Background: Accurate assessment of language comprehension is crucial to positive outcomes for children with cerebral palsy (CP) and limited functional speech (LFS). This study describes Canadian caregivers’ and clinicians’ language comprehension assessment experiences and needs when working with these children prior to soliciting feedback on the Computer-Based instrument for Low motor Language Testing (C-BiLLT-CAN), a new validated standardized assessment tool, to support its implementation in Canada. Materials and Methods: We conducted an environmental scan using surveys codesigned by the research team, including rehabilitation professionals, and families with lived experiences. Surveys collected quantitative and qualitative data from 22 caregivers of and 39 clinicians who provided services to children with CP and LFS. Results: Most caregivers (n = 17; 77%) and clinicians (n= 26; 72%) had experienced language comprehension assessment. Experienced caregivers and clinicians highlighted the importance of accurate language comprehension assessment but had limited confidence in current practices that typically rely on informal tools (i.e., clinical observation, caregiver interview, informal questions) (n= 25-26; 96 – 100 %). Qualitative comments identified a need for population specific test/testing procedures and/or associated normative data. Participants identified that the C-BiLLT-CAN would have a significant impact on children with CP and LFS, with most clinicians (n = 15; 71%) anticipating at least a moderate effect on practice. Perceived benefits of the C-BiLLT-CAN included improved interaction with, participation for, and understanding of the abilities of these children; improved services including better language comprehension assessment procedures and results; and improved interventions and outcomes for these children and their families. Participants indicated that currently available response methods could be improved by including joystick, contact access, orofacial access, brain-computer interface, and vocalization and/or humming based access and by supporting visual and auditory access modifications to promote customization to the needs of individual children. Conclusions: The C-BiLLT-CAN could fill a critical gap in services available to Canadian children with CP and LFS. Caregivers and clinicians recognized the importance and potential benefits of a reliable standardized language comprehension assessment for this population but indicated the need for additional response methods and features to support access and implementation in Canada.

Purpose: Barriers to moving evidence into clinical practice have been widely reported in the literature. Engaging clinicians as knowledge brokers (KBs) has been proposed to help address these barriers; however, research investigating the feasibility of the KB strategy in communication sciences and disorders is limited. Method: This project aimed to investigate the feasibility of using a KB strategy to support clinicians in one large preschool communicative health care system in learning about a new clinical tool. Regional representatives from across the program participated as KBs. KBs received training on the new tool and strategies to support local dissemination. After KBs shared the new tool with their staff, they completed a survey to report their perceptions of the acceptability, adaptability, appropriateness, and feasibility of the KB strategy. Quantitative data were analyzed descriptively, and an inductive content analysis was used for the qualitative data. Results: The KB strategy was viewed as an acceptable, adaptable, appropriate, and feasible way to support clinicians' learning at local levels, and KBs felt this strategy should be considered for future dissemination initiatives. While KBs noted successes in sharing new information with their staff, they also experienced barriers relating to organizational factors, the KB strategy, and the new clinical tool. Conclusions: Findings suggest that engaging clinical end users as KBs may be a promising way of supporting dissemination initiatives in large communicative health care systems. Future work should investigate the impact of the KB strategy on clinicians' practice and the application of the KB strategy across other settings and initiatives.

PURPOSE:Children with limited speech and motor function, frequently subsequent to neurodevelopmental conditions, often require augmentative and alternative communication (AAC). Assessment practices to inform effective AAC interventions for these children can be challenging because of the considerable heterogeneity and range of factors that require consideration. An improved understanding of current assessment practices is imperative to optimize the provision of AAC. MATERIALS AND METHODS:We conducted a scoping review to identify the assessment practices used with children with limited speech and motor function subsequent to neurodevelopmental conditions (birth to 18 years) within the Participation Model of AAC. RESULTS:In total, 171 assessment practices were identified. Almost all were related to access supports and barriers, of which the majority focused on children's capabilities. Relatively few methods were identified to support the assessment of children's participation patterns and communication needs or opportunity supports and barriers. Twenty-three percent of identified formal assessment practices required modifications to established procedures, and 10% could not be completed by all child participants. CONCLUSION:Identified assessment practices focused primarily on children and their abilities, whereas very few focused on external factors (e.g., environmental and opportunity supports and barriers). Additionally, identified assessment practices may inaccurately measure the abilities of children with limited speech and motor function, as the procedures often required modification. IMPLICATIONS FOR REHABILITATIONWithout adequate practices to assess all areas of the Participation Model, clinicians may have difficulty providing comprehensive AAC servicesFuture research should focus on developing practices to assess children's opportunity and environmental supports and barriersThere is a need for practices that are more accessible to children with limited speech and motor function.

