Past BSLTRU Research

Children with specific receptive language impairments (SRLI) have been found to be vulnerable to negative outcomes later in life, in terms of mental health, behaviour and literacy.  Currently there is little evidence of the efficacy of speech and language therapy in this area, and a dearth of studies that have investigated interventions for receptive language.  Following recommended steps from the Medical Research Council’s guidance for the development of complex interventions, this research focused on identifying and developing evidence and theory for interventions for SRLI.

The research found that; SLTs did not often refer to explicit theories underpinning their intervention for SRLI and had difficulty describing processes of change.  However, core therapy components, and common approaches for selecting targets across groups were identified.  Data indicated that the interventions SLTs describe often focus on children’s participation and functioning rather than impairment.

This research was undertaken in partial fulfillment of a PhD by Dr Lydia Morgan.  A copy of her thesis can be downloaded from the University of the West of England.

Summary of this research 

An exploration of evidence of deficits and theories of therapy for specificreceptive language impairment in children

Children with specific receptive language impairments (SRLI) have been found to be vulnerable to negative outcomes later in life, in terms of mental health, behaviour and literacy. Currently there is little evidence of the efficacy of speech and language therapy in this area, and a dearth of studies that have investigated interventions for receptive language. Following recommended steps from the Medical Research Council’s guidance for the development of complex interventions, this research focuses on identifying and developing evidence and theory for interventions for SRLI. Evidence of deficit was first explored in a systematic literature review (SLR), examining the nature of the cognitive and linguistic deficits in children with SRLI. Grammar and word learning were identified as areas of particular difficulty for this population. Deficits in information processing, in particular short term and working memory, were also identified as playing a role in these children’s impairments. However, a number of issues were identified with the validity of studies in the area. Theories of therapy were examined in relation to the areas of deficit identified in the SLR through examination of existing intervention studies for children with SRLI, and exploring expert speech and language therapists (SLTs) views in focus groups. Three focus groups with 16 expert SLTs were conducted, followed by a larger group with 23 SLTs who had a range of experience. The groups explored intervention approaches for SRLI, in relation to the deficits identified in the SLR, as well as their rationales for these interventions. It was found that SLTs did not often refer to explicit theories underpinning their intervention for SRLI and had difficulty describing processes of change. However, thematic analysis revealed core therapy components, as well as common approaches for selecting targets across groups. Responses also indicated that the interventions SLTs describe often focus on children’s participation and functioning rather than impairment. The findings of the research are used to present a model of interventions for SRLI. The findings are also drawn upon to examine possible mechanisms of change in interventions for children with SRLI. Researcher: Lydia Morgan Publications: Morgan, L. 2013. An exploration of evidence of deficits and theories of therapy for specific-receptive language impairment in children. Doctoral Thesis (PhD). University of the West of England. Available from: http://eprints.uwe.ac.uk/20397

Speech and Language Therapists regard language sampling as an essential part of the assessment process because it provides the most clinically rich information about children’s expressive language.  This study piloted the employment of a Speech and Language Therapy Assistant who was trained to transcribe language samples using a computer program (SALT software).

The results showed that the SLT Assistant could transcribe language reliably and efficiently using SALT, indicating that this would be a cost-effective service innovation. 

Further studies are needed to determine the usefulness and reliability of computerised language sampling in measuring efficacy and to further develop software so that it more closely matches the needs of SLTs in clinical practice.

More about this research can be read in this PDF:

In this information age we are now living in, many people are looking to find computer software which can help people with aphasia.  More and more aphasia software

programmes are coming onto the market.  Knowing which to choose can be an uncertain, expensive and chancy process as there has been no central point that links to all the available software.  Also it is often difficult to determine whether a given piece of software is suitable for an individual person just by looking at the suppliers’ sites.  The Tavistock Trust for Aphasia commissioned the Bristol Speech & Language Therapy Research Unit to create a free, online resource that aims to meet this need, designed for people with aphasia, their carers, as well as for Speech & Language Therapists.

It enables them to specify their area of language difficulty and immediately be given a list of available relevant treatment software programmes.  Detailed information is then provided regarding each programme, enabling an informed choice to be made.  This tool will make the search and selection process quick, simple and objective thus helping avoid inappropriate purchases.

The resource can be accessed at www.aphasiasoftwarefinder.org

For information about the project download the PDF below.

The Better Communication Research Programme (BCRP) followed the Bercow Review of services for children and young people with speech, language and communication needs in 2008 and was funded by the Department for Education. 

