BACKGROUND:Speech language therapists (SLTs) are recognised as key members of the multidisciplinary team in adult critical care and have more recently been assessing and managing swallowing with adults on high-flow nasal oxygen (HFNO). HFNO is a non-invasive respiratory support that delivers a stable fraction of inspired oxygen ranging from 0.21 to 1.0 with flow rates of 15-60 litres per min. Despite HFNO being used routinely in critical care and SLTs postulating an effect of HFNO on oropharyngeal swallowing, there is limited evidence and consensus of potential effects in the literature. Subsequently, there are no clear guidelines or practice patterns for managing dysphagia in this patient cohort. There is limited understanding of how SLTs are interpreting and applying the available literature to their practice patterns. AIM:The aim of this qualitative study was to explore international SLTs' practice approaches and opinions when assessing and managing oropharyngeal swallowing in adults on HFNO. METHODS & PROCEDURES:Participants were SLTs with at least two years of experience working in critical care. Three online focus groups consisting of 18 participants from six countries were conducted. The participants were asked about their current practices, opinions, considerations, and perceptions of challenges and opportunities when assessing and managing adults on HFNO. Inductive content analysis was used to analyse the data. OUTCOMES & RESULTS:Six content categories were identified; 'consider the patient individually and holistically', 'types of assessment procedures', 'impact of HFNO on oropharyngeal swallowing', 'considerations when assessing adults on HFNO', 'current knowledge and practice landscape', and 'collaboration and communication'. A further 15 subcategories were derived. CONCLUSION:This research has identified concerns amongst SLTs that there is a lack of evidence to guide assessment and management of dysphagia in patients receiving HFNO. Research efforts should focus on clarifying how different flow rates impact swallowing function. This would help establish best-practice approaches for screening, assessing, and managing swallowing in patients receiving HFNO. WHAT THIS PAPER ADDS:What is already known on this subject High-flow nasal oxygen (HFNO) is being used more frequently to treat critically-ill adults, however the impact of HFNO on oropharyngeal swallowing has not been fully established. Speech and language therapists (SLTs) are now routinely integrated into the multidisciplinary team in critical care and assess adults on HFNO. To the authors knowledge, no study has previously explored in-depth the perspectives of critical care SLTs who assess and manage oropharyngeal swallowing in adults on HFNO. What this paper adds to the existing knowledge This is the first qualitative study exploring international SLTs opinions and practices when assessing and managing oropharyngeal swallowing in adults on HFNO. This study provides valuable insights into how oropharyngeal swallowing is currently being assessed and managed internationally by SLTs and provides guidance on future research in this area. What are the potential or actual clinical implications of this work? Findings from this study demonstrate variability in clinical practice and highlights uncertainty regarding assessment and management in this patient population. Some participants emphasised the value of instrumental assessment in supporting clinical decision making. This study identified that there are currently no standardised protocols or guidelines for the screening and comprehensive assessment for adults on HFNO. Further research is needed to guide the development of such protocols and guidelines to enable best practice.
BACKGROUND:Although speech and language therapy (SLT) is central to post-stroke aphasia rehabilitation, global SLT provision often falls short of recommended dosages. In response, interest has grown in technology-based interventions, including therapy software, virtual reality (VR) and artificial intelligence (AI) tools. However, current evidence for the effectiveness of technology is fragmented, and no recent review offers a comprehensive synthesis across these three modalities. AIM:This review examined the range of technologies used in aphasia assessment and therapy and summarised their effectiveness across different intervention targets. The two research questions were: (1) What types of technology have been investigated for assessing and treating people with aphasia (PWA)? (2) How effective is the use of technology in the assessment and treatment of PWA? METHODS:A systematic search of four databases (PubMed, PsycINFO, Web of Science and Scopus) covering the period 2013 to May 2026 identified 67 included studies, of which 14 were randomised controlled trials. Studies reporting quantitative outcomes, were peer-reviewed, and focused on technology-based intervention for PWA were eligible. Quality was appraised using the NICE checklist. The GRADE framework was applied to evaluate certainty of evidence for each intervention target. Findings were then synthesised narratively due to heterogeneity across study designs, and outcome measures. RESULTS:Three technology types were identified: computerised speech and language therapy (CSLT) (38 studies), VR (17 studies) and AI (13 studies). AI was used predominantly for aphasia assessment and classification. The strongest and most consistent evidence related to word-finding, where high certainty of evidence was supported by multiple RCTs delivering therapy at or above the recommended 20-h threshold. For language production and comprehension, functional communication, and reading, outcomes were more variable, reflecting moderate certainty of evidence, and inconsistent dose adherence. Writing interventions received a low certainty rating, reflecting small samples, limited blinding and task-specific rather than generalised gains. Across domains, higher-dose studies were consistently associated with better outcomes, which may suggest that technology functions primarily as a tool to enable high-intensity practice rather than as an independently effective treatment ingredient. CONCLUSION:CSLT, VR and AI tools show promise as adjuncts to face-to-face SLT for aphasia assessment and rehabilitation. Word-finding interventions delivered at recommended doses have the strongest evidence base. Some studies did not use technology to support the recommended therapy dose. For other intervention targets, larger, higher-dose trials are needed. Future research should also examine whether integrating different technology types could offer additional clinical benefit. WHAT THIS PAPER ADDS:What is already known about the subject Previous systematic reviews have demonstrated the emerging role of technology in aphasia rehabilitation, with earlier work focusing primarily on computer-based therapy or AI technologies. However, these reviews were either narrow in scope (targeted specific technology type), or outdated. What this study adds to the existing knowledge This review provides an updated, cross-technology synthesis encompassing AI, virtual reality, and computerised speech-and-language therapy. It outlines how these tools were applied within the studies in the literature. The review also identifies persistent limitations in therapy dosage across studies, underscoring the need for future higher-dose trials to confirm the certainty of evidence across different intervention targets. What are the clinical implications of this study? The growing evidence for computerised speech and language therapy, virtual reality, and artificial intelligence tools continues to support their role as adjuncts to face to face SLT, particularly for language assessment and targeted word-finding interventions. These technologies may extend therapy provision beyond clinical hours, enable therapeutic doses of practice to be achieved, and improve consistency in assessment procedures.
BACKGROUND:The OPTIMAL (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory is a motor learning framework proposing that optimizing intrinsic motivation enhances motor performance and learning. The theory identifies three key components-Enhanced Expectancies (EE), Autonomy Support (AS) and External Focus of Attention (EF)-which facilitate more efficient, goal-directed movement. These components have been shown to improve motor outcomes in limb-based tasks; however, their application to respiratory training, particularly in clinical contexts such as voice and swallowing therapy in patients with Parkinson's disease (pwPD), has not yet been systematically explored. AIMS:This study aimed to investigate whether implementing OPTIMAL theory strategies during a respiratory muscle strength training (RMST) task improves immediate respiratory motor performance in healthy adults and pwPD. Additionally, we aimed to examine the effects of these strategies on motivation and cognitive engagement. METHODS:This quasi-randomized, single-session trial included 47 participants: Healthy CONTROL (n = 17), Healthy OPTIMAL (n = 16) and PD OPTIMAL (n = 14). Healthy participants were quasi-randomly assigned to either intervention or control conditions, whereas pwPD completed the intervention only. All participants completed a single respiratory session that included baseline, practice and retention phases. Outcome measures included peak expiratory flow, cough peak expiratory flow, cognitive engagement (EEG-based Cognitive Engagement Index) and self-administered motivation questionnaire. OUTCOMES AND RESULTS:Exhalation force improved from baseline to retention in the Healthy OPTIMAL group (baseline: M = 296 L/min; retention: M = 338 L/min; p < 0.001) and the PD OPTIMAL group (baseline: M = 315 L/min; retention: M = 370 L/min; p < 0.0001), but not in the Healthy CONTROL group (p > 0.05). No significant changes in cough strength were observed in any group. No correlations were found between cognitive engagement and exhalation force or motivation scores. However, motivation increased more in the Healthy OPTIMAL group (Questionnaire 1: M = 57.2; Questionnaire 2: M = 60.7) and the PD OPTIMAL group (Questionnaire 1: M = 60.1; Questionnaire 2: M = 62.8) than in the Healthy CONTROL group (Questionnaire 1: M = 61.1; Questionnaire 2: M = 62.5). CONCLUSIONS AND IMPLICATIONS:Implementing the OPTIMAL theory enhances immediate respiratory motor performance in both healthy participants and pwPD. OPTIMAL theory has clinical value in voice and swallowing therapy, although further research is needed to establish long-term efficacy and clinical impact. WHAT THIS PAPER ADDS:What is already known on the subject Motivation is a critical factor in rehabilitation. The OPTIMAL theory has been shown to improve both motivation and motor performance in limb-based tasks. Its impact on respiratory training, however, has not been previously examined. What this paper adds to the existing knowledge This study shows that applying OPTIMAL strategies during a respiratory muscle strength training task significantly improved peak expiratory flow in both healthy adults and people with Parkinson's disease. What are the potential or clinical implications of this work? Integrating the OPTIMAL theory principles into respiratory therapy may enhance motor outcomes, supporting voice, swallowing and cough rehabilitation.
