American Journal of Speech-Language Pathology最新文献

Purpose: Pediatricians are the first professionals to provide guidance about language development to families with young children and referrals for those who may have a language or communication disorder. One-quarter of children in the United States are dual language learners (DLLs), yet there is little information about pediatrician's readiness to provide culturally and linguistically responsive care for these children. This pilot study sought to examine pediatricians' knowledge of bilingual language development and its relation to the provision of language and literacy promotion and developmental surveillance for Latine DLLs.

Method: Sixty-seven pediatricians at two academic pediatric clinics completed a survey asking about their knowledge about bilingual language development, Spanish proficiency, and provision of culturally effective health care to Latine DLLs. Analyses examined mean levels of these variables as well as relationships between knowledge, proficiency, and practices.

Results: On average, pediatricians' responses to the knowledge-based questions agreed with the evidence 69% of the time. Only 29% of pediatricians said they felt comfortable counseling Latine parents on bilingual language development, and 75% indicated they had difficulty recognizing signs of a language or communication disorders in Latine children from Spanish-speaking homes. Multiple regressions showed that pediatricians with higher Spanish proficiency and those with greater knowledge of bilingual language development provided more culturally and linguistically responsive care to Latine DLLs.

Conclusions: We identified significant gaps in pediatricians' knowledge about bilingual language development that were associated with their practice patterns. Results highlight the need for incorporating training about bilingual language development into pediatric education and increasing the number of providers that speak languages other than English.

Supplemental material: https://doi.org/10.23641/asha.29954468.

Purpose: For most preterm infants, survival depends on support provided in the neonatal intensive care unit (NICU). Oral feeding skills are key criteria for discharge. The Supplemental Nursing System (SNS) is a device designed to assist breastfeeding by delivering human milk to the infant. This study investigated the impact of the SNS on the oral feeding skills of preterm infants in the NICU.

Method: The study included 60 preterm infants aged 33-37 weeks of postmenstrual age followed in the NICU of a training and research hospital in southeastern Türkiye between August 20, 2022, and August 27, 2023. Once considered ready for oral feeding, infants in the experimental group received three daytime feeds with the SNS; their other five feeds and all feeds in the control group were given by bottle per unit routine. In both groups, three daytime feedings were evaluated in terms of physiological parameters (heart rate, oxygen saturation, and respiratory rate) before, during, and after feeding; Early Feeding Skills score; transition time to full oral feeding; weight change during the first 2 days of oral feeding; feeding efficiency; and average feeding duration.

Results: The SNS had no significant effect on weight (p = .684). However, SNS infants transitioned to full oral feeding earlier (2.97 ± 1.00 days vs. 4.23 ± 0.90 days; p ≤ .001) and had higher Early Feeding Skills scores (44.58 ± 2.96; p = .005), shorter feeding duration (13.55 ± 4.99 min; p = .021), higher oral intake ratio (91.25% ± 8.82%; p ≤ .001), and greater feeding efficiency (2.24 ± 0.91 ml/min; p = .003). Heart and respiratory rates during feeding were more stable in the SNS group (135.37 ± 15.35 vs. 153.95 ± 4.51; p < .001).

Conclusion: The SNS improves oral feeding skills, feeding efficiency, and transition time to oral feeding in preterm infants, offering an effective alternative to bottle-feeding.

Purpose: Co-design of research and services alongside end users is increasingly required by funding bodies and governments. To enable a meaningful inclusion of people with communication disability, planning and modification are required, as standard co-design procedures involve extensive spoken and written language. Experience-based co-design (EBCD) is one co-design approach that is gaining popularity; however, there are few detailed reports to date on adapting EBCD for communication disability. This article outlines our modifications of EBCD to co-design a technology-enabled self-management platform (Communication Connect) for people living with poststroke aphasia and cognitive-communication disability from traumatic brain injury.

Method: Participants included individuals with communication disabilities (n = 8), care partners (n = 3), and health professionals (n = 20) across three Australian states. Data collection involved video-recorded interviews, focus groups, and structured prioritization workshops. This study describes the first four stages of EBCD (project setup, two experience-gathering stages, and identifying priorities).

Results: This article presents a detailed account of the practical decisions and modifications made throughout the EBCD process. Key adaptations are outlined, including the use of text-based video editing to efficiently create touchpoint films, nonlinear presentation of challenges to facilitate engagement, and visual aids to support prioritization and ranking. These modifications supported the meaningful participation of co-designers, including people with communication disability.

Conclusion: This method article contributes to the growing knowledge on adapting EBCD for communication disability, which may be of use to future EBCD projects and for improving the meaningful inclusion of people with communication disability in co-design research.

Purpose: Despite overlapping anatomical foundations, voice and swallowing disorders are often treated separately in clinical practice. This study aimed to explore how speech-language pathologists (SLPs) conceptualize the physiological and therapeutic overlap between these domains, apply integrated strategies in clinical care, and navigate systemic and institutional barriers. Through qualitative analysis of clinician perspectives, we identified factors shaping the use of cross-system approaches.

