Challenges in Service Provision to Children and Families from Linguistically Diverse Backgrounds

The purpose of this study was to examine and describe experiences and perceptions of speech-language pathologists (SLPs) serving children and families from culturally and linguistically diverse populations. Twenty SLPs were interviewed using an online audio platform regarding common practices, resources and supports, challenges, and communication. Participants' responses to the semi-structured questions were transcribed and analyzed to identify themes in experiences. Results suggested six overall themes including: considerations for assessment; cultural impact; linguistic access and barriers; professional preparedness; impact of COVID-19; and helpful tips and resources. The discussion includes recommendations and resources to address obstacles.

Expansion Points Intervention in Young Children with Speech Sound Disorders: A Multiple Baseline Design

The purpose of this investigation was to evaluate the efficacy of expansion points (EXP) intervention with a modified criterion for preschool children with speech sound disorders (SSD). Three preschool-aged children were enrolled in a single-subject multiple baseline intervention study. Intervention took place over 16 sessions. Pre- and post-intervention data are provided. Three outcome measures (generalization to probe words and gains in percent consonants correct, PCC, in words and in conversation) were evaluated to measure the effectiveness of the EXP intervention. All three of the participants demonstrated gains by the end of the intervention phase when measuring PCC in single words. Two of the three participants demonstrated gains in PCC in conversational speech. Progress on individual phonemes was variable across participants. Utilizing the EXP approach, two of the three children showed gains in all three outcome measures. One child showed variable performance in one outcome measure, improvement in one, and a decrease in one. Findings suggest that EXP should be further explored to evaluate intervention efficacy.

Which Speech Sound Norms Are Used in U.S. Public Schools? A Retrospective Survey Analysis

Normative data concerning speech sound acquisition are widely and heavily used in the United States to determine eligibility for services. Normative studies differ in the age and geographic location of participants, which can limit applicability across the United States. In 2016, we queried school-based speech-language pathologists (SLPs) in the United States using a web-based survey to determine which speech sound norms are used. Nine regions from the U.S. census were represented. The Iowa–Nebraska norms were most commonly reported. However, many SLPs were unable to name the source of the data that they used. More than 60% of the sample indicated that they referred to one source of normative data. Results of a logistic regression indicated that region of the United States predicted if SLPs used one or multiple sources. Specifically, SLPs in the West North Central region of the United States (which includes Iowa and Nebraska) were more likely to use only one source of data, the Iowa–Nebraska norms. We recommend that speech sound norms are less heavily relied upon for eligibility decisions, particularly due to the substantial variations in culture and dialect throughout the various regions of the United States.

Clinical Practice Patterns of Speech-Language Pathologists Delivering Dysphagia Services to Persons with COPD: Analysis of Survey Outcomes

Swallowing impairments co-occur with chronic obstructive pulmonary disease (COPD) leading to aspiration, disease exacerbations, and malnutrition. This pilot survey study aimed to identify current clinical practice patterns for swallowing evaluation and treatment in persons with COPD. A 35-question Qualtrics survey was deployed to medical speech-language pathology (SLP) social media sites and professional boards; flyers were distributed at a professional conference. Forty-eight SLPs completed the study. SLPs routinely include a clinical swallow examination (96%), videofluoroscopic swallowing study (79%), adjunctive respiratory measures (respiratory rate [83%], and pulse oximetry [67%], respiratory–swallow pattern [77%]) but less frequently include fiberoptic endoscopic evaluation of swallowing (23%). Self-reported advanced clinical experience and expert respiratory analysis skills were associated with adjunctive respiratory measure (respiratory rate, pulse oximetry) inclusion during assessment. Compensatory strategy training (77%) is a preferred treatment for dysphagia in COPD; however, respiratory–swallow pattern training and expiratory muscle strength training are increasing in use. SLPs self-report a comprehensive, individualized patient-centered care approach with inclusion of adjunctive respiratory-focused methods in dysphagia evaluation and treatment practice in persons with COPD. Advances in the identification of the integral role of respiratory function in swallowing integrity may be translating to clinical practice methods for dysphagia management in persons with COPD.

