Better Conversations with Children: development and evaluation of a new intervention for children with language disorder

Lead Research Organisation: University College London
Department Name: Language and Cognition

Abstract

Developmental Language Disorder (DLD) affects around two children in every Year 1 classroom (Norbury et al., 2016), of whom half will experience difficulties into adolescence and beyond (Stothard et al, 1998). Problems with spoken and written language can lead to poor educational outcomes, mental illness and an increased risk of offending (Bryan et al., 2007). Given the intractability and potential consequences of DLD, early and effective intervention is crucial. To date, the focus of language therapy research has been at the single word and sentence level, despite conversation being the primary context for communication and the main medium through which children build social relationships. The aim of this study is to trial a new conversation-based therapy programme for children with DLD, drawing on established methods used with other clinical populations. It employs a case series design, with each child acting as his/her own control. 20 children, aged six to eight years, and their main carers will participate. Change will be evaluated through formal language assessments and both qualitative and quantitative conversation measures. Broader effects of the intervention will be explored using a quality of life scale.
The research has the potential to improve social and educational outcomes for young people, while parents and teachers will benefit from strategies to support children in conversation. The study may inform policy in both clinical and education settings through its emphasis on incorporating families within therapy. The project will pave the way for larger-scale trials to compare the new intervention with usual clinical practice.

Publications

10 25 50
 
Description A new intervention for children with Developmental Language Disorder has been co-designed, to be called 'Better Conversations with Children'. A feasibility study was completed as part of my funded MRes study to evaluate recruitment, retention and acceptability for the intervention.

Initial results from the first four dyads indicate that primary-aged children with DLD can benefit from the therapy, which was designed to improve their everyday conversation. Following BCC, carers were able to adapt their own communication style in order to support their child's language development. Children made gains on standardised language scores, which were not expected to occur during the time frame of the study. In particular, 3 of the 4 children made progress on a standardised sentence comprehension test, a potentially key finding, as previous studies have consistently reported that receptive language disorder is 'more resistant to intervention' than specific expressive or phonological difficulties (Boyle, McCartney, O'Hare & Law, 2010, p.994). Further analysis will be necessary to determine what factors may influence this change and whether the scale and nature of progress relates to children's underlying language profiles.

The results have the potential to influence the delivery of speech and language services to children in mainstream primary schools, while offering support for a growing population of children and their families who are living with DLD.
Exploitation Route Beyond the PhD, it is hoped that findings will be taken forward by Speech and Language Therapists and other professionals who work with this clinical population. Contacts have been made, which may lead to future collaborations in order to further develop the BCC intervention, with a view to influencing both individual practice and service delivery.
Sectors Education,Healthcare
 
Description Findings from individual children who have participated in the study have been used to provide advice and support to parents and education staff on how best to support the child's communication at home and at school. Both carers and teachers have reported using recommended strategies from the 'Better Conversations' programme and the parent-reported 'Children's Communication Checklist' indicates that children have shown improvement in their functional communication as a result of the research. Clinicians who have attended events and talks, raising awareness of the 'Better Conversations' project have reported a change in their own attitudes to intervention, which may inform their therapeutic provision. For example, the NHS team who invited me to talk at their Continuing Professional Development Day are now looking to increase parental involvement in speech and language therapy for school-aged children. The Californian SLPs who visited our department reported that they intend to focus more on conversation and working with parents within their own practice.
First Year Of Impact 2019
Sector Education,Healthcare
Impact Types Societal,Policy & public services
 
Description ESRC Business Boost Programme - The Language and Life Ladder: expert evaluation and development
Amount £1,000 (GBP)
Funding ID 164497 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 04/2019 
End 07/2019
 
Description UKRI Phase 2 funding extension
Amount £5,934 (GBP)
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 09/2021 
End 01/2022
 
Title Language and Life Ladder 
Description Two children in every Year 1 class have Developmental Language Disorder (DLD) and many are referred to clinical services. Published assessment covers the children's speech and language but does not routinely capture the children's own views of the impact of their communication disorder on their life. Therefore, the 'Language and Life Ladder' has been developed to encourage children to explore their feelings about their own talking, using simple visual scales (including a ladder) to elicit their views. Findings from the tool can be used to inform clinical goal-setting prior to the 'Better Conversations' intervention, as well as to track progress on language-related quality of life. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2019 
Provided To Others? No  
Impact So far, the new tool has been used within 'Better Conversations with Children' to capture children's feelings about thier speech and language difficulties before and after intervention. The measure can demonstrate whether children are feeling OK/ better about their language, even if they show little progress on other assessments. This information can be shared with parents and teachers and can be used to provide a more rounded picture of the child, e.g. when transitioning to a new class. The child's views can also be used to help inform therapy, e.g. by highlighting areas of greater or less concern to them. Overall, it is hoped that the use of the tool throughout the 'Better Conversations' project will help increase our understanding of the impact of DLD from the child's perspective and shape decisions about the ongoing development of our intervention. 
 