The Programme involved researchers from across the UK working on 5 strands of research examining evidence for interventions, prevalence of SLCN, costs of services, families’ preferred outcomes and factors influencing socio-emotional outcomes.

Bristol Speech and Language Therapy Research Unit (BSLTRU) was primarily involved in the following strands of the Programme:

1. Best Evidence – understanding the effectiveness and cost effectiveness of different interventions and understanding factors that influence their effectiveness and efficiency
2. Children’s and parent’s preferred outcomes
3. A stammering cohort study

Interim and full reports for all studies can be found on the BCRP website.

More details of how BSLTRU were involved in this research can be downloaded here:

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A substantial proportion of the World’s population is bilingual or multilingual. In the UK, the number of bilingual children appears to be rising, with 15.2% of children in primary schools in the UK speaking a language other than English at home, up 1% in 12 months.  This has implications for the identification of speech and language impairments as many of the assessment tools have been developed and tested on monolingual populations.  Consequently there has been a history of both over and under diagnosis of speech and language impairments in bilingual populations.

To understand more about how speech develops when children are exposed to more than one language in their everyday lives, a review of the literature was conducted.

Findings from the review emphasise the importance of taking a careful case history and assessing speech sound production in both languages of a bilingual child.  They also point towards the use of nonword repetition tasks to assist in the diagnosis of disorder in bilingual children.

More information on this project can be downloaded from this PDF:

Primary speech and language impairments affect 7.4% of primary school children.  Early intervention by speech and language therapists (SLTs) is crucial to lessen their impact on these children’s life chances; however, there is wide variation in how families are assessed and interventions implemented.

The aim of the research was to improve speech and language therapy services by developing a framework that speech and language therapists could use to inform the clinical decisions they make regarding which interventions to use with children.  The framework was developed from published evidence, experiences of children and families and knowledge of the practitioners.

A copy of the report can be downloaded for FREE from the National Institute for Health Research.

More information on this project can be downloaded from this PDF:

Children with language impairment (LI) can experience a wide range of social and emotional difficulties in addition to linguistic difficulties, but there is limited understanding about how LI impacts on these broader, psychosocial aspects of children’s lives. Furthermore, psychosocial outcomes for children are not assessed routinely in speech and language therapy research and practice. The study sought to uncover psychosocial features of LI and identify goals for support.

For children, LI was predominantly relational, that is, it was mainly experienced in relationship with others. Psychosocial goals for intervention include addressing attitudes, understandings and behaviours of professionals and peers towards children, in addition to children’s understanding and use of language; promoting children’s experience of agency; and addressing children’s emotional wellbeing and risk for bullying. Good communication and understanding between children, families and professionals is essential for intervention.

This research was undertaken in partial fulfillment of a PhD by Dr Helen Hambly.  A copy of her thesis can be downloaded from the University of the West of England.

Summary of this research

Children's, parents', peers' and professionals' experiences of language impairment: a multi-perspective study to identify psychosocial goals for intervention

Children with language impairment (LI) can experience a wide range of social and emotional difficulties in addition to linguistic difficulties, but there is limited understanding about how LI impacts on these broader, psychosocial aspects of children’s lives. Furthermore, psychosocial outcomes for children are not assessed routinely in speech and language therapy research and practice. Studies of experiences of disability and impairment in other areas have highlighted the importance of addressing the psychosocial beyond the medical. This study draws on interpretive phenomenological analysis (IPA) to explore children’s, parents’, peers’ and professionals’ experiences of children’s LI. Using a phenomenological methodology to explore LI from multipleperspectives, the study sought to uncover psychosocial features of LI and identify goals for support. Four children, aged 8-10 years with a diagnosis of LI, were interviewed about their experiences using arts-based methods. Children’s parents, teachers, learning support assistants, speech and language therapists and siblings and/or friends were also interviewed. Analysis of the 22 interviews is presented as four case studies that include each perspective around the child. Themes were identified through coding and analysing within and across cases. A second stage literature review was undertaken to understand, theorise and discuss emerging themes. Analysis revealed three themes: Agency, Understandings and Misunderstandings, and Making Sense of Difference. Children’s experiences of agency were associated with their emotions and their engagement in classroom and social activities, and not always dependent on their communication abilities. Children with LI often had different understandings of others’ intentions, situations and instructions to that of their peers, professionals and parents. Mismatches in understandings were associated with children being considered unusual, immature, egocentric or rude by others, impacting on their risk for bullying and social exclusion. There were divergent experiences and understanding of LI. Interpretations included impaired speech, language and social communication; social and emotional immaturity; parental neglect; and other people’s attitudes and behaviours. For children, LI was predominantly relational, that is, it was mainly experienced in relationship with others. Psychosocial goals for intervention include addressing attitudes, understandings and behaviours of professionals and peers towards children, in addition to children’s understanding and use of language; promoting children’s experience of agency; and addressing children’s emotional wellbeing and risk for bullying. Good communication and understanding between children, families and professionals is essential for intervention. Researcher: Helen Hambly Publications: Hambly, H. 2014. Children's, parents', peers' and professionals' experiences of language impairment: a multi-perspective study to identify psychosocial goals for intervention. Doctoral thesis (PhD). University of the West of England. Available from: http://eprints.uwe.ac.uk/23120