Mental State Language Use in Children with Down Syndrome and the Role of Caregivers

Children with Down syndrome (DS) have both strengths and difficulties in speech, language, and social communication. Mental state language—the ability to discuss others' perspectives such as their thoughts, feelings, and intentions—represents a foundational social communicative skill that is delayed in many children with DS, even into the school-age years. The purpose of this article is to review the evidence base on mental state language development in school-age children with DS, focusing in particular on assessment and intervention. We discuss assessment procedures that are both age appropriate and developmentally appropriate for this population. We also present preliminary data highlighting the role of caregivers in supporting mental state language development in school-age children with DS through shared storytelling. We propose that interventions aimed at supporting mental state language development in DS should include a focus on caregiver–child shared storybook reading, even in the school-age years. Therefore, we discuss key considerations for clinicians when teaching caregivers strategies for supporting mental state language and social communication in children with DS.

Responsive Parenting as a Target for Telehealth Language Interventions in Fragile X Syndrome: Implications for Scalability and Best Practices

This review highlights the ways in which telehealth procedures can be implemented to help bridge the research-to-practice gap in supporting developmental outcomes for youth with fragile X syndrome (FXS). We review how the literature to date has informed potential treatment targets in the areas of speech and language development with a focus on understanding and supporting the dyadic relationship between the child and their biological mother, who is also impacted biologically. Notably, parental responsivity is an area that is strongly related to child language outcomes, both early and into adolescence, and thus, it is an important treatment target for subsequent interventions. To date, several parent-implemented interventions have been done in FXS across a broad age range (2–17-year-olds) all showing support not only that parents are successful in learning responsive strategies but also that there are subsequent impacts to child language development. Moreover, these interventions were successfully implemented at a distance through telehealth procedures including video teleconferencing and shared recordings of parent–child interactions. This review also addresses potential moderators of treatment gains. Implications for scaling such interventions in the future as well as best practices for incorporating telehealth procedures into future research and intervention programs are also discussed.

Characterizing the Richness of Maternal Input for Word Learning in Neurogenetic Disorders

Promoting language abilities, including early word learning, in children with neurogenetic disorders with associated language disorders, such as Down syndrome (DS) and fragile X syndrome (FXS), is a main concern for caregivers and clinicians. For typically developing children, the quality and quantity of maternal language input and maternal gesture use contributes to child word learning, and a similar relation is likely present in DS and FXS. However, few studies have examined the combined effect of maternal language input and maternal gesture use on child word learning. We present a multidimensional approach for coding word-referent transparency in naturally occurring input to children with neurogenetic disorders. We conceptualize high-quality input from a multidimensional perspective, considering features from linguistic, interactive, and conceptual dimensions simultaneously. Using case examples, we highlight how infrequent the moments of word-referent transparency are for three toddlers with DS during play with their mothers. We discuss the implications of this multidimensional framework for children with DS and FXS, including the clinical application of our approach to promote early word learning for these children.

Family as a Context for Child Development: Mothers with the FMR1 Premutation and Their Children with Fragile X Syndrome

Fragile X syndrome (FXS) is a genetic disorder caused by changes of the FMR1 gene that is passed along among families. A range of developmental processes may be impacted with wide variation in abilities across individuals with FXS. Mothers of children with FXS are often carriers of a “premutation” expansion on the FMR1 gene, which is associated with its own clinical phenotype. These maternal features may increase individual and family vulnerabilities, including increased risk for depression and anxiety disorders and difficulties in social and cognitive ability. These characteristics may worsen with age, and potentially interact with a child's challenging behaviors and with family dynamics. Thus, families of children with FXS may experience unique challenges related to genetic risk, manifested across both children and parents, that should be considered in therapeutic planning to optimize outcomes for children and their families. In this article, we review core features of the FMR1 premutation as expressed in mothers and aspects of the family environment that interface with developmental outcomes of children with FXS. Recommendations for family-centered support services are discussed.

Reading Skills in Down Syndrome: Implications for Clinical Practice

Though children with Down syndrome can learn to read, they may have difficulty developing some component skills, including phonological awareness and word decoding. Given reading's foundation in language, speech-language pathologists (SLPs) should play a central role in supporting access to and providing reading instruction for children with Down syndrome. This article reviews the available research on reading in Down syndrome and offers guidance for SLPs working with this population. We start by reviewing the Down syndrome phenotype, highlighting physical features and cognitive and linguistic patterns of strength and weakness that impact reading development. Next, we define different reading subskills and outline typical reading development, including stages of prereading, learning to read, and transitioning to using reading as a tool for learning. We then use these stages to review what is known about reading in Down syndrome, including relevant intervention work. We also incorporate considerations for clinical practice. In particular, we encourage SLPs to advocate for supporting reading development in children with Down syndrome, to work with families to develop rich home literacy environments, and to work with educators to promote phonological awareness and decoding skills. Lastly, we note limitations in our current knowledge and include a call for more research.