PurposeReliable assessment of language comprehension is difficult for children with significant speech and motor limitations. The Computer-Based instrument for Low motor Language Testing (C-BiLLT) was designed for children with cerebral palsy (CP) and speech and motor limitations. A Canadian English version (C-BiLLT-CAN) has been validated. However, early investigation identified feasibility challenges necessitating further exploration. This study aimed to understand parents' perceived barriers and facilitators to implementing the C-BiLLT-CAN in the Canadian clinical context.Materials and methodsSeven focus groups were conducted synchronously online with 16 parents from five Canadian provinces/territories. Transcripts were analyzed using semi-deductive thematic analysis, framing results within the Consolidated Framework for Implementation Research (CFIR).ResultsParents unanimously expressed interest in making the C-BiLLT-CAN clinically available. Facilitators and barriers were discussed under five themes. Key facilitators included the unique design, standardized nature, and potential flexibility of the C-BiLLT-CAN. Barriers involved the inability to accommodate all children, the potential for unintended assessment impacts, and clinics' readiness and willingness to prioritize implementation.ConclusionsThis study contributes new knowledge surrounding the assessment needs of parents of children with CP and speech and motor limitations. Alongside findings from a parallel clinician study, results will inform adaptations to the C-BiLLT-CAN to facilitate implementation.

PurposeCurrently available methods may not reliably assess language comprehension in children with significant speech and motor limitations. The Computer-Based instrument for Low motor Language Testing (C-BiLLT) is a standardized assessment designed for children with cerebral palsy that allows them to participate using various alternative response methods. This study aimed to understand speech-language pathologists' and occupational therapists' perceived facilitators and barriers to implementing the Canadian C-BiLLT (C-BiLLT-CAN).Materials and MethodsSix focus groups were conducted with 30 clinicians. Transcripts were analyzed using a semi-deductive thematic analysis. The Consolidated Framework for Implementation Research was used to guide the identification of clinicians' perceived facilitators and barriers.ResultsClinicians unanimously reported interest in implementing the C-BiLLT-CAN. Facilitators and barriers were classified into five primary themes. Key facilitators related to the test's evidence-based design, standardized nature, and potential flexibility. Key barriers related to Internet connectivity, the need to expand customization and response options to meet a greater breadth of needs, privacy policies, lack of resources, and perceived costs associated with equipment, training, and time.ConclusionsMany perceived barriers aligned with previous European and Canadian C-BiLLT implementation research. However, findings elucidated unique considerations that will inform adaptations to the C-BiLLT-CAN and development of training/educational materials.

Purpose: Previous literature has proposed barriers to speech-language pathologists (SLPs) using standard clinical labels; however, the perspectives of SLPs have been studied to a lesser extent. This quality improvement project reports on SLPs' perceived barriers and facilitators to using currently recommended clinical labels for preschool communication disorders and identifies next steps to support implementation in one preschool communicative health system. Method: This project aimed to establish the consistent use of clinical labels in one large Canadian preschool speech and language program. After completing a web-based training and a 3-month trial period, 387 SLPs completed an exit survey to share their perceived barriers and facilitators to label use. Qualitative survey data were analyzed using a hybrid codebook inductive/deductive thematic analysis approach. Results: Six themes were identified, which aligned with the diffusion of innovations theory. SLPs identified several facilitators and barriers to using the recommended clinical labels within each theme. Major facilitators included improved communication, better caregiver understanding of children's communication, positive feedback from caregivers, SLPs' increased confidence in sharing labels, and improved access to services for children. Major barriers related to additional time required to share labels, SLPs' perceptions of caregivers' values, SLPs' views surrounding the recommended labels, lack of comfort using some labels, and limited opportunity to practice label use or observe successful label use by others. Conclusions: Contextual barriers continue to impact SLPs' use of the recommended clinical labels. Ongoing collaboration with SLPs and caregivers will be critical for supporting implementation. Further research examining SLPs' perspectives across other clinical settings and geographic areas is needed. Supplemental Material: https://doi.org/10.23641/asha.27296970