Primary language impairment (PLI) affects approximately one in 20 young children, who may have difficulties with language in later life. The importance of parent-child interaction (PCI) for language development has been well established. Many early speech and language therapy interventions have focused on modifying characteristics of PCI to enhance opportunities for language learning. However, the success of such programmes is mixed. Furthermore, there is a dearth of literature examining the developmental nature of the relationship between parent and child language with children who have PLI.

Using a case study methodology, the study aimed to understand the dynamics of the relationship between PCI and the trajectories of vocabulary growth of children with PLI. Four case studies were developed using data from preschool children and their families.

Following baseline assessments, data were collected at four time points across 9-10 months. Vocabulary development was examined using MacArthur-Bates Communicative Development Inventories. Children wore a LENA (Language ENvironment Analysis) recorder at home, which collected naturalistic all-day audio, used to sample PCI for transcription and analysis. The LENA audio was coded to examine how talk varied across everyday activities.

In addition, mother-child dyads were video-recorded looking at a picture-book to examine parent teaching behaviours. Semi-structured interviews were carried out with parents to get their perspectives on having a child with PLI.

The findings demonstrated cross-case differences in the trajectories of children’s vocabulary growth, which were consistent with differences in maternal talk. Across cases, mothers were generally found to dominate interactions. There was no clear pattern in maternal responsiveness that suggested change over time. However, there was a trend for increased responsiveness during picture-book sharing compared to the naturalistic PCI samples. Mother-child play was infrequent during the LENA recordings.

These findings challenged previous research that observed PCI in single, researcher-defined settings such as toy play and its representativeness for understanding PCI more broadly.

Further research is discussed, including evaluation of PCI interventions in naturalistic settings to assess integration of strategies. The interviews with parents identified factors to improve engagement and satisfaction with interventions. Understanding individual differences in response to interventions is essential for improving the effectiveness of support for children.

This research was undertaken in partial fulfillment of a PhD by Dr Anna Blackwell.  A copy of her thesis can be downloaded from the University of the West of England.

The effect of different feeding methods and sucking behaviours on speech sound development in children aged 2-5 years.

In the UK every year around 48,000 children aged 2-5 years are referred to NHS Speech & Language Therapy (SLT) services with difficulties using the right sounds in their talking.  This is known as speech sound disorders (SSD).  This is the largest population seen by Speech and Language Therapists and costs the NHS about £24 million per year.  Children with SSD are more at risk of mental health problems and difficulties making relationships with those around them.  They are also more likely to struggle with learning at school and be involved with the criminal justice system at some point in their early lives.  When a baby is born parents make different choices about feeding their baby.  Some breastfeed, some bottle-feed and some use a mixture of both.  Some babies also like to have a dummy, while others suck their hand and some don’t suck anything.  Some studies have found that breastfeeding is linked to better language and learning in later childhood, while others have found that dummy sucking has the opposite effect.  However, the effect that different types of feeding have on speech development has not been looked at in as much detail.

Empowering and engaging clinical colleagues in healthcare research from Research and Improvement Team.

Speech sound disorder (SSD) is one of the common problems that children face in their childhoods.  According to research, between 2% and 25% of children aged 5 and 7 years old have SSD (Law et al, 2000). When children learn to say new words, most children make some speech errors, which should diminish as they get older. SSD occurs when these errors continue beyond the age when we expect a child to have mastered specific speech sounds.  Most speech errors occur when the speech sounds are substituted, omitted or distorted.  The errors may affect how well a child is understood and can potentially limit his/her interactions with other people and negatively impact on the child's social and emotional development.

SSD is usually diagnosed by speech and language therapists using formal articulation tests and oral mechanism assessments.  As children make age-appropriate and age-inappropriate mistakes during their development, it can be difficult for parents or teachers to identify if there is a problem. Therefore, a request may be made for a formal assessment by a speech and language therapist to determine if a problem with speech exists.  This can lead to delays in accessing intervention.