Title New dataset of children's conversation data 
Description There is limited data available for studying conversational interactions between children and their carers. The UCL Human Communication Audio-Visual Archive (CAVA) is a UK repository of natural audio-visual recordings, consisting of conversations, interviews and assessments between a person who has atypical communication and a conversation partner. Thus far, the available materials include interactions between infants (up to the age of two) and their parents, and between children with language impairment and their teachers, but not conversations between school-aged children and their carers which are the focus of our proposed study. The Child Language Data Exchange System (CHILDES) is a US-based resource, consisting mainly of written transcripts. The majority of data originates from North America, although there is a smaller British English corpus. Little data exists for our target age group and the method of data collection varies across the contributing studies. The 'Better Conversations' project will include collecting video-recorded conversations between primary-aged children and their parents. 10 of these children will present with clinical language difficulties (as demonstrated by their scores on the Clinical Evaluation of Language Fundamentals; CELF-5, Semel et al., 2017) and will form part of our research intervention group. A control group of children with typically-developing language will be recruited so that we may compare features of their own recorded conversations with carers against those of the DLD group. Data will be analysed using conversation measures, which have been used with other clinical populations, e.g. child mean length of utterance, ratio of child:adult speech (measured in seconds) and counts of conversation behaviours, such as test questions by parents or children giving up when stuck on a word. Participants will be offered a range of consent options, e.g. to delete their video data a year after the 'Better Conversations' project is completed or to allow their recordings and transcripts to be kept and shared with other researchers. 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? No  
Impact Raised understanding of the effect of language disorder on children's conversations with their main carers. Analysis is currently underway to compare the data from DLD children against that of the typically-developing group. 
 
Title 'Better Conversations with Children': intervention development 
Description 'Better Conversations with Children' (BCC) is a novel Speech and Language Therapy intervention for primary school children with Developmental Language Disorder and their main carers. The programme is based on principles and techniques used successfully with other clinical populations, e.g. conversation-based therapy for adults with acquired language disorder ('Better Conversations with Aphasia'; Beeke et al., 2013) and parent-child interaction therapy for pre-school children with language delay (Falkus et al., 2016). BCC is at an early stage of development, having been piloted with six carer-child dyads as part of my funded MRes and PhD research. Results from a total of 10 dyads will be collected and analysed at both an individual and group level within my PhD study. Outcomes will be evaluated to inform future development of the intervention and to help guide sample size calculations for a larger scale trial. 
Type Therapeutic Intervention - Psychological/Behavioural
Current Stage Of Development Initial development
Year Development Stage Completed 2019
Development Status Under active development/distribution
Impact This study is the first to explore the use of a conversation-based intervention, BCC, with school-aged children and their main carers. Case series findings from the first four parent-child dyads strongly support the further development of the programme and add to the emerging evidence for conversation therapy, which up to now has been focused on adults with acquired language disorder. Following therapy, adults were able to re-design their turns to support their child's language development (as evidenced by their increased use of facilitative conversation behaviours and reduction in barriers), though children may require more prompting and explicit practice to reflect on and change their own conversation behaviours. This is consistent with the findings of Samuelsson and Plejert (2015). Following BCC, children made gains on standardised language scores, which were not expected to occur during the time frame of the study. In particular, 3 of the 4 children made progress on the CELF sentence comprehension subtest, a potentially key finding, as previous studies have consistently reported that receptive language disorder is 'more resistant to intervention' than specific expressive or phonological difficulties (Boyle, McCartney, O'Hare & Law, 2010, p.994). Further analysis will be necessary to determine what factors may influence this change and whether the scale and nature of progress relates to children's underlying language profile. For example, participants A and C made the greatest gains on their CELF Core Language Composite and were also the two children who started with the highest standard scores. The project has extended the use of principles and methods from PCI to older children, involving them actively in therapy alongside their parents. Positive changes in adult-child conversations were achieved within a clinically realistic time frame and mixed methods provided a detailed view of how BCC impacted on participants' everyday interactions. 
 
Description Focus groups for specialist clinicians to develop a new language-related quality of life measure 
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 Planned and organised two focus groups to develop a new quality of life-related measure for children with Developmental Language Disorder (May 2019). The events were attended by 11 specialist clinicians from the NHS and private practice and moderated by an external marketing research professional.

Overall, the response to the proposed new tool was positive, with many participants highlighting the need for a tailored instrument to capture children's thoughts and feelings about their language disorder. Practical solutions were proposed to address some of the current weaknesses of the prototype, e.g. opportunities to simplify language and increase visual support. The tool has been modified in response to feedback.
Year(s) Of Engagement Activity 2019
 
Description Invited talk to visiting Speech and Language Pathologists from California, US 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A group of Speech and Language Pathologists from the California Speech Hearing Association visited UCL in October 2018. They were keen to make contacts in the UK and to develop research and practice collaborations with international partners. As part of their programme of visits, I was asked to give a talk with my supervisor about the 'Better Conversations with Children' project. This prompted a lively discussion, with several of the participants reporting that they would try incorporating conversation-based therapy into their clinical work and welcoming our insights into working with parents to support children with Developmental Language Disorder.
Year(s) Of Engagement Activity 2018
 
Description Poster presentation at the Royal College of Speech and Language Therapists biennial conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Over 400 participants at the RCSLT's virtual conference accessed our poster across the two-day event, with several leaving comments and questions on the Whova platform. The event led to an invitation to speak to researchers and clinicians at Birmingham City University, as well as a follow-up meeting with a researcher who is developing a similar conversation-based intervention for adults with learning disability.
Year(s) Of Engagement Activity 2021
URL https://www.rcslt.org/events/rcslt-conference-2021/
 
Description Presentation to NHS speech and language therapy team as part of their annual study day 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact 15 Speech and Language Therapists attended the invited talk, which formed part of their team's Continuing Professional Development study day. The presentation sparked questions and discussion about how therapists currently deliver their therapy within schools and whether they could engage more actively with parents, using insights from the 'Better Conversations with Children' project.
Year(s) Of Engagement Activity 2019
 
Description Twighlight talk to Speech and Language Therapists who were considering undertaking a PhD at UCL 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact 45 therapists attended a doctoral information session held within UCL's Psychology and Language Sciences department. I was asked to give a presentation about my research and journey from clinical practice to academic study. This generated questions from the audience, as well as follow-up emails seeking more information about my project and how to put together a PhD / funding proposal.
Year(s) Of Engagement Activity 2018