Method: This qualitative analysis involved semistructured interviews with 25 experienced clinicians working with voice and swallowing disorders in clinics, hospitals, and private practices. The interviews were audio-recorded, transcribed, and analyzed using NVivo software. A hybrid thematic approach combined deductive codes from the interview guide with inductive codes from the data, aiming to identify key themes related to therapeutic integration and system-level influences.

Results: Clinicians recognized a significant anatomical and functional overlap between voice and swallowing. Fifteen themes emerged, grouped into four domains: (a) Perspectives on Integrating Voice and Swallowing Therapy; (b) Implementing Integrated Therapy; (c) Barriers to Integration; and (d) Expanding Education, Research, and Institutional Support. Although various dual-purpose strategies were described, their use was inconsistent. Key challenges included reimbursement policies favoring one modality, segmented training that reinforces clinical silos, and limited interdisciplinary collaboration.

Conclusions: Although SLPs recognize the overlap between voice and swallowing, systemic, educational, and policy-level barriers limited consistent integration. Addressing these challenges through training reform, institutional support, and stronger research-practice collaboration may enhance access to comprehensive care for patients with co-occurring disorders.

Purpose: A common intervention to address aspiration and reflux in infants is thickening milk. However, thickening milk may further complicate feeding management for infants with cleft palate using adaptive feeding methods. The purpose of this scoping review was to identify and describe the types of milk thickener used for infants with cleft palate (with or without cleft lip) and the feeding modalities through which thickened milk is administered.

Method: A comprehensive scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Five databases were searched: PubMed, Scopus, CINAHL, Google Scholar, and EBSCO Open Dissertations, in addition to citation searching. Records were limited to English-language publications with no date restrictions. Both peer-reviewed and gray-literature sources were included. After removing 868 duplicates, 2,282 records were screened by title and abstract. Sixty-four full-text articles were assessed for eligibility.

Results: One study met the inclusion criteria. Milk thickening was used as an intervention for infants with isolated Pierre Robin sequence and cleft palate. The thickener used was a modified corn-based flour at approximately 3% concentration to achieve a thicker liquid consistency. The thickened milk was offered via a bottle with latex nipples of varying hole sizes (original, intermediate, and 1-mm) depending on the infant's needs. Despite only one study meeting the inclusion criteria by specifying thickener type and/or feeding modality, 11 tutorial and seminar articles that discussed milk thickening as an intervention strategy in this population were identified. However, these articles lacked any information on the type of thickener and feeding modality, and none implemented the intervention with infants.

Conclusion: Although milk thickening is described as a strategy in several tutorial and seminar articles, there is a paucity of empirical evidence to support milk thickening as a feeding intervention strategy for infants using cleft-adapted feeding methods.

Purpose: The aim of this study was to determine the age at which children with voice disorders can complete videostroboscopy, acoustic, and aerodynamic voice assessments. Factors predicting videostroboscopy tolerance were examined.

Method: A retrospective observational cohort design was used. Three hundred twelve children with voice disorders were divided into the following age groups: 3-4, 5-6, 7-9, 10-12, and 13-17 years. Videostroboscopy was considered complete if patients produced enough phonation during the exam to allow for stroboscopic ratings of vocal fold oscillation (i.e., mucosal wave, amplitude) to be performed. Patient demographics, voice-related diagnoses, voice symptoms, vocal fold oscillation ratings, clinician experience level, and acoustic and aerodynamic voice measures were collected from the medical record.

Results: All children tolerated laryngeal imaging under steady-state halogen light. Almost 17% of 3- to 4-year-olds tolerated videostroboscopy. This number significantly increased to 55% in 5- to 6-year-olds (p < .01) and to 60% in 7- to 9-year-olds. Success rates again significantly increased to 85% in 10- to 12-year-olds (p < .01) and 93.1% in children ≥ 13 years old. Age (p = .03) and ability to perform the voice range profile (p < .01) and aerodynamic voice assessment (p < .01) tasks significantly predicted which patients could tolerate videostroboscopy. Half of 3- to 4-year-old children produced sustained phonation for acoustic analyses compared to 91.7% of 5- to 6-year-olds (p < .01). The majority of children ≥ 5 years old completed the voice range profile task (63.3%) and aerodynamic voice assessments (66.7%).

Conclusions: Videostroboscopy is viable for young children with voice disorders. The ability to complete aerodynamic and voice range profile tasks may serve as a preliminary indicator of how well a patient will tolerate videostroboscopy. Future prospective study may determine the most effective approach to help children tolerate instrumental voice assessments.

Purpose: The purpose of this study was to investigate the communication success of partners with matched or mixed neurotypes and to explore how these differences influence the identification of neurotypes during interactions.