Not all children need a formal articulation assessment. Some can be assessed using a screening tool which can be used to identify those children who need a more complete and thorough assessment from those who need advice only. The purpose of a screening tool is to quickly identify those children whose speech is within normal limits and those who may have SSD. People identified as falling outside normal limits can be seen or referred for complete formal evaluation in a timely fashion.

In recent years, computerised digital sound analysers have started to be widely used in speech sound analysis in detecting voice disorders, speech and audio-signal processing, etc.  Ms Ng Wing Yee (Chief investigator of this study) has recently developed a Cantonese speech sound analyser in order to make speech screening more accessible to parents and teachers in Hong Kong.  The speech sound analyser is a computer algorithm which carries out acoustic analysis of speech sounds. Now this analyser has been developed in Cantonese, we want to assess its application in an English speaking population.

Thus, the primary purpose of this study was to determine:
1) If a test which has been developed to screen children’s speech is accurate enough to be used as a screening tool to identify children with speech sound disorder.
2) How accurate the algorithm which has been developed to analyse speech sounds is when compared to a speech and language therapist.

Data collection has been completed. The research team at the Bristol Speech and Language Therapy Research Unit (BSLTRU) have been phonetically transcribing the speech of 200 native English speaking children aged 3 to 6 years old. At the end of the data collection, the transcriptions and audio recordings were be sent to the Chinese University of Hong Kong for analysis in order to answer the research questions above.

An additional concern with regards to speech development in children today is the anecdotal evidence from teachers that children are starting school with weaker speech and language skills than twenty years ago, and that this is having an impact on their developing literacy skills.

The data collected in this study will also be compared with that collected in a previous community population study and will enable us to investigate whether this is indeed the case. We will therefore explore:

3) How parent report of children’s intelligibility compares to that of teachers’ for children aged 3 years to 6 years, 11 months.
4) How parents and teachers reports of intelligibility correlate with measures of speech production collected during assessment by a speech and language therapist.
5) What patterns of speech production are observed in a sample of children aged 3 years to 6 years, 11 months today and how this compares with the speech of child participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) in the 1990s.

Public Health England (PHE) has commissioned Speech and Language Sciences at the University of Newcastle to develop and evaluate a new process for early identification of children at risk of developing speech and language disorders, in collaboration with Bristol Speech and Language Therapy Research Unit and the Institute of Health Visiting.

Why is this important?

Speech and language are critical to children’s development, and speech, language and communication needs (SLCN) can affect their educational attainment, social and emotional development and opportunities later in life. It is therefore essential that children with SLCN are identified early to ensure they receive the right support and reduce the risk of problems in the long term.

However, the Bercow 10 Years On Report published in 2018 found that “more than half of young children in school are not having their needs identified, often due to insufficient knowledge and skills in the workforce” (p30). The report also showed that the screening tools which are currently used do not feature important ‘red flags’, which could provide early signs of SLCN.

How the project worked?

PHE have developed a programme to improve identification of SLCN, including training health visitors, providing better guidance to local authorities and provision of an early assessment tool. The University of Newcastle has been selected to create this tool, led by Professor James Law in collaboration with Dr. Cristina McKean.

The new screening tool was conducted alongside the Ages and Stages Questionnaire (ASQ), which is commonly employed by health visitors and early years practitioners at children’s 2-year developmental checks. The screening tool was tested and evaluated by health visiting teams in five areas around England, working with a total of 1280 preschool children. The project also developed resources to foster understanding of SLCN among health visiting teams and parents, and to help them to support children with their speech and language.

How BSLTRU was involved?

There are four strands to the project:
1)      Development of the early assessment tool
2)      Public and Patient Involvement (PPI) Groups
3)      Evaluation and Feedback
4)      Co-Design

The team at BSLTRU, led by Professor Sue Roulstone in collaboration with Caitlin Holme, were responsible for evaluation and feedback. They gathered parent and professional perspectives of the new process and contribute this insight to the development of the tool, with the objective of ensuring acceptability for those who will be using and receiving the assessment in future.

Evaluation of the parent and professional perspective comprised a parent survey, completed by all parents whose children have been assessed via the new process, as well as telephone interviews with parents and focus groups with health visitors and speech and language therapy teams.

BSLTRU also ran the PPI groups and co-design elements of the project, which aimed to include parents and professionals in the design of the assessment tool and further resources.

The Covid-19 virus has resulted in a wide number of changes in our behaviour to reduce the spread of infection. Some of these changes impact on how we communicate with each other. Wearing face masks, for example, changes our interactions since we are no longer assisted by lipreading and facial expression. Use of video-calling (e.g. Zoom meetings, FaceTime) can also change the way we interact and make it more difficult to use non-verbal cues to indicate when we want to speak. In contrast a ‘chat’ box on a virtual platform potentially reduces pressure on communication.