INTRODUCTION:Globally, there is a lack of awareness of rare dementias such as those led by language decline (the primary progressive aphasias, PPA). The main treatment for PPA is speech and language therapy, yet many people are unaware of the benefits and are often not referred on by other health care professionals. Delays in diagnosis can exacerbate a delay in accessing resources such as speech and language therapy which can assist in maintenance of communication and independence. Some people affected by PPA are able to seek out information independently and navigate their own way to these services, but others experience substantial challenges in accessing support. This study was born out of discussions with people affected by PPA who identified an urgent need to raise awareness of PPA and the benefits of speech and language therapy. The aim of the project was to co-develop a PPA awareness campaign and, through feedback, understand the impact of a co-produced and delivered awareness campaign on awareness and knowledge of PPA and the role of the speech and language therapy. METHODS:This study was informed by the People with Aphasia and Other Layperson Involvement (PAOLI) framework for guiding patient and public involvement (PPI) in aphasia research. Key components of the PPA awareness campaign were co-developed at a World Café event with 30 people affected by PPA. Consequently, engagement data were collected from social media posts during the 10-week campaign, and registration and attendance at the co-planned webinars. A feedback survey was collected from attendees after the event, and a micro-costing analysis conducted to understand the costs. RESULTS:The 10-week PPA awareness campaign focused on raising awareness of the role of speech and language therapy for PPA and a bespoke logo was developed that was shared across seven participating countries internationally. Attendees reported increased knowledge of the role of speech and language therapists and valued hearing the voices of people affected by PPA throughout the campaign. Webinar events were well attended across the participating countries with an average of 300 attendees, ranging from 233 in Greece to 369 in the UK. The cost of developing the awareness campaign was calculated at £26.20 per webinar attendee in the UK. DISCUSSION:The PPA awareness campaign was conceived by people affected by PPA and aimed to increase awareness that speech and language therapy can support people affected by the condition. The awareness campaign developed iteratively and concluded with an awareness day event spanning seven-countries internationally which are all now permanently accessible as resources on the International Speech and Language Therapist / Pathologist PPA network (International SLT/P PPA network) website. Future campaigns will take a more focused approach by targeting more specific audiences such as trainee doctors. The co-development blueprint for the PPA awareness campaigns provides actionable, field-tested recommendations for planning future health awareness initiatives. WHAT THIS PAPER ADDS:What is already known on the subject Primary Progressive Aphasia (PPA) is a rare language led dementia for which speech and language therapy is the main treatment. At present, people affected by PPA report a lack of information available about speech and language therapy. This can perpetuate feelings of loneliness and social isolation. What this paper adds to the existing knowledge This paper provides the key components of a co-developed PPA awareness campaign and describes a collaboration across organisations and countries to deliver the first year of the PPA awareness campaign. Future PPA awareness campaigns will build on this, by targeting specific audiences and aiming to increase knowledge and awareness of the role of the speech and language therapist. What are the clinical implications of this study? Increasing awareness of PPA and the role of the speech and language therapist has been identified by people with lived experience in the UK, as the core care pathway for people with PPA and their families. The PPA awareness campaign has made this information available to people affected by PPA and health care professionals. This includes a set of recommendations for the development of future similar awareness campaigns beyond PPA.
BACKGROUND:Consensus guidelines advocate multidisciplinary care to optimise recovery following laryngectomy. However, limited evidence exists regarding the nature of the patient recovery journey or their experience accessing rehabilitation services. AIMS:This study examined the services accessed by, and experiences of, individuals with a laryngectomy (IWL) in the first 12 months post-surgery. METHODS AND PROCEDURES:Patient journey mapping methodology was used to explore the healthcare journey and patient experience of 12 IWL across the first 12 months of rehabilitation. Demographics and detailed service data were collated from medical records and later reviewed for accuracy with each participant. Individual interviews were used to explore issues that influenced care experiences, and participants also provided experiential ratings relating to the emotional impact of each appointment (positive/negative/neutral) and the reason for the rating. Journeys were explored collectively as a group, then 3 detailed patient journeys are presented highlighting similarities and differences in participant experiences. OUTCOMES AND RESULTS:Participants attended a median (Mdn) of 7 medical visits (range = 4-14), 12 allied health visits (range = 4-45), saw 13 different professionals (range = 6-22), and travelled to 6 locations (range = 2-6) for healthcare. Factors adding to the complexity of the health care journeys included preparation for surgery, nature of surgery (primary versus salvage), access to trained specialists throughout phases of care, coordinating between services, travel and funding for consumables. Despite issues, participants largely rated experiences as positive (Mdn = 77; range = 37%-100% positive). Participant perspectives on issues impacting their healthcare journey formed 6 themes: (1) Preparation for laryngectomy surgery, (2) Recovery post-surgery (3) Access to skilled and coordinated services, (4) Approach of healthcare staff, (5) Communication difficulties impacting healthcare, and (6) Accessing laryngectomy resources and costs. CONCLUSIONS AND IMPLICATIONS:Following laryngectomy, a wide range of multidisciplinary services are accessed to support recovery and rehabilitation. Examining patient experiences through journey mapping has highlighted challenges that can influence the care pathway. Addressing issues that impact service access and patient experience will assist in enhancing laryngectomy care pathways and improve the patient experience. WHAT THIS PAPER ADDS:What is already known on the subject Current care pathways advocate specialist, multidisciplinary care for optimal recovery for individuals with a laryngectomy (IWL). Although existing laryngectomy guidelines specify that a range of specialist services are required, and detail what those services should entail, what this actually looks like and means for IWL as they live this path of recovery, remains largely unexplored. What this study adds to the existing knowledge This work expands the body of evidence in laryngectomy care by exploring the healthcare journeys of a cohort of IWL to better understand the extent of medical and allied health services required in the first 12-months post-surgery and the patients' experiences of that care. This work is the first to use journey mapping, a methodology that provides detailed insights gained from both quantitative and qualitative data to elucidate the patients' care experience. Understanding the patients lived experience, and any challenges faced, is essential information needed to continue to inform future care optimisation. What are the clinical implications of this study? The collective findings from this study highlight the potential challenges IWL can face accessing care in the post-acute phase. Participants attended a high number of medical and allied health visits, from a variety of professions and services, and faced several challenges including being prepared for their recovery, accessing skilled professionals, communication with healthcare staff, and costs of necessary consumables/equipment. Healthcare providers, including speech-language pathologists, must recognise and address these issues where possible, to optimise care and reduce patient burden.
