TIC May 2015.pdf

Tongue-in-cheek Speech-Language & Hearing Association (Singapore)

May 2015 www.shas.org.sg

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Page Content 3 Editors Letter 4 Article: Core Subjects at the End of Primary School: Identifying and Explaining

Relative Strengths of Children with Specific Language Impairment (SLI) 5 Interview: Direct from Singapore 8 Article: Does Bilingualism Influence Cognitive Aging? 9 Article: The Cognitive Science of Bilingualism 10 Interview: Direct from UK 12 Article: Terminological Debate over Language Impairment in Children: Forward

Movement and Sticking Points 18 Article: How Much Exposure to English is Necessary for a Bilingual Toddler to

Perform like a Monolingual Peer in Language Tests? 19 Interview: Direct from HK 22 Article: Learning Difficulties or Learning English Difficulties? Additional Language

Acquisition: An Update for Paediatricians 23 Interview: Why Choose a Career in SLT 30 Article: Longitudinal Trajectories of Peer Relations in Children with Specific

Language Impairment 31 Article: Improving Comprehension in Adolescents with Severe Receptive

Language Impairments: a Randomized Control Trial of Intervention for Coordinating Conjunctions

33 Article: Do Infant Vocabulary Skills Predict School-Age Language and Literacy Outcomes?

34 Interview: Direct from Singapore 37 Article: Tracing Children's Vocabulary Development From Preschool Through the

School-Age Years: An 8-year Longitudinal Study 38 Interview: Direct from Singapore 42 Events

Contents

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Dear Fellow SLTs,

One year ago we published our first issue under this new Publications Committee. It has been a fabulous year of meeting new people who so kindly helped us with their professional and clinical insight, and finding avenues to bring you contemporaneous and relevant articles. This time around, we were able to compile some great articles that address many areas of language development, from the ever so tricky terminology issue that our community across different countries considers we should use, recent findings in bilingualism and specific language impairment, to therapeutic approaches related to the development of vocabulary. We hope you find these articles interesting and we hope you can use them to enhance your service delivery (and hopefully generate some pretty good discussions at lunch time!).

We were also fortunate to have a number of people who wanted to contribute to TIC with their valuable professional and clinical experience, including SLT students who shared what made them choose this fantastic profession and their hopes for the future. A heartfelt thank you to Fatimazahra Khaki, Raphaela Hew, Marie Robert, Carolanna Rodriguez, Mrcia Filipe, Ctia Ribeiro, Ana Athayde Campos, Raquel Vieira, Zlia Fernandes, Ndia Silva, Ins Mestre, Daniela Silva, Siew Li Goh and Alison Cannon.

Last, but not least, there are some great workshops happening in the next few months, from Autism - What every parent ought to know, Autism What every education professional ought to know to Leading From One Step Behind: A Solution-Focused Brief Approach To Working With Clients.

Happy May everyone.

We all have ability. The difference is how we use it.

Stevie Wonder

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The following article was published online on http://onlinelibrary.wiley.com on 03/12/2014, DOI: 10.1111/1460-6984.12137.

Core Subjects at the End of Primary School: Identifying and Explaining Relative Strengths of Children with Specific Language Impairment (SLI)

Kevin Durkin, Pearl L. H. Mok and Gina Conti-Ramsden International Journal of Language & Communication Disorders

Volume 50, Issue 2, pages 226240, March-April 2015

Background: In general, children with specific language impairment (SLI) tend to fall behind their typically developing (TD) peers in educational attainment. Less is known about how children with SLI fare in particular areas of the curriculum and what predicts their levels of performance.

Aims: To compare the distributions of performance of children with SLI in three core school subjects (English, Mathematics and Science); to test the possibility that performance would vary across the core subjects; and to examine the extent to which language impairment predicts performance.

Methods & Procedures: This study was conducted in England and reports historical data on educational attainments. Teacher assessment and test scores of 176 eleven-year-old children with SLI were examined in the three core subjects and compared with known national norms. Possible predictors of performance were measured, including language ability at ages 7 and 11, educational placement type, and performance IQ.

Outcomes & Results: Children with SLI, compared with national norms, were found to be at a disadvantage in core school subjects. Nevertheless, some children attained the levels expected of TD peers. Performance was poorest in English; relative strengths were indicated in Science and, to a lesser extent, in Mathematics. Language skills were significant predictors of performance in all three core subjects. PIQ was the strongest predictor for Mathematics. For Science, both early language skills at 7 years and PIQ made significant contributions.

Conclusions & Implications: Language impacts on the school performance of children with SLI, but differentially across subjects. English for these children is the most challenging of the core subjects, reflecting the high levels of language demand it incurs. Science is an area of relative strength and mathematics appears to be intermediate, arguably because some tasks in these subjects can be performed with less reliance on verbal processing. Many children with SLI do have the potential to reach or exceed educational targets that are set at national levels for TD children.

What does this study add: The study confirms that children with SLI do perform, overall, below national norms in core subjects at the end of primary school but shows also that some attain the levels expected of TD peers. Performance varies among subjects (poorest in English, with relative strengths in Science). Children with SLI undoubtedly face many hurdles due to the language of education but may profit from learning opportunities that draw on other capacities, such as visual representation.

Research Article

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Raphaela Hew & Marie Robert work as Speech and Language therapists at KK Womens and Childrens Hospital.

Caseload:

Marie: Most of my caseload is outpatient and is made up of children with language difficulties (delay and disorder) ranging from very young all the way up to 18 years of age. I also have an individual social skills clinic and a social skills paired clinic where the children come in pairs to work on pragmatic goals. I run the baby feeding clinic for our premature babies, after they have been discharged from the wards, and a combined OT, SLT, PT clinic for assessment of complex cases. Finally, both Raphaela and I cover the wards for children with dysphagia and when other therapists are off, and we also see the warded children with language difficulties as much as we can. Life is never dull!

Raphaela: The majority of my caseload is outpatient. I see children from 0 - 18 with language delays, language disorders, stuttering and children who have feeding difficulties. I also cover the wards and see children with dysphagia.

Duties: Duties for outpatient clinics cover the range of the therapeutic process, from assessment through therapy until discharge. There is also a hefty amount of paper work and follow up involved. We spend a lot of time contacting other people working with the children to make sure everyone is on the same page. It is a little different for inpatients, as they are only warded temporarily, so we try and get as much done as possible in a short space of time. There is direct assessment and therapy both for the usual speech and language difficulties and dysphagia, or other feeding problems. Parent education is also a major factor in every patient we see, no matter what their difficulties are.

Typical Day:

Marie: I usually get into work very early. I like to have time to prepare over my cup of tea, check all my files and plan. Depending on the clinic I am running, I will prepare all the toys or equipment I might need. I also do clinic education of colleagues, so I might need to do preparation for that, as well as pull my weight for research. As I mostly cover outpatient clinics, my day is often back to back patients, squeezing administration into the spaces inbetween. As I always say, Id rather be busy than bored!.

Raphaela: A typical day is a big, exciting rush with pockets of joy in between, e.g. when a child learns to say a new word, or initiates communication for the first time, or when parents report progress noted in their childs language and/or feeding development. I split the day between individual and/or group therapy, clinical education of new colleagues, as well as administrative duties. As a team, we are very much involved in research (so there is always an ongoing research project). Other administrative duties include multidisciplinary projects with doctors and nurses (e.g. to train nurses to screen for communication delay for toddlers 8 months and upwards) and dieticians, for example. As you can tell, there probably isnt a dull moment in the day.

Challenges: Marie: As a therapist who is not Singaporean, I initially found it a challenge to get used to the way language works here and the effects those differences can have on therapy (since my area is language!). But since Ive been here for such a long time, my current challenges are more based in teasing out the often complex language difficulties some of my patients present with, and always coming up with new and fun ways to improve childrens skills.

