Search

Α psycholinguistic framework for speech processing was adopted to investigate the development of phonological and morphological skills in children learning Greek. It was investigated whether morphological items pose specific challenges in terms of speech processing. Two groups of typically developing children aged 3.0-3.5 years (N = 16) and 4.6-5.0 years (N = 22), respectively, were assessed longitudinally at three assessment points 6 months apart. A range of phonologically based and morphologically based experimental speech processing tasks was administered to address the research question, along with language comprehension and production assessments to ensure that the children were developmentally typical. Stimuli of minimal phonological difference and minimal morphological difference, respectively, were used. Phonologically based experimental stimuli were used to assess performance differences across properties such as voicing, manner and place of articulation, in addition to variation in phonotactic structure. Morphologically based experimental stimuli were used to assess the impact of characteristics such as verb tense and possessive pronouns. Stimuli were incorporated into tasks of real word and nonword auditory discrimination and repetition, to assess input and output processing. Items were matched across tasks so that comparisons could be made. On most of the matched tasks, there was no significant difference in performance accuracy between morphological and phonological conditions. Moreover, a significant relationship was found between domains. It is suggested that morphological items, compared to phonological items, do not pose specific challenges in terms of speech processing. The clinical implications of these findings for assessment and intervention are discussed.

Intervention with children with speech and language difficulties has been proven beneficial compared with no treatment yet, knowing what type of intervention to provide remains a challenge. Studies of English-speaking children indicate that intervention targeting the production of morphological targets may have a positive effect on phonological aspects and vice versa. However, studies have not reported on generalization effects to untreated morphemes and little is yet known about morphological intervention in the context of a highly inflected language. The purpose of the current intervention case study was to investigate the effect of intervention in relation to phonological and morphological targets in Greek, a language characterized by complex inflectional morphology. A single subject research design was used with pre- and post-intervention assessment carried out. The participant was a four-year-old Greek-speaking boy with speech difficulties. The production of /s/, a phoneme used in multiple phonological and morphological contexts was targeted with alternating focus of intervention between phonological and morphological targets. Assessment took place at two levels: macro-assessment to monitor broad changes in speech; micro-assessment to measure therapy-specific changes in the production of treated targets and generalization to untreated targets and control items. There were four phases of intervention with a total of 24 hours of therapy. Significant improvement in performance accuracy was found between assessment scores immediately pre- and post-intervention. Intervention targeting the production of a phoneme in the word stem was not sufficient to accomplish the accurate production of morphemes requiring the same phoneme; intervention directly targeting morphemes was successful. Within-domain generalization was observed in both domains. Improved naming accuracy was observed post-intervention that was maintained at follow-up. The present study supports the case for morphophonological intervention. Morphological elements should be addressed in a comprehensive intervention for speech sound disorders.

Research indicates that a significant number of children enter primary school with insufficient vocabulary knowledge. This study investigates whether a small group daily word learning programme delivered by the class teacher can improve word learning in young children. Eighteen children, aged five to six years, with English as an additional language or poor language development, attending three schools in an area of social deprivation, participated in the study. Class teachers implemented a principled approach for teaching and learning vocabulary that included the development of word-learning strategies. Vocabulary knowledge was assessed pre- and post-intervention using a non-standardized, study-specific measure that compared taught and untaught vocabulary. Receptive vocabulary was also measured using standardized assessment. Pupil and teacher questionnaires were presented before and after the intervention. There were significant changes in children’s knowledge of both taught and untaught words, with more change in knowledge of taught words. Some children also showed significant change on standardized measurement of vocabulary. Class teachers reported changes in their practice and some children reported using a wider range of strategies to learn words.