PURPOSE:Evaluating caregiver-delivered programs in clinical settings is necessary to generate practice-based evidence. One challenge of such research is the burden placed on clinicians to complete additional measurement tools. This exploratory study examined the validity of clinical forms already completed as part of the standard delivery of the More Than Words® (MTW) program and explored whether this clinical data would reveal distinct clinical and outcome profiles in real-world contexts. METHOD:The Social Communication Checklist (SCC), a MTW program-specific form completed by the speech-language pathologist, was collected for 36 autistic preschoolers during publicly funded delivery of MTW. We assessed the concurrent validity of autistic preschoolers' social communication stage and skills rated on the SCC pre- and post-program with two of their scores on reliable, validated tools: the Communication Function Classification System (CFCS) and the Focus on the Outcomes of Communication Under Six (FOCUS-34). We also explored autistic preschoolers' communicative participation outcome profiles on the FOCUS-34 with their assigned social communication stages on the SCC. RESULTS:Autistic preschoolers' pre-program social communication stage on the MTW SCC correlated with their pre-program CFCS communication level and FOCUS-34 score. Most children showed positive social communication changes post-program according to the SCC, and two-thirds showed meaningful or possibly meaningful clinical change on the FOCUS-34; however, scores on these measures did not correlate. Autistic preschoolers at different pre-program SCC stages showed distinct communicative participation outcome profiles on the FOCUS-34. CONCLUSION:Program-specific clinical forms like the SCC can be valuable for classifying autistic preschoolers' social communication skills, exploring differences in outcomes, capturing novel outcomes, and generating practice-based evidence.

PURPOSE:This study, conducted virtually during the COVID-19 pandemic, aimed to assess children's vocabulary, grammar, communicative participation, and phonology skills targeted during the virtual parent-implemented Target Word program. METHOD:Forty children between 16 and 27 months who were considered late-to-talk were assigned to immediate treatment or delayed treatment groups using a 1:2 ratio and assessed at four points. Of the 20 children in the immediate treatment group, 16 completed the entire study. Of the 20 children in the delayed treatment group, five completed entire study. RESULT:Across assessment points, most scores in vocabulary (p = 0.17; p = 0.28; p = 0.40), grammar (complexity: p = 0.65; mean length of utterance: p = 0.21; p = 0. 77; p = 0.29) and communicative participation (p = 0.88; p = 0.12; p = 0.98) were not statistically different between groups. However, children made clinically meaningful gains in communicative participation during their Target Word programs (16 and 25 points of average change on the FOCUS-34). Statistically significant differences in phonology were observed during Target Word (p< .01, p = 0.02, p = 0.15). Statistically significant differences in grammar complexity were observed (p< .01; p = 0.02), but not aligned with intervention periods. CONCLUSION:Further research is needed to support interpretation of these results, including additional research to explore the most appropriate service pathways for children who are late-to-talk.

PURPOSE:Cerebral palsy (CP) is the most prevalent motor disability affecting children. Many children with CP have significant speech difficulties and require augmentative and alternative communication (AAC) to participate in communication. Despite demonstrable benefits, the use of AAC systems among children with CP remains constrained, although research in Canada is lacking. METHOD:Data were collected as part of an exploratory survey of Canadian caregivers and clinicians (N = 60) who shared their perspectives on children's need for, access to, and use of AAC systems. Quantitative data were summarized using descriptive statistics. Qualitative data were analyzed using inductive content analysis. RESULTS:Caregivers and clinicians reported high rates of need for AAC systems (> 75%) among children with CP. Both groups reported that access was roughly equivalent to need, although caregiver reports were lower. Despite high rates of need and access, only 38% of children used AAC systems. Children who used AAC primarily used high-tech systems, mostly to make choices, rather than engaging in meaningful reciprocal interactions and conversations. CONCLUSIONS:Canadian children with CP who required AAC systems generally received them. However, AAC systems were not used to their full potential, suggesting limited participation in social and learning situations. Like reports on other pediatric populations, barriers to obtaining AAC systems related to service, family, and child-specific factors. Although our sample captured the complexity present in the CP population, sample sizes were small and unlikely to be representative of the population of Canada, indicating the need for further research on a national scale. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.28229720.

