Browsing by Person "Law, J."

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Assessing children referred to speech and language therapy: Static and dynamic assessment of receptive vocabulary
(2007) Camilleri, B.; Law, J.
Dynamic assessment (DA) has been proposed as an alternative or complementary means for assessing children's language development. This study investigates the use of a DA methodology alongside a static assessment in order to obtain information on the receptive vocabulary skills of young children with suspected language impairments. A DA procedure was piloted with a group of 14 children for whom there were no concerns about speech and language development and 40 children who had been referred to speech and language therapy (age 3;05 to 5 years). Twelve of the referred children had English as an additional language (EAL) and 28 were monolingual English. The static assessment from which the DA was developed was the British Picture Vocabulary Scales. The DA incorporated measures of children's ability to match a word to a referent and to retain the words for expressive and receptive purposes. Results indicated that monolingual children and those with EAL had comparable DA scores even though their static vocabulary scores were significantly different. Children with normally developing language and children referred to speech and language therapy performed significantly differently on these dynamic measures. In addition, there was greater variability in performance on the dynamic measures within the delayed language group than in the language normal group. The DA appears to capture additional information above and beyond that captured by the BPVS especially in the group of children with the lowest language skills.
Characterizing the Growth Trajectories of Language-Impaired Children Between 7 and 11 Years of Age
(2008-06) Law, J.; Tomblin, J. B.; Zhang, X.
A number of different systems have been suggested for classifying language impairment in children but, to date, no one system has been widely accepted. Method: This paper outlines an alternative system looking for distinct patterns of change in receptive language skills across time, involving a secondary analysis of children identified as having specific language impairment. Participants: The participants were 184 children age-assessed at 3 time points-7, 8, and 11 years of age. Results: The pattern of receptive language development is highly predictable. The dominant pattern of growth is consistent with declining rates of growth over time for all children. The primary way in which the children differ is with respect to their initial severity. The testing of the 2 classification systems revealed some statistically significant differences among the subtypes with regard to the shape of the growth rates, but the effect sizes associated with these differences were very small. Thus, it is possible to conclude that beyond the dominant pattern of growth, some subtypes of language impairment at 7 years of age showed only subtle differences in receptive language change across time. The results are discussed in terms of the sample selection and the age of the children who were studied. American Speech-Language-Hearing Association.
Children's language ability and psychosocial development: a 29-year follow-up study.
(2010) Schoon, I.; Parsons, S.; Rush, R.; Law, J.
OBJECTIVES: Little is known on the psychosocial adult outcomes of children's early language skills or intervening circumstances. The aim of this study was to assess the longitudinal trajectory linking childhood receptive language skills to psychosocial outcomes in later life. METHODS: The study comprised 6941 men and women who participated in a nationally representative Birth Cohort Study. Direct assessment of language skills were made at age 5. The sample was studied again at age 34 to assess psychosocial outcomes and levels of adult mental health. Characteristics of the family environment, individual adjustment, and social adaptation in the transition to adulthood were assessed as potential moderating factors linking early language skills to adult mental health. RESULTS: In early childhood, cohort members with poor receptive language experienced more disadvantaged socioeconomic circumstances than cohort members with normal language skills and showed more behavior and psychosocial adjustment problems in the transition to adulthood. At age 34, cohort members with poor early language skills reported lower levels of mental health than cohort members with normal language. After adjustment for family background and experiences of social adaptation, early language skills maintained a significant and independent impact in predicting adult mental health. CONCLUSIONS: Early receptive language skills are significantly associated with adult mental health as well as psychosocial adjustment during early childhood and in later life. The needs of children with language problems are complex and call for early and continuing provision of educational support and services.
Communication skills in a population of primary school-aged children raised in an area of pronounced social disadvantage
(Informa Healthcare, 2011-11) Law, J.; McBean, K.; Rush, R.
Background: Previous studies have highlighted the level of communication difficulty experienced by children from socially disadvantaged backgrounds, but the pattern of difficulties remains unclear. Aims: The study asks whether the performance of a community sample of children from one of the most socially disadvantaged neighbourhoods in Scotland is best characterized by a general delay in all areas of development, by difficulties across the more formal structural aspects of language or in phonological skills. Methods & Procedures: The study included 138 monolingual English-speaking children: 63 (45.7%) boys and 75 (54.3%) girls aged between 5 and 12 years. All children were assessed blind to educational attainment in the school. Outcomes & Results: Nearly 40% of children had delayed language development with 10% having severe difficulties. The children presented with an uneven profile with much lower structural language scores than reading, general communication skills or non-verbal performance. Although service use was high in the group as a whole, the proportion who met criteria for specific language impairment on discrepancy criteria were not those who were being referred to speech and language therapy. Conclusions & Implications: Although many children were performing well within the normal range, a substantial proportion were not, having considerable implications for the way that services are delivered to these children. Given the high prevalence of delayed structural language difficulties in this group, there is a clear need for a more universal population-based approaches to service delivery.