Interview Corner

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Continuation.

Raphaela: I really value the partnership parents can offer when it comes to capitalising on a childs strengths and remediating his/ her areas of difficulties. I find it challenging when parents are not ready to offer that yet, either because they are still coming to terms with their childs condition or they are looking for a magical quick fix instead of the hard work we are telling them well need to do together.

Surprises: We are constantly surprised by the variety of difficulties children in our language clinics present with. Some children could look exactly the same on paper, based on report or test scores, but present totally differently in our clinics. It is one of the things we like about language; no one uses it the same way. We are also constantly surprised (and delighted) by the lengths some parents, carers and sometimes siblings, will go to to help a child who is having difficulties.

Carry Over: This is an area we find difficult in our setting. We cannot see the children as often as we would like due to the large numbers of patients, so we engage significantly in parent and carer education. This way, the carers can go home and implement the strategies at home. I try to make sure the carer understands what we are doing and, more importantly, why we are doing it. No one will work on something at home if they dont see how it will benefit their child. We also adjust tasks according to the childs interests.

Impact: Everything! We use language all day every day. How do you tease apart language from everything else? Apart from poor academic achievement, language disorder may also result in poor acquisition of world knowledge, which can be simply understood as what the child understands of the world. We find this is through general poor understanding of what people around the child are saying/ teaching as well as inability to learn from reading. It is, therefore, important to also target this from an early age! We also often notice language disordered kids have social skills difficulties. They cannot read the signs other people send in their voices or with their bodies. That means that a world, which is already reduced thanks to lack of language, is further impoverished by lack of friends and social connections. The impact of a language disorder is everything. Language is life!

Success Story:

Marie: H is a girl who is now around 8 years old. She has a rare, mosaic form of genetic disorder. When she first attended my clinic, she was about 3 and had severely delayed motor (she is not yet able to walk) and language skills. She had just started using some single words and mostly used gestures. Her understanding was also significantly poor; however, she had such potential shining out of her eyes! Given the rare quality of her disorder, her mother was very concerned that no one was able to tell her how well H would do in the long run. There was counselling needed to help her see that H had potential to learn, and that maximising her skills should be our focus, regardless of the end point! Her mum rose to the challenge wonderfully and now, thanks to her family and a lot of therapy, H can not only use sentences but we are now working on basic narrative. She is functional in speaking to new people, her school teachers and friends. She is in a special needs school, albeit in the academic stream, and learning well.

Interview Corner

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Continuation.

Loved Resources:

Marie: Toys! Any toy! Fun is a major key to therapy and anything boring can always be jazzed up with a fun reward.

Raphaela: Social media and the internet, because it is inherently motivating to many of our older kids. Youll be surprised to see how many language tasks we can incorporate into social media and tasks on the internet! A great resource is always going to be the childs motivation so we always maximize that.

Wish List:

Marie: We are well resourced here and I am a big fan of being flexible. You will often catch me using the same toys to target different skills. My rule is if you cant use it for at least 3 different things, its probably not worth having!

Top Tips for Clinicians:

1. Always remember to first see what your child can do, as too many people will point out what he cannot do.

2. Remember to always find out what is motivating for the child; many, many language tasks can be done within contexts that are personally motivating for the child.

3. We find task analysis is always helpful to tease apart task demands, which lead to task breakdown! It is not important that they cannot do something, as what is important is why they cannot do it.

Top Tips for Other Professionals/ Parents: Always remember to see what your child can do first and work up from there. Also, celebrate small achievements. Too many language disordered children feel like they never achieve anything. Parents are so important because they can be reminders of how far the child has come! The praise of a parent is often worth a lot more than that of someone else, so praise small achievements, perseverance and effort. These kids work so hard! They need more than your average encouragement.

Interview Corner

Always remember to first see what your child can do, as too many people will point out what he cannot do.

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The following article was published online on http://onlinelibrary.wiley.com on 02/06/2014, DOI: 0.1002/ana.24158.

Does Bilingualism Influence Cognitive Aging?

Thomas H. Bak MD, Jack J. Nissan PhD, Michael M. Allerhand PhD and Ian J. Deary MD Annals of Neurology

Volume 75, Issue 6, pages 959963, June 2014

Abstract: Recent evidence suggests a positive impact of bilingualism on cognition, including later onset of dementia. However, monolinguals and bilinguals might have different baseline cognitive ability. We present the first study examining the effect of bilingualism on later-life cognition controlling for childhood intelligence. We studied 853 participants, first tested in 1947 (age=11 years), and retested in 20082010. Bilinguals performed significantly better than predicted from their baseline cognitive abilities, with strongest effects on general intelligence and reading. Our results suggest a positive effect of bilingualism on later-life cognition, including in those who acquired their second language in adulthood. Discussion: Our results suggest a protective effect of bilingualism against age-related cognitive decline independently of CI. The effects are not explained by other variables, such as gender, socioeconomic status, or immigration. Importantly, we detected no negative effects of bilingualism. The cognitive effects of bilingualism showed a consistent pattern, affecting reading, verbal fluency, and general intelligence to a higher degree than memory, reasoning, and speed of processing. The effect on the NART could be explained by its loanwords with cognates in other languages: bilingualism leads to higher familiarity and hence better performance. The effects on general intelligence are likely to be related to frontal executive advantages, the best documented nonverbal cognitive feature of bilingualism. In terms of types of bilingualism, early versus late acquisition showed differential effects, depending on childhood IQ. Overall, individuals with high intelligence seem to benefit more from early acquisition and those with low intelligence from late acquisition, but neither group showed negative effects. Early and late acquisition of a second language might have different effects on frontal executive functions, possibly modulated by baseline intelligence. Knowing 3 or more languages produced stronger effects than knowing 2. This variable has yielded contradictory results in previous studies and requires further research. Little difference was found between active and passive bilinguals, possibly due to low frequency of second language use, even in active bilinguals. However, it is conceivable that acquisition of a second language leaves lasting cognitive traces independently of its subsequent use. If bilinguals automatically and unconsciously activate both languages, they constantly need to select, monitor, and suppress linguistic information, stimulating frontal executive functions. The observed effect sizes are comparable to those reported for other factors contributing to differences in cognitive ability and cognitive change, such as the effect of variation in the gene for apolipoprotein E, physical fitness, and (not) smoking. Accordingly, the interpretation of our data should be in terms of cognitive epidemiology, rather than clinical application to an individual. As a small reduction in a population's blood pressure can have a sizeable effect on the number of strokes despite blood pressure accounting for only a small variation in stroke, a modest change in the proportion of people who learn 1 or more extra languages could have a population effect on cognitive pathology rates. Our study has limitations. The knowledge of language was defined by a questionnaire, not proficiency. Only few participants acquired their second language before age 11 years, so we could not study the classical cases of parallel, perfect, early acquisition of both languages. However, this limitation is also a strength. Millions of people across the world acquire their second language later in life: in school, university, or work, or through migration or marriage to a member of another linguistic community. Many never reach native-like perfection. For this population, our results are particularly relevant; bilingualism in its broad definition, even if acquired in adulthood, might have beneficial effects on cognition independent of CI.

Research Article

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The following article was published online on http://onlinelibrary.wiley.com on 25/01/2015, DOI: 10.1111/lnc3.12099.