Objectives Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into the National Cancer Screening Programmes in England in 2013. Patient-reported outcome measures (PROMs) from trial participants indicate high acceptability and no adverse physical or psychological consequences, but this may not generalize to routine screening in the community. This study examined PROMs in a community-based FS screening programme. Methods Eligible adults aged 58–59 ( n = 2016) registered at 34 London general practices were mailed a National Health Service-endorsed invitation to attend FS screening. Pain and side-effects were assessed in a ‘morning-after’ questionnaire, and satisfaction was assessed in a three-month follow-up questionnaire. Anxiety, self-rated health and colorectal symptoms were assessed at prescreening and follow-up. Results In total, 1020 people attended screening and were included in the current analyses, of whom 913 (90%) returned the morning-after questionnaire, and 674 (66%) the follow-up questionnaire. The prescreening questionnaire had been completed by 751 (74%) of those who attended. The majority (87%) of respondents reported no pain or mild pain, and the most frequent side-effect (wind) was only experienced more than mildly by 16%. Satisfaction was extremely high, with 98% glad they had the test; 97% would encourage a friend to have it. From prescreening to follow-up there were no changes in anxiety or self-rated health, and the number of colorectal symptoms declined. Satisfaction and changes in wellbeing were not moderated by gender, deprivation, ethnicity or screening outcome. Conclusions PROMs indicate high acceptability of FS screening in 58–59 year olds, with no adverse effects on colorectal symptoms, health status or psychological wellbeing.

Evidencing the effectiveness of speech, language and communication interventions continues to be a challenge for both researchers and practitioners who work with children and young people with speech, language and communication needs (SLCN). The use of case study design as a methodology for evaluating the effectiveness of these interventions, and the value of their contribution to the evidence base, is often not recognized. In this editorial, the merits of case study design as a robust and achievable methodology for practitioners to use to evidence the effectiveness of their interventions are discussed. Child Language Teaching and Therapy has published a number of case studies or case series reports over the years. Some case studies have been descriptive, with the aim of explicating aspects of a child’s difficulties. Carvey and Bernhardt (2009) used a framework for profiling intentional communication to describe the skills of a child with a rare genetic syndrome, thus adding to the literature on this particular disorder. Worth and Reynolds (2008) presented detailed assessment findings of a boy with Asperger’s syndrome and showed how these enabled a better understanding of the nature of his difficulties. The findings were explored in relation to the research literature and the implication for assessment practices and for intervention. Murphy and Dodd (2010) used assessment findings from the case of a child with a hearing impairment and a non-dominant language home background to discuss diagnostic criteria for specific language impairment. Whilst this type of case study is useful for illuminating our understanding of children with SLCN, it neither aims, nor is designed, to evaluate interventions. However, case study research that includes some element of experimental control can and does contribute to the evidence base for speech, language and communication interventions. Within a hierarchy of evidence composed of five levels, the highest is systematic reviews, and meta-analyses of randomized controlled trials, single case studies and case study series are ranked at level 2, above observation and expert opinion (Sackett et al., 2000). Logan et al. (2008) also present levels of evidence for single case research, from those that are designed to prove causal inference of the effects of intervention, to those that can hint at or suggest causal inference. These experimental case studies are known by a number of terms, such as single subject design, single subject research, single case design/research and n of 1. The design can include more than one individual receiving the same intervention reported as a case series or case study series. Each participant serves as his or her own control (Horner et al., 2005). Studies such as these have been and are published in Child Language Teaching and Therapy and can make an important contribution to the evidence base. 457766 CLT28310.1177/0265659012457766Child Language Teaching and TherapyEditorial 2012

Many children with speech, language and communication needs are educated in mainstream schools. Current policy and practice includes training for school staff in facilitating the development of speaking and listening skills. This study evaluates one such training package that focuses on supporting pupils’ listening skills, delivered in a mainstream primary school. Perceived changes in teacher practice following training were evaluated using a questionnaire completed by pupils. Twenty-seven pupils completed a questionnaire two months prior to the training, immediately preceding the training and three months after the training. Pupils’ responses at the three time points were compared. These suggest positive changes following the training. Pupils were more aware of the specific skills that they needed to practise to develop good listening. They also indicated that school staff were using a wider range of strategies to support listening activities in the classroom.

