Current practices, supports, and challenges in speech-language pathology service provision for autistic preschoolers

Binns, A.V., Cunningham, B. J., Andres, A., & Oram Cardy, J. (2022). Current practices, supports, and challenges in speech-language pathology service provision for autistic preschoolers. Autism & Developmental Language Impairments, 7, 23969415221120768–23969415221120768. https://doi.org/10.1177/23969415221120768

    Speech-language pathology services are one of the most frequently accessed services for autistic preschoolers. In Ontario, this service is mostly accessed through the Preschool Speech and Language Program. Capturing current speech-language pathology practices used with autistic preschoolers as well as supports and challenges is needed to inform research and clinical decisions about the program.

    In this study, 258 clinicians including speech-language pathologists (SLPs) and communication disorders assistants (CDAs) were surveyed on their experiences of delivering services to autistic preschool children and their family. Results were as follows:

• Assessment – SLPs used a variety of assessment tools (3-4 per assessment) to primarily evaluate four skills: prelinguistic skills (e.g., joint attention, nonverbal skills), language, play, and pragmatics (social use of language)
• Intervention – Clinicians provided services to about 23 children per month, with 39% of their caseload being children with suspected or diagnosed autism. Therapy goals aligned with the four areas assessed. Although therapy tended to be caregiver training, up to 26 unique therapy programs were reported. In addition, there was no difference in reported practice for children with suspected or diagnosed autism
• Facilitators – At the individual level, having professional development in e.g., caregiver training, ADOS training, and learning about regulation and sensory processing facilitated practice. At the program level, being able to collaborate with other professionals and access to supports (e.g., CDAs) were ranked highly
• Barriers – At the individual level, challenges included access to professional development and counseling families. At the program level, managing caseload (number of clients for whom therapy is provided) and workload (other activities such as documentation and meetings) and community messaging (undervaluing speech-language pathology services in favour of ABA) were ranked as challenges

    Overall, the findings revealed variability in speech-language pathology practices used with autistic preschoolers, highlighting a need to establish and promote equity in services. Our lab aims to initiate a similar line of research by capturing current practices in school-board speech-language pathology services.

Blogger: Theresa Pham is a Postdoctoral Associate working with Drs. Lisa Archibald and Janis Cardy.

The use of questions to scaffold narrative coherence and cohesion: Use of questions to scaffold narrative

Silva, & Cain, K. (2019). The use of questions to scaffold narrative coherence and cohesion: Use of questions to scaffold narrative. Journal of Research in Reading, 42(1), 1–17. https://doi.org/10.1111/1467-9817.12129

    Narrative abilities refer to the telling of a story. Narrative skills require complex language skills including being able to tell a story that makes sense (also known as coherence) and is grammatically correct (also known as cohesion). Coherence refers to how story elements (e.g., character, settings, problem, solution) are included in the story, whereas cohesion refers to how one sentence is related to another by using causal (because) and temporal terms (before). 

    One potential way to improve the quality of narratives is through the use of questions. Some reasons why questions are beneficial include highlighting important aspects of the story, helping children elaborate, and guiding children’s attention to relevant information to include in narratives. However, the timing of the question may be an important factor to consider. Therefore, the goal of this study was to examine whether questions asked before or after narrative production affected the coherence and cohesion of the story. Further, the researchers examined whether cognitive or linguistic abilities were related to narrative skills.

    In this study, 81 4-to 6-year-olds told two stories, one before answering story questions and one after answering story questions. They also completed an assessment battery to measure their cognitive abilities, working memory skills, receptive vocabulary, and grammar knowledge. Results revealed that older children performed better than younger children. More interestingly, answering questions before narrative production improved coherence but not cohesion. Working memory was also related to the narrative coherence benefit. 

    The results are encouraging inasmuch as they suggest that exposure to questions before story telling benefited narrative coherence. Future work in our lab aims to look at how to improve narrative cohesion through the use of questions as well. The results of this work will be clinically important for findings ways to support children’s narrative skills.

Blogger: Theresa Pham is a Postdoctoral Associate working with Drs. Lisa Archibald and Janis Cardy.

Governing the voice: A critical history of speech-language pathology

St. Pierre, J., & St. Pierre, C. (2018). Governing the voice: A critical history of speech-language pathology. Foucault Studies, 24, 151-184.

This essay examines the history of the profession of speech-language pathology in the United States. The argument is made that at the beginning of the 20^th century, speech became more central to civic and capitalist operations in the U.S. There came to be dominant norms of communication, which could be quantified especially as many children began attending school allowing for the calculation of ‘deviance’ across the population. These differences were considered medical and scientific, not political. The goal of correction was to ‘normalize speech’ (according to norms of civility, class, and whiteness). The question arises as to whether speech correction is a rational social response to non-normative forms of communication? A critical history allows us to question why we hold certain views about speech, and imagine a less ableist view.

This challenging essay provides an important viewpoint for examining the historical basis of practices in speech-language pathology. It points to important racist and ableist influences that continue to shape practice. 