Background and aims Caregiver-delivered programs are a recommended best practice to support young autistic children. While research has extensively explored children's outcomes quantitatively, minimal qualitative research has been conducted to understand caregivers’ perspectives of program outcomes for themselves and their children. Hearing directly from caregivers is an important step in ensuring these programs are meeting the needs of those who use them. This study explored caregivers’ perceived outcomes following one virtual caregiver-delivered program, The Hanen Centre's More Than Words ® (MTW) program . Methods This study was a secondary analysis of data from individual interviews conducted with 21 caregivers who had recently participated in a virtual MTW program. A hybrid codebook thematic analysis approach was taken to analyze the interview data. Program outcomes were coded and analyzed within the International Classification Functioning, Disability, and Health (ICF) framework. Additionally, caregivers completed an online survey and rated Likert Scale items about perceived program outcomes, which were analyzed descriptively. Results Five themes were identified: (1) caregivers learned new strategies to facilitate their child's development, (2) caregivers developed a new mindset, (3) children gained functional communication skills, (4) caregiver–child relationships improved, and (5) caregivers gained a social and professional support network. These themes fell within four of five ICF framework components (activities, participation, personal factors, and environmental factors). No themes were identified under Body Structures and Functions. Survey results indicated most caregivers reported learning new communication strategies ( n = 20, 95%), and identifying new teaching opportunities with their child ( n = 21, 100%). Conclusions Some reported outcomes, related to Activities and Participation, were consistent with previous reports in the literature on the MTW program. In line with previous research, caregivers learned strategies to support their child's communication development. Contrary to previous quantitative studies, caregivers in this study rarely commented on gains in vocabulary and instead focused on gains in skills that positively impacted their child's ability to engage in meaningful social interaction. Novel outcomes were identified within the Participation, Personal Factors, and Environmental Factors components of the ICF framework. Implications Caregivers in this study identified important outcomes for themselves and their child that have not been the focus of prior research, suggesting it is important to integrate their perspectives in the development and evaluation of caregiver-delivered programs. Clinicians should include goals that address outcomes identified as important by caregivers, including those that address children's Participation, and those that target caregivers’ Personal and Environmental Factors. Developers of caregiver-delivered programs could integrate identified goals to ensure they are meeting families’ needs.

PURPOSE:This quality improvement project aimed to address the inconsistent use of clinical labels across a preschool speech and language program in Ontario, Canada. The study investigated whether a multicomponent knowledge translation (KT) intervention could increase speech-language pathologists' (SLPs') knowledge about the recommended clinical labels, motivate their intentions to use the labels, and facilitate practice change during a 3-month pilot period.METHOD:The diffusion of innovations theory was utilized to identify and address known and suspected barriers and facilitators that could influence the adoption of consistent terminology. The intervention was evaluated using a pre-experimental study design (with pre, post, and follow-up testing) and included two phases: Phase 1 involved the pretraining survey, KT intervention, and posttraining survey, and Phase 2 included an exit survey after a 3-month pilot period.RESULTS:Five hundred twenty-nine SLPs in Phase 1 and 387 SLPs in Phase 2 participated. Following the web-based intervention, SLPs demonstrated improved knowledge about the recommended labels with most indicating intentions to communicate the labels going forward. SLPs also reported increased comfort using labels and positive views on their importance and value. After the 3-month pilot period, SLPs' reported use of most recommended labels decreased, as did ratings of comfort, value, and importance. However, most SLPs reported intentions to use the labels going forward.CONCLUSIONS:Despite having intentions to adopt the recommended labels, the lack of implementation by SLPs suggests the presence of additional barriers impacting their use of the recommended clinical labels in practice. Future work should investigate clinician-identified barriers to inform future implementation efforts.SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.25254940.

