of knowledge amongst professionals who do not specialize in stroke care and about public awareness of aphasia. Service providers indicated a shift in the model of service delivery of which the service users were largely unaware. Although the majority of speech and language therapists spend most of their time providing one-to-one therapy, and this is valued by service users, there is undoubtedly an emerging shift towards a focus on broader social function and the inclusion of the person with aphasia in supportive social networks. This creates tensions because of the existing pressure for individualized models of delivery. Concern was expressed by practitioners, although not echoed by patients, about the transition from the acute sector to primary care. Practitioners also expressed concern about the introduction of more recent services like NHS 24 and e-health initiatives, which rely on means of communication that may be particularly challenging for people with aphasia. Conclusions & Implications: The findings from this study indicate that although there are clearly common perspectives, the views of people with aphasia about services do not necessarily coincide with those of service providers. This is an important consideration when initiating consultation and highlights the need for clarity on the part of practitioners in identifying the aims and objectives of their ervices as far as people with aphasia are concerned. [ABSTRACT FROM AUTHOR]

Introduction: The relationship between mental health, behaviour and language development is widely recognized in the literature. Recent advances in assessment tools allows one to consider the role of pragmatic language skills in this co-occurrence. Aims: This pilot study aimed to investigate (1) the level of association between pragmatic language difficulties and emotional/behavioural difficulties; and (2) what explanations there might there be for any such association. The roles of language, word decoding, and non-verbal cognitive ability and also socio-demographic factors are considered. Method & Procedures: Seventeen participants aged 7–11 years were identified from Educational Psychologist caseloads as having behaviour that is causing concern at school. Comparisons were made with 16 age- and sex-matched controls. Participants' language, literacy and non-verbal cognitive ability were assessed at school. Parents and teachers completed questionnaires investigating communication skills, behaviour and emotional wellbeing. Outcomes & Results: No significant difference was found between the groups for non-verbal cognitive ability. However, children in the referred group were significantly more likely to have structural language, word decoding and pragmatic language difficulties and mothers with no further education beyond school. Taking a broad view of language skills to include structural language, pragmatic language and word decoding, 94% ( n = 15) of referred children had significant difficulties with at least one of these three factors. The only factor not found on its own was structural language difficulties, indicating that on their own they are perhaps not associated with emotional/behavioural difficulties. Conclusions & Implications: The results of this pilot study have implications for how we view language and behaviour difficulties in primary schools. Future larger-scale research should consider the role of parenting factors, pragmatic language skills and literacy ability in the high co-existence rate of emotional/behavioural difficulties and language/communication needs. [ABSTRACT FROM AUTHOR]

Background: The UK government set up a review of provision for children and young people with the full range of speech, language and communication needs led by a Member of Parliament, John Bercow. A research study was commissioned to provide empirical evidence to inform the Bercow Review. Aims: To examine the efficiency and effectiveness of different arrangements for organizing and providing services for children and young people with needs associated with primary speech, language and communication difficulties. Methods & Procedures: Six Local Authorities in England and associated Primary Care Trusts were selected to represent a range of locations reflecting geographic spread, urban/rural and prevalence of children with speech, language and communication difficulties. In each case study, interviews were held with the senior Local Authority manager for special educational needs and a Primary Care Trust senior manager for speech and language therapy. A further 23 head teachers or heads of specialist provision for speech, language and communication difficulties were also interviewed and policy documents were examined. Outcomes & Results: A thematic analysis of the interviews produced four main themes: identification of children and young people with speech, language and communication difficulties; meeting their needs; monitoring and evaluation; and research and evaluation. There were important differences between Local Authorities and Primary Care Trusts in the collection, analysis and use of data, in particular. There were also differences between Local Authority/Primary Care Trust pairs, especially in the degree to which they collaborated in developing policy and implementing practice. Conclusions & Implications: This study has demonstrated a lack of consistency across Local Authorities and Primary Care Trusts. Optimizing provision to meet the needs of children and young people with speech, language and communication difficulties will require concerted action, with leadership from central government. The study was used by the Bercow Review whose recommendations have been addressed by central government and a funded action plan has been implemented as a result. [ABSTRACT FROM AUTHOR]

A meta-analysis was carried out of interventions for children with primary developmental speech and language delays/disorders. The data were categorized depending on the control group used in the study (no treatment, general stimulation, or routine speech and language therapy) and were considered in terms of the effects of intervention on expressive and receptive phonology, syntax, and vocabulary. The outcomes used in the analysis were dependent on the aims of the study; only the primary effects of intervention are considered in this review. These were investigated at the level of the target of therapy, measures of overall linguistic development, and broader measures of linguistic functioning taken from parent report or language samples. Thirty-six articles reporting 33 different trials were found. Of these articles, 25 provided sufficient information for use in the meta-analyses; however, only 13 of these, spanning 25 years, were considered to be sufficiently similar to be combined. The results indicated that speech and language therapy might be effective for children with phonological or expressive vocabulary difficulties. There was mixed evidence concerning the effectiveness of intervention for children with expressive syntax difficulties and little evidence available considering the effectiveness of intervention for children with receptive language difficulties. No significant differences were found between interventions administered by trained parents and those administered by clinicians. The review identified longer duration (>8 weeks) of therapy as being a potential factor in good clinical outcomes. A number of gaps in the evidence base are identified. [ABSTRACT FROM AUTHOR]