Developing policy in the provision of parenting programmes: integrating a review of reviews with the perspectives of both parents and professionals
(2009) Law, J.; Plunkett, C.; Taylor, J.; Gunning, M.
Background: Parenting programmes are a key component of the delivery of children's services, but evidence-based policy has often proved difficult to implement. Methods: The present review addressed this issue by integrating a review of systematic reviews of parenting programmes and a series of focus groups with parents and professionals involved in parenting across three agencies in a regional area (health, education and social work). The review summarizes parenting interventions targeting infant mental health, emotional and behavioural difficulties, autism spectrum disorder and attention deficit hyperactivity disorder, abuse/neglect, alcohol/ substance abuse and 'vulnerable' parents. The focus groups discussed topics such as the range of parenting services across the three agencies, accessibility, gaps in the service and future directions. Results and conclusions: Twenty systematic reviews were summarized. These reviews demonstrated that there is a wide range of parenting programmes available that have the potential to benefit families who are affected by problems ranging from emotional and behavioural difficulties to adolescent substance abuse. However, the findings of the focus groups reveal that the success of these programmes will depend in part on how they can be tailored to meet the social context of the families targeted. These integrated findings are discussed in terms of their implications for policy and practice. 2009 Blackwell Publishing Ltd.
Dynamic assessment and its application to children with speech and language learning difficulties
(2007) Law, J.; Camilleri, B.
Electropalatography for articulation disorders associated with cleft palate
(The Cochrane Collaboration, 2009) Lee, A.; Law, J.; Gibbon, F.
Background: Cleft palate is the most common congenital deformity of the face. It could affect speech acquisition, resulting in articulation errors that could persist into adulthood. Electropalatography (EPG) has been used in speech therapy with individuals who have articulation problems that are unresponsive to standard treatment procedures. Objectives: To determine the effectiveness of speech intervention using electropalatography (EPG) for treating articulation errors in individuals with repaired cleft palate. Search strategy: The following databases were searched: CENTRAL 2008 (Issue1), MEDLINE 1966 to March 2008, EMBASE 1974 to March 2008, CINAHL 1982 to March 2008, PsycINFO 1967 to March 2008 and eight other databases. We handsearched Clinical Linguistics and Phonetics (1987 to 2008, Issue 2), Cleft Palate Journal/ Cleft Palate-Craniofacial Journal (1980 to 2008, Issue 1), and the International Journal of Language and Communication Disorders (1980 to 2008, Issue 1). We searched the EPG bibliography (Gibbon 2007). We reviewed reference lists of relevant articles and approached researchers to identify other possible published and unpublished studies. Selection criteria: Randomised controlled studies comparing EPG intervention to no treatment, delayed treatment, standard treatment, or alternative treatment techniques for managing articulation problems associated with cleft palate in children or adults. Data collection and analysis: One author searched the titles and abstracts and assessed trial quality. A second author checked judgements; disagreement was resolved through discussion. Three authors were available to examine any potential trials for possible inclusion in the review. Main results: One trial using parallel design met the inclusion criteria of this review; no meta-analysis was performed. The study reported that fewer therapy sessions were needed to achieve the treatment goals for the EPG therapy and frication display method (N = 2), followed by EPG therapy (N = 2) and standard treatment (N = 2). Authors' conclusions: The included trial was a small-scaled study and therewere serious limitations in the design andmethodology (e.g. allocation concealment was unclear, blinding of outcome assessor(s) was not ensured, few quantitative outcome measures were used, and the results were not reported as planned). Therefore, the current evidence supporting the efficacy of EPG is not strong and there remains a need for high-quality randomised controlled trials to be undertaken in this area. Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Long-term Outcomes for Children with Early Language Problems: Beating the Odds
(2011-05) Parsons, S.; Schoon, I.; Rush, R.; Law, J.