BACKGROUND:Speech and voice disorders are frequently observed in individuals with acquired immunodeficiency syndrome (AIDS). However, the literature lacks detailed descriptions of how perceptual and acoustic characteristics manifest in the voice quality profiles of this population. AIM:To characterize the voice quality profile of older adults living with AIDS by describing the relationship between perceptual and acoustic voice measures. METHODS:The research group (RG) comprised 20 individuals with AIDS, aged 50-60 years, all presenting with lipodystrophy, metabolic conditions including dyslipidemia, and 2-9 years of antiretroviral therapy. The control group (CG) comprised 9 age-matched individuals with metabolic conditions, including dyslipidemia, but without AIDS or antiretroviral therapy. The corpus included semi-spontaneous speech samples and repetitions of three key sentences designed for the perceptual evaluation of voice quality settings (VQS) across the vocal tract, muscular tension, and phonatory domains. For the acoustic analysis, data were processed using a script in the Praat software, which automatically extracted measures of fundamental frequency (f0), intensity, spectral slope, and the long-term average spectrum (LTAS). A preliminary statistical analysis was performed to establish the basis for presenting the results. Among the sociophonetic factors examined, gender emerged as the most influential variable and was included in the multivariate statistical approach. RESULTS:The results indicated a significant prevalence of vocal tract VQS in the RG, including a retracted and lowered tongue body, pharyngeal constriction, and vocal tract hyperfunction, demonstrating strong discriminative power for classifying RG (98.7%) and CG (98.3%) samples. Acoustic measures showed a lower correlation factor (R2: 36.5%) for distinguishing the RG (77.4%) and CG (77.5%) samples. Regarding the relationship between acoustic measures and perceived voice qualities, f0 (particularly for females), LTAS (especially for males), and spectral slope were found to be relevant. CONCLUSIONS:Vocal tract and tension VQS, together with correlated spectral measures, were relevant in the RG. These findings may reflect the combined functional consequences of long-term antiretroviral therapy, opportunistic diseases, lipodystrophy, and associated metabolic alterations. The results highlight the need for further studies to support the future development of preventive, monitoring, and rehabilitative speech-language pathology strategies during the long-term follow-up of individuals living with AIDS. WHAT THIS PAPER ADDS:What is already known on this subject Research suggests a high prevalence of speech and voice disorders among patients with acquired immunodeficiency syndrome (AIDS). However, the relationship between perceived and acoustic voice quality in this population remains unexplored. What this study adds to existing knowledge Adjustments in vocal tract and tension-related voice quality, along with correlated spectral measures, were found to be significant in RG. These findings may relate to reported effects of lipodystrophy on the vocal tract and upper respiratory infections from opportunistic diseases. What are the clinical implications of this study? The findings of this study may be linked to the effects of lipodystrophy on the vocal tract in AIDS patients, as well as upper airway weakness due to opportunistic diseases. This underscores the need to develop therapeutic strategies for ongoing care in the AIDS population.
BACKGROUND:Children with language disorders, including developmental language disorder (DLD), experience challenges with word learning. Common components of vocabulary interventions include presenting target words in a story, providing explicit teaching and using sign/gesture alongside speech. However, previous studies have not investigated the relative contribution of these components, in isolation or combination. AIM:To measure the effects of adding explicit teaching and/or augmentative signing to a story-based vocabulary intervention. METHODS:Eighteen participants, aged 7;09-15;02 years, took part in our within-participant design study. All had a language disorder; 14 with DLD, and four with an associated biomedical condition. They were taught 48 real verbs and adjectives, randomly assigned to one of four conditions, over an 8-week intervention period. In the reference condition, participants watched videos of a speech and language therapist (SLT) reading a story where target words were presented incidentally, four at a time. In the first experimental condition, the delivering SLT added explicit teaching to the reference intervention. This included: providing definitions, modelling words in sentences, requesting retrieval and employing a cueing hierarchy. The second experimental condition added augmentative signing to the reference intervention, whereby the SLT in the video signed the target words as they appeared in the story. The final experimental condition added both explicit teaching and signing. In all conditions, frequency of word presentations was controlled. Word sets were counterbalanced to minimise confounds. Outcome measures assessed vocabulary knowledge and use with: (1) a word definition task and (2) sentence generation. RESULTS:Participants showed stronger progress in all experimental conditions, compared to the reference condition. Bayesian models showed that adding both explicit teaching and augmentative signing in combination to the reference intervention did not lead to greater progress than adding just one of these components. Neither participants' age nor language ability were associated with intervention progress. DISCUSSION:Our results indicate that adding either explicit teaching or augmentative signing to story-based vocabulary intervention is similarly advantageous. Adding both does not confer additional advantage. Larger-scale studies are needed to explore differences between participants and experimental conditions. CONCLUSIONS/IMPLICATIONS:Our study highlights the importance of evaluating systematically the contribution of potential active ingredients within interventions. In particular, analysing how they work together and separately is important, as adding more ingredients does not necessarily improve effectiveness. Our results inform vocabulary teaching, indicating that staff should incorporate either augmentative signing or explicit teaching whenever possible to support the vocabulary learning of those with language disorders. WHAT THIS PAPER ADDS:What is already known on this subject Children with (developmental) language disorders experience difficulties with word learning, which can affect their education and social participation. Previous research indicates that story-based intervention, explicit teaching and, in some cases, augmentative signing can support vocabulary learning. However, many interventions combine multiple components, making it difficult to determine which specific components are active ingredients, responsible for progress. What this paper adds to existing knowledge This study systematically compared the effects of adding explicit teaching and/or augmentative signing to a story-based (implicit) vocabulary intervention for school-aged children with (D)LD. Our results indicate that adding explicit teaching and/or augmentative signing can lead to greater improvements in learning new verbs and adjectives than the implicit intervention alone. Combining explicit teaching and signing does not appear to lead to additional benefit. What are the potential or actual clinical implications of this work? SLTs and school staff working with children with (D)LD should prioritise incorporating either augmentative signing or explicit teaching strategies whenever feasible to support vocabulary development. Signing may be quicker to implement as this can be delivered alongside speech. Intervention choices could be tailored to children and staff's individual preferences and skills. Larger studies are required to explore differences between participants and experimental conditions.
