The origins, outcomes and impact of persisting phonological impairment

Lead Research Organisation: University of the West of England
Department Name: Research Business and Innovation

Abstract

Children with speech difficulties form the largest group of those referred to children?s speech and language therapy departments. Though some children grow out of their difficulties, others have persistent problems that can affect their educational progress and social development.
Previous research into children?s speech impairments has been unable to agree on the percentage of the population who are affected by this. In addition, a number of factors such as intelligence and family factors have been found to be associated with speech impairment though there is no conclusive agreement on which factors are most important. Similarly, the degree to which educational and social development is affected is in dispute.
Some speech impairments are associated with anatomical or neurological impairments such as cleft palate or cerebral palsy, but for a large number of children, there is no identifiable cause. Research has suggested many possibilities and it is also thought that different subgroups may exist.
Some of the research on speech impairments is now outdated and uses definitions of speech impairment that are no longer accepted. With the more recent studies, there has been a tendency to use small samples of children, in some instances just one or two cases. There is therefore an urgent need for population-based research.
The Avon Longitudinal Study of Parents and Children (ALSPAC) is a large scale study of children?s development which has collected information on children?s speech development at ages 2, 5 and 8. This provides a unique opportunity to investigate some of the questions surrounding speech impairment. The proposed study will identify the percentage of children aged 5 and 8 years who have speech impairments, what factors predict persistent problems and what factors are associated with a good prognosis . It will identify outcomes for children with speech impairments and investigate the existence of any subgroups.

The researcher team have considerable expertise in the field of children?s speech impairment as well as being familiar with the data collected in the ALSPAC study.

Findings from this study will support the early identification of children at risk of persisting speech impairments and help to identify interventions which may prevent long term negative outcomes. In addition, a clear understanding of the numbers affected by these difficulty together with information on the factors which are associated with it, will enable services to be planned more effectively and resources targeted where they are most needed.

Technical Summary

Children with speech impairments (SI) form the largest group of children referred to speech and language therapy. However, our knowledge of the origins, nature and outcomes of SI lacks coherence; services and therapists therefore have limited knowledge upon which to base decisions.

Research literature reports varying prevalence rates for SI. This arises because of the differing definitions used and the various ages at which prevalence has been investigated. Many factors have been identified in younger children that could be used to predict SI but these are based on studies that are either dated or use small samples. There is also ongoing debate about the educational outcomes and social impact for children with SI. The presence of possible subgroups has been proposed but not validated in large-scale studies.

The Avon Longitudinal Study of Parents and Children is a population-based study that has collected wide-ranging data about the children?s cognitive, social, emotional and physical development. The study has also sampled speech data from the children at the ages of 2, 5 and 8 years. The study therefore provides a unique opportunity to investigate the nature of SI in children.

The aims of the research are to establish prevalence figures for SI in 5 and 8 year olds, to identify predictive factors and outcomes, to describe the profile of the children with SI in terms of language, cognitive and motor skills and to investigate the existence and nature of subgroups of speech problems.

Children will be categorised as either case or control children using algorithms for the identification of SI and the measure of Percentage of Consonants Correct. Following descriptive analysis of putative variables, data for case and control children will be compared using a series of logistic regressions to identify predictive factors, outcomes and co-morbidity. Prevalence figures at each age would be calculated using 95% confidence intervals and the existence of subgroups based on surface phonological patterns will be investigated.

The research team are familiar with the ALSPAC data set and have successfully collaborated on a variety of projects regarding children with speech and language impairments.

The importance of children?s speech and language development to their future educational and social success has attracted increasing attention in government policy. However, the amount of speech and language therapy available is also of concern. Access to improved research data about the nature and outcome of SI is crucial to effective targeting of therapy resources.

Publications

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Shriberg LD (2019) A frequent acoustic sign of speech motor delay (SMD). in Clinical linguistics & phonetics

 
Description Bercow report
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact understanding of the prevalence of speech impairment, its impact and actions to help
URL http://webarchive.nationalarchives.gov.uk/20130401151715/http://www.education.gov.uk/publications/st...
 