Using the 1970 British Cohort Study, this study examines factors promoting positive language development and subsequent successful education and employment transitions among children showing early receptive language problems (age 5). We find that 61 per cent of children with early receptive language problems develop into competent readers by age 10. Factors promoting positive language development include parental support and more importantly a good school environment, characterised by only few children receiving remedial help. Post-16 education and employment experiences indicated competent reading to be associated with a less challenging journey into adulthood. Findings are discussed in terms of their policy implications.
Meeting the needs of children and young people with speech, language and communication difficulties
(Taylor & Francis (Informa Healthcare), 2010-07) Lindsay, G.; Dockrell, J. E.; Desforges, M.; Law, J.; Peacey, N.
Background: The UK government set up a review of provision for children and young people with the full range of speech, language and communication needs led by a Member of Parliament, John Bercow. A research study was commissioned to provide empirical evidence to inform the Bercow Review.Aims: To examine the efficiency and effectiveness of different arrangements for organizing and providing services for children and young people with needs associated with primary speech, language and communication difficulties.Methods & Procedures: Six Local Authorities in England and associated Primary Care Trusts were selected to represent a range of locations reflecting geographic spread, urban/rural and prevalence of children with speech, language and communication difficulties. In each case study, interviews were held with the senior Local Authority manager for special educational needs and a Primary Care Trust senior manager for speech and language therapy. A further 23 head teachers or heads of specialist provision for speech, language and communication difficulties were also interviewed and policy documents were examined.Outcomes & Results: A thematic analysis of the interviews produced four main themes: Identification of children and young people with speech, language and communication difficulties; meeting their needs; monitoring and evaluation; and research and evaluation. There were important differences between Local Authorities and Primary Care Trusts in the collection, analysis and use of data, in particular. There were also differences between Local Authority/Primary Care Trust pairs, especially in the degree to which they collaborated in developing policy and implementing practice.Conclusions & Implications: This study has demonstrated a lack of consistency across Local Authorities and Primary Care Trusts. Optimizing provision to meet the needs of children and young people with speech, language and communication difficulties will require concerted action, with leadership from central government. The study was used by the Bercow Review whose recommendations have been addressed by central government and a funded action plan has been implemented as a result. 2010 Royal College of Speech & Language Therapists.
Modeling Developmental Language Difficulties From School Entry Into Adulthood: Literacy, Mental Health, and Employment Outcomes
(2009-12) Law, J.; Rush, R.; Schoon, I.; Parsons, S.
Purpose: Understanding the long-term outcomes of developmental language difficulties is key to knowing what significance to attach to them. To date, most prognostic studies have tended to be clinical rather than population-based, which necessarily affects the interpretation. This study sought to address this issue using data from a U.K. birth cohort of 17,196 children, following them from school entry to adulthood, examining literacy, mental health, and employment at 34 years of age. The study compared groups with specific language impairment (SLI), nonspecific language impairment (N-SLI), and typically developing language (TL). Method: Secondary data analysis of the imputed 5-year and 34-year data was carried using multivariate logistic regressions. Results: The results show strong associations for demographic and biological risk for both impairment groups. The associations are consistent for the N-SLI group but rather more mixed for the SLI group. Conclusions: The data indicate that both SLI and N-SLI represent significant risk factors for all the outcomes identified. There is a strong case for the identification of these children and the development of appropriate interventions. The results are discussed in terms of the measures used and the implications for practice. American Speech-Language-Hearing Association.
Parental Report of Infant Language Skills: A Review of the Development and Application of the Communicative Development Inventories
(2008) Law, J.; Roy, P.
The Communicative Development Inventories (CDIs) are parent report measures of vocabulary and other aspects of language development in very young children. They have evolved over the past 20 years to be one of the most well recognised assessments of infant language. Of particular significance is the fact that the CDIs are the first measures of their kind to be widely translated and adapted for use in many different languages. The inventories have served a variety of functions including measuring early language acquisition, deriving normative data on language acquisition, and both identifying and describing children whose early language is significantly delayed. This review describes the development of the CDIs, summarises the volume of research that has been generated in a range of applications of the measures, and evaluates their current standing both as a research tool and as a clinical measure. Issues around the sensitivity and predictive value of the CDIs are also considered. 2008 Association for Child and Adolescent Mental Health.
Pragmatic language and the child with emotional/behavioural difficulties (EBD): a pilot study exploring the interaction between behaviour and communication disability
(Taylor & Francis Ltd, 2010-07) Mackie, L.; Law, J.