Whilst these changes to the way we communicate with each other affect all of us in different ways, little is known about how they affect people with speech, language and communication challenges. One group who were uniquely impacted are people who stammer (also known as stuttering). For example, some people who stammer may find wearing masks and using virtual meeting makes speaking easier whilst could find communication more stressful and difficult. It is also important to consider how the increased difficulties that some people who stammer may experience has led to an increase or change in referral patterns to speech and language therapy (SLT) and enquiries to support services.

In this project, we gathered the experiences of people who stammer, so that we can learn about the impact of COVID-19 on their lives. We used the results of this project to better understand how people who stammer have been affected during COVID-19, and to develop recommendations and guidelines to provide the best support possible as we emerge from the pandemic.

The project had 3 parts:

1. Exploring experiences of living through the pandemic, using an online survey for people who stammer aged 18 and over, based in the UK.
2. Investigating the impact of the pandemic on referral of  children and adults who stammer to Speech And Language Therapy, using data from the Royal College of Speech and Language Therapists outcome database.
3. Exploring the impact of the pandemic on requests for support and information made to STAMMA (British Stammering Association) support services.

The project was funded by the Underwood Trust for research, and the Principal Investigator was Dr Yvonne Wren.

The full report is available by downloading this file - 

Medically Unexplained Dysphagia (MUD) can be defined as oropharyngeal dysphagia occurring without demonstrable abnormalities in the anatomy of the upper aero-digestive tract or swallowing physiology.  However, within the published literature and clinical experience, numerous words/ terms have been used to diagnose and explain the condition.  This had led to a lack of clarity between and within specialties when defining and diagnosing this condition.  It is hoped that consensus will be reached regarding the most helpful and appropriate terminology that can be used when explaining, diagnosing and treating MUD. 

This is a North Bristol NHS Trust sponsored study, made possible with charitable funding through the Speech and Language Therapy Department (PAT Fund).

Would mindfulness techniques enable the person with aphasia to minimise the impact of anxiety? 

Currently there is little existing research work in the area of mindfulness in relation to people with aphasia.  However, the techniques used in mindfulness would seem to lend themselves to being carried out by people with aphasia, as it is substantially based in non-verbal activities.

The development of this research was therefore being informed by asking people with aphasia about any current strategies they use to minimise anxiety and its impact on communication.  In addition to this the researcher is exploring mindfulness to consider how it may increase the ability of people with aphasia to cope with anxiety and to minimise the impact of their language difficulties in both 'comfortable' and more stress-inducing situations.

To find out more download the PDF below.

Optimising outcomes for young people with cleft lip and/or palate in adolescence

Investigator: Yvonne Wren, Lucy Southby, Peter Fowler, Alistair Cobb, Shaheel Chummun

Timescale: July 2021 - March 2022

Funder: Above and Beyond and University Hospitals Bristol and Weston NIHR Research Capability Funding

In this project, we worked with clinicians from cleft care centres across the UK and young people affected by cleft to determine what information needs to be collected in a dedicated clinic for young people aged 15-17 years born with clefts. We also aimed to determine how we should collect the data and the logistics of running such a clinic. This work will inform a follow-on study where we will collect data which we can use to determine which young people born with cleft do well and why. The ultimate aim of this work is to provide information for services to plan services and care that will maximise outcomes for this at-risk population and ensure fewer children born with clefts are disadvantaged in adolescence and adult life.

Before planning a research clinic to understand outcomes for young people born with a cleft, it is important to establish what outcomes should be collected and how best to collect them. The aim of this project was therefore to determine what clinicians involved in cleft care and young people aged 16-20 years who were born with a cleft consider to be important to measure in this age group and how this should be done.

We worked with audiologists, dentists, nurses, orthodontists, psychologists, speech and language therapists, and surgeons from specialist NHS cleft teams across the UK, and young people affected by cleft. Our aim was to try to understand what these different groups of people believe are important factors for young people aged 15-20 years who were born with a cleft. This will enable the selection of outcome measures to collect and how these will inform ongoing needs that young people may have. It would also allow a retrospective assessment of the success of their previous care.