Download This Paper Open PDF in Browser Add Paper to My Library Share: Permalink Using these links will ensure access to this page indefinitely Copy URL Copy DOI

This brief report presents interrater reliability data for the Focus on the Outcomes of Communication Under Six (FOCUS-34) between parents, and between parents and speech-language pathologists (SLPs). Reliability for all three raters combined was good to excellent across three assessments. Reliability for pairs of raters was variable but generally good.

Purpose: The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children's speech-language outcomes secondary to pandemic-related social restrictions. Method: Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children's communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD ( n = 226) Jamaican Creole-English–speaking preschoolers and those with fSSDs ( n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica. Results: Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate. Conclusions: Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children's speech-language outcomes in the context of acutely changing environmental circumstances. Supplemental Material: https://doi.org/10.23641/asha.25461505

Caregivers' needs and preferences regarding outcome measurement in pediatric speech-language pathology are not well-understood, but are critical to the development and implementation of meaningful clinical tools. This project engaged caregivers of preschoolers with speech, language and communication needs to understand their views on the potential for, and their preferences surrounding a digital version of one participation-focused outcome measure called the Focus on the Outcomes of Communication Under Six (FOCUS-34). Fifteen caregivers of preschoolers who were receiving services in a large health system participated in one of four 30-60-minute virtual focus groups or one of three individual interviews. Caregivers shared their perceptions of whether and how a digital FOCUS-34 may improve their service experience, and their preferred features and formats to make it useful. An inductive content analysis was used to identify relevant categories that described caregivers' perspectives. Data were sorted into two categories: (1) caregivers believe a digital solution would improve their service experience, and (2) caregivers want a user-friendly digital FOCUS-34 to measure and give feedback on intervention outcomes. Multiple sub-categories were also identified, which further described caregivers' views on how a digital measure would improve the feasibility of outcome measurement, family engagement in services, and transparent communication with providers. Sub-categories also outlined caregivers' preferences for the features and functions of a digital measure and their suggested considerations for developers of the digital tool. Results provide new insight into caregivers' perspectives on digital outcome measurement and will inform efforts to improve the utility of the FOCUS-34 for families.

This project engaged speech-language pathologists (S-LPs) working with preschoolers to understand theirviews and identify their needs regarding the features and functions required fora digital participation-focused measure to be clinically useful. The Focus on the Outcomes of Communication Under Six (FOCUS-34) served as the measurement tool. Using principles of integrated knowledge translation, 23 preschool S-LPs were engaged in 60-min virtual focus groups to identify their perceived barriers and facilitators to using a digital FOCUS-34 and the features required fora digital measure to be helpful forfamilies, S-LPs, and programs. Participants completed an initial demographic survey and were then engaged in one of five virtual focus groups conducted using a semistructured interview guide. Quantitative survey data were analyzed descriptively, and qualitative focus group data were coded inductively and explored using content analysis. Two main categories were identified: (a) S-LPs' suggestions to support administration ofa digital FOCUS-34 and (b) S-LPs' suggested features to improve use of FOCUS-34 data in practice. Each main category included subcategories that described S-LPs' suggestions and requests. Integration of S-LPs' feedback is expected to support the development ofa digital FOCUS-34 that is clinically meaningful and useful. It is also expected to facilitate implementation ofa digital FOCUS-34 and improve the collection, interpretation, and use of participation-focused data in practice.

