Globally, as many as 1 in 8 children experience severe and persistent language difficulties. These children are at heightened risk for mental health difficulties, however, both the ways in which mental health concerns manifest in the context of language difficulties, and the experiences of children with language difficulties and their caregivers in accessing and engaging with formal mental health supports remain under researched. The aim of the current study was to explore lived experience perspectives (child and caregiver) on mental health concerns and, mental health support, for children (≤ 18 years) with language difficulties. A 2-phased sequential explanatory design was employed, which combined findings from an online international survey of caregivers (n = 120) of children with language difficulties with data from semi-structured interviews with both children (n = 4) and caregivers (n = 12). Combined data from the survey and interviews highlighted a high level of caregiver concern about the mental health of children with language difficulties but low levels of access to formal mental health support. Interviews highlighted several reasons for not accessing formal mental health supports including limited availability of mental health care providers; funding and time constraints (i.e., not wanting to over-schedule their child); mental health providers lacking knowledge about DLD, and perceived or actual barriers of traditional methods of therapy (e.g., one-on-one talk therapy) for children with language difficulties. The findings of our study support the view that children with language difficulties are at risk of mental health concerns and yet are also under-served by mental health services. These findings highlight the need for targeted interprofessional training and integrated models of collaborative care between mental health and language specialists to more adequately meet these children's needs. Future research to engage a wider range of child perspectives and the perspectives of clinicians on the facilitators and barriers to engaging children with language difficulties in formal mental health support is needed. Children and adolescents with language difficulties experience high rates of anxiety, low self-esteem, and social difficulties, often in response to academic and peer-related challenges. Despite significant mental health concerns, most families report limited access to formal mental health support, citing barriers such as service unavailability, lack of professional understanding of language difficulties, and the unsuitability of traditional talk-based therapies. There is a critical need for interprofessional collaboration between speech-language pathologists and mental health professionals, alongside targeted training and inclusive therapeutic approaches, to ensure accessible and effective support for this population. What is already known on this subject Globally, as many as 1 in 8 children experience severe and persistent language difficulties. These children are at heightened risk for mental health difficulties. What this study adds to existing knowledge Our study provides lived experience perspectives on mental health concerns and mental health support in the context of language difficulties. The findings highlight caregiver concerns about self-esteem, anxiety, peer difficulties and the inaccessibility of formal mental health support. What are the potential or actual clinical implication of this study? Children with language difficulties are at risk of mental health concerns and yet are also under-served by mental health services. Findings highlight the need for targeted interprofessional training and integrated models of collaborative care between mental health and language specialists to more adequately meet these children's needs.
Cognitive communication changes are common after acquired brain injury (ABI) and can impact a person's ability to return to and sustain work. To understand the practices and experiences of speech-language pathologists (SLPs) involved in assessing cognitive communication skills for return to work (RTW) after ABI. An explanatory sequential mixed methods design was used, involving sequential data collection points of a benchmarking survey followed by expert opinion focus groups. Descriptive statistics and content analysis were used to analyse the data. Thirty-four SLPs completed an online survey. Six participants took part in focus groups. Findings suggest SLPs are currently involved in assessing the communication skills of individuals aiming to RTW after an ABI, and that they use a variety of approaches, including standardised and informal or dynamic assessments. They may benefit from training resources, and support to integrate into interprofessional teams. This study emphasises the need to prioritise assessing cognitive communication skills for individuals aiming to RTW post injury. While SLPs provide assessment for this population, improving their integration in interprofessional teams, training and detailed clinical resources will be valuable. SLPs have specialised expertise that can be applied to assessing cognitive communication skills for return to work (RTW). Practice guidelines that are specific to cognitive-communication assessment for RTW are needed to support decision-making and ensure greater practice consistency and confidence. Interdisciplinary collaboration and involvement of SLPs in the RTW process can ensure communication skills are appropriately assessed. What is already known on the subject It is known that cognitive and social communication changes following ABI can impact a person's ability to return to and maintain work. Existing guidelines, such as the International Cognitive Rehabilitation Guidelines for Cognitive Rehabilitation following Traumatic Brain Injury, models such as the Model of Cognitive Communication Competence and professional associations such as Speech Pathology Australia (SPA) and the American Speech Language Hearing Association (ASHA) support the role of SLPs in assessing cognitive communication disorders that impact return to work (RTW) after ABI. These however, provide general advice rather than specific clinical practice information or training resources. There are a variety of cognitive communication assessments but there is a limited understanding of how these are applied in practice. What this paper adds to the existing knowledge This study identifies current RTW cognitive communication assessment practice challenges and opportunities for improvement. What are the potential or actual implications of this work? Findings provide additional support for the role of SLPs in RTW teams. It provides an overview of what is currently occurring in clinical practice and offers guidance on areas for development including functional assessment approaches and interprofessional collaboration.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