Description JSLHR papers chosen for ASHA self study programmes for practising SLTs
Geographic Reach North America 
Policy Influence Type Influenced training of practitioners or researchers
 
Guideline Title Developmental Speech Difficulties
Description RCSLT Clinical Resources on child speech disorder
Geographic Reach National 
Policy Influence Type Citation in clinical guidelines
URL https://www.rcslt.org/clinical_resources/developmental_speech/prevalence
 
Guideline Title RCSLT Introduction to developmental speech difficulties - vulnerability and risk issues
Description RCSLT Introduction to developmental speech difficulties - vulnerability and risk issues
Geographic Reach National 
Policy Influence Type Citation in clinical guidelines
URL https://www.rcslt.org/clinical_resources/developmental_speech/introduction
 
Guideline Title All Wales Speech Pathway
Description Use of risk factors for persistent speech disorder in care pathway for speech sound disorders in Wales
Geographic Reach National 
Policy Influence Type Citation in clinical guidelines
Impact The guidelines use the findings from the publications on risk factors for speech sound disorder to determine which children should prioritised for early intervention for speech sound disorder. Simultaneously it enables them to identify those children who are unlikely to need additional intervention and whose speech should resolve spontaneously
 
Description NIHR Post Doc Fellowship
Amount £340,000 (GBP)
Funding ID PDF-2012-05-195 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 10/2012 
End 09/2017
 
Description Programme Grant
Amount £1,200,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2011 
End 04/2015
 
Description Research Seminars Competition
Amount £24,786 (GBP)
Organisation Economic and Social Research Council 
Department ESRC Seminar Series
Sector Academic/University
Country United Kingdom
Start 01/2015 
End 03/2017
 
Description Small grant scheme/North Bristol NHS Trust
Amount £17,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 01/2011 
End 12/2011
 
Description ALSPAC 
Organisation University of Bristol
Department School of Social and Community Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution I have used ALSPAC data for analysis of speech
Collaborator Contribution ALSPAC provide the dataset
Impact Four papers have been published so far with more in preparation
Start Year 2007
 
Description ALSPAC 24/25 
Organisation Newcastle University
Department School of Education, Communication and Language Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution I am leading on a bid for submission to the ESRC using data from a large scale population study, ALSPAC.
Collaborator Contribution The collaborators are co-applicants and are contributing to sections of the bid development and will be involved in delivering the research if we are successful.
Impact The outcome of this collaboration will be a submission to ESRC. The partnership is multidisciplinary: Speech and language therapy, statisticians, health economist.
Start Year 2015
 
Description ALSPAC 24/25 
Organisation University of Bristol
Department School of Chemistry
Country United Kingdom 
Sector Academic/University 
PI Contribution I am leading on a bid for submission to the ESRC using data from a large scale population study, ALSPAC.
Collaborator Contribution The collaborators are co-applicants and are contributing to sections of the bid development and will be involved in delivering the research if we are successful.
Impact The outcome of this collaboration will be a submission to ESRC. The partnership is multidisciplinary: Speech and language therapy, statisticians, health economist.
Start Year 2015
 
Description ALSPAC 24/25 
Organisation University of Sheffield
Department Department of Infection, Immunity and Cardiovascular Disease
Country United Kingdom 
Sector Academic/University 
PI Contribution I am leading on a bid for submission to the ESRC using data from a large scale population study, ALSPAC.
Collaborator Contribution The collaborators are co-applicants and are contributing to sections of the bid development and will be involved in delivering the research if we are successful.
Impact The outcome of this collaboration will be a submission to ESRC. The partnership is multidisciplinary: Speech and language therapy, statisticians, health economist.
Start Year 2015
 
Description ALSPAC 24/25 
Organisation University of the West of England
Department Bristol Business School
Country United Kingdom 
Sector Academic/University 
PI Contribution I am leading on a bid for submission to the ESRC using data from a large scale population study, ALSPAC.
Collaborator Contribution The collaborators are co-applicants and are contributing to sections of the bid development and will be involved in delivering the research if we are successful.
Impact The outcome of this collaboration will be a submission to ESRC. The partnership is multidisciplinary: Speech and language therapy, statisticians, health economist.
Start Year 2015
 
Description ALSPAC MRC with Jan McAllister 
Organisation University of East Anglia
Country United Kingdom 
Sector Academic/University 
PI Contribution I am a co-applicant on a grant application to the MRC led by Dr Jan McAllister
Collaborator Contribution Dr McAllister led the application to the MRC
Impact Grant submission to MRC
Start Year 2018
 