We found that both young people born with a cleft and all clinical specialities prioritised overall psychological well-being, and functional outcomes as important. However, consideration of specific aspects including appearance, hearing, speech and satisfaction with treatment were also highlighted. The clinician groups identified some specific measurement tools but all clinician groups with the exception of psychology highlighted aspects that they thought would be important to measure but for which appropriate tools were not available. In addition to their well-being, confidence and considering aspects of function and appearance, the young people identified that understanding how they could access cleft care and being asked what they want from cleft teams in relation to their care is being important.

Problems making and using the sounds of speech in conversation is the most common reason for referral to speech and language therapy.  Children may have difficulties with this aspect of their development for a variety of reasons – for example hearing impairment, cleft palate or cerebral palsy.

This Medical Research Council funded project used data from the ALSPAC (Avon Longitudinal Study of Parents and Children).  Data showed that children could be broadly grouped into those showing mild articulation errors which are unlikely to impact on long term outcomes.

More about this research can be read in this PDF:

A randomised controlled trial of the effectiveness of parent-based models of speech and language therapy intervention, and parent attitudes, for 2 to 3 year old children with primary language delay in areas of social disadvantage.

Primary language delay remains one of the most prevalent developmental delays in early childhood and previous research has established that language difficulties are a particular risk factor for adverse outcomes.

Research has established that the prevalence and prognosis of early language delay is exacerbated by social disadvantage in two ways.  Firstly, low socio-economic status has been identified as a predictive factor in indicating persisting language difficulties and adverse outcomes (Paul & Roth, 2011; Fernald et al, 2013, Clegg et al, 2015).  Secondly, in disadvantaged areas, access and engagement with services is a challenge, and health outcomes are affected by both social and geographical factors (Maggi et al, 2010).

However, research indicates that the negative effects of social disadvantage can be mediated by a positive parenting environment (Gutman & Feinstein, 2007; Raviv et al, 2004).  Although it is unclear exactly how parental attitude and involvement mediates the impact of intervention, evidence links the home learning environment, including parenting behaviours, skills and attitudes, to children’s learning outcomes at age three and five (Gregg & Goodman, 2010; Growing Up in Scotland, Scottish Government, 2015).

Aims of the research and expected outcomes were:

1. Carry out a randomised controlled trial (RCT) to evaluate the clinical effectiveness of the enhanced parent-based intervention (EPBI) programme compared to the standard parent-based Intervention (PBI) in 2 to 3 year old children with a clinical diagnosis of primary language delay in areas of social disadvantage.  These outcomes will lead to a clearer understanding of the value of delivering parent based intervention with socially disadvantaged clinical populations.
2. Evaluate the effect of parental skills, attitude and confidence to engagement with treatment, and child outcomes. These outcomes will lead to a clearer understanding of the practical, physical and psychosocial effects of the home learning environment on children’s language development.

Developing a language protocol to support communication with people who have Parkinson’s.
Parkinson Disease & Language. At a recent PPI event in Bristol, people with Parkinson’s (PwP) expressed their desire to explore the language problems which arise from the disease and to have strategies and therapy that are specific to them. This desire fits with established research which indicates that the language impairment experienced by PwP differs to that seen more frequently in people with aphasia as a result of stroke or traumatic head injury.  The ‘Guidelines for Speech-Language Therapy in Parkinson’s Disease’ and the UK Parkinson’s Audit highlight the need for speech and language therapists (SLT) to ask PwP about any difficulty they might have finding words and participating in conversation but as yet it is not recommended to administer a formal language test.  Following the introduction of this question, local speech and language therapists report an increasing number of PwP affirming the presence of language impairment and the need to address it.

There is currently no validated or standardised language assessment for PwP nor agreed strategies to help alleviate the effects of those language problems. Stephanie Ticehurst is interested in developing a language assessment protocol alongside PwP to ensure that it is  meaningful,  effective, practical and efficient for SLT to use in clinic.

Service resources for children with speech, language and communication needs are finite.  Inevitably SLTs make prioritisation decisions on a daily basis.  Decisions are not always easy and they often go on without explicit discussion.  The study investigated how therapists prioritise pre-school children for speech and language therapy.  Although other factors such as parental anxiety and family history are influential, this study specifically explored which speech and language behaviours displayed by young children raise a therapist’s concern and leads to their decision to refer a child on a particular care pathway.

More about this research can be read in this PDF:

Background

Early speech, language and communication difficulties can have a long-term impact into adulthood with effects reported on literacy, social and emotional well-being and employment. By identifying children who are at risk of language difficulties early in life it is possible for them to receive intervention in a timely manner to prevent any potential wider effects. Up to two thirds of children identified with speech, language and communication needs require support to make progress and there is evidence that intervention for speech, language and communication difficulties is effective. The challenge is knowing when and how to identify the children who need and will benefit from this intervention.

