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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.

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.

Background: Historically speech and language therapy services for children have been framed within a rehabilitative framework with explicit assumptions made about providing therapy to individuals. While this is clearly important in many cases, we argue that this model needs revisiting for a number of reasons. First, our understanding of the nature of disability, and therefore communication disabilities, has changed over the past century. Second, there is an increasing understanding of the impact that the social gradient has on early communication difficulties. Finally, understanding how these factors interact with one other and have an impact across the life course remains poorly understood. Aims: To describe the public health paradigm and explore its implications for speech and language therapy with children. Methods & Procedures: We test the application of public health methodologies to speech and language therapy services by looking at four dimensions of service delivery: (1) the uptake of services and whether those children who need services receive them; (2) the development of universal prevention services in relation to social disadvantage; (3) the risk of over-interpreting co-morbidity from clinical samples; and (4) the overlap between communicative competence and mental health. Outcomes & Conclusions: It is concluded that there is a strong case for speech and language therapy services to be reconceptualized to respond to the needs of the whole population and according to socially determined needs, focusing on primary prevention. This is not to disregard individual need, but to highlight the needs of the population as a whole. Although the socio-political context is different between countries, we maintain that this is relevant wherever speech and language therapists have a responsibility for covering whole populations. Finally, we recommend that speech and language therapy services be conceptualized within the framework laid down in The Ottawa Charter for Health Promotion.

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]

Speech, language and communication needs (SLCN) and social, emotional and behaviour difficulties (SEBD) commonly overlap, yet we know relatively little about the mechanism linking the two, specifically to what extent it is possible to reduce behaviour difficulties by targeted communication skills. The EPPI Centre systematic review methodology was applied to the intervention literature related to primary school aged children with both SLCN and SEBD. Studies were graded for study quality. Nineteen studies including 148 children met the inclusion criteria. Heterogeneity was high in terms of symptoms, methodology, interventions and outcomes. All studies reported positive effects of intervention on both communication and behavioural outcomes although the majority were graded as being of relatively low quality. Despite study limitations the findings suggest that this is a promising direction of enquiry. There remain many gaps in the evidence, for example study quality needs to improve, comparative work is rare and it is difficult to use these interventions to reflect on the type of systemic classroom models of service delivery recommended for many of these children. The results have implications for both clinical practice and further research. (Contains 2 tables.)

Background: There are few economic evaluations of speech and language interventions. Such work requires underpinning by an accurate estimate of the costs of the intervention. This study seeks to address some of the complexities of this task by applying existing approaches of cost estimation to interventions described in published effectiveness studies. Aims: The study has two aims: to identify a method of estimating unit costs based on the principle of long-run marginal opportunity costs; and to illustrate the challenges in estimating unit costs for speech and language interventions. Method & Procedures: Descriptions of interventions were extracted from eight papers and combined with information on the unit cost of speech and language therapists to identify information requirements for a full-cost estimation of an intervention. Outcomes & Results: Four challenges were found relating to the level of detail about the therapists, the participants, the scope of activities and parents. Different assumptions made about any of these elements will have a marked effect on the cost of the intervention. Conclusions & Implications: Nationally applicable unit cost data for speech and language therapists can be used as a reference point, but sufficient descriptive data about delivery and receipt of the intervention are key to accuracy. (Contains 1 note and 3 tables.)

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. (Contains 6 tables, 2 figures and 3 notes.)