PURPOSE:This study examined the test-retest and inter-rater reliability of non-clinician severity judgments using two brief rating tools-the 11-point Severity Scale (SEV) and the Visual Analog Scale (VAS)-and evaluated their concurrent validity with clinician-rated Stuttering Severity Instrument-4-Turkish version (SSI-4-TR) scores. METHOD:This observational cross-sectional study used speech samples from 15 adults who stutter as stimulus materials. Recordings were evaluated by two speech-language therapists (SLTs) and two independent groups of non-clinician raters (n = 26 per group). SLTs assessed stuttering severity using the SSI-4-TR. One non-clinician group rated severity using a VAS, whereas the other used SEV. All ratings were completed online across three sessions. To examine temporal stability, 30% of the samples were re-rated after a one-week interval. RESULTS:Both tools demonstrated excellent test-retest reliability, with intraclass correlation coefficients of 0.997 for the VAS and 0.987 for the SEV. Inter-rater reliability was moderate, with ICC values of 0.656 for the VAS and 0.573 for the SEV. Both scales showed strong positive correlations with SSI-4-TR scores, with correlation coefficients of 0.835 for the VAS and .814 for the SEV (p < 0.001). CONCLUSIONS:The findings indicate that the VAS and SEV demonstrated high test-retest reliability and moderate inter-rater reliability and showed strong associations with SSI-4-TR scores, supporting the use of brief perceptual rating scales as practical screening instruments in large-scale and time-limited clinical and research settings where rapid and resource-efficient assessment is required. WHAT THIS PAPER ADDS:What is already known on this subject Perceptual severity ratings are widely used to estimate stuttering severity in both clinical and research contexts. Likert-type scales have demonstrated acceptable reliability when applied by trained listeners, whereas the Visual Analog Scale (VAS) has shown strong psychometric performance in several perceptual domains such as voice and resonance assessment. However, empirical evidence regarding the reliability and validity of a single-item VAS for evaluating stuttering severity remains limited. In addition, it is not yet clear whether trained non-clinician raters can apply brief perceptual severity scales consistently, particularly when ratings are compared with standardized clinical measures such as the SSI-4. What this study adds to the existing knowledge This study provides novel psychometric evidence comparing an 11-point Likert-type severity scale (SEV) and a Visual Analog Scale (VAS) for rating stuttering severity using trained non-clinician raters. Both tools demonstrated excellent test-retest reliability, moderate inter-rater reliability, and strong concurrent validity with clinician-rated SSI-4-TR scores. The findings extend previous research by demonstrating that brief perceptual severity ratings can produce stable and clinically meaningful estimates when administered by trained but non-expert listeners. The study also contributes to the literature by directly comparing continuous and categorical response formats within the same experimental framework. What are the clinical implications of this study? The findings suggest that brief perceptual severity scales such as VAS and SEV may serve as practical adjunct tools for screening, monitoring change, and large-scale data collection in clinical and research settings where time and resources are limited. Trained non-clinician raters may provide consistent evaluations under controlled conditions, supporting their potential role in structured assessment contexts. However, perceptual ratings should not replace comprehensive clinical evaluation and may be most informative when used alongside standardized measures such as the SSI-4 or frequency-based indices to obtain a more complete representation of stuttering severity.
BACKGROUND:A positive family history is a significant risk factor for developmental stuttering. However, the reported rates of positive family histories are inconsistent across studies, making it difficult to synthesise the findings. AIM:This scoping review aimed to systematically map the literature on family histories of stuttering to clarify the reported stuttering proportions and identify methodological trends and gaps. METHOD & PROCEDURES:We conducted a literature search of PubMed, Web of Science, and PsycINFO on 4 February 2025. Two authors independently screened the records in two stages: first by title and abstract, and then by full text. OUTCOMES & RESULTS:We reviewed 19 studies that reported family histories of participants with developmental stuttering. Basic study characteristics such as sample size and country were extracted, and descriptive statistics, including family history rates, were calculated for quantitative data. A key finding was the wide variability in the reported proportion of individuals with a positive family history, ranging from 20.0% to 90.9%. This variability was strongly associated with inconsistencies in methodology, including the scope of relatives considered, the definition of stuttering within the family, and data collection methods. CONCLUSIONS & IMPLICATIONS:This review found that methodological variability appeared to be the primary factor contributing to the wide variation in reported rates in the research on family histories of stuttering. The findings suggest the need for rigorous research approaches to obtain a more comprehensive understanding of this phenomenon. WHAT THIS PAPER ADDS:What is already known on this subject A positive family history is widely recognized as a major risk factor for developmental stuttering, and genetic evidence suggests a strong heritable component. However, reported proportions of individuals with a family history of stuttering vary substantially across studies, making it difficult to synthesize the evidence and interpret findings consistently. What this study adds to the existing knowledge This scoping review systematically mapped 19 studies and revealed that reported rates of positive family history range widely from 20.0% to 90.9%. The review identifies key sources of methodological variability as primary contributors to this inconsistency. These findings highlight the need for greater clarification when defining and assessing family history in stuttering research. What are the potential clinical implications of this study? Clinicians and researchers may benefit from using clearer criteria and consistent reporting frameworks, which could support more accurate risk evaluation and better integration of genetic, epidemiological, and clinical evidence.
BACKGROUND:Early language delay is a common presenting concern among toddlers with autism spectrum disorder (ASD) and developmental language disorder (DLD), creating challenges for clinical assessment and referral decisions. Although ASD and DLD differ in core social-communicative features, restricted/repetitive behaviours, and developmental mechanisms, language-focused assessment may provide complementary information about early communicative profiles. However, culturally adapted tools for assessing early language and communication in Mandarin-speaking toddlers remain limited. METHODS:A total of 213 children aged 24-36 months (ASD = 89, DLD = 60, TD = 64) were recruited from the Child Healthcare Department of a tertiary hospital between 2020 and 2022. Clinical diagnoses were established by multidisciplinary teams based on DSM-5 and CATALISE criteria. Caregivers completed the Diagnostic Receptive and Expressive Assessment of Mandarin-Infant & Toddler (DREAM-IT), which evaluates receptive and expressive language, cognitive play, and social communication. Receiver operating characteristic (ROC) curve analyses assessed discriminative validity across diagnostic groups, logistic regression examined the contribution of DREAM-IT domains to ASD-versus-DLD classification, and concurrent validity was evaluated against GDS, ABC, CARS, and ADOS-2. RESULTS:DREAM-IT showed strong diagnostic accuracy in distinguishing children with ASD or DLD from TD children (AUC = 0.84-0.998), but its ASD-versus-DLD discrimination was domain-specific and more limited. Receptive language provided the strongest ASD-versus-DLD discrimination (AUC = 0.81; sensitivity = 69.1%; specificity = 84.3%; optimal cutoff = 86.5), whereas expressive language, cognitive play, and social communication showed poor-to-limited standalone performance (AUC = 0.51-0.57). Logistic regression indicated that receptive language (OR = 1.10, p < 0.05) and expressive language (OR = 0.77, p = 0.015) independent contributed to ASD-versus-DLD discrimination, with an overall classification accuracy of 79.2%. DREAM-IT classifications demonstrated moderate-to-substantial agreement with established developmental and autism-related instruments, including GDS, ABC, CARS, and ADOS-2 (Cohen's κ = 0.62-0.82). Developmental age comparisons revealed domain-specific lags, with ASD characterized by greater receptive and social delays and DLD showing the largest lag in expressive language. CONCLUSIONS:The Mandarin DREAM-IT provides clinically useful information about early language and communication development in Mandarin-speaking toddlers with ASD and DLD and shows moderate-to-strong concurrent alignment with established developmental and autism-related measures. Its primary value lies in characterizing domain-specific developmental patterns and offering useful complementary information within a broader, multi-method diagnostic framework for Mandarin-speaking populations. WHAT THIS PAPER ADDS:What is already known on this subject Differentiating autism spectrum disorder (ASD) from developmental language disorder (DLD) in toddlers is clinically important but challenging. Both conditions may present with early language delay, while ASD is characterised by core social-communication difficulties and restricted or repetitive behaviours. Accurate interpretation therefore requires a multi-method assessment integrating language evaluation, developmental history, direct observation, and autism-specific measures. However, culturally and linguistically appropriate tools for characterising early language and communication in Mandarin-speaking toddlers remain limited. What this study adds to the existing knowledge This study evaluated the diagnostic accuracy and concurrent validity of the Mandarin DREAM-IT in 213 toddlers with ASD, DLD, or typical development. DREAMIT showed good-to-excellent accuracy in distinguishing children with ASD or DLD from typically developing children, but ASD-versus-DLD discrimination was more limited and domain-specific. Receptive language provided the clearest discriminatory signal, whereas expressive language, cognitive play, and social communication showed substantial overlap. DREAM-IT developmental age scores showed moderate correlations with corresponding GDS measures, and its descriptive rule-based patterns showed substantial agreement with autism-specific instruments. What are the potential or actual clinical implications of this study? DREAM-IT may provide useful caregiver-reported information about receptive language, expressive language, cognitive play, and social communication in Mandarin-speaking toddlers. Its main clinical value lies in characterising domain-specific developmental patterns and providing complementary information within a broader, multi-method assessment framework. It should not be used as a standalone instrument to diagnose ASD or DLD or to differentiate between them. Results should be interpreted alongside developmental history, direct clinical observation, developmental testing, and autism-specific measures.
