Language in Special Populations Intervention

Language in Special Populations

Intervention

Capone, N. C., & Mcgregor, K. K. (2004). Gesture development: A review for clinical and research practices. Journal of Speech, Language, and Hearing Research, 47, 173-186.

Usefulness to Clinical Practice

Describes gesture development

Provides time course for gesture
development

Suggests uses of gestures in
assessment & treatment

Characteristics of Review
Population	Bilingual language impairments
Review Type	Narrative
Country	USA
Number of studies	6 included

The aim of this article is to provide clinicians and researchers a comprehensive overview of the development and functions of gesture in childhood and in select populations with developmental language impairments. Of significance is the growing body of evidence that gesture enhances, not hinders, language development. In both normal and impaired populations, gesture and language development parallel each other and share underlying symbolic abilities. Gesture serves several functions, including those of communication, compensation, and transition to spoken language. In clinical practice, gesture may play a valuable role in diagnosis, prognosis, goal selection, and intervention for children with language impairments. Where available, supporting evidence is presented. Needs for additional research on gesture are also highlighted. (Journal Abstract).

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Diggle, T., McConachie, H. R., & Randle, V. R. L. (2002). Parent-mediated early intervention for young children with autism spectrum disorder. The Cochrane Database of Systematic Review, Issue 2. Art. No.: CD003496. DOI: 10.1002/14651858.CD003496.

Usefulness to Clinical Practice

Identifies child & parent factors
that influence the effectiveness of
parent intervention

Characteristics of Review
Population	Autism
Review Type	Systematic
Country	Australia
Number of studies	2 included

Background: Recent estimates concerning the prevalence of autistic spectrum disorder are much higher than those reported 30 years ago, with at least 1 in 400 children affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children.
Objectives: The objective of this review was to determine the extent to which parent-mediated early intervention has been shown to be effective in the treatment of children aged 1 year to 6 years 11 months with autistic spectrum disorder. In particular, it aimed to assess the effectiveness of such intervention in terms of the benefits for both children and their parents.
Search strategy: A range of psychological, educational and biomedical databases were searched. Bibliographies and reference lists of key articles were searched, field experts were contacted and key journals were hand searched.
Selection criteria: Only randomized or quasi-randomised studies were included. Study interventions had a significant focus on parent-implemented early intervention, compared to a group of children who received no treatment, a waiting list group or a different form of intervention. There was at least one objective, a child related outcome measure.
Data collection and analysis: Appraisal of the methodological quality of included studies was carried out independently by two reviewers. Differences between the included studies in terms of the type of intervention, the comparison groups used and the outcome measures were too great to allow for direct comparison.
Main results: The results of this review are based on data from two studies. Two significant results were found to favour parent training in one study: child language and maternal knowledge of autism. In the other, intensive intervention (involving parents, but primarily delivered by professionals) was associated with better child outcomes on direct measurement than were found for parent-mediated early intervention, but no differences were found in relation to measures of parent and teacher perceptions of skills and behaviours.
Authors' conclusions: This review has little to offer in the way of implications for practice: there are only two studies, the numbers of participants included were small, and the two studies could not be compared directly to one another. In terms of research, randomised controlled trials involving large samples need to be carried out, involving both short and long-term outcome information and full economic evaluations. Research in this area is hampered by barriers to randomisation, such as availability of equivalent services. (Journal Abstract).

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Kohnert, K., Yim, D., Nett, K., Kan, P. F., & Duran, L. (2005). Intervention with linguistically diverse preschool children: A focus on developing home language(s). Language Speech and Hearing Services in Schools, 36, 251-263.

Usefulness to Clinical Practice

Rationale for SLPs to support home
language

Examples of intervention strategies
for supporting development in home
language

Characteristics of Review
Population	Bilingual language impairments
Review Type	Narrative
Country	USA
Number of studies	85 included

Purpose: This article addresses a series of questions that are critical to planning and implementing effective intervention programs for young linguistically diverse learners with primary language impairment (LI). Linguistically diverse learners in the United States include children whose families speak languages such as Spanish, Korean, Cantonese, Hmong, Vietnamese, or any language other than, or in addition to, English.
Method: A narrative review of the relevant literature addresses clinical questions including (a) Why support the home language when it is not the language used in school or the majority community? (b) Does continued support for the home language undermine attainment in a second language? (c) Should we support the home language when it includes the code switching or mixing of two traditionally separate languages? and (d) What are some strategies that can be used to support the home language when it is a language that the speech-language pathologist (SLP) does not speak?
Conclusion: SLPs should provide services to linguistically diverse preschool-age children with LI in a manner that effectively supports the development of the home language. Parent and paraprofessional training along with peer-mediated models of intervention are presented as two possible methods for facilitating the home language in children with LI. (Journal Abstract).