Blogger: Lisa Archibald

Building Sustainable Models of Research-Practice Partnerships Within Educational Systems

Alonzo, C. N., Komesidou, R., Wolter, J. A., Curran, M., Ricketts, J., & Hogan, T. P. (2022). Building Sustainable Models of Research-Practice Partnerships Within Educational Systems. American Journal of Speech-Language Pathology, 1-13.

    The research-practice gap refers to a disconnect between the latest evidence regarding practice in a field and the practices used in clinical settings. In speech-language pathology there is a current and ongoing movement for the use of implementation science to minimize the research-practice gap. Implementation science studies strategies that facilitate the movement of evidence-based practices into clinical settings. Central to implementation science are sustainable collaborations between researchers and those who use the research or knowledge, called knowledge users. Given the importance of partnerships, researchers have begun to look at how to build partnerships. Henrick and colleagues (2017) propose five critical dimensions for successful partnerships that include: (1) building trust and cultivating partnership relationships, (2) conducting research to inform action, (3) supporting the partner organization in achieving their goals, (4) producing knowledge to inform educational efforts, and (5) building capacity of participating researchers, knowledge users, and the organization.

    In the current article, the authors apply this partnership framework to their own partnerships in elementary schools. They outline three different ongoing partnerships in which they have been involved and describe the characteristics of the three schools, and the researchers and knowledge users included in each partnership. Each partnership also included the use of a knowledge broker who worked with the knowledge users and researchers to support the partnership and its success. The authors then mapped their own experiences onto the five dimensions proposed by Henrick et al., (2017). These authors report that their collaborative projects improved clinical knowledge for both the researchers and knowledge users.

    By sharing their experiences of working in partnerships, the authors provide an example of successful partnerships and how their partnership activities map onto an established framework in the field. Since there is a lot of momentum in communication sciences and disorders to use knowledge translation approaches such as implementation science, examples demonstrating experiences and outcomes support others looking to use similar approaches.

                 

         

Blogger: Meghan Vollebregt is a student in the combined SLP MClSc/PhD program working under the supervision of Dr. Lisa Archibald.

The duality of patterning in language and its relationship to reading in children with hearing loss

Nittrouer, S., (2020). The duality of patterning in language and its relationship to reading in children with hearing loss. Perspectives of the ASHA Special Interest Groups, 5, pp. 1400-1409.

    By the time we reach adulthood, reading is something we do without thinking about it. However, reading is a task that we spend years of our lives learning to do and practicing as children. It involves coordinating multiple skills, from recognizing the letters on a page to understanding the meaning behind what is written. Nittrouer (2020) discusses the concept of duality of patterning in which two different levels of structure are involved in reading: the semantic level, referring to the words that make up speech and their meanings, and the phonological level, referring to the sounds that make up words. These two levels work together in language, but develop somewhat separately. When learning a new language, development begins with the semantic level (or meaning) followed by the phonological level (or sounds).

    For children with hearing loss, some of the auditory information they hear will be degraded (even with hearing aids), which causes more problems for learning phonological than semantic information. To look at how this impacts the learning to read in children, Nittrouer (2020) followed a group of 122 US children: 49 with normal hearing (NH), 19 with moderate hearing loss and using a hearing aid (HA), and 54 with moderate-to-profound hearing loss and using a cochlear implant (CI) from infancy to grade 8. The researchers found that those with hearing loss had lower vocabulary skills than those with normal hearing, with the CI group showing lower performance than the HA group. On measures of phonological structure, children with normal hearing had higher scores than their peers with hearing loss, and again, those with CIs scored lower than those with HAs. Although these skills improved for everyone, by grade 8, the CI group had reached a level equivalent to that of the normal hearing group in grade 2, suggesting significant difficulty for the CI group in phonological structure. In reading, the normal group used phonological processes for phonological tasks and semantic processes for semantic tasks. In contrast, however, the groups with hearing loss used both phonological and semantic processes for phonological and semantic tasks, suggesting that they relied on a combination of both, especially for the phonological tasks.

    The authors suggest that intervention for children with hearing loss should include the use of meaningful structures, visual speech signals, and target both the semantic and phonological levels of structure throughout childhood.

Blogger: Rachel Benninger is a combined MClSc/PhD student working under the supervision of Dr. Lisa Archibald

Are Individual Differences in Response to Intervention Influenced by the Methods and Measures Used to Define Response? Implications for Identifying Children With Learning Disabilities.

Hendricks, & Fuchs, D. (2020). Are Individual Differences in Response to Intervention Influenced by the Methods and Measures Used to Define Response? Implications for Identifying Children With Learning Disabilities. Journal of Learning Disabilities, 53(6), 428–443. https://doi.org/10.1177/0022219420920379

Measuring response to intervention is important for capturing change in a student’s progress over time. However, there are numerous ways to measure change, highlighting a need to understand how different methods and measures are used to claim that a student has indeed changed as a result of the intervention. In this study, the authors compared three measures (near-transfer vs. mid-transfer vs. far-transfer) and two methods (final status vs. growth method) to evaluate response to their reading intervention:

Briefly, in their reading intervention, students who had poor reading skills were tutored 3x/week for 14-15 weeks. In each 45-minute session, students were taught strategies for understanding texts related to social studies or science topics. Students were then tested on their knowledge by answering multiple choice questions related to the passage they read.

