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PubMedDate not supplied

Consensus and variation between speech and language therapists in the assessment and selection of preschool children for intervention: a body of knowledge or idiosyncratic decisions?

The aim was to investigate consensus between speech and language therapists (SLT) during the initial assessment of preschool children. A multimethod design was used. The qualitative component provided SLT's own views of the process as the starting point for the study. Data were generated from semistructured interviews and focus group discussions. The interviews investigated factors considered during an initial assessment of a preschool child. The focus groups discussed the process and content of a videotaped initial assessment carried out by the author. Quantitative data was generated from six case analyses and from a card sorting exercise. In the former, SLT were asked to record important features of newly referred cases. In the latter, SLT sorted statements about preschool children according to a simple concern/not concerned decision. Data collection tasks and analysis took place successively to build a composite and triangulated picture. The main subjects were 11 SLT, experienced in childrens' work with a further six acting as a broader reference group. The results show an interacting pattern of consensus and variation. SLT agreed about the relative priority of children, categories that informed the assessment; they made similar interpretations of incoming information. There was variation in their preferred assessment methods, in the thresholds of concern and in the interventions offered. Sources of variation that were identified included individual confidence in and access to assessments, personal levels of concern and in the approach to the SLT's role, as well as the influence of workplace policies. The study concluded that, consensus and variation both exist within the context of SLT's initial assessment of preschool children, but that there are discernible patterns to the variation. While such variation may be inevitable, it is suggested that any variation should be made explicit and used to challenge and develop the shared knowledge base of the speech and language therapy profession.

Child, Preschool↗
PubMedDate not supplied

Animal-assisted therapy for persons with aphasia: A pilot study.

This study explored the effects and effectiveness of animal-assisted therapy (AAT) for persons with aphasia. Three men with aphasia from left-hemisphere strokes participated in this study. The men received one semester of traditional therapy followed by one semester of AAT. While both therapies were effective, in that each participant met his goals, no significant differences existed between test results following traditional speech-language therapy versus AAT. Results of a client-satisfaction questionnaire, however, indicated that each of the participants was more motivated, enjoyed the therapy sessions more, and felt that the atmosphere of the sessions was lighter and less stressed during AAT compared with traditional therapy.

Activities of Daily Living↗
PubMedDate not supplied

[The long-term average spectrum in research and in the clinical practice of speech therapists].

BACKGROUND: One of the great difficulties in evaluating a voice is the judgment of quality through the perceptual auditive analysis--although frequently used--, as it is influenced by socioeconomic and cultural aspects as well as individual preferences. Many are the adjectives and methods used in this assessment, especially because of the subjectivity involved in the process, leading to incompatibilities between listeners and difficulties in reaching a consensus on the use of this or that terminology. In such a context, the voice laboratory and more specifically the acoustic computerized analysis, has guided and complemented speech-language treatments. Among the several possibilities of spectrographic analysis, the (Long-Term Average Spectrum--LTAS) quantifies the quality of voices, pointing differences between gender, age, professional--spoken and sang--and dysphonic voices. The LTAS has been used a lot in researches that investigate voice. As it evidences the contribution of the glottic source and of resonance to the quality of voice, it provides objective parameters for the evaluation of this aspect which usually depends on our auditive perception. AIM: to demonstrate how LTAS can be applied in voice research and in the speech-language therapy practice, describing both the technical aspects required for the production and interpretation of results, and its limitations. CONCLUSION: The area of voice research has developed a lot in these last two decades especially because of the advent of the voice and speech laboratory. For this reason, the knowledge about the applicability of more tools for voice analysis, as the LTAS, as well as the existing need for more studies in this area, will most certainly contribute for the creation of new research areas not only in the field of professional voice but also in the field of therapy.

Humans↗
PubMed1997

What's driving you? A template which underpins the assessment of preschool children by speech and language therapists.

This paper presents a diagrammatic representation of features which underpin the initial assessment of preschool children newly referred to speech and language therapy. This model forms part of the results of a project whose overall aim was to make explicit the way in which expert speech and language therapists consider preschool children for intervention. Within a mainly qualitative methodology, data were collected by use of semistructured interviews, case analyses and a focus group workshop. The notational tool used for analysis, systemic grammar networks, is described and used to represent an assessment paradigm. The model is presented as a potential support for less experienced therapists or as a stimulus to reflection in more experienced therapists.