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Pennington, L., Goldbart, J., & Marshall, L. (2003). Speech and language therapy to improve the communication skills of children with cerebral palsy. The Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003466.pub2. DOI: 10.1002/14651858.CD003466.pub2.

Usefulness to Clinical Practice

Compares training that focuses on
communication partners vs. training
that focuses on children

Provides tables describing studies
included & excluded from the review

Characteristics of Review
Population	Cerebral palsy
Review Type	Systematic
Country	Australia
Number of studies	5 included

Background: The production of speech, language and gesture for communication is often affected by cerebral palsy. Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments, and children with this diagnosis can experience mild to severe difficulties in expressing themselves. They are often referred to speech and language therapy (SLT) services, to maximise their communication skills and help them to take an independent a role as possible in interaction. This can include introducing augmentative and alternative communication (AAC) systems, such as symbol charts or speech synthesizers, as well treating children’s natural forms of communication. Various strategies have been used to treat the communication disorders associated with cerebral palsy but evidence of their effectiveness is limited.
Objectives: To determine the effectiveness of SLT that focuses on the child or their familiar communication partners, as measured by chance in interaction partners. To determine if individual types of SLT intervention are more effective than others in changing interaction patterns.
Search strategy: Searches were conducted of MEDLINE, CINAHL, EMBASE, PSYCH INFO, LLBA, ERIC, WEB of SCIENCE, NRR, BEI, SIGLE up to December 2002. References from identified studies were examined and relevant journals and conference reports were hand-searched.
Selection criteria: Any experimental study containing an element of control was included in this review. This includes non-randomised group studies and single case experimental designs in which two interventions were compared to two communication processes were examined.
Data Collection and analysis: L Pennington searched for and selected studies for inclusion. J Goldbart and J Marshall independently assessed separated random samples each comprising 25% of all identified studies. Two reviewers independently abstracted data from each selected study. Disagreements were settled by discussion between the three reviewers.
Main results: Eleven studies were included in the review. Seven studies evaluated treatment given directly to children, four investigated the effects of training for communication partners. Subjects in the studies varied widely in age, type and severity of cerebral palsy, cognitive and linguistic skills. Studies focusing directly on children suggest that this model of therapy delivery has been associated with increases in treated communication skills by individual children. However, methodological flaws prevent firm conclusions being made about the effectiveness of therapy. In addition, maintenance of these skills was not investigated thoroughly. The studies targeting communication partners describe small exploratory group projects which contain insufficient details to allow replication, have very low power and cannot provide evidence of effectiveness of this type of treatment.
Authors’ conclusions: Firm evidence of the positive effects of SLT for children with cerebral palsy has not been demonstrated by this review. However, positive trends in communication change were shown. No change in practice is recommended from this review. Further research is needed to describe this client group, and its possible clinical subgroups, and the methods of treatment currently used in SLT. Research is also needed to investigate the effectiveness of new and established interventions and their acceptability to families. Rigour in research practice needs to be extended to enable firm associations between therapy and communication change to be made. (Journal Abstract).

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Pennington, L., Goldbart, J., & Marshall, J. (2004). Interaction training for conversational partners of children with cerebral palsy: A systematic review. International Journal of Language & Communication Disorders, 39, 151-170.

Usefulness to Clinical Practice

Reviews communication
interventions for children with CP

Provides tables describing studies
included in the review

Characteristics of Review
Population	Cerebral palsy
Review Type	Systematic
Country	Australia
Number of studies	11 included