The Cognitive Science of Bilingualism Yanping Dong and Ping Li

Language and Linguistics Compass Volume 9, Issue 1, pages 113, January 2015

Abstract: Recent research in cognitive effects of bilingualism has generated both excitement and controversy. The current paper provides an overview of this literature that has taken a componential approach toward cognitive effects of bilingualism, according to which bilingual advantages in executive functions are measured in terms of executive control (inhibiting, switching, updating) and monitoring. Findings to date indicate that the presence or absence of bilingual advantages may be influenced by a variety of learner and environmental factors, including the bilingual individual's age, age of acquisition, language proficiency, frequency of language use, and difficulty of the experimental task. The cognitive effects of bilingualism must be interpreted in light of the bilingual's lifelong linguistic experience, which results in adaptive changes in the mind and the brain. We suggest directions for future research in this domain. Conclusion: The bilingual's experience of learning and using multiple languages may be unique because it is extensive, long-term, and brings an overall change to not only how linguistic tasks are carried out but also how nonlinguistic tasks are performed, resulting in an enhancement of both linguistic and domain-general nonlinguistic functions (e.g., Bak et al. 2014). The bilingual experience leads to positive changes in both the mind and the brain, and in both the function and the structure of the brain. Although specific patterns of bilingual advantage are subject to debate, enough evidence has accumulated to motivate us to carry on research in this domain and to study neuroplasticity as a result of learning and using a new language. In this short review, we have identified the role of a set of learning and input factors such as the bilingual's age, task difficulty, and language history (e.g. frequency of language use, age of acquisition, and L2 proficiency) and pointed out how these factors and their interactions may jointly influence measurements of bilingual versus monolingual performance in executive functions. While our review has focused on specific components of executive functions such as inhibiting, switching, updating, and monitoring, we are mindful that a more holistic approach needs to be taken to examine bilingualism (Kroll and Bialystok 2013). Finally, we suggest that it is important to examine not only the cognitive effects as consequences of bilingualism but also the mechanisms and locus of these effects reflected in the bilingual mind and the bilingual brain. A significant direction for future research is to identify the causal relationship through longitudinal studies of bilingual experience and the corresponding neurocognitive and neuroanatomical changes. As a final note for future research, we should also attempt at an understanding of the cognitive science of bilingualism by studying not only the cognitive effects due to bilingual experience (i.e., bilinguals compared to monolinguals) but also individual differences in cognitive effects due to the same type of experience (i.e., bilinguals compared with bilinguals).

Research Article

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Fatimazahra Khaki works as Special Educational Needs Learning Support Assistant (SEN LSA) in ARK Aryton Primary Academy, Southsea, UK.

Caseload: My caseload consists of about 13 children with various types of difficulties. I have children in the autistic spectrum, including a child with Asperger's syndrome, a child with dyslexia, one with dyspraxia, and the other children have specific language impairment.

Duties: My role involves creating long-term and short-term targets, planning each session, making resources and activities for the session, building a report with the children, giving 1:1 as well as group speech and language interventions, writing case notes and keeping evidence of the children's progress, and giving feedback and discussing children's progress with my Line Manager and the relevant teachers. Since I work as an SEN LSA, I have break time duty where I'm in the playground with the children - this gives me a chance to observe them during play as well.

Service Structure: The school does not have an SLT visiting every week to give therapy to the children. I am the only person providing speech and language interventions to the children. The children, who have been flagged up, are initially seen by an SLT who comes in to assess them and sets some targets to be followed. Someone in my position would then provide intervention regularly to those children and the SLT would come back after a couple of months to see the children's progress. In the meantime, I assess them informally so that I can prioritize an area of difficulty, as I'm only given around 10 to 15min with each child, 2 to 3 times a week.

Typical Day: A typical day would be coming in to school, planning for that day's session, taking children out of class one by one for intervention from 9:00am or 9:30am (depending on whether they have assembly or not) until 10:30am, taking a short break, and resuming interventions from 10:50am to 12:00pm. Then I'd take another break for lunch from 12:00-1:00pm. During the first hour of my lunchtime, I usually finish my notes for the morning and plan for the afternoon. After lunch, we have a read & write session, where children from the whole school are divided into groups according to their abilities and they are taught phonics. After phonics, it's back to providing interventions, after which I write my case notes for the afternoon.

Challenges: The most challenging thing for me, so far, is providing intervention for the children with Asperger's Syndrome and Autism. I haven't had much experience with children with these difficulties, so I'm learning as I go. At the moment, I'm working on social behavioural skills.

Surprises: Well, children are full of surprises generally! However, I've noticed, in my short time working, that the children who have language difficulties will seem very quiet and shy in class. However, when put together in an intervention group or during 1:1, they will talk, comment, and shout out!

Interview Corner

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Continuation

Carry Over: Im going to describe my own carry over skills. I'm ensuring that I do it by looking out for opportunities for further training, so that I'm continuously able to develop the skills that I already have. However, as an LSA, I sometimes have to work with phonics with other children, and I make sure I use the skills I've learnt as an SLT student and a SEN LSA, to promote better learning for the children.

Impact: My client group's difficulty mainly impacts on their access to the curriculum, since most of the children I see have a speech and language difficulty, i.e. following instructions, understanding what is said/taught in class, and expressing themselves with clarity, and by using long and meaningful sentences, so that they are understood. Behaviour difficulties also impact on their learning, i.e. they may not understand the consequences of their behaviour, have tantrums during class and, thus, access less learning time.

Success Story: I have a child who has difficulties with her speech - she could not say /sk/ in initial position, when blending sounds to read. I've taught her a strategy where you ignore the /s/, read the rest of the word, and then add the /s/ back to the beginning, for example 'skate' can be read initially as k-a-t-e, add the /s/ and then read as s-kate. We had a bit of difficulty at first because when she cannot do something, she gets anxious. Thus, I had to talk to her before every session, explaining that it didn't matter if she couldn't do it the first time, and that repetition would help. Eventually, she learnt the strategy, and is now able to read words beginning with /sk/.

Loved Resources: I love using picture cards to play memory games. I use this to teach 'he/she' pronouns and verbs, with simple pictures of a girl and a boy doing the same action. Recently, I also used this game to teach the concept of same/different. It works well because it is fun, so the children enjoy it. They use their language while describing the pictures every time they turn them over, and it is a great resource for attention and memory, since they have to watch carefully and remember where each picture is to win.

Wish List: I would like to have more resources targeting social skills, cause and effect, and consequences of behaviour.

Top Tips for Clinicians: Always remember that every little progress counts!

Top Tips for Other Professionals: Working in a team with an SLT or someone working with SEN children can be beneficial to both the professional as well as the child, because the child is then looked at holistically. Targets would also be easier to set knowing each professional is working on an area to help the other.

Top Tips for Parents: Continue to spend time with your children while supporting them at home by using lots of modeling techniques, e.g. talk to your children and if they say anything that is not clear or grammatically correct, repeat the sentence to model the correct way. Also, get your children to look at/ read books, as it will help them improve their attention, vocabulary, sentence structure and thought processing.

Interview Corner

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Terminological Debate over Language Impairment in Children: Forward Movement and

Sticking Points Sheena Reilly, Dorothy V. M. Bishop, Bruce Tomblin

International Journal of Language & Communication Disorders Volume 49, Issue 4, pages 452462

Background: There is no agreed terminology for describing childhood language problems. In this special issue Reilly et al. and Bishop review the history of the most widely used label, specific language impairment (SLI), and discuss the pros and cons of various terms. Commentators from a range of backgrounds, in terms of both discipline and geographical background, were then invited to respond to each lead article.

Aims: To summarize the main points made by the commentators and identify (1) points of consensus and disagreement, (2) issues for debate including the drivers for change and diagnostic criteria, and (3) the way forward.