BACKGROUND AND AIMS:Caregiver-mediated interventions are commonly used by Speech and Language Therapists to support early language development. Developmental Language Disorder (DLD) is associated with reduced quality of life throughout the lifespan. Understanding factors that predict intervention success is essential for developing appropriate, cost-effective therapy provision for the approximately 12% of preschool children who present with early markers for Developmental Language Disorder (DLD). This systematic review and meta-analysis examined the effectiveness of caregiver-mediated spoken language interventions for under-fives at risk of DLD, and factors influencing intervention effectiveness. METHODS:A systematic review following PRISMA guidelines was conducted. Five electronic databases were searched to identify experimental studies comparing caregiver-mediated spoken language interventions to control conditions in under-fives presenting with risk factors for DLD. Risk factors included prematurity, socioeconomic factors, caregiver language development concerns, and formal or informal language screening or assessment scores. Twenty-six experimental studies with 1407 child participants were included in qualitative synthesis. Meta-analysis was performed on nine Randomised Controlled Trials involving 947 children. RESULTS:Effectiveness was examined for outcomes including child language gains, child wellbeing, inclusion and attainment. Meta-analysis indicated a significant effect of caregiver-mediated spoken language interventions on language outcomes compared to treatment-as-usual, non-language intervention or waitlist control conditions. Non-language outcomes were evaluated via qualitative synthesis. Interventions significantly improved language development trajectories for under-fives presenting with risk factors or early markers for DLD. CONCLUSION AND IMPLICATIONS:This review contributes to the growing evidence base demonstrating that caregiver-mediated interventions can positively impact language development and wellbeing outcomes for children under five at risk of DLD. These findings support the implementation of caregiver-mediated environmental language interventions in clinical practice to maximise accessibility and cost-effectiveness while delivering optimal outcomes for vulnerable populations. WHAT THIS PAPER ADDS:What is already known on this subject Previous research on caregiver-mediated spoken language interventions has highlighted gaps in the evidence regarding the impact of risk factors, demographic characteristics, dosage and intervention components on child language outcomes. Developmental Language Disorder has relatively high population prevalence, estimated at 7%. Prevalence is associated with risk factors including low household socioeconomic status (SES), prematurity and late language emergence. In contrast to its prevalence, there is low public and professional awareness of DLD and a low diagnostic rate. Therefore, a strengthened evidence base and additional insights into the factors affecting success of family-based interventions is important in order to increase the effectiveness of service provision and care planning for this underserved population. Timely and effective intervention with young children presenting with early markers for DLD has the potential to offer lifelong improvement to their wellbeing, inclusion and attainment outcomes. Recent systematic reviews of the effectiveness of caregiver-mediated language interventions had differences in population age range and diagnostic inclusion criteria. What this paper adds to existing knowledge Our review examines the effectiveness of caregiver-mediated early spoken language interventions on child language, attainment and wellbeing, and on caregiver self-efficacy and adherence to language support strategies. Our population was children under five presenting with risk factors for Developmental Language Disorder, in the absence of other neurodevelopmental or genetic conditions such as intellectual disability or autism. This review adds depth and detail to the evidence base supporting the effectiveness of caregiver-mediated spoken language interventions in improving outcomes for this population of young children, and factors that influence their success. What are the potential or actual clinical implications of this work? The high prevalence of Developmental Language Disorder, estimated at around 7% of the population, and the strong association with risk factors including low SES, prematurity and late language emergence, coupled with the low awareness of DLD and low diagnostic rate, mean that a strengthened evidence base and additional insights into the factors affecting success of family-based interventions can increase the effectiveness of service provision and care planning for this population. Timely and effective intervention in this group of young children has the potential to improve wellbeing and attainment outcomes across the lifespan. This review contributes to our understanding of how to implement cost-effective, socially valid and maximally engaging partnership working with families of young children at risk for DLD.
BACKGROUND AND AIMS:Previous studies have indicated that people who stutter (PWS) and people with ADHD (PWADHD) show similar cognitive profiles, implying a link between the two neurodevelopmental profiles. This study examined the relationship between stuttering and ADHD and investigated the extent of this similarity using Network Models (NMs). METHODS AND PROCEDURES:Neurotypical participants (people who did not stutter and did not have ADHD; N = 67), PWADHD (N = 79) and PWS (N = 33) were assessed for stuttering, ADHD traits, and phonological working memory (PWM). Lower PWM is associated with many conditions including stuttering and ADHD. OUTCOMES AND RESULTS:NM analysis revealed differences in cognitive networks (fluency, attention and PWM) between participant groups. The findings suggest partially different cognitive architectures across participant groups indicating that stuttering and ADHD do not share a common underlying mechanism. There were marked differences between participant groups in the way that traits of attention, stuttering, and PWM linked with each other which emphasises partially unique cognitive architecture of these participant groups. Higher PWM scores were associated with better attention in the neurotypical group and PWADHD but not PWS. Higher stuttering characteristics affected PWM in PWADHD and PWS, but the link was stronger in PWS. Whilst higher stuttering characteristics correlated positively with lower attention in PWADHD, the opposite was the case for PWS. PWM was the most important factor in all groups but the way it affected other cognitive processes differed between neurotypical participants, PWS and PWADHD. CONCLUSIONS AND IMPLICATIONS:Overall NM structures were similar between the neurotypical group and PWADHD but they both differed from those of PWS. Findings argue against a shared underlying mechanism of attention, fluency and PWM in stuttering and ADHD and highlight the importance of including PWM assessments within a network-based framework. WHAT THIS PAPER ADDS:What is already known on this subject Existing research indicates that people who stutter (PWS) and people with ADHD (PWADHD) exhibit overlapping traits in attention, speech fluency, and phonological working memory (PWM). Past studies have reported lower performance in attention, speech fluency and PWM in PWADHD and PWS as compared to neurotypical participants. This trait overlap has often been interpreted as co-occurrence between the two profiles (stuttering and ADHD). However, existing literature has primarily relied on trait co-occurrence and group-level performance differences, without examining whether attention, fluency, and PWM interact in similar ways across the two profiles. As a result, it remains unclear whether these shared traits reflect common underlying mechanisms or distinct cognitive profiles that show similar behavioural outcomes. What this study adds to existing knowledge The present study showed that although attention, fluency, and PWM differ between neurotypical participants versus PWS, and PWADHD, the way these abilities are interconnected differs between groups. Network analyses revealed partially distinct patterns of association, with the PWADHD network more closely resembling that of the neurotypical participants than that of PWS. Whilst PWM was a central component across all groups, its role within the network varied. In neurotypical participants and PWADHD, PWM was closely linked to attention, but this link was lost in PWS. These findings indicate that similar trait profiles do not necessarily imply the same cognitive architecture, and that overlapping traits in stuttering and ADHD can arise from different patterns of interaction among attention, fluency and PWM rather than from a shared underlying mechanism. What are the actual clinical implications of this study? Our findings suggest that overlapping traits in attention, speech and PWM should not automatically be interpreted as evidence of a shared underlying profile in stuttering and ADHD. Instead, clinical evaluation should consider how cognitive processes interact within each profile. The results also highlight the value of including PWM assessment when examining attentional and fluency traits in both PWS and PWADHD, particularly using tools such as the UNWR. More broadly, network-based approaches offer a promising framework for distinguishing between surface-level trait overlap and fundamental differences in cognitive organisation, thereby supporting more precise, profile-specific intervention strategies.
