Treatment of Speech and Language Disorders in Children with Neurodevelopmental Disabilities

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1 Treatment of Speech and Language Disorders in Children with Neurodevelopmental Disabilities Steven F. Warren, PhD Schiefelbusch Institute for Life Span Studies and Department of Speech- Language-Hearing Sciences and Disorders University of Kansas March 9, 2015

2 Conflicts I have no financial or other conflicts related to the content of this presentation or research on which it is based.

3 Acknowledgements NICHD and NIDCD; US Department of Education; LENA Foundation University of Kansas and Vanderbilt University Numerous colleagues including Paul Yoder, Marc Fey, Nancy Brady, Ann Kaiser, Joanne Roberts, Marsha Maalick, Jill Gilkerson, Kim Oller, Len Abbeduto, Don Bailey, Eva Horn, and Kandace Fleming Several hundred children and their parents

4 Outline Premises Screening Treatment Concluding Comments

5 Research Based Premises Speech and language disorders impact many other aspects of development including especially social, cognitive, and emotional development The communication and language problems apparent by age 3 generally emerge much earlier By 30 months of age language learning trajectories predict later differences in literacy development and elementary school success. Nevertheless, much can be done during later childhood to improve the communication abilities of children and adolescents. Stable, involved families are an important key to successful treatment

6 Research Based Premises Children who are relatively passive, unresponsive, and/or difficult to manage will cumulatively experience less language input, and qualitatively different input compared to other children Communication interventions that do not impact a child s social interaction are unlikely to produce meaningful changes in their language development Potentially effective treatments at any age may have little impact due to short duration and/or insufficient dose and/or being mismatched to individual child needs Different speech and language disorders may require specific adaptations but the basic underlying premises and approaches are often the same

7 Screening..what works? Severe disorders (3 or more standard deviations below the mean) can be screened for effectively at a general level due to their severity. However, the specific strengths or weaknesses of a child generally requires an extended period of evaluation. This may affect treatment, but not determination of need

8 Intervention State of the Science Most behavioral treatments in clinical use were initially developed between the 1960 s and 1990 s. Although treatments may go by many different names, they often share many similarities Well controlled RCTs started appearing in the 1990 s The majority of RCTs have been for children with autism. Well done trials have also been conducted for children with Down Syndrome and other unspecified developmental disabilities

9 Interventions for children with very severe disorders 4 or more SD s below the mean Most of the literature is based on single subject design research Systematic reviews and meta-analyses of this literature have supported the efficacy of a number of approaches The focus of much of this work is on communication - by whatever means it is deemed most effective for the child Research supports the efficacy of Functional Communication Training as key to the successful treatment for severe behavior disorders

10 Intervention what do RCTs tell us? High levels of parental responsivity (trained or untrained) over lengthy periods of time. Interventions that combine some level of direct child treatment with parent training. Higher levels of treatment intensity and long treatment durations generally achieve stronger results. Most non-autism RCTs have been conducted at low intensity levels and for relatively short time periods. Effect sizes in these studies generally range from moderate to large. Mediators and moderators often influence outcomes (e.g. object engagement, vocal complexity, maternal responsivity, maternal education)

11 Intervention Research: What s needed? More well controlled RCTs Support for RCTs conducted for up to two years with children for children other than those diagnosed with autism. Well controlled treatment dosage studies- we can t answer the question what is optimal dosage for any specific type of treatment presently in use.

12 Concluding Remarks There is clear evidence that speech and communication delays and disorders in children can be at least partially remediated by a range of treatments Children with these disorders can be reliably identified Major strides have been made in the past 20 years in determining the efficacy of different treatments for children at different ages and with different primary disorders. Buy the pursuit of effective treatment remains very much a work in progress.

13 Supporting References and Literature BEST OVERALL SOURCE FOR RESEARCH BASED INFORMATION: ASHA S EVIDENCE MAPS Evidence maps are intended to provide clinicians, researchers, clients, and caregivers with tools and guidance to engage in evidence-based decision making. These maps highlight the importance of the three components of evidence-based practice (EBP). External Scientific Evidence, Clinical Expertise/Expert Opinion, and Client/Patient/Caregiver Perspectives Just Google ASHA Evidence Maps These are excellent although not perfect. They are not as up to date as one might want in some areas. Most relevant research summaries for the IOM charge are under social communication disorders and autism spectrum disorder.