Introduction: The relationship between mental health, behaviour and language development is widely recognized in the literature. Recent advances in assessment tools allows one to consider the role of pragmatic language skills in this co-occurrence. Aims: This pilot study aimed to investigate (1) the level of association between pragmatic language difficulties and emotional/behavioural difficulties; and (2) what explanations there might there be for any such association. The roles of language, word decoding, and non-verbal cognitive ability and also socio-demographic factors are considered. Method & Procedures: Seventeen participants aged 711 years were identified from Educational Psychologist caseloads as having behaviour that is causing concern at school. Comparisons were made with 16 age- and sex-matched controls. Participants' language, literacy and non-verbal cognitive ability were assessed at school. Parents and teachers completed questionnaires investigating communication skills, behaviour and emotional wellbeing. Outcomes & Results: No significant difference was found between the groups for non-verbal cognitive ability. However, children in the referred group were significantly more likely to have structural language, word decoding and pragmatic language difficulties and mothers with no further education beyond school. Taking a broad view of language skills to include structural language, pragmatic language and word decoding, 94% (n = 15) of referred children had significant difficulties with at least one of these three factors. The only factor not found on its own was structural language difficulties, indicating that on their own they are perhaps not associated with emotional/behavioural difficulties. Conclusions & Implications: The results of this pilot study have implications for how we view language and behaviour difficulties in primary schools. Future larger-scale research should consider the role of parenting factors, pragmatic language skills and literacy ability in the high co-existence rate of emotional/behavioural difficulties and language/communication needs.
Predicting language change between three and five years and its implications for early identification
(2012-07) Law, J.; Rush, R.; Anandan, C.; Cox, M.; Woods, R.
BACKGROUND AND OBJECTIVE: Early language delays across the preschool period have important implications for children, parents, and services raising the significance of early identification. Screening tests are an appealing solution but have proved problematic. A combined risk model would seem promising but has yet to be tested. The goal of this study was to examine the factors that predict language change in a nationally representative sample of children between 3 and 5 years when most children are identified as being in need of services. METHODS: By using data from children (n = 13 016) in the Millennium Cohort Study (a national UK birth cohort), linear regression was used to predict 5-year performance from 3-year test performance data coupled with sociodemographic and within-child factors and indicators of parental concern. Patterns of change were identified and logistic regression was used to predict the difference between children for whom profiles change and those for whom they do not. RESULTS: The final model (predicting 32% of the variance) included maternal education, pattern construction, behavior, language concerns, and 3-year vocabulary. Four change patterns were identified: one consistently low (n = 201), one consistently high (n = 12 066), a group that is resilient (n = 572), and one with a declining profile (n = 177). The models accurately predicted 71% of the declining group and 99% of the resilient group. Maternal education (odds ratio: 0.49) and behavior (odds ratio: 0.9) were significant predictors for the former and maternal education (odds ratio: 0.6) and pattern construction (odds ratio: 1.03) the latter. CONCLUSIONS: Early identification of delayed language remains problematic but, once identified, there are key indicators that predict which children are likely to be more or less at risk across time. The implications are discussed in terms of policy and practice. Copyright 2012 by the American Academy of Pediatrics.
Predicting patterns of developmental change: language development into primary school
(2010) Law, J.; Rush, R.
Objectives: Although it is possible to examine population subgroups using test cut point it is preferable to examine the performance of such groups across time if measures allow. This analysis will compare the profile of childrens language development between three and five years drawing on data (n=11788) in the UKs Millennium Cohort Study. Methods: Following clinical convention, the threshold for caseness was set at -1.5 standard deviations below the mean on the British Ability Scales, a well recognized standardized assessment of language development. We identified four groups based on their profiles across time on the British Abilities Scales. Group 1 comprised those whose scores fell 1.5 SD below the mean at both time points (n=199), Group 2 made up those whose scores deteriorated across time i.e. starting within normal limits and falling outside the normal range at five years (n=234), Group 3 comprised those who appeared to be resilient i.e. starting below the norm and improving across time (n=257) Group 4 comprised those whose scores remained within normal limits between 3 and 5 (n=11098). Multinomial regression was employed to assess the influence of these variables on the first three groups relative to the fourth. Potential predictors included gender, whether the child was small for dates, whether they had been in a special care baby unit, had long term health conditions, report of parental concern about hearing at nine months, attachment and developmental performance at nine months. Conclusion: The findings will be discussed in terms of their implications for our understanding of developmental change which has tended to emphasise continuities rather than discontinuities in child development. We will also interpret the data in terms of current health and educational policy and the popular desire to implement early screening procedures to identify at risk children. We argue that risk itself is not sufficient to warrant universal procedures which tend not to be very strong predictors even across such a narrow age span and using identical measures.