OBJECTIVE:This study aimed to compare phonological awareness and verbal working memory skills, as measured by a nonword repetition task, in children with speech sound disorders (SSD) and typically developing peers. It also examined the relationship between these two cognitive-linguistic abilities within each group. METHODS:The study included 30 children aged 4 to 6 years diagnosed with SSD and 30 age-matched typically developing children. Participants were recruited from a clinical population and their typically developing siblings or relatives. Participants completed phonological awareness test and nonword repetition task. Group comparisons and correlation analyses were conducted to assess performance differences and interrelations between skills. RESULTS:Children with SSD demonstrated significantly lower performance in both phonological awareness tasks and nonword repetition compared to the control group. Within-group correlation analyses revealed a significant relationship between verbal working memory and word awareness in the SSD group, whereas in the control group, verbal working memory was significantly correlated with rhyme awareness. CONCLUSION:The findings suggest that children with SSD experience not only speech production difficulties but also weaknesses in phonological awareness and verbal working memory. The nature of the associations between these abilities appears to differ between children with and without SSD, highlighting the need for comprehensive, multidimensional assessment and intervention approaches that target both speech and underlying cognitive-linguistic processes. WHAT THIS PAPER ADDS:What is already known on this subject Children with speech sound disorders (SSD) frequently demonstrate difficulties in phonological awareness and nonword repetition, both of which are associated with later language and literacy outcomes. Although these relationships have been widely investigated, many studies have included children with co-occurring language impairments or have focused on English-speaking populations. Consequently, the relationship between phonological awareness and verbal working memory in preschool children with isolated SSD remains insufficiently understood. What this study adds to existing knowledge This study compares phonological awareness and nonword repetition performance in Turkish-speaking preschool children with and without SSD. Children with SSD demonstrated significantly poorer performance on both measures than typically developing peers, despite age-appropriate language abilities. The associations between phonological awareness and nonword repetition also differed between groups, providing further evidence that the relationship between phonological processing and verbal working memory may vary according to speech disorder status. The findings also contribute valuable cross-linguistic evidence from a language with relatively transparent phonology. What are the actual clinical implications of this study? The findings support the inclusion of phonological awareness and nonword repetition tasks alongside speech production measures in the assessment of children with SSD. A comprehensive evaluation of phonological processing and verbal working memory may facilitate earlier identification of underlying difficulties and contribute to more individualized intervention planning. Considering these cognitive-linguistic skills together with speech production may improve clinical decision-making and intervention outcomes.
BACKGROUND:The ability to converse with others enables us to participate in everyday life. People with neurogenic communication disorders (NCDs), such as aphasia or traumatic brain injury (TBI), often experience difficulties engaging in conversation. While Systemic Functional Linguistics (SFL) has been used to analyze conversations involving people with NCDs, its application to clinical assessment and intervention remains limited. AIMS:The primary aim of this paper is to make the case for Systemic Functional Linguistics as a clinically useful framework for understanding, assessing, and supporting conversation in people with neurogenic communication disorders. METHOD:We provide an overview of SFL and introduce an SFL-based framework, Discourse Structure Analysis. We review previous SFL-based studies of adult communication disorders and also describe the USeFuL Project, a multinational collaboration focused on developing SFL-based clinical tools. Finally, we present a worked clinical example illustrating how DSA can support detailed analysis of conversations involving people with and without aphasia. MAIN CONTRIBUTIONS:SFL-based frameworks can be used systematically to guide clinical decision-making when providing services to people with neurogenic communication disorders. By enabling detailed, coded analyzes of naturalistic conversations, these approaches reveal patterns of participation that are often missed in standard assessments. Moreover, SFL can inform the development of meaningful, measurable therapy goals and the development of individualized care plans. CONCLUSIONS:SFL offers a powerful, context-sensitive framework for analyzing and supporting communication in people with NCDs. By applying SFL in clinical contexts, clinicians can build more precise, functional, and person-centered interventions that enhance real-world communication. WHAT THIS PAPER ADDS:What is already known on this subject Systemic Functional Linguistics (SFL) is a theory of communication which examines how language users make choices to convey meaning in specific contexts. Over the past 30 years, researchers have used systemic functional linguistics (SFL)- based frameworks to study real-world conversations involving people with neurogenic communication disorders (NCDs). Researchers have investigated interactions that occur in a number of settings, focusing primarily on health care contexts. Two major themes are evident within this literature: control over how conversations play out tends to be exercised predominantly by people without communication disorders, and all participants in an interaction contribute to communicative success. What this study adds to existing knowledge We are the first group to argue for SFL-based studies that provide clinicians with conceptual frameworks and theory-informed tools they can use during all stages of clinical care including assessment, goal setting and treatment. As a first step in meeting this need, we offer an overview of discourse structure analysis (DSA, a form of SFL) and provide a worked example of how clinicians could use DSA when providing services to people with neurogenic communication disorders. Finally, we introduce the Using Systemic Functional Linguistics to Understand Neurogenic Communication Disorders (USeFuL) Project, a collaboration founded to pursue a clinical, SFL-based research agenda. What are the clinical implications of this study? People with NCDs want therapies that will improve communication abilities in the real world. Because SFL-based studies always focus on data gathered in everyday settings, this discipline could be used to develop highly functional and relevant assessments, goal setting procedures and treatments. The worked example provided in this paper illustrates some key ideas about how clinicians might go about applying DSA (a form of SFL) when working in conjunction with clients to develop and carrying out plans of care. Future studies by the USeFuL Project will build on current work and expand the SFL-informed tools and approaches available to clinicians.
BACKGROUND:Cognitive-communication disorders (CCDs) are common after acquired brain injury (ABI). People with CCD experience communication breakdowns, significantly impacting long-term social, familial, and vocational outcomes. Convers-ABI-lity, a web-based communication partner training intervention, was co-designed with key stakeholders, including people with ABI, their family members, speech pathologists, and other allied health professionals, to address communication breakdowns in everyday interactions. Implementing convers-ABI-lity in student speech pathology clinics may develop student skills and confidence when working with ABI clients, increase access to interventions, improve service delivery, and improve cost efficiency. However, students were not involved in the co-design of convers-ABI-lity, and limited research exists about students' understanding of CCD or how to treat this population. AIMS:To explore student speech pathologists' perspectives on their learning of CCD and first impressions of convers-ABI-lity as an overall programme, to understand how to support students using the intervention on future placements. METHODS AND PROCEDURES:Ten undergraduate and postgraduate Speech Pathology students from the University of Sydney who were at intermediate or entry-level clinical level participated in semi-structured, in-person qualitative interviews. Interviews focused on three key areas: knowledge and perceptions of CCD, a concurrent think-aloud protocol as students interacted with the convers-ABI-lity programme, and overall feedback on the intervention. Data were analysed using reflexive thematic analysis. OUTCOME AND RESULTS:Three themes were identified: (1) Varied learning experiences contribute to different understandings of CCD, ultimately impacting students' clinical confidence; (2) 'The actual program makes sense, I just don't think it really helps me figure out what I would do'; (3) Students need support to not feel 'thrown into' a clinical placement. CONCLUSIONS AND IMPLICATIONS:These findings highlight the need for greater clinical and academic support for students when implementing a CCD intervention. The implementation of digital health features and the structure of convers-ABI-lity, may effectively support student learning, however adaptations such as therapy demonstration, may further facilitate the use of convers-ABI-lity on placement. WHAT THIS PAPER ADDS:What is already known on this subject Cognitive-communication disorder is highly prevalent and typically the primary focus for intervention following an acquired brain injury. Intervention consists of communication partner training to facilitate everyday interactions for individuals with acquired brain injury. Current evidence-based interventions exist, including the new digital health programme convers-ABI-lity, however there is limited research regarding speech pathology students' perceptions of cognitive-communication disorder and their support needs when applying convers-ABI-lity in a clinical context. What does this study add to existing knowledge Findings from this study demonstrate how different learning experiences through academic units, clinical placements, independent research, or people with lived experience can influence students' understanding of cognitive-communication disorders and their confidence entering a clinical placement with a client with cognitive-communication disorder. Students described how using a digital health programme, such as convers-ABI-lity, helps facilitate their knowledge and preparation when entering placement; however, further supports through examples and observations are needed. What are the clinical applications of this work? Students commencing clinical placements with clients with cognitive-communication disorder need guidance regarding the nature of cognitive-communication disorder and explicit instruction on how to deliver a communication partner training intervention effectively. Greater exposure to cognitive-communication disorder interventions, such as using convers-ABI-lity during academic or clinical contexts, may facilitate the knowledge and learning needs for students.