Child, Preschool↗
PubMed2003

Speech-language pathologists' beliefs about language assessment of bilingual/bicultural individuals.

A survey of speech/language pathologists, in 5 states across the United States was conducted to determine their beliefs about the language assessment of bilingual/bicultural individuals. Most SLPs reported low efficacy in bilingual assessment for both their own skills (personal efficacy) and those of the field in general (general efficacy). SLPs who learned a second language in the context of cultural experience (the CE group) reported more personal efficacy in bilingual assessment than speech-language pathologists who learned a second language via academic study (the AS group), who in turn felt more competent than monolingual SLPs (the M group). Furthermore, the 3 groups of respondents differed in terms of attributions for their low personal efficacy. The M group was most likely to mention their lack of knowledge about bilingual issues, the AS group commented on their less than optimal language proficiency, and the CE group focused on both proficiency and experience as influences. Over half of all participants (52%) reported that bilingual input in a child's environment would influence their interpretation of that child's language assessment results. Most of these participants (40%) reported that they would be more conservative in recommending language therapy for a bilingual than a monolingual child, particularly due to the respondent's own lack of knowledge of bilingual issues. Implications regarding the relations between language learning experiences and beliefs about the assessment of bilingual/bicultural individuals among SLPs are discussed.

Adolescent↗
PubMedDate not supplied

[Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists].

BACKGROUND: This work presents the results of an epidemiological survey about the professional experience of Speech-Language Pathologists and Audiologists of Rio de Janeiro (Brazil) with children and adolescents who are victims of domestic violence. AIM: To understand the occurrence of child abuse and neglect of children and adolescents treated by speech-language pathologists, characterizing the victims according to: most affected age group, gender, form of violence, aggressor, most frequent speech-language complaint, how the abuse was identified and follow-up. METHOD: 500 self-administered mail surveys were sent to a random sample of professional living in Rio de Janeiro. The survey forms were identified only by numbers to assure anonymity. RESULTS: 224 completed surveys were mailed back. 54 respondents indicated exposure to at least one incident of abuse. The majority of victims were children, the main abuser was the mother, and physical violence was the most frequent form of abuse. The main speech disorder was late language development. In most cases, the victim himself told the therapist about the abuse--through verbal expression or other means of expression such as drawings, story telling, dramatizing or playing. As the majority of the victims abandoned speech-language therapy, it was not possible to follow-up the cases. CONCLUSION: Due to the importance if this issue and the limited Brazilian literature about Speech-Language and Hearing Sciences and child abuse, it is paramount to invest in the training of speech-language pathologists. It is the duty of speech-language pathologists to expose this complex problem and to give voice to children who are victims of violence, understanding that behind a speech-language complaint there might be a cry for help.

Adolescent↗
PubMed1983

International trends in aphasia rehabilitation.

Some of the most prominent international approaches to aphasia therapy are discussed with the aim of stimulating the continued exchange of information within an international, crosscultural, and multilingual framework. The discussion focuses on several central topics of rehabilitation, including efficacy of language therapy, therapies of a general nature, therapies of reading and writing impairments, and rehabilitation of bilingual and foreign-speaking aphasic persons. Past practices are critically assessed with stipulations for future innovative approaches and delineation of areas in which additional research is desirable.

Aphasia↗
PubMed2001

Speech and language functioning in paediatric HIV disease.

The Human Immunodeficiency Virus (HIV) can potentially cause impairment to linguistic functioning. This study was the first to compare selected aspects of speech motor control, expressive language and receptive language functioning in individual HIV infected children. Results suggested clinically stable HIV infected children can develop linguistic impairment. Such impairment is in danger of going unnoticed without assessment. Thorough and regular assessment of the linguistic functioning of long-term survivors of paediatric HIV disease is essential if optimal speech and language therapy management strategies are to be devised.

Child, Preschool↗
PubMed2001

Benchmarking can facilitate the sharing of information on outcomes of care.

Recent restructuring in the national health service (NHS) aimed to effect cultural and organisation changes that would ensure fair and equal access for service users to effective and efficient services. Clinical governance has been introduced as a means of delivering quality improvement. One element of this is the use of benchmarking to assess current process and outcome and to use comparative information to inform about current and best practice. The use of the Therapy Outcome Measure (TOM) (Enderby and John 1997) was investigated as an indicator to benchmark the outcomes of treatment for different client-groups and compare patterns of outcomes from different speech and language therapy (SLT) services. The study recruited eight SLT trust sites and ran for eighteen months. The TOM data was analysed to note similarities and differences in cases entering treatment, in the direction of change resulting from treatment, and on completing treatment. Variation was found on these points between cases with different disorders and across the trusts. TOM data could be used to provide a benchmark for a disorder against which services could make comparisons. However, for benchmarking to succeed there is a need for support and commitment from every level of an organisation.

