JCPSLP - March 2018

group and individual work. The earlier study found that the children who received the OL intervention improved on measures of vocabulary and grammar but not on literacy skills. Similarly, the children who received the PR intervention improved on measures of literacy but not on oral language skills. Crucially, for her clinical question, Bowyer-Crane and colleagues (2011) found that non-verbal IQ did not mediate the response to language intervention, meaning that when children were grouped into DLD with or without lower non-verbal IQ, both groups still improved on measures of vocabulary and expressive grammar. A similar conclusion – that non-verbal IQ did not significantly moderate language intervention outcome – was also reached in another RCT involving older school-aged children (Boyle, McCartney, Forbes, & O’Hare, 2007). The clinician has recently become aware of three valuable, free resources for the identification of evidence – the ASHA Evidence Maps, SpeechBITE and TRIP Database. She searches the ASHA Evidence Maps (https:// www.asha.org/MapLanding.aspx?id =8589947062), using the maps intellectual disability and spoken language disorder, and appropriate filter terms, but finds no relevant papers. Searches of the TRIP database fail to identify relevant papers. Within SpeechBITE she finds the rating of the methodological quality for the Bowyer et al. (2008) study and finds that the original RCT met 6 out of the 10 items relating to the internal validity and adequacy of the statistical comparisons reported for that trial (see http:// speechbite.com/speechbite/search/detail/026151). However, the clinician notes that comparison of intervention outcomes for groups that differ in intellectual ability are difficult to find. Although the clinician does not have access to scholarly databases through her workplace, she does have strong links with the university program in her local area. She contacts an academic staff member with interests in language disorders in school-aged children. The academic agrees to undertake a literature search. Due to demands on her time, she is able to search only one database, PsycINFO. She sends the following summary (Table 1) Note the search term “specific language impairment” is still used in order to capture previously published research. The abstract of the study indicates that the main focus was the question of change over time for children with developmental language impairment (DLI) aged between 4 and 7 years; however, it also states that non-verbal IQ did not predict language change. The clinician thinks that it would be useful to read the whole paper but it is not an open access paper. She decides to use Google to locate

the first author, searches the listing of publications, and is delighted to find that there is a free (pre-print) version of the paper available. She downloads the paper so that she is able to read the details of the study. Clinical bottom line The clinician is confident that she should definitely include school-aged children with DLD with or without low non-verbal IQ in her language intervention but doesn’t know for sure what their outcomes will be. Some indications suggest that non-verbal IQ may not affect progress following intervention, but further research is needed to determine whether children with DLD and non-verbal IQ outside of the normal range will benefit from her interventions. Future directions The clinician has begun a collaboration with a researcher, and both are interested in taking the collaboration further. They agree to meet before the intervention begins to discuss the type of approach and measures that can be taken in order to begin to contribute to the research base. The researcher suggests a single subject, multiple baseline experimental design. This will require that progress is carefully tracked for each child, and reported individually. The researcher also suggests that the research question would benefit from further refinement – for example, by specifying the type of intervention. As the group is due to start soon, they are aware that this will not constitute publishable research, given the timelines for ethics approval. However, the design will provide useful records of progress during intervention for each child. They agree to continue to work together with the aim of developing a research project that will address this important clinical question, obtaining ethical approval and ultimately sharing their findings through publication in an appropriate journal. Conclusion The scenario presented here may well be a familiar one to clinicians. Access to scholarly databases and the articles published within the journals is not always available, but there is an increasing number of freely available, web-based resources for identifying evidence from systematic research. Clinicians can make use of these to address the questions arising in their clinical practice. Once potential evidence from external research is identified, accessing the publication listing of authors may provide access to an open access copy of the research – something which may otherwise be difficult for clinicians. The scenario also indicates the value of clinician– researcher partnerships, in which the knowledge and experience of both can be used to make a contribution to the evidence base. No evidence is not bad evidence – but there are many areas in which we have little evidence. It falls to the profession to work towards addressing these gaps, using scientific methods to ensure the strongest possible evidence. Practice based evidence has the potential to contribute much to evidence-based practice (Lof, 2011). References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Bishop, D. V. M, Adams, C. V., & Rosen, S. (2006). Resistance of grammatical impairment to computerised comprehension training in children with specific and non-

Table 1. Results of literature search by advising academic

Database Search terms

Limited to:

Papers identified

Papers kept

27

1*

peer reviewed, English language, 2010 –2017, scholarly journals

Psycinfo

children, language intervention, language disorders, specific language impairment, non-verbal IQ

* Botting, Gaynor, Tucker, & Orchard-Lisle (2016).

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JCPSLP Volume 20, Number 1 2018

Journal of Clinical Practice in Speech-Language Pathology