Measures:

1. Near-transfer: Near-transfer refers to applying the knowledge learned from the intervention to a very closely related task. Near-transfer passages used the same social studies or science topics, but different passages than those used in the intervention.  After reading the passage, students answered multiple-choice questions, similar to the structure of the intervention.

2. Mid-transfer: Mid-transfer passages were about topics not addressed in the program (e.g., geography), but following the same format. Students were assessed with both multiple-choice questions and fill-in-the-blank questions. 

3. Far-transfer: Far-transfer would indicate that learning applied beyond the trained tasks. In this study, standardized reading comprehension tests were used as a measure of far-transfer. This included the Wechsler Individual Achievement Test and Gates-MacGinitie Reading Test.

Methods: 

1. Final status: The final status (also called “normalization method”) was captured in two ways for the standardized vs. experimental tasks. On the far-transfer tests, students were identified as having changed if they received a final, post-treatment score above a standard score of 100 (50th percentile). On the near- and mid-transfer tests, students were classified as having changed if they had final scores of 75% and 87.5% correct on these experimental tasks. 

2. Growth method: The growth method was also captured in two ways. The authors were able to calculate the reliable change index (RCI) for the standardized tests. RCI compares pre- and post-treatment outcomes; students who changed would have an RCI of greater than 1.96 (corresponding to a cut off on the standardized normal curve indicating the 5% tail of the distribution) . A “limited norm criterion” was used to capture change in the experimental tasks. Here, the authors determined the average change score for the group and students who made a reliable change improved their post-treatment score at/above that value. For example, students would have to improve their score by 3.5 on the near-transfer task to be classified as having changed. 

The results revealed that different measure-method combinations captured change differently. Rates of change ranged from 19% (far-transfer using RCI) to 80% (near-transfer using final status) depending on the method being used. Accordingly, there was low and inconsistent agreement on who improved across the methods of identifying change. On most measures, it was revealed that students with higher pretreatment scores were more likely to be classified as changed. However, on some growth measures, a slightly different pattern emerged: children with lower pretreatment scores (e.g., on all transfer-related measures) were more likely to have improvements following the intervention. 

The authors conclude that while capturing change is important to evaluate the effectiveness of intervention more broadly, the methods for doing so are currently arbitrary. Having benchmarks to compare responsiveness among measures would be useful for clinical decision making and we await future research to come to a consensus on how we should define change.

Blogger: Theresa Pham is a Postdoctoral Associate working with Drs. Lisa Archibald and Janis Cardy.

‘Making the Most of Together-Time’: Development of a Health Visitor Led Intervention to Support Children’s Early Language and Communication Development at the 2-2½ Year-Old Review

McKean, C., Watson, R., Charlton, J., Roulstone, S., Holme, C., Gilroy, V., & Law, J., (preprint). ‘Making the Most of Together-Time’: Development of a Health Visitor Led Intervention to Support Children’s Early Language and Communication Development at the 2-2½ Year-Old Review. Research Square.

    Poor language development may negatively affect many areas of an individual’s life including education and literacy, mental health and social-emotional well-being, and even employment. Early intervention is important, but challenging. This study reported on a process of developing an evidence-based intervention program for healthcare visitors in The Healthy Child Programme (UK) to implement to improve the health of babies, children, and their families in the UK. The goal was to develop the intervention by working together with practitioners and the parents of children currently receiving speech and language services. The paper reports the intervention design process.

    The development process included 5 stages made up of a series of reviews of literature, study team workshops, the development of workshop materials, the development of material and intervention prototypes, and multiple rounds of co-design workshops held with parents and practitioners. Following each stage, the research team used what they had learned to help prepare for the next stage of development. The involvement of the parents and practitioners allowed the research team to gather other perspectives and input from those individuals who would be directly involved in using the intervention.

    Briefly, the final intervention model consists of having the Health Care Visitors show parents how to use a specific behaviour for just 10-15 minutes per day to target a specific language goal for their child. Depending on the needs of the specific child/family, the Health Care Visitor would provide support at one of three levels. For example, if the child was at a low risk for poor language development, the family would be provided with resources to help them create an environment that would support language development (these same resources were provided to all families). If the child was identified as being at risk of poor language development and the family had access to resources and support, the Health Care Visitor would use a self-directed approach, meaning they would show parents/caregivers how to use various strategies to support their child’s language development. Finally, if the child was at risk of poor language development, but the family had barriers in accessing resources or supports (for example, financial barriers, geographic barriers, physical barriers), the Health Care Visitor used a coaching approach, where additional face-to-face support and additional resources (such as books or social supports) were provided.

    This study provides an excellent road map for how a team of researchers, clinicians, and end-users can partner together to design a feasible intervention system that fits a service context and provides a model for early intervention more broadly.

Blogger: Rachel Benninger is a combined MClSc/PhD student working under the supervision of Dr. Lisa Archibald