Conclusions & Implications: There was some common ground, namely that the current situation is not tenable because it impedes clinical and research progress and impacts on access to services. There were also wide-ranging disagreements about which term should be adopted. However, before debating the broad diagnostic label it is essential to consider the diagnostic criteria and the systems used to classify childhood language problems. This is critical in order to facilitate communication between and among clinicians and researchers, across sectors (in particular health and education), with the media and policy-makers and with families and individuals who have language problems. We suggest four criteria be taken into account when establishing diagnostic criteria, including: (1) the features of language, (2) the impact on functioning and participation, (3) the presence/absence of other impairments, and (4) the language trajectory or pathway and age of onset. In future, these criteria may expand to include the genetic and neural markers for language problems. Finally, there was overarching agreement about the need for an international and multidisciplinary forum to move this debate forward. The purpose would be to develop consensus regarding the diagnostic criteria and diagnostic label for children with language problems. This process should include canvassing the views of families and people with language problems as well as the views of policy-makers.

()

What terminology should we adopt? Our focus here is on terminology for children's unexplained language difficulties, and we do not consider further the term speech, language and communication needs (SLCN). This term was used in the Bercow Report (Bercow 2008) and now is widely used in educational contexts in the UK, though not in North America or Australia. Although it includes language impairment, it is much broader than this, including a wide range of problems that have different causes and intervention needs, such as stuttering and voice disorders. In addition, as defined by Bercow, it also covers secondary problems associated with conditions such as autism, cerebral palsy and hearing loss. The papers by Bishop (2014) and Reilly et al. (2014) made specific points about the pros and cons of different terminology for unexplained language problems, and the commentaries gave some additional arguments. We feel that some of these were strong enough to rule out three of the potential labels for children's language problems, as follows.

Research Article

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Continuation.

Language delay None of the commentators favoured this term. There were three strong arguments against it. First, we need to bear in mind that children with language difficulties grow up to be adults who may still have difficulties that need recognition. We need therefore to have a term that highlights the dynamic, changeable nature of the condition. Second, delay is confusing because it implies eventual catch-up in skills, which is not typically what is seen. And finally, it seemed that this term is often used to deny services to children by those who draw a distinction between delay, where the child's language is uniformly behind age level, and disorder where there is an uneven profile (Wright 2014). As noted by Bishop (2014), this distinction has no validity as an indicator of either aetiology or prognosis, and accordingly, we unambiguously recommend that this term be abolished. Primary language impairment Bishop (2014) suggested this term might be a useful alternative to unadorned language impairment, but the points made by commentators reveal that it is not interpreted in a consistent fashion. For a start, as Clark and Carter (2014) noted, in the UK, primary school refers to schools for children under 12 years of age, so there is potential for misunderstanding it to indicate a child's age. Second, several commentators interpreted primary language impairment as meaning that the language impairment was the child's primary problem. This is a subtly different meaning from the one intended by Bishop (2014), which was that the language impairment was not secondary to another condition. In addition, as pointed out by Conti-Ramsden (2014), it is not always easy to judge which condition is primary in this sense when the child has more than one area of impairment. For these reasons, we recommend against the use of this term. Language disorder Although this is the preferred terminology in DSM-5, Bishop (2014) argued against it on the grounds that if entered in a search engine, it would yield many results that were unrelated to children's unexplained language difficulties. In effect, it identifies a symptom that can arise for many different reasons, and so is over-inclusive. To establish how serious this might be, language disorder was entered as a search term in the Web of Science database and the titles of the first 100 returns were scrutinized to see if they referred to children's unexplained language problems. Just under half were relevant. The remainder focused solely on other conditions, specifically: ADHD (N = 1), ageing (N = 1), Alzheimer disease (N = 2), aphasia (N = 2), autism (N = 11), bilingualism (N = 1), brain tumour (N = 1), childhood stroke (N = 1), cobalim C deficiency (N = 1), encephalitis (N = 2), epilepsy (N = 7), fragile X (N = 1), frontotemporal dementia (N = 1), hearing loss (N = 1), hyperthyroidism (N = 1), mood disorder (N = 1), neurogenic communication disorder (N = 1), nosocomial infection (N = 1), primary progressive aphasia (N = 5), schizophrenia (N = 6), sexual abuse (N = 1), subjective cognitive complaints (N = 1) and Tourette syndrome (N = 1). The remaining terms elicited much more varied reactions from commentators.

Research Article

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Continuation.

Specific language impairment (SLI) Bishop (2014) presented data to show this was the most widely used term in the English-speaking research literature, but others noted that it is less familiar to those in clinical contexts. Rice (2014) noted that SLI was a research priority area for the US National Institute for Deafness and Other Communication Disorders (NIDCD), and that this had been a fruitful category in terms of research progress. Reilly et al. (2014), in contrast, argued that the term SLI:

Does not reflect the heterogeneity of language problems. Does not describe the majority of the children with language problems. May as a result deny access to services to children who do not fit the narrow diagnostic criteria. Has variable support among the scientific and clinical community. Causes confusion amongst clinicians, families and policy-makers.

Many commentators agreed that this term was too restrictive if used in a strict sense that required the child to have a substantial mismatch between nonverbal ability and language level, and to have no other exclusionary criteria. They were, however, divided as to how best to deal with this. Around half of them supported Bishop's (2014) proposal that we could retain the term but redefine it so that specific was taken to mean idiopathic, allowing us to retain familiar terminology, which could also ensure a link with an existing body of research. Taylor (2014), for instance, commented that Rather than changing the term SLI, the definition can be updated to include children whose most conspicuous, but not their only, developmental difference is in the language domain. Others, however, felt that this would be too confusing, because use of this term would encourage people to persist with inappropriate exclusionary criteria, and that a change was therefore needed. On this point, it may be worth noting that there are some precedents for retaining a label while redefining how it is used. For instance, the diagnostic criteria for autistic disorder broadened markedly between 1980 and 1994 (Gernsbacher et al. 2005). This does not seem to have led to particular problems in clinical settings, but it has created major problems in epidemiology, as it is extremely hard to judge whether an increase in prevalence of autism is genuine or just reflects more liberal diagnostic criteria. As Baird (2014) notes, the criteria for ASD have recently changed again in DSM-5, in the light of research evidence that some diagnostic distinctions were not valid. Fletcher (2009) noted that the concept of dyslexia has changed over the years so that the notion of a discrepancy between reading level and IQ is no longer part of the definition. However, changes in definition can be confusing for those who are familiar with the original, more restrictive meaning. This is likely to be exacerbated in the case of SLI, where specific has potential for different interpretations. Is there a balance between acting and not acting? Gallagher (2014) raises concerns about the impact of removing a diagnostic label that affected individuals have come to identify with. However, we have new knowledge from population studies that was not available when the term originated. Of course, we need to be sensitive to the fact that for many people labels have connotations that go far beyond a simple definition. As Bishop (2014) argued, a label can give a person a sense of identity and worth, and make them feel their problems are validated. Nevertheless, retention of labels that hinder communication cannot be justified, and if the evidence demands it, we need to reconsider our terminology. If we retain labels solely on the grounds that they have been used for a long time, we would never be able to progress in the light of new knowledge, and would still be using diagnostic terms such as minimal brain damage.

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Continuation.