Description Born in Bradford 
Organisation University of Leeds
Department Leeds Institute of Molecular Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution My role has been to advise the leaders of this population cohort study on measures to use in collecting data on children's developing speech and language
Collaborator Contribution My partners are currently planning a bid for funding to analyse the data which will be collected. I will collaborate with them on this and will be costed into the study.
Impact Multidisciplinary - psychology and speech & language therapy
Start Year 2016
 
Description Cleft Collective 
Organisation University of Bristol
Department School of Oral & Dental Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Specialist input on collection and analysis of speech and language data in this birth cohort study
Collaborator Contribution Access to families of children born with cleft lip and palate; support in plans for data collection and analysis
Impact NIHR post doc fellowship award for member of the research team
Start Year 2012
 
Description Cross validation of the Speech Disorders Classification System 
Organisation University of Wisconsin-Madison
Department Waisman Center
Country United States 
Sector Academic/University 
PI Contribution Access to ALSPAC data and transcripts
Collaborator Contribution Access to other data sources and analysis
Impact Paper submitted to Clinical Linguistics and Phonetics published
Start Year 2013
 
Description NIHR PDG application 
Organisation Association for All Speech Impaired Children
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution I have led an application to NIHR PDG scheme
Collaborator Contribution All partners have contributed to the bid and will contribute to the proposed work packages if funded
Impact Submission of grant to NIHR PDG scheme This is a multidisciplinary activity with psychology, statistics, health economics and PPI and clinical groups represented
Start Year 2018
 
Description NIHR PDG application 
Organisation Bristol Community Health
Department Community Childrens Health Partnership
Country United Kingdom 
Sector Hospitals 
PI Contribution I have led an application to NIHR PDG scheme
Collaborator Contribution All partners have contributed to the bid and will contribute to the proposed work packages if funded
Impact Submission of grant to NIHR PDG scheme This is a multidisciplinary activity with psychology, statistics, health economics and PPI and clinical groups represented
Start Year 2018
 
Description NIHR PDG application 
Organisation Royal College of Speech & Language Therapists (RCSLT)
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution I have led an application to NIHR PDG scheme
Collaborator Contribution All partners have contributed to the bid and will contribute to the proposed work packages if funded
Impact Submission of grant to NIHR PDG scheme This is a multidisciplinary activity with psychology, statistics, health economics and PPI and clinical groups represented
Start Year 2018
 
Description NIHR PDG application 
Organisation University of Newcastle
Country Australia 
Sector Academic/University 
PI Contribution I have led an application to NIHR PDG scheme
Collaborator Contribution All partners have contributed to the bid and will contribute to the proposed work packages if funded
Impact Submission of grant to NIHR PDG scheme This is a multidisciplinary activity with psychology, statistics, health economics and PPI and clinical groups represented
Start Year 2018
 
Description NIHR PDG application 
Organisation University of Strathclyde
Country United Kingdom 
Sector Academic/University 
PI Contribution I have led an application to NIHR PDG scheme
Collaborator Contribution All partners have contributed to the bid and will contribute to the proposed work packages if funded
Impact Submission of grant to NIHR PDG scheme This is a multidisciplinary activity with psychology, statistics, health economics and PPI and clinical groups represented
Start Year 2018
 
Description SuSSD 
Organisation Ulster University
Country United Kingdom 
Sector Academic/University 
PI Contribution I am working with Dr Jill Titterington and Natalie Hegarty on validation of a new tool for SLTs to use in determining which approach to intervention to use with children with speech sound disorder. My contribution is a knowledge and experience of bidding for external research funding and expertise in the area of speech sound disorder.
Collaborator Contribution My partners are developing the software and lead writers for the bid.
Impact None yet
Start Year 2018
 
Description Subtyping in speech sound disorders 
Organisation Charles Sturt University (CSU)
Department Faculty of Education
Country Australia 
Sector Academic/University 
PI Contribution I contribute access to the data and its current analyses, collaborators contribute statistical advice and analyses and international perspectives on the issue
Collaborator Contribution advising on statistical analyses Providing an international perspective on current views re subtyping
Impact One paper has been published. One small grant application for further development work in the area has arisen from the collaboration. The collaboration is multidisciplinary between speech and language therapy and statistics.
Start Year 2010
 
Description Subtyping in speech sound disorders 
Organisation University of the West of England
Department Department of Engineering Design and Mathematics
Country United Kingdom 
Sector Academic/University 
PI Contribution I contribute access to the data and its current analyses, collaborators contribute statistical advice and analyses and international perspectives on the issue
Collaborator Contribution advising on statistical analyses Providing an international perspective on current views re subtyping
Impact One paper has been published. One small grant application for further development work in the area has arisen from the collaboration. The collaboration is multidisciplinary between speech and language therapy and statistics.
Start Year 2010
 