Research aims and methodology

The aim of this research was to conduct a review of what is known to work in terms of early language screening, in terms of content, age relevancy, administration and analysis to inform the specification for the development of a screening tool suitable for the population of Wales. 

The work carried out was based around four objectives.

1. Objective 1: review current evidence regarding the advantages and disadvantages of early language screening in universal and targeted populations. Provide a set of recommendations: should screening take place at all? If so, what should be screened, by whom and at what age(s)?
2. Objective 2: assess, critique and summarise the English and Welsh language screening/ identification tools currently available to assess children’s language ability and progress.
3. Objective 3: assess, critique and summarise what makes an effective screening/ identification tool. Factors including validity, reliability, specificity and bi/multilingualism will need to be considered.
4. Objective 4: provide a set of recommendations on the important components for an English and Welsh All Wales early language screening/ identification tool.

To address these objectives, three rapid scoping reviews were conducted.

1. A review of available screening tools in the English language, which aimed to build on the evidence base of previous systematic reviews and identify additional tools.
2. A review of tools available for use with bilingual or multilingual populations.
3. A review of tools available for use in Welsh. Three searches were conducted across five databases, initially in English. Search terms were then translated into Welsh and a Welsh-language journal was also searched for relevant articles.

The full review can be read and download from the Welsh Government Website, and a recording of a webinar can be viewed - Talk with me: Speech, Language and Communication (SLC) – ExChange (exchangewales.org)

Investigator: Katherine Broomfield

Funder: EPSRC Impact Accelerator award

The Unspoken Voices research project was part of Katherine Broomfield’s NIHR/HEE funded Clinical Doctoral Research Fellowship (2017-2022) and was overseen by Manchester Metropolitan University. This project was concerned with people who use augmentative and alternative communication (AAC) because they cannot speak clearly, or cannot speak at all.  AAC refers to a set of strategies such as pointing to pictures, words or letters as well as the use of special equipment that can speak out messages entered into or stored within it.
The aim of this research project was to understand more about people’s experience of using AAC to communicate to inform the development of clinical tool that will evaluate AAC interventions from the perspective of the patient. Such tools are called patient-reported outcome measures (PROMs). Katherine has completed a systematic literature review of PROMs currently used in AAC, and a qualitative evidence synthesis of literature about the experiences of people who use AAC to communicate. She has conducted over 40 interviews with people who have communication difficulties to understand more about their expectations and experience of AAC to understand what outcomes are important to them. During analysis of this data, she explored theories of communication that could help researchers better represent multimodal data in qualitative analyses of data collected from people with communication disability. Katherine has developed a theoretical and a conceptual framework for a PROM for AAC. She is due to complete her PhD in 2023.
Katherine worked with an expert group of people who use AAC in the delivery of this project and has developed expertise in supporting patient and public involvement creatively to enable the involvement of hard to engage with groups in research. She has published information about the creative methods she has used and co-edited a book with contributions from colleagues at BSLTRU.
Katherine has written a blog to increase awareness of this project. The blog summarises her research journey and documents some of the key learning from this project. If you are interested in reading more than the link to the blog is unspokenvoicesproject.wordpress.com

The Sound Start Study was a research project funded by the Australian Research Council (ARC) Discovery Grant and conducted by researchers from Charles Sturt University, The University of Sydney, and The University of the West of England. 

The Sound Start Study focused on 4- to 5 year-old children who were attending preschool.  The main aim of this study was to investigate the speech skills of 4 to 5 year-old children and to determine the effectiveness of the innovative computer program, Phoneme Factory Sound Sorter (PFSS) as an intervention for preschool children with speech difficulties.

The primary researchers on this project were: Professor Sharynne McLeod, Dr Elise Baker, Dr Jane McCormack, Dr Yvonne Wren and Professor Sue Roulstone

A peer review journal article on this project has been published.

The project website is hosted by Charles Sturt University.

A preliminary investigation into the effectiveness and cost-effectiveness of speech & language therapist led interventions for children with speech sound disorder versus programmes delivered by assistants.

Children with speech disorder are the largest single client group referred to NHS speech and language therapy (SLT).  Whilst the speech problems for as many as 75% of children are known to resolve between the ages of 3 and 6, a substantial number have speech sound disorder (SSD) which continues beyond the age of typical development.  When SSD persists beyond age 5, children are at risk for poor life outcomes in terms of education, employment, relationships, criminal behaviour and mental health.