This article describes a study that set out to explore the experience of endoscopy nurse practitioners participating in the Department of Health-funded UK Nurse-led Flexible Sigmoidoscopy Colorectal Cancer Screening Pilot. Semi-structured interviews were conducted with the three nurse practitioners involved and were analysed using Thematic Analysis, a qualitative method for analysing and reporting patterns (themes) within data. Nurse practitioners found that participating in the study improved their skills and provided job satisfaction despite the hard work it entailed. A varied workload consisting of diagnostic and screening procedures, in addition to the other duties of nurse practitioners, may be desirable for nurses working in the field of gastroenterology.

Few materials are available to assess speech perceptual skills in young children without hearing impairments. However, children with a range of developmental conditions are at risk of speech discrimination deficits. Tasks that reliably assess speech perception skills are thus necessary for research and clinical practice. The development and application of two speech perception tests are described. Data were collected from 105 children, aged 4-5 years, attending mainstream schools, on two tasks, mispronunciation detection and non-word XAB, in quiet and in a background of multi-talker babble. Children's receptive language skills were also measured. Performance on mispronunciation detection was significantly better than on the XAB non-word task, and significantly better in quiet than in babble. Performance significantly improved with age, and speech discrimination was significantly related to receptive language abilities. Scores obtained in quiet and in babble were highly correlated and findings suggest there may be no advantage to testing in noise, except to avoid ceiling effects on performance. These tasks prove useful in the assessment of young children who may have speech discrimination deficits.

Background: Poor performance and inadequate training in colonoscopy in the UK has been reported. Several centers across the UK run intensive hands-on training courses but their efficacy has not been established. Methods: To assess the benefit of the accelerated colonoscopy training course, an audit was conducted for the 50 trainees who individually attended the course. The course objectives were to increase core knowledge and improve the basic hand skills required for colonoscopy on a one-to-one basis. This includes three microteaching, two computer simulator and four hands-on training sessions within 4 days. They performed two multiple-choice question (MCQ) papers. Performance parameters measured at the beginning and end of the course were the Direct Observation of Procedural Skills (DOPS) using visual analog scales for all aspects of colonoscopy technique. Results: The MCQ score significantly increased: mean score 57%vs 66% (P

PURPOSE: To compare the cardiovascular effects of computed tomographic (CT) colonography and conventional endoscopy in a group of patients undergoing both procedures. MATERIALS AND METHODS: A total of 144 patients underwent CT colonography followed by flexible sigmoidoscopy (40 patients) or colonoscopy (104 patients). Pulse, blood pressure, and oxygen saturation were measured before, during, and after the procedures. Forty patients also underwent continuous Holter electrocardiographic (ECG) monitoring. Periprocedural pain was assessed by using a handheld counting device. Outcome variables were assessed by using a combination of paired t testing and multilevel linear regression. RESULTS: When a spasmolytic was not used, CT colonography was associated with only a small increase in oxygen saturation (P =.03), while use of a spasmolytic caused an increase in pulse (mean increase, 19.9 beats per minute; P

The purpose of this study was to compare patient acceptance of multidetector CT colonography, total colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema to ascertain any overall preference. SUBJECTS AND METHODS. One hundred sixty-eight patients underwent CT colonography followed by either flexible sigmoidoscopy (n = 59) or colonoscopy (n = 109). A 25-point questionnaire with principal components relating to satisfaction, worry, and physical discomfort was administered after CT colonography and after endoscopy, and a follow-up questionnaire was administered 1 week after the procedures. Questionnaires were also completed by 140 patients undergoing double-contrast barium enema examinations. Responses were compared using Wilcoxon's matched pairs test and the Mann-Whitney test.Overall satisfaction was greater with colonoscopy (p = 0.01), but CT colonography caused less discomfort (p = 0.002), was better tolerated (p = 0.005), and was the preferred follow-up investigation of those expressing a preference (p = 0.003). Compared with flexible sigmoidoscopy, CT colonography caused less pain (p = 0.004), was more acceptable (p = 0.04), and was preferred as the follow-up investigation (p0.001). Tolerance of colonoscopy was significantly less in women (p = 0.03), but such was not the case for CT colonography (p = 0.58). Patients undergoing CT colonography were less worried (p0.001), were more satisfied (p = 0.001), and suffered less discomfort (p0.001) than those having barium enema.Patients' experiences with barium enema examinations were significantly worse than with any other test. Although patients were most satisfied with colonoscopy, they reported more pain during both colonoscopy and sigmoidoscopy than during CT colonography, and they also found CT more acceptable. In patients expressing a preference, CT colonography was the preferred follow-up investigation.