Language impairment The solution of simply dropping the specific part of the SLI label appealed to many commentators. It is noteworthy that language impairment is almost universally employed by State Departments of Education in the United States as one of the special education categories. Language impairment in this case is always listed in parallel with other categories such as autism, intellectual disability, hearing impairment and specific learning disability. Usually, language impairment refers to the presence of poor language, but does not require that it be distinct from these other conditions. Thus, language impairment may or may not occur in conjunction with other conditions. Bishop (2014) argued against this term for the same reason as language disorder. It is hopeless as a search term because it generates too many false positives. The exercise of searching for the first 100 returns from Web of Science was repeated using language impairment as the topic search term. This yielded 68 returns that could be construed as broadly or potentially relevant to unexplained language problems in children. The remainder focused on other conditions, predominantly autism, acquired language disorders in adults, or hearing impairment. In addition, several commentators noted that in the absence of any additional modifier, the term LI would encompass a much wider range of cases than most other terms, but they differed in terms of whether they thought this was a good or bad thing. Huneke and Lascelles (2014) were concerned that this broadening of the diagnostic category would simply mean that scarce resources would be spread across a greater range of children, with the notion of language impairment as a specific need disappearing. Gallagher (2014) expressed similar concerns, arguing that it would be unethical simply to remove a diagnostic distinction that many were familiar with, and that we would in effect be abandoning a whole clinical and research history before we know how to rewrite it. Snowling (2014) was concerned that it was important to convince policymakers of the primary needs of children with language impairments, and that by abandoning the term SLI we might risk throwing the baby out with the bathwater by removing a term that was useful in advocacy. Rice (2014) stressed the negative consequences of abandoning a term that had served researchers well, and Leonard (2014) noted the confusion that could ensue if, for instance, we attempted to contrast children with LI and those with autismwho might or might not have additional LI. Others argued that a benefit of the term LI was that, while it had much in common with the term SLI, it did not carry connotations of specificity which were often unjustified, and could lead to children being denied services (Strudwick and Bauer 2014). Note that this argument is the mirror image of that proposed by Huneke and Lascelles (2014), who argued that there should be some demarcation between those with primarily language problems and children with broader intellectual limitations. Another argument in support of LI was the fact that it was already being used in the research literature by researchers such as Tomblin and Nippold (2014) and Bishop and McDonald (2009), who recognized the lack of justification for use of IQ criteria. Essentially, this line of argument comes back to the extent to which it is reasonable to incorporate at least some exclusionary criteria in a definition. If we abandon them altogether, we will increase both the number of children we include in the category, and the heterogeneity of the group. Whitehouse (2014) acknowledges this fact but argues we nevertheless need to take this step in order to shift health and educational services from a diagnostic-based funding paradigm to a model based on the level of functional impairment.

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Continuation.

Developmental dysphasia Huneke and Lascelles (2014), representing a parental perspective, came down in favour of developmental dysphasia, noting: it is clearly a medical term; it equates SLI with other specific learning difficulties such as dyslexia and dyspraxia. It also works well as a search term and is the standard label in many non-English speaking countries. However, we note that many would object to both parts of this term: as discussed below, some object to developmental as unsuitable for older children and adults, and dysphasia is seen as misleading precisely because it has medical connotations, when there is no clear neurological basis to most cases of language impairment. While we can see the reasons behind this preference, we doubt it would be acceptable to many in the field of education, who are already concerned about medicalization of children's developmental difficulties. Developmental language disorder/impairment Developmental language disorder is likely to be adopted in ICD-11 as the preferred term for children's unexplained language difficulties (Baird, personal communication). Several commentators thought this was a useful label, stressing as it does the congenital nature of a language problem. In general, there were relatively few objections to this term, but one point that was raised was whether it was suitable for older children and adults. In traditional classification systems, developmental generally marks a contrast from acquired, and does not imply anything about the age of the affected individual; however, one can see that this label might be misinterpreted by lay persons, and seen as inappropriate for older children and adults. Clark and Carter (2014) suggested that affected individuals might want to drop the developmental part of the label as they grew older, much as often happens with developmental dyslexia in adulthood. Language learning impairment Not many commentators discussed this term, but reactions from those who did were broadly positive, noting that it stresses learning and was education-friendly. The only negative came from Huneke and Lascelles (2014) who reported that a small group of parents who were surveyed disliked the term because they felt it would be seen as equivalent to low ability. Future directions We agree with those commentators who suggest that we need to have an international and multidisciplinary forum to take forward the momentum generated by this debate. The goal of the panel should be first to build consensus about the diagnostic criteria and second the diagnostic label. We recommend using the many existing global collaborations to bring clinicians and researchers together. The views of families and people with language problems should be sought as well as those of policy-makers. Given the notable overlaps between developmental language difficulties and other neurodevelopmental disorders (Bishop and Rutter 2008), it would make sense also to gather views from those who see children with a broader range of conditions, such as ADHD, developmental coordination disorder and developmental dyslexia. Consensus should be built around the best evidence currently available; it is important that participants set aside any vested interests. The outputs of this panel might take the form of a position statement and technical paper such as those on Childhood Apraxia of Speech (American SpeechLanguageHearing Association (ASHA), 2007a, 2007b).

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Continuation.

Ultimately we are working towards a diagnostic label that is a superordinate heading or overarching term that describes the problem(s) and works for services, for families and for individuals. This label should be supported by a scaffold that is the diagnostic classification system. This should not be set in stone but change as knowledge becomes available. It should also adapt to encompass an individual's changing profile and needs across the lifespan. As Callard et al. (2013) put it: Diagnosis allows problems to be quantified and tracked over time and space. A diagnostic classification, well defined, is the starting point to research into causes, consequences, and solutions (p. 2). In conclusion, we do not have all the answers for this complex topic, but we are pleased to find that, despite points of disagreement, there is some common ground between the current authors and the range of commentators who offered their views. Our aim in this overview is to identify the remaining points of disagreement and to summarize arguments for and against different viewpoints, so that we will be able to move the debate forward. ()

For more information on the discussion surrounding terminology in the area of language development, please check the following articles:

1. Bishop, D. V. M., (20/08/14), Ten Questions About Terminology for Children with Unexplained

Language Problems, Volume 49, Issue 4, pages 381415, July-August 2014, International Journal of Language & Communication Disorders, DOI: 10.1111/1460-6984.12101.

What does this paper add: () This paper aims to open up discussion about the use of different labels that have been used to refer to children's unexplained language impairments. It notes the wide range of terminology that has been applied and the confusion that results, and links this to debates about the appropriate criteria that are used to identify children in need of intervention. A range of diagnostic terms is evaluated in terms of their advantages and disadvantages. ()

2. Reilly, S. e al, (20/04/14), Language Impairment: A Convenient Label for Whom?, Volume 49, Issue 4, pages 416451, July-August 2014, International Journal of Language & Communication Disorders, DOI: 10.1111/1460-6984.12102 .

What does this paper add: () We review how and why SLI came into use and examine the evidence for and against its use. We conclude the term SLI was proposed and used prior to evidence from population studies being available. Subsequent research has provided little evidence that supports the continued use of the current definition and the exclusionary criteria. To address these shortcomings we propose a set of short-term changes and recommendations for the future. ()

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How Much Exposure to English is Necessary for a Bilingual Toddler to Perform like a

Monolingual Peer in Language Tests? Allegra Cattani, Kirsten Abbot-Smith, Rafalla Farag, Andrea Krott, Frdrique Arreckx, Ian Dennis and

Caroline Floccia International Journal of Language & Communication Disorders

Volume 49, Issue 6, pages 649671, November 2014 Background: Bilingual children are under-referred due to an ostensible expectation that they lag behind their monolingual peers in their English acquisition. The recommendations of the Royal College of Speech and Language Therapists (RCSLT) state that bilingual children should be assessed in both the languages known by the children. However, despite these recommendations, a majority of speech and language professionals report that they assess bilingual children only in English as bilingual children come from a wide array of language backgrounds and standardized language measures are not available for the majority of these. Moreover, even when such measures do exist, they are not tailored for bilingual children. Aims: It was asked whether a cut-off exists in the proportion of exposure to English at which one should expect a bilingual toddler to perform as well as a monolingual on a test standardized for monolingual English-speaking children. Methods & Procedures: Thirty-five bilingual 2;6-year-olds exposed to British English plus an additional language and 36 British monolingual toddlers were assessed on the auditory component of the Preschool Language Scale, British Picture Vocabulary Scale and an object-naming measure. All parents completed the Oxford Communicative Development Inventory (Oxford CDI) and an exposure questionnaire that assessed the proportion of English in the language input. Where the CDI existed in the bilingual's additional language, these data were also collected. Outcomes & Results: Hierarchical regression analyses found the proportion of exposure to English to be the main predictor of the performance of bilingual toddlers. Bilingual toddlers who received 60% exposure to English or more performed like their monolingual peers on all measures. K-means cluster analyses and Levene variance tests confirmed the estimated English exposure cut-off at 60% for all language measures. Finally, for one additional language for which we had multiple participants, additional language CDI production scores were significantly inversely related to the amount of exposure to English. Conclusions & Implications: Typically developing 2;6-year-olds who are bilingual in English and an additional language and who hear English 60% of the time or more, perform equivalently to their typically developing monolingual peers.