Background: Research has shown that children with cerebral palsy have difficulties acquiring communication skills and that conversation with familiar partners follows restricted patterns, which are characterized by high levels of partner control and children's responsivity. Speech and language therapy often includes training for conversational partners to help them to recognize children's communicative signals and to create opportunities for children to take a more equal and independent role in conversation. However, the effectiveness of this indirect therapy has not been demonstrated reliably.
Aims: To review systematically all experimental research on communication training for conversational partners of children with cerebral palsy and to evaluate the effectiveness of this type of intervention.
Methods & Procedures: As part of a wider review, health, psychology and education electronic databases were searched up to December 2002 for reports of experimental studies on the training of conversational partners to facilitate the communication of children with cerebral palsy, which contained an element of control. References from identified studies were followed-up and relevant journals and conference reports were hand-searched. Identified studies were assessed for inclusion by the first author. Two reviewers independently abstracted data on the quality and content of each study.
Outcomes & Results: Four studies were identified from five research reports that met the criteria for inclusion in the review, comprising three group studies and one single case experiment. Common targets for training were observed across the studies. These included positioning of the conversational partner and child for interaction, creating communication opportunities and responding to children's communicative signals. Changes were observed in the conversation patterns used by conversational partners, which should facilitate the communication of children with cerebral palsy. However, the studies contain methodological flaws and as a result they cannot demonstrate that the changes were definitely a result of the intervention.
Conclusions: Research on the effectiveness of interaction training for conversational partners of children with cerebral palsy is in its early stages. Training has incorporated common targets, which are widely acknowledged by clinicians to affect the communication of children with motor disorders. Trends in behaviour change have been suggested by research to date, but further studies that address the methodological inadequacies of the original research are needed to evaluate the effectiveness of this type of intervention. Suggestions of ways to improve the design and reporting of future studies, that will allow the mapping of interventions to clients, are discussed in this review. (Journal Abstract).

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Stow, C., & Dodd, B. (2003). Providing an equitable service to bilingual children in the UK: A review. International Journal of Language & Communication Disorders, 38, 351-377.

Usefulness to Clinical Practice

Provides best-practice guidelines

Lists assessment & intervention
resources

Clinical examples of bilingual
assessment & intervention
sessions

Characteristics of Review
Population	Bilingual language delays
Review Type	Narrative
Country	Australia
Number of studies	5 included

Background: The UK is a multicultural, multilingual society and the majority of paediatric speech and language therapists in England have at least one bilingual child on their caseload. There are many imperatives driving the profession to provide an equitable service for bilingual children. Evidence is beginning to emerge, however, that bilingual children with specific language impairment are not being identified and are, therefore, not accessing services. The situation facing clinicians in the UK is not unique: it is mirrored around the world.
Aims: This paper reviews the literature relating to speech and language services for bilingual children and begins by providing an overview of the forces driving the need to provide equity of service. All aspects of the therapeutic process are then examined, from referral to therapy, in order to identify features that are regarded as best practice. Whilst the focus is on delivery of services in the UK, research findings from around the world are considered.
Main contribution: Certain themes emerged during the review and their implications are discussed. In particular, the need for assessment tools, training and research is highlighted.
Conclusions: Features indicative of best practice are highlighted and tentative suggestions made that would enable services to address the challenges of serving bilingual paediatric caseloads. (Journal Abstract).

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Warr-Leeper, G. A. (2001). A review of early intervention programs and effectiveness research for environmentally disadvantaged children. Journal of Speech-Language Pathology and Audiology, 25, 89-102.

Usefulness to Clinical Practice

Effectiveness of selected early
intervention programs

Model for preschool speech &
language services

Characteristics of Review
Population	Low socio-economic status
Review Type	Narrative
Country	Canada
Number of studies	41 referenced

Widespread awareness of the lasting impact of children’s experiences in the first six years of life has increased interest in early intervention programs for children at risk for poor life outcomes. This article provides an overview of programs and effectiveness research in early intervention for children at risk due to being environmentally disadvantaged. A summary of the effects, program features, and participant characteristics that influence effectiveness is included. Finally, the potential contribution of the speech-language pathologist to prevention and early intervention for the environmentally disadvantaged child is discussed. (Journal Abstract).

Woods, J. J. & Wetherby, A. M. (2003). Early identification of and intervention for infacts and toddlers who are at risk for Austism Spectrum Disorder. Language, Speech, & Hearing Services in Schools, 34, 180-193.

Usefulness to Clinical Practice

Describes social communication
characteristics of children with ASD

Reviews research on intervention
programs targeting communication
skills in ASD

Provides suggestions for
intervention with children at-risk for
ASD

Characteristics of Review
Population	Autism Spectrum Disorder
Review Type	Narrative
Country	USA
Number of studies	43 referenced

Providing intensive early intervention is critical to maximizing outcomes for children with autism spectrum disorder (ASD), and evidence suggests that the earlier intervention can begin, the better the outcome. The first purpose of this article is to review the earliest indicators of ASD in very young children – social and communication impairments – which have important implications for early identifications. The second purpose is to review evidence-based intervention practices for children with ASD and to develop a set of guiding principles for providing intervention for infants and toddlers who are at risk for ASD. Issues that are delineated include providing intervention in natural environments, supporting families in early intervention, and embedding intervention in daily routines. (Journal Abstract).

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