In recent years there has been increased interest in universal provision in that spoken language and communication development is supported for all children in schools, classrooms and early years settings. As well as supporting all children this approach is facilitative for children with speech, language and communication needs, and for children whose home language is different from the language of the school, classroom or setting. Within this context there has been an emphasis on providing environments that are ‘communication friendly’. As editors, we are delighted to present this exciting special issue focusing on the definition, identification, implementation and evaluation of communication friendly environments. The articles selected represent the UK, Europe, New Zealand and Australia, spanning quantitative and qualitative methodologies. The exact nature of communication friendly environments need defining so that they can be implemented and then evaluated to determine their effectiveness in facilitating children’s spoken language and communication. Dockrell, Bakopoulou, Law et al. and Gracia, Vega and GalvanBovaira describe the tools they have devised to identify and measure communication friendly classrooms. Dockrell et al. carried out an extensive review of the literature to determine the aspects of a classroom and the behaviours of professional(s) in the classroom that can be measured and then developed further to enable a classroom to become more communication friendly. Their Communication Supporting Tool (CSC) is not only grounded in the research literature but has also been tested in schools to confirm it has inter-rater reliability and validity and is, therefore, a robust measure for primary schools to use that can also facilitate professionals to make classrooms more communication friendly. The EVALOE tool (Gracia et al.) is perhaps more specific, aiming to capture and measure the interaction between teachers and children. The EVALOE tool measures the spoken language learning and teaching in the classroom and then offers a method by which teachers can reflect on their practice and develop strategies to improve this. An ethnographic approach to exploring the nature of communication friendly classrooms and the role of the education practitioner is taken by Bain, James and Harrison. Here, a detailed and reflective account is given of the practitioner and her or his role in supporting children’s communication development, with an emphasis on the often neglected role of the children’s parents in creating communication friendly environments. Communication friendly environments are an intrinsic component of the current universal provision ethos. Universal provision promotes the development of practitioners’ knowledge of children’s language and communication development across early years and into primary school age. Along with increased knowledge, these practitioners are also expected to implement strategies that can develop children’s language and communication as part of their everyday care of the children. 604058 CLT0010.1177/0265659015604058Child Language Teaching and TherapyEditorial research-article2015

This paper stresses the need to refer to normal control data when assessing children with speech disorders. It is based on the findings of a completed, one-year, full-time research project designed to investigate the normal development of speech, auditory and rhyme skills within a psycholinguistic framework (Stackhouse & Wells, 1993). The aim of the project was to examine phonological processing skills in normally developing children for comparison with children presenting with speech, lexical and literacy disorders. A range of tasks was presented to 100 normally developing children, aged 3–7 years. The tasks included auditory discrimination, rhyme judgement, detection and production; speech repetition, naming and continuous speech. The tasks were presented in both visual and auditory modalities, and both real and non-word stimuli were used. For each set of tasks stimuli were identical or closely matched, using phonetic criteria. Data was analysed for subjects within each age band, i.e. 3-year-olds, 4-year-olds, 5-year-olds, 6-year-olds and 7-year-olds. Analysis of variance revealed significant effects of age on all tasks. Comparisons were made of performance across the different presentations and stimuli-type relevant to each task and significant effects of presentation and stimuli-type were found for some tasks but not for all comparisons made. These findings allowed us to present a profile of normal development in performance across a range of input and output processing tasks. The time constraint prevents the full profile of results being included. However, the implications of the results for clinical practice will be presented. For example, given that normally developing children find non-word repetition more difficult than real-word repetition, at what point is the difference in performance on these tasks indicative of a motor programming deficit? Further, given the relationship between rhyme detection and production skills in normally developing children, at what age is the failure to produce any rhyming words significant? In summary, this study identified typical developmental profiles of phonological processing skills in children of 3–7 years of age. Speech and language therapists can use these results to identify with greater accuracy children with speech and language difficulties who may present with atypical psycholinguistic profiles. Subsequent therapy can be targeted in a more precise way.