Method: Thirty-three autistic adults and 37 non-autistic adults were paired in either a matched-neurotype or mixed-neurotype condition and were not told their assigned condition. The pairs completed two structured communication tasks (20 questions and tangram identification), for which accuracy and efficiency of completion were measured. Participants completed a survey about rapport in their interactions and their perception of their partner's neurotype.

Results: Matched autistic pairs communicated significantly more accurately (p = .037) but significantly less efficiently (p = .047) than matched non-autistic pairs. Mixed-neurotype pairs reported significantly lower rapport than the matched-neurotype pair conditions (p = .023), which did not differ significantly from one another. Matched autistic pairs were significantly more accurate (p = .009) and more confident (p = .035) in their guesses about their partner's neurotype than participants in other conditions. However, participants' guesses were not significantly related to their communication success in the experimental tasks.

Conclusions: Neurotype-matching is associated with stronger rapport development and greater communication success, suggesting that autistic and non-autistic communication styles differ. Autistic participants demonstrated strengths in perceiving others' neurotypes, but communication success factors were not associated with neurotype perceptions.

Purpose: The aim of this study was to reach consensus among researchers, clinicians, and service managers on the most important outcomes of cognitive-communication treatments for children and adolescents (ages 5-18 years) with traumatic brain injury, in the postacute stage of rehabilitation and beyond.

Method: This is an international three-round e-Delphi study. In Round 1, participants answered three open-ended questions, generating important treatment outcomes at three stages of development (5-11, 12-15, and > 15-18 years). Results were analyzed using qualitative content analysis and combined with outcomes from a previous scoping review. In Rounds 2-3, outcome importance was ranked on a 9-point scale. Consensus was defined a priori with outcomes rated as being "essential" (7-9) by at least 70% of respondents and rated 1-3 by less than 15% of respondents. Consensus outcomes were linked to the International Classification of Functioning, Disability and Health (ICF).

Results: A total of 360 outcomes met consensus for all age groups. For 5- to 11-year-old children, important outcomes linked almost equally to the Body Functions (n = 52, 13.1%) and Activity/Participation (n = 50, 12.6%) components of the ICF. Outcomes of "successful start to school," "return to school," and "school functioning" were uniquely important. For older children and adolescents, outcomes linked to the Activity/Participation component of the ICF most frequently (12-15 years: n = 62, 15.6%; > 15-18 years: n = 73, 18.4%). For older cohorts, unique outcomes of "emotional safety," "employment," and "life skill development" met consensus.

Conclusions: Participants consider many outcomes, spanning most of the ICF, to be important for children and adolescents with cognitive-communication disorders (CCDs). As children and adolescents age, the importance of ICF components shifts, and distinct outcomes emerge, highlighting the necessity of developmentally relevant rehabilitation. The broad range of outcomes reaching consensus reflects pediatric CCD complexity and the need for holistic, person-centered care. Future research should explore the priorities of children and adolescents with CCDs and their families.

Purpose: This viewpoint explores the idea that a neurodiversity-affirming social model and a medical model of stuttering health care are not mutually exclusive. In all cases, they should be used in combination. For any client, the only way to attain an optimal clinical outcome is to apply a combined medical and social health care perspective. The two models have a changing contribution across the lifespan, according to the client's requirements, age, and presenting complaints and the viability of neuroplastic change of the speech mechanism.

Conclusions: The benefits of neurodiversity applied to stuttering are a "feast" that is "moveable" according to the developmental stage of stuttering and the personal needs of clients. A less flexible view of the matter may prevent the best treatment outcome for clients. In the case of early stuttering, an inflexible approach may cause serious, long-term harm to children.

Purpose: This qualitative study explored the perspectives of parents of young children with childhood apraxia of speech (CAS) in terms of (a) long-term desired outcomes for their child and (b) experiences of early intervention (EI). Although parent and client perspectives are recognized as a key component of evidence-based practice (EBP), there is currently sparse information about parent experiences to direct speech-language pathologists' clinical practice.

Method: The parents of 14 children with a confirmed CAS diagnosis participated in this study. Participants were from Australia and the United States. Online semistructured interviews were used to explore parents' desired long-term aspirations for their child as well as their experience of EI. Reflexive thematic analysis was used to analyze the data.

Results: Three themes described the long-term desired outcomes, with participants aspiring for their child to communicate effectively, participate in everyday life, and experience feelings of well-being. There were four main themes related to parents' experiences of EI with their child with CAS: (1) finding and maintaining access to EI services is time consuming and complex; (2) quality CAS services are about therapist skills, frequency, and do-ability; (3) the wider context: EI is not just about what is happening for the child and family in speech-language pathology; and (4) children improve, but at what cost?

Conclusions: Parents have clear long-term aspirations for their child to be able to communicate effectively and to participate in and have a good quality of life, despite acknowledging the long-term nature of CAS. Experiences of EI indicate complexities in receiving appropriate intervention and the impact on the child and family as a whole. Clinicians are encouraged to consider these findings in implementing EBP.

Supplemental material: https://doi.org/10.23641/asha.30179068.