BACKGROUND:The application of non-invasive brain stimulation in the rehabilitation of bilingual individuals with aphasia following a stroke is understudied. Recent studies show benefits of anodal cerebellar transcranial Direct Current Stimulation in bilinguals, while in monolinguals, repetitive Transcranial Magnetic Stimulation (rTMS) targeting the motor cortex of the lips seems to be effective in aphasia recovery. OBJECTIVE:We aimed to investigate the effects of inhibitory continuous theta burst rTMS stimulation targeting the right motor cortex of the lips during picture naming task in the second language of a French-English post-stroke bilingual individual. METHODS:We enrolled a single bilingual (PR) exhibiting chronic post-stroke aphasia in both her second language (L2), and first language (L1). In the present study PR engaged in naming tasks three times a week for six weeks, including 2-week baseline, 2-week intervention and 2-week follow-up. RESULTS:The results demonstrated a statistically significant improvement in naming accuracy in the second language of the patient, as evidenced by visual analysis in both cognate and non-cognate words, as well as, overall language accuracy. Visual analysis revealed a positive improvement in all variables, with the greatest improvements observed in phonology, overall accuracy, and pathological language switching. CONCLUSION:The stimulation of the motor cortex of the lips resulted in an improvement in naming accuracy in both the first and second language of the participant, despite the possible varying language recovery after stroke. This suggests the possible existence of shared representations of language in the brain, which is likely due to the similarities between the languages. Further studies are required to confirm the efficacy of non-invasive brain stimulation in bilingual individuals with aphasia for deeper understanding of the underlying mechanisms influencing these outcomes. WHAT THIS PAPER ADDS:What is already known on this subject The application of non-invasive brain stimulation in bilinguals with post-stroke aphasia is understudied. Studies have indicated that the cortical organization of each language in bilingual individuals may exhibit overlap particularly in the case of similar languages, leading to a pathological language switching following cerebral lesions. A study by Coemans et al. (2023) demonstrated the efficacy of cerebellar transcranial direct current stimulation in bilingual individuals. The objective of this study is to investigate the effects of transcranial magnetic stimulation during a naming task on the second language of a post-stroke bilingual aphasia individual and to gain insight into the cortical organisation of each language. What this study adds to existing knowledge The present study demonstrates the potential of inhibitory repetitive transcranial magnetic stimulation (rTMS) targeting the right motor cortex of the lips to enhance picture naming accuracy in both languages and reduce pathological language switching in bilingual individuals with aphasia. The results demonstrate that rTMS not only facilitates recovery in each language but also has a beneficial impact on the cognitive control mechanisms involved in language switching, particularly for cognate words. That suggests that rTMS impacts both the targeted motor areas and broader cognitive networks, thereby providing insights into the bilingual language recovery process and highlighting the benefits of rTMS in bilingual aphasia. What are the clinical implications of this study? The clinical implications of this study indicate that rTMS may serve as a valuable tool for enhancing naming abilities and, consequently, language abilities in bilingual patients, particularly when the two languages exhibit similarities. The results suggest that rTMS targeting the motor cortex of the lip has the potential to simultaneously address linguistic and cognitive aspects of bilingual aphasia by targeting the phonological pathway and brain regions involved in cognitive control and language selection. These findings may assist clinicians in the development of personalized rehabilitation strategies for bilingual individuals with post-stroke aphasia.
BACKGROUND:Spoken and written language are closely linked, and Speech and Language Therapists (SLTs) have expertise in the language skills that support both. However, unlike countries such as the US and Australia, UK SLTs lack clear guidance on their role in written language. This study explores the views of SLTs working with adults (aged 16+) and children to inform consideration of a UK position statement. AIMS:To examine UK SLTs' views on their role and scope of practice in written language assessment and intervention, and to ascertain whether a position statement is needed. METHODS AND PROCEDURES:In 2021, an online survey was completed by 511 SLTs across the UK. The survey explored SLTs' views on their role in written language, alongside their reported involvement in direct and indirect written language assessment and intervention. Quantitative data was analysed using R (R Core Team, 2024). OUTCOMES AND RESULTS:SLTs working with adults or across adults and children are more likely than those working solely with children to report having knowledge, skills, and a role in written language. Those already working in this area held a more positive view of their role. Most UK SLT respondents (89%) supported the development of a UK position statement. There was also strong support for greater emphasis on the links between language and literacy in university training. CONCLUSIONS AND IMPLICATIONS:SLTs working across the lifespan are more likely to engage in written language than those working only with children. Findings indicate a clear need for UK specific guidance on SLTs' role in written language. Addressing this will require enhanced pre-registration education and continuing professional development on the links between language and literacy. WHAT THE PAPER ADDS:What is already known on the subject Language is the foundation for reading (word reading and reading comprehension) and underpins spelling and writing skills. SLT training covers areas of language that are important for literacy development. Internationally, SLTs in countries such as the USA and Australia have clearer guidance and more established roles in supporting written language and literacy, whereas in the UK this guidance remains limited. What does this study add to existing knowledge The paper enhances our understanding of UK SLTs' views on their role in written language across the lifespan. It highlights differing views across those who work with adults and those who work with children, and their scope of practice within written language. The level of certainty around SLTs' role is influenced by whether they work on written language, resource allocation, and/or training. What are the potential clinical implications of this work? Key clinical implications include: greater clarity regarding the role and scope of practice of UK SLTs with written language across the lifespan; UK policy and guidance through, for example, a formal position statement; research into how current training institutions embed the links between language and literacy within their curricula; enhanced pre-registration training and continuing professional development opportunities for practising clinicians; and a strategic approach to supporting therapists working with children through interprofessional education and education-based placements.
INTRODUCTION:The Crosslinguistic Nonword Repetition Test (CL-NWR) was designed to accommodate the phonological diversity of human languages, providing a tool that may support the identification of Developmental Language Disorder (DLD) across different linguistic backgrounds. The test materials, including a PowerPoint game with recorded stimuli, administration guidelines, and scoring instructions, were available upon request. This study examines the uptake and application of the CL-NWR in clinical and research settings through a survey of individuals who have accessed the materials. The survey covered three main areas: (i) participant demographics; (ii) experience of using the CL-NWR task; and (iii) views on administration and scoring of the CL-NWR task. METHODS:We explored views of CL-NWR users through an online survey delivered through the Qualtrics platform and distributed to 156 individuals who had requested CL-NWR materials up to November 2024. Follow-up reminders were sent at one- and two-week intervals to maximise response rates. Response formats included yes/no, multiple choice, Likert scales and open-ended text responses. Survey data were analysed through descriptive statistics and content analysis of open-ended questions. RESULTS:A total of 109 respondents from 36 countries completed the survey, yielding a response rate of 70%. The test was most commonly used with multilingual children and those with suspected DLD. Notably, 92% of respondents indicated that the CL-NWR made a valuable contribution to their assessments. Qualitative responses highlighted its practical benefits as well as areas for refinement. CONCLUSION:The high response rate and overwhelmingly positive feedback suggest a high level of engagement and interest in the CL-NWR, particularly in multilingual populations. These findings will inform future developments of the CL-NWR test, ensuring its continued relevance and effectiveness in both clinical and research applications. The study also underscores the value of crosslinguistic tools in supporting equitable language assessment worldwide. WHAT THIS PAPER ADDS:What is already known on this subject Nonword repetition tasks are widely used to support the identification of Developmental Language Disorder across languages. The Crosslinguistic Nonword Repetition Test (CL-NWR) was developed as a language-neutral tool for multilingual populations, and a growing body of research has reported findings from diverse samples using the task. However, its uptake, usability, and application in clinical and research settings have not yet been systematically evaluated. What this study adds to existing knowledge This study provides the first large-scale evidence of global uptake and application of the CL-NWR across clinical and research contexts. Findings show high levels of use, particularly with multilingual children, and strong perceived value in assessment. The results highlight both the practical utility of the tool and areas for further development. What are the clinical implications of this study? The CL-NWR is a feasible and valuable tool for supporting language assessment, particularly in linguistically diverse populations. The identified need for clearer guidance on administration, scoring, and developmental norms has informed the provision of additional materials and access instructions, supporting more consistent and informed use in clinical and research practice.