Many children receive NHS intervention for SSD at school.  In some areas this is typically delivered by SLTs, whilst in other areas NHS SLT provision for some children consists of providing a programme which is delivered by SLT assistants.  The decision regarding delivery of intervention by SLT or by assistant has been determined by service needs rather than research evidence.

Aims and objectives
To estimate the impact of SLT led versus assistant led intervention for children with SSD on outcomes in speech.  Specifically to:

• Explore the efficacy of SLT led versus assistant led interventions
• To examine the cost associated with SLT and assistant led interventions
• To gather information that will help to inform a future clinical trial

Evidence suggests that differences in early childhood are associated with later speech and language development.  Specifically, patterns of interaction between parents and children have been shown to be associated with language development while very early speech behaviours are linked to later speech outcomes.  However, there is currently little research on the role of early language environment on speech development.

The purpose of this pilot study was to examine the relationship between patterns of interaction and early speech output, using LENA (Language ENvironment Analysis).  LENA is small recording device placed into a pocket of a vest worn by the child.

Thirteen month old infants and their parents were recruited for this study.  Recruited children wore a LENA vest, which recorded the child and their environment for 16 hours.  The LENA software provided numerical data on the child’s language environment; including the number of child and adult vocalisations as well as conversational turns.  This data was examined in relation to recordings of the children’s speech (for example, the sounds the children used and their babbling patterns).

The Bristol Project film is about five teenage boys.  These young people worked with Professor Sue Roulstone and Dr Clodagh Miskelly from the University of the West of England (UWE) and a film production company to explore the research question:

'What is it like to be a teenager with speech and language difficulties?'

The answers to that question were not what the researchers expected to hear. The young people challenged us to focus on their interests and their positive contributions rather than on their difficulties.  The film portrays these teenagers with affection and humour and gives them a chance to share their enthusiasms. Although the boys' difficulties with communication may be apparent in the film, we are challenged to consider our role in defining their difficulties.

More about this research can be read in this PDF:

There is a recurrent problem that many people with communication difficulties are given communication aids but never use them to their full potential or even don’t use them at all.  One of the reasons for this is that it can be difficult for many people to get enough practice in using the aid to the extent that it becomes more effective than other strategies such as gesture, and thus is a functional improvement for them. 

This project developed a computer based dialogue practice system.  The thinking behind the project was that many people do not have a willing communication partner to practice with, and also in the early stages of learning to use an aid it can be tiresome and even embarrassing for both aid user and partner and thus the initial steep part of the learning curve in using the aid is never surmounted.

More about this research can be read in this PDF:

The study aimed to find out how the Lidcombe Program (LP) for stammering was used in clinics across the world and whether therapists, who do not work closely with the research team, obtained similar results to the expert LP practitioners.

More about this research can be read in this PDF:

Primary speech and language impairment (PSLI) is a term used to describe children with a range of significant speech and language impairments, in the context of normal cognitive abilities. 

The aim of this research was firstly to explore identify construction in children with PSLI, and secondly to explore how these children made sense of their experiences.

This work contributed to the field of practice in four ways:

1. Provided new insights into identify construction in children with PSLI
2. Added to understanding of ways in which children conceptualise communication impairment
3. Deepened understanding of the determinants of well-being and belonging in children with PSLI
4. Highlighted the value of narrative inquiry as a means for listening to the voices of children with communication impairments

More about this research can be read in this PDF:

Understanding the impact of the COVID-19 pandemic on surgery and speech and language therapy for children born with cleft palate

Investigator: Yvonne Wren and Lucy Southby

Timescale: April 2021 - October 2021

Funder: Bristol Health Research Charity

This work aimed to determine the degree to which surgery and SLT services for children with CP+/-L were delayed and/or changed as a result of the Covid-19 pandemic and how this varied across the country. It also aimed to determine the impact that these delays and disruption to surgery and SLT services had on children with CP+/-L and their families as well as inform further funding applications. Two peer reviewed papers from this work have been published as has a policy briefing from the University of Bristol with a further peer-reviewed paper in preparation.

Southby, L., Harding, S., Davies, A., Lane, H., Chandler, H. and Wren, Y., 2022. Parent/Caregiver Views of the Effectiveness of Speech-Language Pathology for Children Born With Cleft Palate Delivered via Telemedicine During COVID-19. Language, speech, and hearing services in schools, pp.1-10. 

Southby, L., Harding, S., Davies, A., Fell, M. and Wren, Y., 2021. Speech-Language Pathology Provision During the COVID-19 Pandemic for Children Born With Cleft Palate in the United Kingdom—Parent/Caregiver Perspectives and Experiences. Perspectives of the ASHA Special Interest Groups, 6(6), pp.1809-1819.