JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Table 1. Characteristics of children referred

Childcare centre

Preschool

Primary school 1

Primary school 2

32 80

24 125 19.2% 50%

34 270 12.6% 50%

24 540 4.4% 54%

Total referred School roll % referred % male

40% 56%

Age (no. of children referred) Primary concern Late talkers Speech Language Literacy

1;7–3;3 (8) 3;4–5;8 (24)

3;4–4;11 (24)

5;6–8;11 (20) 9;0 – 12;11 (14)

5;6–8;11 (16) 9;0–12;11 (8)

8 16

16 8 –

10 10 14

7 11 6

8 –

Screening concerns

PA, story grammar awareness and memory for narrative

Treated (%)

28 (88%)

14 (58%)

28 (82%)

20 (83%)

1 IPD ➔ Delay

6 SSD ➔ PA (4) SSD ➔ language (2)

3 SSD ➔ PA (1) SSD ➔ language (2)

Re-referrals 2016 ➔ 2017 treatment targets

2 late talker ➔ IPD CPD ➔ CPD

IPD: inconsistent phonological disorder; Delay: speech errors typical of a younger child; CPD: consistent phonological disorder; PA: phonological awareness.

Case synopses Each student selected one case they had found challenging for inclusion as a case study. Three were chosen to illustrate range of communication difficulties and therapy outcomes. A. Child aged 5;2 years: speech. Although all age-appropriate speech sounds could be articulated, A made systematic vowel errors, reduced clusters and deleted syllables (PCC 32%, PVC 54%). Fluent connected speech, appropriate prosody and typical oromotor skills indicated a phonological SSD. Individual phonological contrast intervention in seven 40-minute sessions targeting vowels using minimal triplets (e.g., big , bag , bug ) and consonant clusters using minimal pairs (e.g., boo vs blue ) led to improved PCC 64% and PVC 68%. At follow-up assessment after 2 months A showed PCC 75% and PVC 93% and was referred to the school SLP. B. Child aged 4;3 years: pragmatic language impairment. Standardised assessment indicated a gap between expressive language (39th percentile) and comprehension (75th percentile) that reflected poor pragmatic use of language (e.g., turn taking, topic maintenance). Eight 60-minute therapy sessions, involving retelling stories, describing pictures and pretend play, targeted the use of language to predict and solve problems, while increasing attention span. Discussion with family encouraged shared reading involving story retelling. While reassessment found age-appropriate expressive language scores at the clinic’s end and the 2-month follow-up, as B’s teachers reported difficulty using language to engage with peers, further therapy was recommended. C. Child aged 6;10 years: language delay. Standardised assessment performance was below the normal range for following instructions, expressive morphology and sentence grammar. Eight individual 30-minute sessions targeted two-step instructions (e.g.,

Intervention was provided to 90 (79%) of the 114 children referred, 49 children received individual therapy and 41 children only received group therapy. Twelve children (13%) treated in 2017 had been previously referred in 2016. Table 1 indicates identified different communication concerns for the two years (e.g., literacy difficulties emerged despite resolved SSD). Prioritisation and intervention goals Students’ clinical reasoning for prioritisation of their caseload for treatment was justified by: additional assessment results; poor attendance (e.g., contraindicating intensive intervention); or, communication difficulties associated with a pervasive disorder (e.g., autism spectrum disorder). Reports provided assessment findings, referrals and/or recommendations for the 24 children who did not receive intervention. Students established intervention block goals and evidence-based intervention plans for 90 children selected for individual and/or group intervention (see table 2). Some children receiving individual intervention also attended group sessions. Two to three groups were delivered bi-weekly at each site (e.g., targeting story grammar, PA, letter knowledge). Reports for all participants included recommendations for staff and parents. Staff at three sites were trained and given resources to provide ongoing treatment. Students collaboratively designed handouts for supporting language development and shared reading. Table 3 indicates that 17% of all children treated were referred for further therapy. Only 14% of preschoolers were referred on as compared to 20% of primary children. The findings show that at the end of 3 weeks’ intensive intervention (on average each child received six 30-minute sessions), around 80% of children performed age appropriately on administration of either subtests or complete standardised assessments. Intervention outcomes Need for additional therapy

Michelle Wong (top) and Meg Keage

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JCPSLP Volume 21, Number 2 2019

Journal of Clinical Practice in Speech-Language Pathology