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Carolanna Rodriguez is a Speech and Language therapist at a private therapy clinic in Hong Kong.

Caseload: I work in a private therapy clinic in Hong Kong and we accept both paediatric and adult referrals. As a result, I have a mixed caseload, including a range of paediatric speech clients, language delay, ASD, and some professional voice users. I am also based 2 days a week in an Adult Learning Disability facility, and once a week in an International school where I have a largely consultative role.

Duties: I am the lead Clinician at the clinic. As part of this role, I manage my individual caseload, liaise with our Director during weekly clinic meetings, and supervise another SLT colleague. From time to time, we have student SLTs from overseas come to us, whom I act as clinical supervisor for. Other aspects of my role include carrying out assessments, maintaining client records and carrying out screening assessments in international schools to identify children who may need SLT input.

Service Structure: As we are a private practice, the majority of our referrals come directly from parents, carers and adult clients, and from other professionals. We are fortunate enough to have a minimal waiting list and so the process between referral and assessment is usually quick (a matter of days). Our clinicians take telephone and email referrals, contact the referee back with assessment process information and book the initial consultation and assessment. Following assessment, a summary and recommendations are sent out, and then a package of care is offered (individual treatment/ home and classroom recommendations/ mixture of both).

Typical Day: A typical day involves going to my base (be that clinic, ALD facility or School) and setting up the resources for my groups or 1:1 sessions. I then usually see about 3 clients before lunch time for 1:1 sessions, have an afternoon social skills group (if I am based at the ALD Centre that day), followed by 2 or 3 more 1:1 clients, then do my paperwork, including plans for the next day's therapy sessions, go home and repeat it all the next day!

Challenges: So far the attitudes and lack of awareness towards SLT as a profession and towards any perception of 'disability' in Hong Kong have been something I've found highly challenging. Having trained in the UK, I have always worked in a culture where having any sort of diagnosis or individual communication need was addressed with additional help and differentiation. Here the need for that is largely perceived in a negative way, i.e. children with these needs can be denied school access solely on this basis. There is also reluctance to address the problem through early intervention, the prevailing idea seeming to be that ignoring the problem will make it 'go away' or that children are immediately 'written off' once they have an additional need. Very challenging and somewhat frustrating!

Surprises: The huge capacity that clients have for change once given the right tools always surprises me. Not because I dont know it can happen, just because it is always a lovely thing when clients do make progress, and every little achievement for clients still makes me love what I do.

Interview Corner

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Continuation

Carry Over: I ensure carry-over of skills by providing home tasks after each session and reviewing the progress of these at the start of the next session, through discussion with carers/clients and a quick review task. I also, where applicable, provide school based recommendations and carry out classroom observations periodically to see what I need to do to review the current skills being targeted.

Impact: As I have such a mixed client group, the impact varies. For my paediatric clients, the difficulties impact mainly on the child, as well as their parents and teachers. For my ALD clients, often they are not aware of their difficulties, which can then be frustrating for them when they are socially or communicatively impeded, because they often perceive the breakdown to be coming from the listener. This can be hard on their families too. And for my 3 adult voice clients the impact is directly on them, as it affects their ability to perform their professional role (teacher, singer, yoga instructor), but also on their partners because of the impact on the mental wellbeing of the client, and employers because it impacts on their work. In a nutshell, the answer to that question is it impacts on everyone with whom the individual interacts in his or her daily lives.

Success Story: I have been working with a young lady who has Downs syndrome and Selective Mutism. Her receptive language skills are age appropriate and so are her expressive skills when she is in an environment she feels confident speaking in. At the start of therapy in December, she would only be able to speak at home with her parents, not in any other contexts. The aims of therapy have been to reduce her anxiety around speaking situations so that she can speak in a wider number of contexts and with a wider number of people. Therapy takes place at the ALD centre she attends daily with me (and her father present at first). She now speaks within the Centre to me without her father being present, and is beginning to speak to me in front of other people outside of the therapy room. For this young lady that is a huge achievement because, although speaking still makes her anxious, she is finding coping with this much easier and has reported to me that she feels that her quality of life has improved as a result.

Loved Resources: My 'What's in the box?' box! This is a colourful box filled with sensory-stimulating toys and objects, e.g. bubbles, things that light up, wind up, are colourful, textured, make noises, you name it! Children sit in a circle around me while I hold the box, we sing a song with accompanying Makaton signs, then I take out an item from the box and the children name it, have turns playing with it, put it back and then we start over again with a new item. It is an amazing resource for targeting so many different areas with young children, including attention and listening, turn taking, sharing and expressive vocabulary, as well as being something children always really enjoy and look forward to using.

Wish List: Am I allowed to say more items for my 'what's in the box?' box?

Interview Corner

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Continuation

Top Tips for Clinicians: Be confident in your knowledge and ability as a professional, all the while realising just how important peer support and supervision is - there is nothing wrong with asking colleagues for advice when you experience a particular case/issue which is either outside of your professional comfort zone or which you feel a colleague would know more about. In fact, I think this recognition of your own limitations makes you a better professional because it means you acknowledge there is always room to grow.

Top Tips for Other Professionals: If in doubt about a possible communication need, always seek SLT advice. Most SLTs are more than happy to provide informal advice with no obligation and often just having that conversation can put parents/clients at ease. Where the discussion leads to a referral and assessment, it means that you are on the way to getting help. Its all about early intervention, early intervention, and early intervention!

Interview Corner

Be confident in your knowledge and ability as a professional, all the while realising just how important peer support and supervision is - there is nothing wrong with asking colleagues for advice when you

experience a particular case/issue which is either outside of your professional comfort zone or

which you feel a colleague would know more about.

'What's in the box?' box! This is a colourful box filled with sensory-stimulating toys and objects, e.g. bubbles,

things that light up, wind up, are colourful,

textured, make noises, you name it!

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The following article was published online on http://onlinelibrary.wiley.com on 18/11/2013, DOI: 10.1111/jpc.12396.

Learning Difficulties or Learning English Difficulties? Additional Language Acquisition: An

Update for Paediatricians Vanessa Clifford, Anthea Rhodes and Georgia Paxton

Journal of Paediatrics and Child Health Volume 50, Issue 3, pages 175181, March 2014

Abstract: Australia is a diverse society: 26% of the population were born overseas, a further 20% have at least one parent born overseas and 19% speak a language other than English at home. Paediatricians are frequently involved in the assessment and management of non-English-speaking-background children with developmental delay, disability or learning issues. Despite the diversity of our patient population, information on how children learn additional or later languages is remarkably absent in paediatric training. An understanding of second language acquisition is essential to provide appropriate advice to this patient group. It takes a long time (5 years or more) for any student to develop academic competency in a second language, even a student who has received adequate prior schooling in their first language. Refugee students are doubly disadvantaged as they frequently have limited or interrupted prior schooling, and many are unable to read and write in their first language. We review the evidence on second language acquisition during childhood, describe support for English language learners within the Australian education system, consider refugee-background students as a special risk group and address common misconceptions about how children learn English as an additional language. Key points:

Students take 5 years or more to develop academic competency in a second or subsequent language, even those who have received adequate prior schooling in their first language. Cognitive development, proficiency and schooling in first language are key variables affecting additional language acquisition; thus, older children learn additional languages more quickly than younger children. Adolescents may not have enough time to develop academic language proficiency during their time in high school.

