Development of an outcome measurement system for service planning for children and youth with special needs.

AIM: This study described the process used in developing an outcome measurement framework for system planning to improve services for children and youth with special needs and their families in a Canadian province. The study reports the results of several parent-completed measures, which would be useful in service planning as well as the acceptability and utility of these measures for use by families and service centres. METHODS/RESULTS: Development of a theoretical framework, consultation with key stakeholders, testing the utility of selected outcome measures and initial dissemination of results were critical elements in the successful development of an outcome system. Consultation with stakeholders confirmed use of the International Classification of Functioning, Disability and Health and the child-within-family-within community model as theoretical frameworks while building valuable partnerships and identifying potential barriers to implementation. Pilot testing showed three outcome measures were feasible for families to complete and the measures provided information about services for children that was valuable to families as well as service providers. Gaps in service delivery were identified and the need for better communication between service providers and communities to facilitate integrated services was highlighted. CONCLUSION: The findings from this study can be used to implement an outcome measurement system for children with special needs and may serve as a resource for international researchers who are working to develop valid tools as well as outcome systems that are useful for system planning.

Risk for speech disorder associated with early recurrent otitis media with effusion: two retrospective studies.

The goals of this two-part series on children with histories of early recurrent otitis media with effusion (OME) were to assess the risk for speech disorder with and without hearing loss and to develop a preliminary descriptive-explanatory model for the findings. Recently available speech analysis programs, lifespan reference data, and statistical techniques were implemented with three cohorts of children with OME and their controls originally assessed in the 1980s: 35 typically developing 3-year-old children followed since infancy in a university-affiliated pediatrics clinic, 50 typically developing children of Native American background followed since infancy in a tribal health clinic, and (in the second paper) 70 children followed prospectively from 2 months of age to 3 years of age and older. Dependent variables included information from a suite of 10 metrics of speech production (Shriberg, Austin, Lewis, McSweeny, & Wilson, 1997a, 1 997b). Constraints on available sociodemographic and hearing status information limit generalizations from the comparative findings for each database, particularly data from the two retrospective studies. The present paper reports findings from risk analysis of conversational speech data from the first two cohorts, each of which included retrospective study of children for whom data on hearing loss were not available. Early recurrent OME was not associated with increased risk for speech disorder in the pediatrics sample but was associated with approximately 4.6 (CI = 1.10-20.20) increased risk for subclinical or clinical speech disorder in the children of Native American background. Discussion underscores the appropriateness of multifactorial risk models for this subtype of child speech disorder.

Speech and phonological characteristics of individual children with a history of tracheostomy.

The present investigation studied the speech production and phonological skills of 6 children between the ages of 2;8 and 6;8 (years;months) who had undergone tracheostomy before age 8 months. Each child's speech was analyzed for size and composition of phonetic inventory, use of phonological processes, production of vowels, and production of the voicing contrast for stops. Analyses were completed once consistent air support for vocalization was established for each child and 3 months after that date. This study highlights the slow development of sound acquisition, vowel production, and the distinction between voiced and voiceless stops for some, but not all, children with a history of tracheostomy. Each child exhibited his or her own pattern of speech production difficulties on four tasks. Excessive use of inappropriate phonological processes relative to age was the most prevalent speech production problem. Five of 6 subjects exhibited clinically significant use of Stridency Deletion, Liquid Deviation, and/or Cluster Reduction. Adjustments were noted in the speech of all subjects during a 3-month period.

The effect of conversational setting on topic continuation in mother-child dyads.

Twelve children (five boys and seven girls, mean age 4; I) interacted with their mothers in two conversational settings: playing with a favourite toy and helping to prepare lunch or muffins. The percentage of two topic continuation processes--topic incorporation and collaboration--used by mothers and children was analysed. It was hypothesized that the help setting with a predetermined structure would elicit a greater percentage of topic incorporation by the dyads than the play setting. In fact, the play setting elicited a greater percentage of topic incorporation from mothers than the help setting. Children did not differ significantly in the percentage of use of topic incorporation between the two settings, but appeared to be equally proficient in incorporating topics in settings with and without a predetermined structure. The play setting also elicited more topic collaboration from the children than the help setting. While the help setting appeared to support collaborative action, the play setting permitted the dyads to be informative about the toys as well as related topics. Therefore, the two settings provided different opportunities for the dyads to continue topics.

Listening comprehension for sentences: the accessibility of referents for pronouns as a function of age, topic continuity, and pronoun emphasis.

An auditory comprehension task was employed to determine how subjects (20 first graders, 20 fifth graders, and 20 adults) use topic continuity and contrastive emphasis in the assignment of referents for pronouns in sentences. Significant differences in performance for emphasized and unemphasized pronouns were found suggesting that subjects used contrastive emphasis when assigning referents for pronouns. Fifth graders overused the cue of topic continuity in assigning referents for emphasized pronouns. This effect has not been shown previously in studies of children's understanding of pronomial reference. An interaction between age and pronoun emphasis was also significant. This interaction suggests that developmental changes continued to take place in the learning of cues for resolving pronouns by school age children.