Benchmarking↗
PubMedDate not supplied

'Thinking for two': a case study of speech and language therapists working through assistants.

BACKGROUND: Many speech and language therapists (SLTs) in the UK work with speech and language therapy assistants, and the numbers of SLT assistants is expected to grow. There has been very little empirical investigation of how SLTs feel about this situation or the effect on working practices of working indirectly. AIMS: To investigate SLTs' opinions on working with SLT assistants in a small-scale research case study. METHODS AND PROCEDURES: The study design was a case study of five SLTs delivering intervention within a research intervention project. Prepared questionnaire and formal interview techniques were used to elicit opinions on working through assistants, and a content analysis was performed. OUTCOMES AND RESULTS: Although respondents could see value in working through assistants, they stressed the time required to do so and the difficulties of adapting and updating therapy plans when working indirectly. CONCLUSIONS: The study suggests a variety of factors that have to be carefully managed if SLTs are to work competently through assistants.

Allied Health Personnel↗
PubMed1996

Management of speech and language disorders in a mental illness unit.

Few speech and language therapists work with psychiatric patients. This study investigates how the specific communication problems of this population are addressed by care staff. Following a survey to determine the prevalence of speech and language problems in a psychiatric population, subjects assessed as having moderate or severe difficulties were selected for further study in order to investigate how they were currently being managed by the people responsible for their care. Key workers or charge nurses were interviewed, and ward and department nursing care plans were examined for mentions of speech and language problems, for aims in connection with these problems and for strategies to achieve these aims. Speech and language problems were not mentioned in 40% of the nursing care plans inspected. Where speech and language problems were mentioned there were aims in connection with half of these and strategies to achieve the aims in only 10% of the sample. The reasons for failure to mention speech and language in nursing care plans and for discrepancies between the results of speech and language therapy assessment and assessments of ward and department staff are discussed.

Adolescent↗
PubMed1996

Right cerebral hemisphere damage: incidence of language problems.

While dysphasia is rare after right cerebral hemisphere damage (RHD), there is now a body of evidence to suggest that language and communication problems can occur. This paper reports the findings of a pilot study that estimated the incidence of non-dysphasic language and communication problems following RHD. Eleven subjects completed language assessments within 2 weeks of onset and again 3 months later. The results show that language impairment can follow a unilateral RHD for 50% of the sample, and that there are marked difficulties for 20%. Furthermore these problems do not resolve spontaneously over a 3 month period. The case for speech and language therapy intervention for this patient group is discussed.

Adult↗
PubMed2001

Helping children with communication difficulties in the classroom.

As we move towards a more inclusive education system teachers are becoming more aware of children with speech and language difficulties and the implications for their future learning and literacy development. In order to address this and promote collaborative working practice between teachers and speech and language therapists two advisory speech and language therapy posts were created for a two-year pilot project.

Child↗
PubMed2000

An investigation into aspects of the Mayo early language screening test.

The concurrent validity and inter-tester agreement on the Mayo early language screening test (MELST), and the concurrent validity of parental anxiety about speech and language development as a screening measure were investigated. A sample (aged 18 months to 5 years) comprising 120 children referred to the Mayo speech and language therapy department during 1995 and 80 controls, was assessed on the MELST by their local public health nurse. Within a calendar month each child was reassessed on the MELST by the therapist, who also administered the Reynell developmental language scales (RDLS) and the Edinburgh articulation test (EAT) as criterion measures. Overall, the MELST achieved moderately high sensitivity and specificity measures. Phonological problems were identified with more accuracy than language problems and the test was equally sensitive to impairments in comprehension and expression. The test tended to over-refer and was least accurate in screening the language skills of children at the highest age level (4-5 years). A significant association was found between parental concern and pass/failure on each of the MELST, RDLS and EAT. As a screening measure, parental anxiety achieved high sensitivity, moderate specificity and a moderate positive predictive value. However, it also tended to over-refer, and was also least accurate in identifying speech and/or language disorders at the highest age level. Moderately high inter-tester agreement measures were found, with greater agreement between scoring for controls than referrals. The phonology sections were scored significantly higher by the public health nurses than by the therapist. The results of this study imply that the MELST is sufficiently accurate and reliable to recommend its continued use in child surveillance programmes.