Refugee students may be further disadvantaged by limited or interrupted prior schooling, low first language literacy, their refugee/trauma experience, medical or mental health issues, and factors related to settlement.

Current provisions for teaching newly arrived refugee children tend to encourage subtractive bilingualism and are likely to be less than optimal for the needs of migrant and refugee-background children.

Recommendations:

Encourage continued first language development for children, including interaction with family in their first language (on increasingly complex topics) and positive family attitudes to maintaining first language.

An explanation of additional language acquisition is often helpful for both students and their families in order to counter unrealistic expectations, support parents and families to maintain cultural integrity and help families make informed choices about schooling options.

Encourage attendance at English language schools and centres during early settlement wherever possible and first language schooling where available.

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6 SLT students from Portugal shared with TIC what made them choose a career in SLT, their views on the profession, and their hopes for the future. A big thank you to:

Mrcia Filipe Ctia Ribeiro Ana Athayde Campos Raquel Vieira

Zlia Fernandes Ndia Silva Ins Mestre Daniela Silva

Sofia Veloso

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Were all in our last year of a 4 year degree in Speech and Language Therapy.

Why did you decide to study SLT?

M. F.: When I finished high school, I didnt know what to choose and since I had many friends studying physiotherapy in Escola Superior Sade do Alcoito (ESSA) I decided to register in this school. Thats when I saw they had SLT too and decided to go ahead it.

C. R.: Aside from limited knowledge from some acquaintances in this area regarding their duties and work areas, I honestly did not what I was getting myself into. Over time, I realized that we are able to help and provide a better quality of life to the population and this makes me want to continue my course every day.

A. A. C: Because I saw communication as something necessary to live with quality; it keeps us in touch with each other and allows us to share ourselves with others and build relationships. I knew these professionals help people to communicate and one day I just thought that this was what I would want to do as much as possible.

R. V.: I decided to study SLT because I was interested in a profession that was related to health and allowed for human interaction. Having dealt with some difficulties myself with being bilingual, I felt that this would be an area of interest.

Z. F.: Because I love language and to help people who may have difficulties in this area.

N. S.: I chose SLT by chance. I knew I wanted to work with people who need help, in the field of health. I read about the course and I thought I would like it!

I. M.: Having ongoing and specific training in this area is a plus.

D. S.: I decided to study SLT because I can see myself doing it.

S.V.: My mum works really close to an SLT (she's a special needs teacher) and my grandfather had a total laryngectomy. This allowed me to be in touch with two different intervention areas.

What has been the most rewarding and the most difficult so far?

M. F.: It is rewarding to receive positive feedback during the clinical placements. Coordinating all subjects with personal life is challenging.

C. R.: The time that some steps take to work is challenging; however, it is rewarding to see how these small steps become significant, for us and for the family, and how our intervention has a big impact in that person's life and family.

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Continuation.

A. A. C: The most rewarding has been to see people evolve in the rehabilitation process: a boy with severe dysphagia at first who now eats all consistencies, for instance. The most difficult has been adapting my behaviour towards the patients, their families and the team I work with; to know when to talk and when not to talk, when to touch, when to move.

R. V.: Knowing and feeling that my intervention contributes to the wellness and quality of life of the patients I work with is the most rewarding aspect for me. The most difficult is being confronted with some of the family situations, and the general health of some of the people I work with.

Z. F.: It is rewarding to learn so many things about care, health, and pathologies, and to meet teachers and other people who are passionate about SLT. It is difficult to have so little time for my personal life.

N. S.: The fact that SLT can make a difference and contribute to a persons quality of life is rewarding. On the other hand, it is difficult that this profession is not valued in Portugal enough.

I. M.: The most rewarding is to known that I can, from now on, help individuals who need support.

D. S.: The impact we can have as SLTs in a persons life through direct and indirect intervention is the most rewarding. The most difficult is, undoubtedly, the management of information from all the SLT areas.

S. V.: Clinical placements! They were the most difficult and the most rewarding parts!

Has anything surprised you/ something you werent expecting? M. F. & Z. F. & I. M. & D.S. & S. V.: I had no idea how wide the SLT scope can be, from paediatric dysphagia to voice. C. R.: SLT may cover many areas that people may be unaware of and, subsequently, they may not seek our services. It is concerning that many health professionals may not be aware of their professional boundaries and work on areas that pertain to SLT without having all the necessary knowledge that is required.

A. A. C: An SLT can actually make a huge difference in ones life. Once someone communicates, (s)he is valued, accountable. I saw a man wth aphasia who had a stroke four years ago and who only produced stereotyped speech. After four years of SLT, I saw him chatting effortlessly in a complex conversation. I saw a child with ASD using a commnication device to talk to his mom, who until then had to guess what was on his mind.

R. V.: Having chosen a profession where one has to be an expert at communicating in every situation, sometimes it happens that we are the only ones who understand, and are willing to spend the time to understand, the patients we work with. This is important because we are almost like therapists to these patients, and constitute their only support.

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Continuation.

N. S.: What surprises me in a positive way is knowing that the SLTs have a wide job scope and that we can work with patients since birth to the end of their lives.

What has been the most influential teacher/ SLT you have met and why? M. F.: The most influential teacher/ SLT were Dlia Nogueira and Lusa Taveira because they think out of the box. They see things in a different, better way.

C. R.: Professor Margarida Grilo, who has given me confidence from the start. She is an example of not only a good person and teacher but also of an excellent SLT.

A. A. C: I have met many influential and inspirational SLTs who share their knowledge, experience and motivation with their students and peers. These special ones take time to answer our questions, search what we dont know yet, and are not afraid to show they care. They are sensitive to our thoughts, questions and insecurities. They all are also very demanding with themselves and with us, students. We are proud of having them as teachers and models and want to learn the most with them. They always want us to improve, and if needed, they will help us doing so.

R. V. & Z. F. & I. M.: Every teacher I have been taught by has affected my learning and who I am in different ways. Some have accompanied my school life longer than others, and some have had a bigger impact than others. I believe that, without that group of teachers, I would not be the student I am today.

N. S.: It is difficult to point out a name. I value the professional who vales evidence-based practice. As a student, I have been given the privilege of being in contact with several professionals with this quality.

D. S.: The teacher who influenced me most was Professor Dlia Nogueira - her knowledge and willingness to learn more and her ongoing concern about transmitting all her knowledge to her students.

S. V.: Dlia Nogueira! She introduced me to the world of dysphagia and scientific research.

What has been the most challenging case you have worked with during clinical placements? M. F.: A woman who has primary progressive aphasia. Its the 1st case that I came across that had no visible improvements.

C. R.: A child with ASD characteristics. Many people label children and have low expectations. However, a child is always changing, his/ her language skills can always progress. Cognitively, it does not mean that the child is not capable of learning, only that he/she may learn slower.

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Continuation.

A. A. C: A woman who suffered a traumatic brain injury, the lesions are significantly extensive and she has severe dysphagia and cognitive-communicative disorder. We are trying to inhibit pathological reflexes, stimulate the typical ones, increase time of attention, and establish consistent answers. However, it has been difficult to succed in all the above.

R. V.: An adult with global aphasia and with stereotyped discourse. It is not easy because the SLT goes from working with a patient who is not completely aware of their condition in the beginning to one who is aware and gets easily frustrated with not being able to say what they want or being understood. The learning curve when working with these cases is of great importance in this profession.

