a safari amongst language research

1: A Safari Amongst Language Research NSW EBPN: Paediatric Language Group Clinical Network Leader: Brooke Funnell Liverpool Health Service 9828 4776

2: The Crew Auburn CHC Chatswood CHC Dubbo CHC Forster CHC Hills CHC Hillview CHC Lismore CHC Liverpool CHC Macarthur Health Service Mt Druitt CHC NEXUS (John Hunter) Queenscliffe CHC SCH Uni of Sydney

3: Where Did We Come From? Difficulties with clinical questions and searches Dearth of positive useful data Multiple baseline designs Topics covered included phonological awareness, models of service delivery, long term effects of language disorder, language therapy techniques, parent training On the path to a CAT In the beginning we tried very hard to form clinical questions using the framework patient/problem, intervention, comparison and outcome. We then did literature searches and often got no relevant studies. However we did come across interesting articles in the process and so it came to pass that we did CAPs on these and wrote the clinical question post hoc. I know, not quite the right sequence, but it worked for us for a while and we followed up with studies from the reference list. The language area is so broad and well- designed studies, according to guidelines, so few that we struggled to find positive useful data. We returned to the more conventional approach of formulating a clinical question and covered topics such as the long term effects of language disorder the effect of phonological awareness therapy on literacy the effect of therapy on school age children with SLI parent training, group therapy vs. individual therapy models of service delivery spontaneous recovery of early language delay. Our next move was to look at more practical research designs for speech pathology. We reviewed multiple-baseline designs and found some practical information. We have now returned to the designated path towards a CAT. In the beginning we tried very hard to form clinical questions using the framework patient/problem, intervention, comparison and outcome. We then did literature searches and often got no relevant studies. However we did come across interesting articles in the process and so it came to pass that we did CAPs on these and wrote the clinical question post hoc. I know, not quite the right sequence, but it worked for us for a while and we followed up with studies from the reference list. The language area is so broad and well- designed studies, according to guidelines, so few that we struggled to find positive useful data. We returned to the more conventional approach of formulating a clinical question and covered topics such as the long term effects of language disorder the effect of phonological awareness therapy on literacy the effect of therapy on school age children with SLI parent training, group therapy vs. individual therapy models of service delivery spontaneous recovery of early language delay. Our next move was to look at more practical research designs for speech pathology. We reviewed multiple-baseline designs and found some practical information. We have now returned to the designated path towards a CAT.

4: Where Are We?? Our CATs to date What is the most Effective form of treatment for 4 year olds?� Word Finding Difficulty� EI SDM � Parent Training vs Clinician Led Rx vs No Rx This one we�ve just finished the CAPS and only need to collate them into a CAT In process Completed CompletedThis one we�ve just finished the CAPS and only need to collate them into a CAT In process Completed Completed

5: Lost in the NH&MRC How can we achieve NH&MRC 1? What makes a �pseudorandomised� control trial in language? Some of our quandaries Linda will talk to these more Some of our quandaries Linda will talk to these more

6: A Good Trek Vasilyeva, M., Huttenlocher, J., & Waterfall, H. (2006). Effects of language intervention on syntactic levels in preschoolers. Developmental Psychology, 42(1), 164-174. Level II Current research Still lots of questions (weaknesses) arose from it. Study didn�t determine if the participants had any underlying language, development, or emotional/behavioural difficulties Poor comprehension task � not statistically strong data

7: A Good Trek Hodge, T. & Downie, J. (2004). Together we are heard: Effectiveness of daily �language� groups in a community preschool. Nursing and Health Sciences, 6, 101-107. Level IV Weak research but clinically good Australian The program wasn�t referenced, extraneous variables weren�t controlled for & there was no control group � why not? Multiple baseline design??

8: A Poor Trek Telleen, S., Wren, C. (1985). Acquisition of prepositions in language delayed preschoolers: is intervention effective? British Journal of Disorders of Communication, 20, pg 301-309 No strengths! Couldn�t give it an evidence rating!!! No control groups or randomisation No statistical analysis Poor description of procedure � testing, therapy, criterion Poor description of subjects: reason for cognitive delay and there was a huge range Poor inclusion/exclusion criteria - No information regarding other services the children were receiving i.e. SP

9: Our Challenges Lack of good research Where are the randomised control trials?? Clinical Questions Need to be specific Lots to cover Slow progress � is it more effective? A lot of our papers may be statistically sound or well researched but aren�t practical. Or they�re practical but not well researched As mentioned in the history, writing a good clinical question that will get us a good number of papers has been difficult We went broad but found it hard to complete a topic Narrow it down too much and you don�t get many papers We are averaging 1 CAT a year. This may seem like a slow process but we feel that in doing things this way we are understanding our papers better and everyone is involved in each paper. 3 articles are sent out for each meeting. Members select 1 or more of the articles to CAP. They�re brought to the meeting and discussed. Comments are added to each CAP and then it is edited for publishing.A lot of our papers may be statistically sound or well researched but aren�t practical. Or they�re practical but not well researched As mentioned in the history, writing a good clinical question that will get us a good number of papers has been difficult We went broad but found it hard to complete a topic Narrow it down too much and you don�t get many papers We are averaging 1 CAT a year. This may seem like a slow process but we feel that in doing things this way we are understanding our papers better and everyone is involved in each paper. 3 articles are sent out for each meeting. Members select 1 or more of the articles to CAP. They�re brought to the meeting and discussed. Comments are added to each CAP and then it is edited for publishing.

10: Where Are We Heading? General comprehension Auditory Processing Disorders Looking at the evidence for specific therapy programs � �Blades� and �Prompt� School language / Curriculum Based Learning

11: Thank You Come and join us next year. Contact me on (02) 9828 4776 or Brooke.Funnell@sswahs.nsw.gov.au Our meetings are the 3rd Tuesday of February, May, August, & November 2.30 � 4.30