Child, Preschool↗
PubMed1996

Unrecognized language and speech deficits in preadolescent psychiatric inpatients.

Of 55 psychiatrically hospitalized preadolescents with DSM-III-R diagnoses that are not commonly associated with language deficits, 60% were determined to have language or speech deficits, although only 38% had ever received speech or language therapy. The clinical implications of these findings are discussed and guidelines for practice outlined.

Child↗
PubMed2001

Users in the driving seat or sitting alongside map-reading?

The government agenda is clear. At the highest level users are involved in policy making. We as service providers need to show evidence that users views are elicited and used to improve the quality of care. The tool bag of techniques used to elicit users views will be explored--questionnaires, structured interviews, focus groups and innovative cognitive techniques such as perception score cards. We explore the continuum of user-led qualitative techniques to provider-led quantitative approaches. Building a framework of techniques which cover the diverse needs of people using a speech and language therapy (SLT) service is a challenge. A greater challenge is using the views of users to bring about meaningful change.

Humans↗
PubMed1999

In the long run...longitudinal studies of psychopathology in children. Committee on Child Psychology. Group for the Advancement of Psychiatry. Report no.143.

Longitudinal studies are difficult to do well. Too short a study and the results may be meaningless. Too long a study and the subjects cannot be found, money runs out, and research methods become seriously out of date. Despite these problems, there have been some longitudinal studies done that have greatly advanced our understanding of the nature and the treatment of psychopathology in childhood. Without these studies, much less would be known about the clinical course of important disorders, the effects of treatments, and the various risk and protective factors. None of these studies has been perfect. Some longitudinal studies did not focus on quite the right questions, some produced contradictory results, and others produced results that were hard to interpret. What have we learned from the longitudinal studies reviewed in this Group for the Advancement of Psychiatry (GAP) report? Many of the things that we have learned have been surprising--even counterintuitive. Pre- and perinatal insults need not necessarily lead to serious consequences in later life. Premature infants, if raised in nondeprived settings, are not likely to be mentally retarded or learning disabled. Today, of course, premature infants who would not have been kept alive 15 years ago are surviving. Will this advancement led to an untoward outcome? We do not know. New longitudinal studies need to be done. Certain serious illnesses emerging later in childhood may be associated with a greater risk of psychopathology. This risk is true at least for those with asthma. Psychological factors, such as psychological stress, also may lead to exacerbation of asthmatic attacks. Whether other illnesses are associated with a greater risk of psychopathology simply has not been studied adequately. Infant temperamental characteristics can be classified and measured; however, they appear to predict little in terms of later personality development or psychopathology. Although temperamental characteristics measured in infancy correlate poorly with temperamental characteristics measured at age 4 or 5 years, they appear to be much more stable and correlate well with temperament at ages 8 and 12 years. Some of these temperamental characteristics, particularly aggressivity and negativity at age 5 years, are serious risk factors for behavioral psychopathology at age 8 or 12 years and, possibly, at later ages as well. Aggressive, negative 5-year-olds do not necessarily grow out of their problems. Their problems are important and should be dealt with when children are age 5 years. What does appear important is early language development. Delays in language development or developmental language disorders are risk factors for later psychopathology. Fifty percent of school-age children with language problems requiring speech and language therapy also have diagnosable psychopathology. Hyperactivity and short attention span are characteristics that tend to persist in later childhood--even adulthood. Alone, each of these characteristics may not be a risk factor for later psychopathology, but, when accompanied by oppositional behavior and conduct disorder, the outcome is detrimental to the child. Many studies have shown that children with these comorbid problems are at risk later for becoming delinquent and antisocial. Conduct disorder in childhood, which is much more common in males, is a risk factor for later delinquency, even if it is not associated with hyperactivity. Again, early intervention is important. The effects of comorbidity in this instance can be serious. Comorbidity in general, especially as children grow older, leads to adverse social, academic, and psychopathological outcomes. Depression does occur in children, in all of its adult manifestations. Mania, in contrast, is rarely seen in children younger than age 12 years. Depression in school-age children can be severe or mild. In contrast to adolescents with depression, depressed children are most likely to have somatic compla

Adolescent↗