Description The role of language in children's social and educational outcomes 
Organisation Newcastle University
Department School of Education, Communication and Language Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution lead applicant on a successful bid to the department for children Schools and Families (now DfE)
Collaborator Contribution Further analysis of ALSPAC data to uderstand risk and resilience in the broader contact of language developent and the role it plays in a child's educational success.
Impact Interim report to the DfE Final report to the DfE
Start Year 2009
 
Description Vision and speech development in young children 
Organisation Cardiff University
Department School of Optometry and Vision Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution I have been advising a clinical researcher who is applying for a fellowship. I will be a collaborator on her subsequent bid.
Collaborator Contribution The partner will submit an application for funding to pursue a joint bid on the topic of vision and speech development
Impact No outputs yet. Multidisciplinary
Start Year 2016
 
Description All Wales Speech Pathway 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Meeting with the leaders of the All Wales Speech Pathway followed by a presentation five months later to the members.
Outcome = use of findings from MRC funded study on risk factors for persistent speech disorder in their prioritisation document and care pathway
Year(s) Of Engagement Activity 2019,2020
 
Description Child Speech Disorders Research Network 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This expert panel discussed issues relating to professional practice and research relating to children with speech sound disorder. Feedback and actions took place after the event with the professional body, the RCSLT, and with professional practitioners.
Year(s) Of Engagement Activity 2017
URL https://www.nbt.nhs.uk/bristol-speech-language-therapy-research-unit/bsltru-research/child-speech-di...
 
Description March NBT SLT Enlightning talks 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact I spoke at the local NHS trust's series, 'Enlightning talks'. approximately 50 people attended, most of whom were clinical speech and language therapists. The aim of my talk was to speak about my research and its potential clinical applications. In response to this talk, one member in the audience explained that she would be changing her advice to parents in light of my findings, specifically with regards to the finding that when strangers can't understand children at age 3, there are at higher risk of persistent speech disorder.
Year(s) Of Engagement Activity 2017
 
Description North East Speech CEN 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Opportunity to challenge existing care pathways regarding prioritisation of children with speech sound disorder for intervention
Year(s) Of Engagement Activity 2018
 
Description Northern Ireland Speech CEN 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact This one day long clinical excellence network meeting provided the opportunity to talk with clinicians about the findings of my work on risk factors for persistent speech disorder and to challenge some existing care pathways regarding who to prioritise for intervention.
Year(s) Of Engagement Activity 2017
 
Description Persistent speech sound disorder 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented to a group of speech language pathologists at the American Speech & hearing Conference, a paper and led a workshop on predicting outcomes

speech pathologist discussed how this affects prioritisation of cases
Year(s) Of Engagement Activity 2009,2010,2012
 
Description Portsmouth University - Who's talking? Using Birth Cohort data to understand the risk factors for persistent speech disorder. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Undergraduate students
Results and Impact 25 attendees from the University of Portsmouth and local clinical services attended to hear about risk factors for persistent speech disorder. This led to a new collaboration with one of the teaching staff.
Year(s) Of Engagement Activity 2017
 
Description Scotland Speech CEN 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Opportunity to present research findings to clinicians and to challenge care pathways regarding prioritisation of children for speech and language therapy intervention
Year(s) Of Engagement Activity 2017
 
Description The Child Speech Disorder Research Network (September 2017) Developing guidelines to support good practice in children's speech disorders. Royal College of Speech and Language Therapists Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This poster showcased the work which had gone into developing the guidelines for analysis of children's speech samples
Year(s) Of Engagement Activity 2017
URL https://www.nbt.nhs.uk/bristol-speech-language-therapy-research-unit/bsltru-research/child-speech-di...
 
Description Wren, Y., Roulstone, S. (September 2017) Predicting persistent speech disorder in the early years: Findings from a population study. Royal College of Speech and Language Therapists Conference, Glasgow 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This paper reported on risk factors for persistent speech disorder at age 8 and how these can be used to prioritise children at risk of persistent problems in the earlier years.
Year(s) Of Engagement Activity 2017
URL https://www.nbt.nhs.uk/sites/default/files/BSLTRU_origins_PSD_Download.pdf