Services for children with speech and language needs in England and Wales are in a period of change. The context is subject to major systemic pressures deriving from government policies. These include the development of inclusive education and encouragement of multiprofessional collaboration in policy development and practice ('joined up thinking'). In addition, structures at local level are changing with the establishment of unitary authorities and the change from Health Trusts to Primary Care Trusts. Professional practice is also changing with a shift from clinical to community settings for speech and language therapists working with children. The present study reports on a survey sponsored by the Department for Education and Employment, Department of Health and the Welsh Assembly to identify the nature of speech and language therapy (SLT) services provided to education in England and Wales. The sample comprised all SLT service managers (n = 133, response rate 74%). The results indicate that services vary greatly in size and in their SLT: child ratio, with a mean of one SLT to 4257 child population. The caseload was highest for the 5-10 age group, and service delivery was targeted at these children, with low levels of work with secondary aged pupils. Most provision in educational settings was made to mainstream schools, but the provision of SLT time per child was substantially higher in specialist language resources. Apart from the preschool phase, most SLT provision was for children with statements of special educational needs. Prioritization of service delivery was usually by severity of need. The provision of bilingual SLT services was very limited, with only 14.0 full-time equivalents SLTs fluent in a community language, other than Welsh, where proportionately availability was much greater. Most LEAs funded SLT posts, although these were usually employed as part of the SLT service, with only about 10% of LEAs employing SLTs direct. However, 55.5% of SLT managers reported that recruitment and retention were problematic, resulting in gaps in the service. These findings are discussed with respect to changes driven by professional judgements on the nature of optimal service delivery, and government policy, with particular reference to inclusion and equity of service delivery. [ABSTRACT FROM AUTHOR]

It is important to ascertain the validity of screening and case-finding procedures m terms of long-term outcome, particularly if they constitute the primary mode of accessing services. This study is a follow-up of a group of Tree Negatives and False Positives from the 'original' study (Laing et al. 2000), which investigated the concurrent validity of a parent-led method and a formal screening method. Nine (29.03%) of the 31 children who were re-assessed fell below the cut-off point for referral and were identified as cases. In particular, as many as eight (57.14%) of the 14 false positives were referred. [ABSTRACT FROM AUTHOR]

The prevalence and the natural history of primary speech and language delays were two of four domains covered in a systematic review of the literature related to screening for speech and language delay carried out for the NHS in the UK. The structure and process of the full literature review is introduced and criteria for inclusion in the two domains are specified. The resulting data set gave 16 prevalence estimates generated from 21 publications and 12 natural history studies generated from 18 publications. Results are summarized for six subdivisions of primary speech and language delays: (1) speech and/or language, (2) language only, (3) speech only, (4) expression with comprehension, (5) expression only and (6) comprehension only. Combination of the data suggests that both concurrent and predictive case definition can be problematic. Prediction improves if language is taken independently of speech and if expressive and receptive language are taken together. The results are discussed in terms of the need to develop a model of prevalence based on risk of subsequent difficulties. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to the article "Language Delay: Why Do Parents Fail Appointments?" in published in a previous issue of the journal.

Background: Children with Developmental Language Disorder (DLD) have a significant deficit in spoken language ability which affects their communication skills, education, mental health, employment and social inclusion.Aim: The present study reports findings from a survey by EU network COST ACTION 1406 and aims to explore differences in service delivery and funding of SLT services for children with DLD across Europe and beyond.Methods and Procedures: The survey was completed by 5024 European professionals. COST countries were grouped into Nordic, Anglo-Saxon, Continental, Mediterranean, Central/Eastern and Non-European categories. The use of direct, indirect and mixed interventions, and their relationship to funding available (public, private or mixed) were considered for further analysis.Outcomes and Results: The results revealed that for direct therapy, there were more cases than expected receiving private funding. For indirect therapy, fewer than expected received private and more than expected public funding. For mixed therapy, fewer cases than expected received private funding.Conclusions and Implications: The results implies that other factors than evidence-based practices, practitioners experience, and patient preferences, drive choices in therapy. More research is needed to gain a better understanding of factors affecting the choice of therapy. [ABSTRACT FROM AUTHOR]

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of Authors and Editor-in-Chief. Whilst conducting further analyses for a companion paper in June 2021 using the survey data reported in this study, it came to the authors' attention that unfortunately there were errors in the data used in the analyses for this paper. The authors believe this to be either human error in data entry or coding or a technical error whilst recoding a variable. They therefore reran their analyses with the correct data for the paper to understand if and how the results differed from those published, and they did indeed change the findings. As soon as this came to the authors' attention (July 2021), they contacted the Editorial office. All authors on the paper are in agreement with this retraction. A new revised article with the correct data, analysis and results is now available: 10.1016/j.ridd.2021.104139. [ABSTRACT FROM AUTHOR]