BACKGROUND:Orofacial clefts are among the most common congenital anomalies worldwide, affecting approximately 1 in 700 live births. Despite surgical repair, most children require long-term speech therapy; parental perspectives on accessing and continuing this therapy remain poorly documented in Low resource contexts. OBJECTIVE:To explore the facilitators and barriers influencing access to and continuation of speech therapy for children with CP within the low resource context. METHODS:A qualitative descriptive design was employed. Semi-structured interviews were conducted with 32 caregivers (15 mothers, 17 fathers) of children with non-syndromic cleft palate (all post-palate repair) at a tertiary cleft care centre, (November 2023-July 2025). Purposive sampling ensured variation in child age, urban/rural residence, and therapy status. Sixteen interviews were conducted in-person (mean duration 20 min) and 16 by telephone (mean duration 18 min) by a single Speech-Language Pathologist interviewer. All interviews were conducted in Hindi. Data were analysed using Braun and Clarke's (2006) six-phase reflexive thematic analysis by two independent coders. Member-checking was conducted with six purposively selected participants to validate findings. RESULTS:Four themes were identified: (1) Information deficit as a barrier-28/32 (87.5%) caregivers reported inadequate guidance at diagnosis or post-surgery (mean importance 4.5 ± 0.8); (2) Structural, geographic, and financial barriers-20/32 (62.5%) reported challenges attending therapy (mean importance 3.8 ± 0.9), with a distinct urban/rural pattern; (3) Perceived therapy outcomes as a facilitator-all 32 participants discussed visible speech progress as the primary motivator for continuation (mean importance 4.7 ± 0.6); and (4) Social, emotional, and cultural impact-22/32 (68.8%) described stigma, psychosocial burden, and protective family support (mean importance 4.2 ± 0.7). CONCLUSION:Continuity of speech therapy is contingent on timely information, accessible care models, and empowered family engagement. Structured information at diagnosis, teletherapy, community rehabilitation worker models, and parent-implemented home programmes represent actionable, context-appropriate solutions. WHAT THIS STUDY ADDS:What is already known on this subject Existing research on cleft palate (CP) in low- and middle-income countries (LMICs), highlights significant barriers to speech therapy access, such as limited local SLP providers, financial constraints, long travel distances, and resource shortages. Studies document high unmet needs for rehabilitative care, delayed intervention, and caregiver concerns about speech outcomes, social impacts, and information gaps at diagnosis. Qualitative work from LMICs has explored general parental experiences, psychosocial challenges, and treatment pathways, but caregiver perspectives specifically on facilitators and barriers to initiating and continuing speech therapy remain limited. What this study adds to existing knowledge This qualitative study provides novel, in-depth insights from 32 LMICs caregivers on facilitators and barriers to accessing and continuing speech therapy for children with non-syndromic cleft palate in a high-burden LMIC setting. Using reflexive thematic analysis, it identifies four key themes: information deficits delaying early engagement; structural/geographic/financial barriers with urban-rural contrasts; perceived therapy benefits as the main continuation driver; and broader social/emotional/cultural impacts. It offers the first detailed, context-specific exploration of these issues from a tertiary centre perspective. What are the potential or actual clinical implications of this study? Findings underscore the need for improved information delivery at diagnosis to promote early SLP referral and engagement. Clinicians should address urban-rural disparities through targeted strategies, such as telepractice or community outreach for geographic/financial barriers. Emphasizing observable therapy benefits may enhance continuation rates. Recommendations include multidisciplinary training for non-specialists, culturally sensitive guidance, policy support for affordable SLP services, and community programs to reduce stigma and emotional burden-ultimately improving access, adherence, and outcomes in resource-constrained LMIC settings. PRACTITIONER POINTS:Information deficits at diagnosis are a major barrier to early speech therapy engagement for children with cleft palate in LMICs-clinicians should prioritize clear, timely education. Structural and geographic barriers differ markedly between urban and rural caregivers; telepractice and community outreach may improve access and continuation. Perceived positive therapy outcomes strongly facilitate ongoing attendance-emphasizing observable benefits can enhance adherence in resource-limited settings.
BACKGROUND:Selective mutism (SM), an anxiety disorder often beginning in early childhood, can impair communication, social interaction, and educational progress. When left untreated, problems may persist into adulthood and impact longer term mental health. Although effective interventions exist, many children with SM are unable to access support services, in part due to the lack of suitable training for professionals in SM, the absence of national guidelines, and unclear professional responsibilities which together create gaps in provision. AIM:To survey UK therapists working in the National Health Service (NHS), Local Authorities or Health and Social Care (HSC) services who support preschool and primary school-aged children (3-12 years) with SM to identify the training therapists have received, their perceived training needs, the professions providing interventions, and the nature of the interventions delivered. METHODS:A 32-item online survey was distributed via professional organisations and specialist networks, charity forums, and social media using snowball sampling. Results were analysed using descriptive statistics and free text quotes depicting therapists' opinions or experiences were used to triangulate the quantitative data. RESULTS:Of 244 responses, 201 met eligibility criteria. Most respondents were speech and language therapists (81%), followed by clinical psychologists (11%), educational psychologists (5%) and other professions (3%). Just over half (59%) had received some form of SM training, but only 15% received training during their professional qualification. The majority (85%) expressed the need for additional training in SM to do their jobs particularly in the areas of delivering intervention, addressing co-occurring conditions and working within multidisciplinary teams. Three quarters of the sample (75%) had provided intervention for children with SM, predominantly within schools, involving parents/carers (95%) and teaching staff (96%). Intervention complexity and number of components increased with child age; the most common components across ages were exposure, rapport building, transfer of control and psychoeducation. However, there was extensive variability in the dosage of the interventions provided. CONCLUSIONS AND IMPLICATIONS:This exploratory survey with a non-representative sample suggested that the intervention components used, the people involved, and where the intervention occurred generally reflected the available evidence base. However, even in this sample who are more likely to have an interest in SM, there are still gaps in professional training and variability in service provision for children with SM. To promote consistent, evidence-based care, we recommend development of national cross-profession guidelines and quality standards for professional training and clinical management of children with SM. WHAT THIS PAPER ADDS:What is already known on the subject Effective interventions for selective mutism (SM) exist, but many children cannot access appropriate support. Inadequate professional training, absence of national guidelines, and unclear responsibilities across professions have been identified as key barriers to provision. What this paper adds to the existing knowledge This first UK-wide exploratory survey of therapists highlights that SM training is rarely included in professional qualification courses, leaving most practitioners seeking additional training post-qualification. Intervention components used by the sample of therapists reflected the current evidence base and increased in complexity with age; there was wide variation in dosage and delivery. The findings provide new evidence on which professions deliver SM interventions in a sample of UK therapists and the training gaps they experience. What are the potential implications of this study? There is a pressing need to embed SM training into professional qualification programmes and to provide accessible cross-professional specialist training post-qualification. Developing cross-profession guidelines and quality standards will help ensure consistency, accountability and equitable delivery of evidence-based interventions for children with SM across the UK.