Purpose: The COVID-19 pandemic required most pediatric rehabilitation programs to shift to a virtual delivery format without the benefits of evidence to support this transition. Our study explored families' experiences participating virtually in More Than Words , a program for parents of autistic children, with the goal of generating new evidence to inform both virtual service delivery and program development. Method: Twenty-one families who recently completed a virtual More Than Words program participated in a semistructured interview. The interviews were transcribed and analyzed in NVivo using a top-down deductive approach that referenced a modified Dynamic Knowledge Transfer Capacity model. Results: Six themes capturing families' experiences with different components of virtual service delivery were identified: (a) experiences participating from home, (b) accessing the More Than Words program, (c) delivery methods and program materials, (d) the speech-language pathologist–caregiver relationship, (e) new skills learned, and (f) virtual program engagement. Conclusions: Most participants had a positive experience in the virtual program. Suggested areas for improvement included the time and length of intervention sessions and increasing social connections with other families. Practice considerations related to the importance of childcare during group sessions and having another adult to support the videorecording of parent–child interactions. Clinical implications include suggestions for how clinicians can create a positive virtual experience for families. Supplemental Material: https://doi.org/10.23641/asha.22177601

Purpose: The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework to conceptualise clinical services. This study explored how speech-language pathologists (SLPs) conceptualised therapy goals for preschoolers with language difficulties and disorders within the ICF framework.Method: An online survey was distributed to SLPs practising in a publicly funded Preschool Speech and Language program in Ontario, Canada. SLPs rated their familiarity with the ICF framework, and then reported all therapy goals for one child with language difficulty/disorder on their caseload. For each reported goal, SLPs indicated the ICF component(s) they felt the goal addressed. Researchers then independently categorised SLPs' reported goals into the ICF components.Result: Ninety-three SLPs completed the survey, and 81% reported they were at least "somewhat" familiar with the ICF framework. On average, SLPs reported three therapy goals per child, and felt the Activities and Participation components were most frequently targeted (73% and 72% of all reported goals, respectively). Researchers categorised SLPs' reported goals differently, and identified 57% of goals addressing the Activities component, and 21% the Participation component.Conclusion: There is a need to better understand how SLPs and researchers conceptualise the ICF framework, particularly the Participation component.

This study assessed implementation of the Computer-based Instrument for Low-motor Language Testing (C-BiLLT). The C-BiLLT is an accessible language comprehension assessment tool originally developed for children with cerebral palsy and complex communication needs. The purpose of the current study was to understand the clinical contexts in which the C-BiLLT is used in the Netherlands, Belgium, and Norway and assess barriers and facilitators to implementation. An online survey was distributed to rehabilitation clinicians working in the Netherlands, Dutch-speaking parts of Belgium, and Norway. A total of 90 clinicians reported their training in and use of the C-BiLLT; assessed its acceptability, appropriateness, and feasibility; and commented on perceived barriers as well as advantages of the tool. Acceptability, appropriateness, and feasibility were all rated highly. The C-BiLLT was used with various populations and age groups but most often with children who were younger than 12 years of age, and those with cerebral palsy. The main implementation facilitator was clinicians’ motivation; the main barriers were related to resources and complexity of cases. Findings suggest implementation of new assessment tools is an ongoing process that should be monitored following initial training, in order to understand clinical contexts in which the tools are being used.

Purpose: To conduct an exploratory study to establish construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS) in the Jamaican context for FOCUS Total and Profile scores.Method: Parents of a representative sample of 3-to-6-year-old Jamaican Creole (JC)-English-speaking simultaneous bilingual children completed the FOCUS in English, and the Intelligibility in Context Scale (ICS) in JC and in English. Children completed the Diagnostic Evaluation of Articulation and Phonology (DEAP) in both languages. Percent phonemes, consonants, and vowels correct were calculated using single word responses to DEAP items. Pearson correlations were completed to describe relationships between measurement scores.Result: Convergent validity was found for FOCUS Total and ICS/JC scores. Convergent and divergent validity were found for specific FOCUS Profile scores and ICS/JC scores. Minimal evidence of convergent validity was found with FOCUS Total scores and transcription-based measures of speech production in JC and in English. Convergent and divergent validity were found between specific FOCUS Profile scores and some transcription-based measures of speech production in JC and in English.Conclusion: This study provides evidence of construct validity for FOCUS Total and Profile scores. It also provides validity evidence for FOCUS scores in a multilingual context using a representative sample of children that serves to broaden the range of applicability of the FOCUS.