The comprehension of non-literal language was investigated in 18 children with specific language impairment (SLI), including a subgroup identified by clinicians as having semantic-pragmatic difficulties, match ed with a normally developing control group. No difference in group mean scores was found between the SLI children and the control group; however, differences in the relationship between receptive language level and non-literal comprehension performance were found. The subgroup identified as having semantic-pragmatic difficulties performed no worse than the other SLI children and the control children. Implications are discussed for the diagnosis and treatment of semantic-pragmatic dis order.

Deficits in speech perception are reported for some children with language impairments. This deficit is more marked when listening against background noise. This study investigated the speech perception skills of young children with and without language difficulties. A speech discrimination task, using non-word minimal pairs in an XAB paradigm, was presented to 20 5-7-year-old children with language difficulties and 33 typically-developing (TD) children aged between 4- to 7-years. Stimuli were presented in quiet and in background noise (babble), and stimuli varied in phonetic contrasts, differing in either place of articulation or presence/absence of voicing. Children with language difficulties performed less well than TD children in all conditions. There was an interaction between group and noise condition, such that children with language difficulties were more affected by the presence of noise. Both groups of children made more errors with one voicing contrast /s z/ and there was some indication that children with language difficulties had proportionately greater difficulty with this contrast. Speech discrimination scores were significantly correlated with language scores for children with language difficulties. Issues in developing material for assessment of speech discrimination in children with LI are discussed.

Introduction One aspect of applied linguistics is clinical linguistics, defined as ‘the study of the numerous ways in which the unique human capacity for language can be disordered’ (Cummings 2008: 2). Whilst clinical linguistics might be considered to be the domain of the speech and language therapist, children with speech language and communication needs (SLCN) are present in every classroom, and, therefore, one can argue the case for teachers to have sufficient linguistic knowledge to support these pupils. This chapter is primarily about spoken language. However, mention will be made of children with dyslexia, as similar issues pertain to this group. It will describe the range of speech, language and communication difficulties experienced by children in schools, addressing policy and practice issues. Different aspects of language will be considered to identify what knowledge might be useful for teachers and how it might be applied. Issues in teaching children from a minority language background who are learning through their second language are not addressed here, but are covered in the chapter by Letts (this volume). The UK educational context will be used to illustrate the key issues. What are speech language and communication needs? There are a number of ways in which SLCN can be defined. A clear description has been provided by Marshall, Ralph and Palmer (2002).

Objective The aim of this study was is to examine uptake of population-based, flexible sigmoidoscopy (FS) screening delivered by nurses in a socioeconomically and ethnically diverse area of London, England. Methods All adults aged 58 and 59 years registered at 34 general practices in North London ( n = 2260) were mailed an invitation to attend FS screening at the local hospital. Results In total, 45% (1024/2260) accepted the invitation and attended, 5% (114/2260) accepted the invitation but failed to attend, 5% (111/2260) accepted the invitation but were unable to attend within the time-frame of the pilot study, 7% (165/2260) declined the offer, 27% (602/2260) did not respond, and 11% (244/2260) were ineligible or did not receive the invitation. Among those eligible to be screened, the uptake rate was 51% (1024/2016). Uptake did not differ by gender, but people living in the most affluent quintile of areas had a substantially higher uptake rate (63%) than those living in the most deprived quintile (38%). Conclusion Uptake of FS screening delivered as a population-based programme was over 50% among the eligible population in a socioeconomically and ethnically diverse area of London. Disparities in uptake should be addressed to avoid exacerbating health inequalities.

