Language intervention in the school years: a systemic approach

En este artículo se considera la intervención enniños con dificultades madurativas del lenguajedesde un abordaje sistémico. Gran parte de la bibliografía sobre la intervención en las dificultadesdel lenguaje se centra en el niño y en el terapeuta.Nuestro argumento se centra en la necesidad deconsiderar al niño en un contexto educacional ysocial más amplio. El contexto inmediato o proximalprincipalmente está compuesto por la escuelay la familia, puesto que estos son los dos ámbitosen que los niños pasan la mayoría de su tiempo. Elcontexto más distal atañe a la sociedad, en sentidoamplio, en la que el niño vive. Por tanto, esteanálisis considera no sólo al niño y a las intervencionesdirectas, sino también al contexto sociopolítico en el que tienen lugar las intervenciones

In this paper we consider intervention for childrenwith developmental language difficulties from asystemic approach. Much of the literature concerningintervention for language difficulties focuses on childand therapist. Our argument is that it is necessary toconsider the child in the wider educational and socialcontext. The immediate or proximal context is primarilythe school and family for it is in these two settingsthat children spend the large majority of theirtime. The more distal context concerns the widersociety in which the child lives. This analysis, therefore, considers not only the child and direct interventions but also the socio-political context in which the interventions occur

Early Years Centres for pre-school children with primary language difficulties: what do they cost, and are they cost-effective?

BACKGROUND: High levels of early language difficulties raise practical issues about the efficient and effective means of meeting children's needs. Persistent language difficulties place significant financial pressures on health and education services. This has led to large investment in intervention in the early years; yet, little is known about the actual and relative costs of early years provision. AIMS: To profile the different costs incurred by two Early Years Centres (EYCs) partially funded by the charity I CAN and children receiving what might be termed 'routine' NHS speech therapy to provide an analysis of cost efficiency and equity. METHODS & PROCEDURES: Costings for service provision for 91 children (mean age 2;9) were collected. The activity of staff at each site and the cost of staff allocated to services were computed. Data on other resources were also collected. OUTCOMES & RESULTS: The cost per child per session was on average 12 pounds. Despite the longer course of intervention in the first centre (10 compared with 6 weeks), the cost of the course per child was of the same order (245 pounds compared with 253 pounds). The annual cost of the early years provision per child was higher relative to the costs of the NHS provision, 645 pounds compared with 181 pounds in one EYC (A) and 462 pounds compared with 173 pounds in the other (B). When the cost of standard nursery provision was factored in, the difference in annual costs was rather less, with 5298 pounds for the early years provision (EYC A) relative to 4276 pounds in the comparison group. By contrast, the annual cost of early provision rises to 5926 pounds relative to 8861 pounds in the comparison group (EYC B). CONCLUSIONS: The cost of the EYCs is relatively low and given the positive outcomes reported in the study of which this economic evaluation is a part, there is a good case for saying that they represent an efficient use of resources. The strengths and limitations of the economic evaluation are considered and the need for long-term evaluations is highlighted.

Speech and language skills and cognitive functioning in children with Apert syndrome: a pilot study.

There are few studies that report findings on the speech and language characteristics of Apert syndrome and little is known about the cognitive profile of the syndrome. The current study addresses this gap and explores speech, language, resonance/voice, attention oro-motor and cognitive skills in a group of 10 children (4;1-5;11) with Apert syndrome. The speech and language battery included: the CELF-Pre-school, the PLS-3, the Vocal Profile Analysis, GOS.SP.ASS, PACS; and the Brodsky Drooling Scale. Subscales of the BAS II-Early Years Version were used to assess cognition. Data were also collected on other factors that could influence developmental outcome such as audiological history and management; occlusion/dentition; respiratory problems and management; neuroanatomical abnormalities; the number and nature of cranial surgeries; and the occurrence of raised intracranial pressure. All children for whom a Performance IQ was obtained (n = 8) had abilities within the average range and IQ scores were considerably higher than those reported in previous studies. Eight children had moderate or severe language difficulties and expressive language difficulties were the most frequent. These language difficulties were not associated with a general cognitive deficit. All the children had problems with attention, speech and oro-motor skills. Nine had abnormal voice. In addition, a range of other associated factors that could affect functioning were identified. The discrepancies between the current study and previous investigations are outlined. Parameters for assessment are considered. The implications of these findings for valid assessments of children with Apert syndrome are discussed. Multidisciplinary assessment of children with Apert syndrome across a broad range of dimensions is recommended to obtain a profile of each child's strengths and weaknesses to ensure that appropriate educational placements and early interventions are implemented. Considering patterns of development over time at key ages is also argued to be of central importance.

Children with word-finding difficulties--prevalence, presentation and naming problems.

There is increasing interest from therapists and researchers in children's word-finding difficulties (WFDs). Word finding difficulties are usually considered to be present when children are able to identify a referent from a set of exemplars, but have difficulty producing the target word when shown a picture or in conversation. Word finding difficulties are associated with a number of conversational forms such as delays in the production of a word, the use of long pauses within phrases, frequent use of place holders ('uh', 'um', etc.) and the use of circumlocutions. Although interest is being shown in WFDs, most of the data come from relatively small samples with the result that one knows little about the prevalence of the condition, what circumstances exacerbate the condition, the occurrence of associated difficulties and the types of therapy that are employed. To obtain this information a survey was carried out in the South-East of England of practitioners working with children who have language difficulties. Twenty-three per cent of children in language support services were identified as having WFDs. Most respondents used a mixture of formal and informal assessments. It was reported that WFDs were associated with difficulties in grammatical production, word meaning and grammatical comprehension. WFDs in addition were more likely to occur in situations with high processing demands. A variety of intervention strategies were identified. These findings are discussed in relation to current practice and the authors understanding of the condition.

An economic analysis of the resettlement of people with mild learning disabilities and challenging behaviour.

New models of care are needed following the closure of long-stay mental handicap hospitals. Based on an evaluation of a recently established assessment and treatment service in south-east England, this paper is concerned with the costs and likely benefits of different patterns of services for people with mild learning disabilities and severely challenging behaviour. Different models of provision are compared in terms of their costs and quality of life opportunities for clients. The assessment and treatment services provided a better understanding of the care needs, and achieved a reduction in challenging behaviours. It was therefore possible to give access to care settings closer to a normal life. For approximately 25% additional expenditure, 20 out of 34 clients who received the service moved to community placements, including three who had been referred following a breakdown in the community. If community care is to be implemented as a policy for clients with learning disabilities and serious challenging behaviours, it is necessary to recognise the financial implications. Better quality of life opportunities for this client group are associated with higher costs. When seen in the dynamic context of the costs and quality of life opportunities of the subsequent care, a high cost assessment and treatment service may be a good investment. On current evidence, the additional benefits of community homes, with a closer association with the local community, and greater freedom for clients is bought only at quite a high cost.