Reconciling the perspective of practitioner and service user: Findings from the Aphasia in Scotland study
(Taylor & Francis Ltd, 2010-09) Law, J.; Huby, G.; Irving, A.; Pringle, A.; Conochie, D.; Haworth, C.; Burston, A.
Background: It is widely accepted that service users should be actively involved in new service developments, but there remain issues about how best to consult with them and how to reconcile their views with those of service providers. Aims: This paper uses data from The Aphasia in Scotland study, set up by NHS Quality Improvement Scotland to identify the direction of the development of services for people with aphasia in Scotland. It examines the views both of those who provide and of those who receive those services.Methods & Procedures: The study integrated findings from a questionnaire to all speech and language therapists treating people with aphasia across Scotland with findings from focus groups with service users and aphasia practitioners. Outcomes & Results: Three themes were identified: (1) public and professional awareness of the impact of aphasia on the individual and their family; (2) current service provision and gaps in services; and (3) directions for the future development of services and barriers to change. Although the impact of aphasia is well recognized amongst most professionals (that is, not just speech and language therapists), considerable concern was expressed about the level of knowledge amongst professionals who do not specialize in stroke care and about public awareness of aphasia. Service providers indicated a shift in the model of service delivery of which the service users were largely unaware. Although the majority of speech and language therapists spend most of their time providing one-to-one therapy, and this is valued by service users, there is undoubtedly an emerging shift towards a focus on broader social function and the inclusion of the person with aphasia in supportive social networks. This creates tensions because of the existing pressure for individualized models of delivery. Concern was expressed by practitioners, although not echoed by patients, about the transition from the acute sector to primary care. Practitioners also expressed concern about the introduction of more recent services like NHS 24 and e-health initiatives, which rely on means of communication that may be particularly challenging for people with aphasia. Conclusions & Implications: The findings from this study indicate that although there are clearly common perspectives, the views of people with aphasia about services do not necessarily coincide with those of service providers. This is an important consideration when initiating consultation and highlights the need for clarity on the part of practitioners in identifying the aims and objectives of their ervices as far as people with aphasia are concerned. 2010 Royal College of Speech & Language Therapists.
The incidence of cases of aphasia following first stroke referred to speech and language therapy services in Scotland
(2009) Law, J.; Rush, R.; Pringle, A.; Irving, A.; Huby, G.; Smith, M.; Conochie, D.; Haworth, C.; Burston, A.
Background: Key to the provision of appropriate services is an understanding of the number of cases in a given population. This study examined the incidence of aphasia following first ever stroke. It was part of a larger study, the Aphasia in Scotland Study, which examined the provision of services for people with aphasia in Scotland. Aims: The present study examines the incidence of aphasia referred to speech and language therapy services in people who have experienced their first ever stroke. The specific questions addressed were: What is the incidence of aphasia following first ever stroke? What is the percentage of aphasia following first ever stroke? What are the crude figures for aphasia following first ever stroke by age? What are the crude figures for aphasia following first ever stroke by gender? What are the crude figures for aphasia following first ever stroke by severity? Methods & Procedures: All 14 health boards in Scotland were approached but only 3, NHS Borders, Orkney, and Shetland, were able to provide the level of information required. Respondents were asked to provide information about the age and gender and level of communication need of referred cases over a given year. Outcomes & Results: Results suggested that the incidence of aphasia following first ever stroke was found to be 54, 57, and 77.5 per 100,000, for NHS Borders, Orkney, and Shetland respectively. This is slightly higher than in other comparable studies. The percentage of new cases of aphasia following a first ever stroke across NHS Borders, Orkney, and Shetland was 19, 22, and 34% respectively. The variability across the three sites is probably a function of the potential effect of small changes in the relatively low numbers. The majority of cases were, unsurprisingly, over 65 years of age but a substantial minority-17% (Shetland), 26% (Borders) and 36% (Orkney)-were below 65 years of age. One third of new cases resulted in severe aphasia. Although the proportions of men and women with aphasia were similar, women tended to be older at the point at which they experienced their first stroke. Conclusions: The results are discussed in terms the practicalities of this sort of data collection exercise and the implications of the results for service delivery. There is a need for comparable local data collection exercises tied in to current epidemiological studies.