Background: Although economic evaluation has been widely recognized as a key feature of both health services and educational research, for many years there has been a paucity of such studies relevant to services for children with speech, language and communication needs (SLCN), making the application of economic arguments to the development of services difficult. Aims: The study has two aims, namely to review systematically the cost-effectiveness literature related to services for children with SLCN and to highlight key issues that need to be included in future economic effectiveness studies. Methods & Procedures: A comprehensive search of the international literature for the last 30 years was completed and the studies were evaluated against the "gold standard" criteria developed by Drummond and colleagues in 1996 and 2005. Outcomes & Results: Five studies met the review inclusion criteria. All focused on young (2-11 years) children with SLCN and most compared clinic-based and parent-administered interventions. The studies provide variable levels of detail on the key elements needed, but few provided sufficient details of costs to draw comparisons across studies. Only two studies attempted to bring together costs and effectiveness data. Conclusions & Implications: The studies point to the importance of home-based and indirect intervention and, in many cases, emphasize the parental perspective. There is a need for intervention studies to include a cost dimension based on readily comparable methods of establishing unit costs and for greater use to be made of cost-effectiveness analysis more generally. (Contains 2 tables.)

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 services as far as people with aphasia are concerned. (Contains 1 figure.)

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. (Contains 7 figures and 2 tables.)

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. (Contains 3 tables and 4 notes.)

Purpose: Understanding the long-term outcomes of developmental language difficulties is key to knowing what significance to attach to them. To date, most prognostic studies have tended to be clinical rather than population-based, which necessarily affects the interpretation. This study sought to address this issue using data from a U.K. birth cohort of 17,196 children, following them from school entry to adulthood, examining literacy, mental health, and employment at 34 years of age. The study compared groups with specific language impairment (SLI), nonspecific language impairment (N-SLI), and typically developing language (TL). Method: Secondary data analysis of the imputed 5-year and 34-year data was carried using multivariate logistic regressions. Results: The results show strong associations for demographic and biological risk for both impairment groups. The associations are consistent for the N-SLI group but rather more mixed for the SLI group. Conclusions: The data indicate that both SLI and N-SLI represent significant risk factors for all the outcomes identified. There is a strong case for the identification of these children and the development of appropriate interventions. The results are discussed in terms of the measures used and the implications for practice.

Background: A number of different systems have been suggested for classifying language impairment in children but, to date, no one system has been widely accepted. Method: This paper outlines an alternative system looking for distinct patterns of change in receptive language skills across time, involving a secondary analysis of children identified as having specific language impairment. Participants: The participants were 184 children age-assessed at 3 time points--7, 8, and 11 years of age. Results: The pattern of receptive language development is highly predictable. The dominant pattern of growth is consistent with declining rates of growth over time for all children. The primary way in which the children differ is with respect to their initial severity. The testing of the 2 classification systems revealed some statistically significant differences among the subtypes with regard to the shape of the growth rates, but the effect sizes associated with these differences were very small. Thus, it is possible to conclude that beyond the dominant pattern of growth, some subtypes of language impairment at 7 years of age showed only subtle differences in receptive language change across time. The results are discussed in terms of the sample selection and the age of the children who were studied.

Children with specific language impairment (SLI) frequently experience difficulties with understanding vocabulary and are subsequently academically disadvantaged. This study describes a curriculum-based assessment and therapy technique and its implementation with two children with language difficulties. Mathematical vocabulary that the children did not understand was randomly allocated to either the treatment or the control conditions. Over a period of seven to eight weeks, two boys were individually taught 18 words each. Each word was taught in one session only. The intervention was found to be effective for both children. The results of this study have implications for the rate of teaching of receptive vocabulary, the role of speech and language therapy in schools and the assessment of receptive vocabulary.

While semantic change is notoriously idiosyncratic, cross-linguistic evidence suggests some general trends in the directions and mechanisms of semantic shifts. Notable among these are trends applying to the target domain of the human body, a domain that has received considerable attention due to its universality. However, broad surveys of many languages risk missing significant details. Data from the Dictionnaire étymologique et cognitif des langues romanes (DECOLAR) on the etymologies of terms for 97 body parts in 14 Romance languages calls some proposed trends into question. In particular, counterexamples are found to a supposed unidirectional shift from visible parts to the wholes that include them. Analysis of individual changes reveals contextual factors that can cause a lexical trend to not apply. The findings contribute to a more complex model of metaphorization and metonymization, the primary processes involved in lexical semantic change. [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.KEY WORDS: child language, child speech, intervention, efficacy, meta-analysis