This article briefly describes Landau-Kleffner Syndrome and gives the case-history of one child, diagnosed as having this disorder, who presented with severe receptive aphasia. Several of the programmes used in speech therapy and classroom situations are described, including sign language, auditory training, cued articulation, daily diary, and graphic conversation. Some indication of the child's progress is given.

Objective: To assess uptake of once-only flexible sigmoidoscopy (FS) in a community sample to determine whether FS would be viable as a method of population-based screening for colorectal cancer. Methods: All adults aged 60–64 years registered at three General Practices in North West London, UK (510 men and women) were sent a letter of invitation to attend FS screening carried out by an experienced nurse, followed by a reminder if they did not make contact to confirm or decline the invitation. The primary outcome was attendance at the endoscopy unit for a FS test. Results: Of the 510 people invited to attend, 280 (55%) underwent FS. Among non-attenders, 91 (18%) were ineligible for screening or did not receive the invitation, 19 (4%) accepted the offer of screening but were unable to attend during the study period, 52 (10%) declined the offer, 41 (8%) did not respond to the invitation, and 27 (5%) accepted the offer of screening but did not attend. Attendance among those eligible to be screened, who had received the invitation, was 67%. People from more socioeconomically deprived neighbourhoods were less likely to attend (odds ratio [OR] = 0.90; confidence interval [CI] = 0.84–0.96; P = 0.003). Women were more likely to attend than men (OR = 1.44; CI = 1.01–2.05; P = 0.041). Conclusions: Attendance rates in this pilot for nurse-led, population-based FS screening were higher than those reported in other FS studies, and comparable with adherence to fecal occult blood testing (FOBT) in the UK FOBT pilot. Having a female nurse endoscopist may have been responsible for increasing female uptake rates but this warrants confirmation in a larger study.

In recent years, clinicians have been using a psycholinguistic approach to the assessment and remediation of children's developmental speech disorders. This requires the comparison of a child's performance across a range of speech-production tasks.To describe the profile of performance across different speech-production tasks in normal development and to discuss the application of such data to clinical findings.Three speech-production tasks, picture naming, word repetition and non-word repetition, were presented to 100 children with normal speech development, aged between 3 and 7 years of age. The speech-processing demands of the different tasks were considered using a developmental speech-processing model. Stimuli used in the three task paradigms were carefully matched so that children's performance across the tasks could be directly compared.Within the context of normal speech development, there were significant improvements in performance for all three tasks as children get older. There were also significant differences in performance across the three tasks, and the pattern of these relationships changed with age. Significant differences were found in the accuracy of production of words of increasing length.Profiles of speech-production task performance are presented within the context of normal development. Comparison of performance across three different speech-production tasks might provide useful insight into the nature of a child's speech disorder.

Is as clinically effective as that delivered by doctors, but may cost more The multicentre randomised controlled trial by Williams and colleagues (doi:10.1136/bmj.b231) compares the clinical effectiveness of doctors and nurses undertaking upper and lower gastrointestinal endoscopy. The study by Richardson and colleagues (doi:10.1136/bmj.b270) assesses the cost effectiveness of this approach. The studies found no significant difference in clinical outcomes, although doctors seemed to be more cost effective.1 2 Nurse led services in the United Kingdom have been encouraged by government policy, a shortage of doctors, a willingness of nurses to adopt expanded roles, and a salaried NHS workforce where professionals are not in competition for income from patients. Evaluations of substituting doctors with nurses have consistently found little difference in performance. In primary care, no appreciable differences between doctors and nurses have been found in health outcomes for patients, process of care, or use and cost of resources, whereas nurse led care has resulted in higher patient satisfaction.3 These findings have been reported across a wide range of diseases. Nurse endoscopists are firmly established in the UK, with 350 nurses currently in practice. Endoscopy is a diagnostic test so the results might …