N. S.: The patient who presents with more than one impairment. It forces you to define intervention priorities, always having in mind the patients well being and taking into account his/her circumstances at the moment.

I. M.: A 79 years old lady who had thyroid surgery and, as a result, had vocal cord paralysis. D. S.: The most challenging case I ever had was a 9 year old autistic child who was non-verbal and had sensory needs.

S. V.: A patient with Parkinsons who had significant dysphagia difficulties (with obvious signs of aspiration) and who did not accept his diagnosis, putting himself at risk.

What hopes do you have for your profession in the future? M. F.: In the future, I hope more people who need SLT treatment will be able to access it. Lack of awareness about what we do means that most health professionals dont refer patients to us.

C. R.: That all the knowledge acquired along with the different experiences and professionals that I dealt with serves to help those in need of our care.

A. A. C: I hope the SLT profession keeps developing through research and learning opportunities, and that it continues to be a useful profession that targets what is best for patients. I also wish people were more aware of what we do.

R. V.: I hope that there is an increase in awareness of SLT, so that we are allowed to contribute, to our full potential, to the health and wellbeing of those who need us.

Z. F.: To find a place to work with a good team, one that works collaboratively.

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Continuation.

N. S.: That our professions importance is recognised in Portugal.

I. M.: I hope to be a successful professional, do my job well and help people.

D. S.: I hope that the profession continues to evolve and that there is an investment in scientific research as well as a sharing of knowledge between all SLTs.

S. V.: Public recognition! So many people don't know anything about SLT. But this needs to be done by all the SLT community.

Children or adults and why? M. F.: I dont know. I had clinical placements in both areas and I like them both.

C. R.: I have always wanted to work with children due to their characteristics, work dynamics and the way they progress.

A. A. C: Adults. They may not often know how to depend on others but they have others who depend on them.

R. V.: I would prefer to work with adults because it is a different kind of interaction that, personally, appeals to me more.

Z. F.: I dont know if I can choose it right now, but I like working with acquired language impairments.

N. S.: As the prospects of having a job are reduced, I think it is important to be open minded to all ages and areas. However, if I could choose, I would choose adults.

I. M.: I love adults but with my last clinical paediatric placement I was torn between the two.

D. S.: Adults because I find it more interesting and challenging in terms of therapy planning and intervention.

S. V.: I always thought it would be adults, but now Im not sure now. I'm sure that dysphagia is an area of interest.

The best advice you have been given by your teachers/ supervisors?

M. F.: Dont stop working and see the patient as a person with multifactorial barriers.

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Continuation.

C. R.: During my last stage of intervention, Dr. Nuno Lobo Antunes said something that resonated with me - "We believe that no child is a detached island from school and their parents and siblings, so if we want to help, we must be in solidarity with the equal sides of this triangle." This aspect does not concern only children but the general population we work with, i.e. the different partners of communication.

A. A. C: Not all knowledge comes from books. Observe, think, practise and always evaluate the result.

R. V.: The best advice I have been given so far is to trust my instinct and to think for myself. Books will teach the why of things but, in the end, I need to trust my own judgment to adapt the know how to real life situations.

Z. F.: Walk in their shoes.

N. S.: Always value what is important/relevant to the individual, and guide the intervention in that direction.

I. M.: To never give up on your dreams. Make your work as SLT valuable.

D. S.: To continue to invest in education research and specialisation.

S. V.: Take all the opportunities you can get, you never know what is going to happen and every person is a different.

"We believe that no child is a detached island from school and their parents and siblings, so if we

want to help, we must be in solidarity with the equal sides of this

triangle."

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The following article was published online on http://onlinelibrary.wiley.com on 11/01/2014, DOI: 10.1111/jcpp.12190.

Longitudinal Trajectories of Peer Relations in Children with Specific Language Impairment

Pearl L. H. Mok, Andrew Pickles, Kevin Durkin, Gina Conti-Ramsden Journal of Child Psychology and Psychiatry

Volume 55, Issue 5, pages 516527, May 2014

Background: Peer relations is a vulnerable area of functioning in children with specific language impairment (SLI), but little is known about the developmental trajectories of individuals. Methods: Peer problems were investigated over a 9-year period (from 7 to 16 years of age) in 171 children with a history of SLI. Discrete factor growth modeling was used to chart developmental trajectories. Multinomial logistic regression analysis was conducted to investigate factors associated with group membership. Results: Four distinct developmental trajectories were identified: low-level/no problems in peer relations (22.2% of participants), childhood-limited problems (12.3%), childhood-onset persistent problems (39.2%) and adolescent-onset problems (26.3%). Risk of poor trajectories of peer relations was greater for those children with pragmatic language difficulties. Prosocial behaviour was the factor most strongly associated with trajectory group membership. Overall, the more prosocial children with better pragmatic language skills and lower levels of emotional problems had less difficulty in developing peer relations. Conclusions: Analysis of developmental trajectories enriches our understanding of social development. A sizeable minority in the present sample sustained positive relations through childhood and adolescence, and others overcame early difficulties to achieve low levels of problems by their early teens; the majority, however, showed childhood-onset persistent or adolescent-onset problems. Clinical implications: We provide encouraging evidence that some children with a history of SLI progress from childhood to adolescence with relatively low levels of peer problems. Nevertheless, the majority showed childhood-onset persistent or adolescent-onset difficulties. This is important information in terms of our understanding of the developmental course of peer relations in those with language impairments and has implications for identification, referral to services and the targeting of interventions. Clinically, our findings suggest that the identification of pragmatic difficulties and emotional problems could be critical to the amelioration of potential difficulties in peer relations. In this study, the use of teacher report of pragmatic difficulties were informative at age 7 as was the CCC and the SDQ emotional scale in middle childhood, at age 11. Results of randomized controlled trials show that pragmatic difficulties (Adams et al., 2012) and emotional problems (Sanders, Baker & Turner, 2012) can be addressed effectively, in at least some children. Our results also suggest that, clinically, it is advisable not only to identify deficits but to evaluate the extent to which potential protective and/or positive factors are present. We found that the SDQ prosocial scale in middle childhood to be a particularly strong predictor of differences in the trajectories of peer relations of children with a history of SLI. Prosocial behaviours are also open to contextual influence and intervention. For example, children whose parents express responsiveness and warmth are more likely to display prosocial behaviours (Zhou et al., 2002), as are adolescents whose best friends engage in such behaviours (Barry & Wentzel, 2006). Interventions, such as Family Talk Intervention (Solantous, Paavonen, Toikka & Punamki, 2010) and school-based strategies (Riedel, 2002; Solomon, Battistich, Watson, Schaps & Lewis, 2000) have been shown to be effective in improving prosocial behaviours in children. To the authors knowledge, however, there are no intervention studies that have directly targeted prosocial behaviours in children with language impairments. Finally, it is salutary to reflect that, in most countries, provision for language therapy diminishes for children post- the elementary school range, and provision for social skills training in peer relations in these children is scant at all ages.

Research Article

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The following article was published online on http:// http://www.laryngologyandvoice.org on 11/09/2013, DOI: 10.1111/1460-6984.12047.

Improving Comprehension in Adolescents with Severe Receptive Language Impairments:

a Randomized Control Trial of Intervention for Coordinating Conjunctions Susan H. Ebbels, Nataa Mari, Aoife Murphy, Gail Turner

International Journal of Language & Communication Disorders Volume 49, Issue 1, pages 3048, January-February 2014

Background: Little evidence exists for the effectiveness of therapy for children with receptive language difficulties, particularly those whose difficulties are severe and persistent. Aims: To establish the effectiveness of explicit speech and language

TIC May 2015.pdf

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