Helping children with impaired communication skills

Research at UWE Bristol has reassessed services for children with speech, language and communication impairment, emphasising the perspectives of the children themselves and their families. The findings have directly influenced major policy reports, a National Year of Communication, and have improved therapy practice.

Evidence from research

Language skills are crucial to children’s development, yet impairments in these skills affect around 7% of children of primary-school age. What are the best ways to help their language development skills, and what are the priorities of their families and of the affected children themselves? Research led by Professor Sue Roulstone has provided evidence that helps answer these questions.

Perspectives of children and parents

There was already a consensus that services for children were likely to improve if their perspective is listened to. This is a particular challenge in the case of children with speech, language and communication impairment. Using non-verbal activities such as drawing, taking photographs and compiling a scrapbook, the UWE Bristol team created a supportive environment within which the children could express themselves. This made their own thoughts on their impairment explicit for the first time.

In 2007, the UK’s then Secretaries of State for Health and for Children, Schools and Families asked John Bercow MP (later the Speaker of the House of Commons) to lead a review of the services provided for children and young people with speech, language and communication needs. This review commissioned Roulstone to undertake independent research on the views of children and parents.

Roulstone’s team found that parents saw communication as central to their child’s development. They wanted well-signposted services, access to specialist resources, and a timely diagnostic process in which professionals worked in partnership with parents.

Finding the factors influencing development

How do parents’ activities with their children affect their language development? In 2011, working with colleagues from the Universities of Bristol, Newcastle and Sheffield, the UWE Bristol team analysed data from a large-population study (the Avon Longitudinal Study of Parents and Children) with which they had been involved. They found a significant link between the child’s language abilities at age two and the parents’ activities with them when they were younger. This ability level was in turn significantly linked to their performance in school entry assessments, suggesting children who develop their language early are at an important advantage.

The research also looked in 2012 at current practice in programmes designed to support the development of children’s communication. In collaboration with the Universities of Warwick and Newcastle, Roulstone and Dr Yvonne Wren from UWE Bristol found that only 5% of these programmes were based on strong evidence; 56% had evidence from at least one trial and 39% had only face validity or were based solely on case studies.

Influencing public policy and guidance

The research had a direct influence on the report of the Bercow Review, published in 2008. As well as acknowledging and quoting from the research directly, the headings of four out of its five key conclusions reflect the findings on parents’ priorities:

• Communication is crucial
• Early identification and intervention are essential
• A continuum of services, designed around the family, is needed
• Joint working is critical

In response to the Bercow Review, the Government established a ‘Better Communication Action Plan’. As part of this, the UK national Commissioning Support Programme published in 2011 a guidance document for professionals such as those who commission services for children with communication impairments. This included, as a substantial appendix, the materials and guidance tools developed by Roulstone and her team to help the children express their perspectives. The document encouraged care professionals to use these tools to involve the children in planning their care.

The Government announced that 2011 would be a National Year of Communication. This was recommended in the Bercow Report, which had picked up Roulstone’s finding emphasising the central role of communication in children’s lives. The National Year highlighted the findings linking parents’ activities with their children in their first two years with their subsequent language skills, inviting Roulstone to present them to relevant professionals including speech and language therapists.

Several other policy documents that recommend the development of services to identify and help children with communication impairments draw evidence from Roulstone’s research. Examples at the UK national level include the Nutbrown Review (2012) and the All-Party Parliamentary Group on Speech and Language Difficulties (2013). Similarly, at the regional level in South Wales, the Aneurin Bevan Health Board ‘Flying Start’ Speech, Language and Communication Development Service drew on the research in drawing up their ‘Strategy for the Prevention, Early Identification and Intervention for Speech, Language and Communication Needs for Children’.

Influencing practice

All this has had a direct bearing on practice on the ground. Feedback confirms that speech and language therapists have introduced children’s views into their auditing process as a result of hearing about Roulstone’s research findings in this area.

The findings on the level of evidence that underpinned current therapy programmes have stimulated moves towards better evidence-based practice. The Communication Trust, a coalition of voluntary-sector organisations with expertise in speech, language and communication, commissioned Roulstone to help develop a database called ‘What Works’.

The database provides information to care commissioners, managers and practitioners on the level of evidence underpinning particular programmes and interventions, so that they can take this into account in making their selections. The site was launched in March 2013. By the end of July, there had already been over 5,000 individual registrants.

Relevant, rigorous research at UWE Bristol, via engagement with policymakers and practitioners, is helping to bring about real changes in the help that is offered to children with communication difficulties.