This study aimed to translate, culturally adapt, and psychometrically validate the Turkish version of the Communication Complexity Scale (CCS) for minimally verbal children with autism spectrum disorder (ASD) and developmental delay (DD). A total of 130 children aged 24-60 months (diagnosed according to DSM-5 criteria and recruited from developmental podiatric clinics) with fewer than 20 functional words (as verified through caregiver report and direct clinical observation) completed CCS sessions that were video-recorded and independently coded. Reliability was assessed using intraclass correlation coefficients (ICC), Cohen's kappa, and test-retest correlations. Concurrent validity was examined through correlations with the Turkish versions of the Communicative Development Inventory (CDI) and the Test of Early Language Development (TELD). Construct validity was tested with exploratory and confirmatory factor analyses (CFA). Known-groups validity compared Behaviour Regulation (BR) and Joint Attention (JA) scores between ASD and DD groups. Most children demonstrated intentional non-symbolic communication, confirming the scale's sensitivity to minimally verbal behaviours. Inter-rater reliability was excellent (ICC = 0.86-0.91), and test-retest stability was strong (r = 0.88-0.93). CCS scores showed moderate correlations with standardized language measures (r = 0.39-0.42). CFA supported a one-factor model (RMSEA = 0.06; CFI = 0.93). Children with ASD had higher BR scores, whereas children with DD showed higher JA scores. The Turkish CCS is a reliable, valid, and culturally appropriate tool for assessing communication complexity in minimally verbal children. Its sensitivity to non-symbolic and emerging symbolic behaviours support its use in clinical evaluation, individualized intervention planning, and cross-cultural research. What is already known on this subject Minimally verbal children with autism spectrum disorder and developmental delay often communicate through non-symbolic behaviours such as gestures, eye gaze, and coordinated actions rather than spoken language. Conventional language assessments primarily target verbal output and therefore underestimate early communicative competence in this population. The Communication Complexity Scale (CCS) is an observational measure designed to capture hierarchical communicative behaviours from pre-intentional to emerging symbolic levels and has demonstrated strong reliability, validity, and sensitivity to change in English- and Mandarin-speaking populations. What this study adds to the existing knowledge This study provides the first culturally adapted and psychometrically validated Turkish version of the Communication Complexity Scale. The Turkish CCS demonstrated excellent inter-rater and test-retest reliability, strong construct validity supported by confirmatory factor analysis, and meaningful concurrent validity with standardized Turkish language measures. The scale successfully differentiated communication profiles between children with autism spectrum disorder and developmental delay, confirming its diagnostic sensitivity. These findings establish the Turkish CCS as a robust, culturally appropriate observational tool for assessing communication complexity in minimally verbal Turkish-speaking children. What are the potentials or actual clinical implications of this study? The Turkish CCS enables clinicians to systematically assess early communicative behaviours in minimally verbal children who cannot be accurately evaluated using standard language tests. By capturing intentional non-symbolic and emerging symbolic communication, the scale supports individualized intervention planning, goal setting, and progress monitoring. Its strong reliability and diagnostic sensitivity make it suitable for multidisciplinary clinical settings and early intervention programs. The availability of a validated Turkish CCS also facilitates inclusion of Turkish-speaking children in international research and promotes standardized, strengths-based communication assessment in clinical practice. Minimally verbal children often communicate through gestures, eye gaze, facial expressions, or simple actions rather than spoken words. Clinicians in Türkiye currently lack a standardized observational tool that captures these early and non‐symbolic forms of communication. This study introduces the first Turkish version of the Communication Complexity Scale (CCS), a widely used tool for assessing communication abilities in children who speak few or no words. The Turkish CCS was tested with 130 children diagnosed with autism spectrum disorder or developmental delay. The results showed that the scale is reliable, valid, and sensitive to different types of communication behaviours. It can help clinicians better understand how children express themselves, identify communication strengths, and plan individualized interventions. The availability of the Turkish CCS also enables Turkish‐speaking children to be included in international research on early communication.
Communication Partner Training (CPT) is an evidence-based approach that enhances conversation and participation for people with aphasia (PwA) by involving their communication partners (CPs) in therapy. Although CPT is endorsed in international guidelines, little is known about its application in Latin American contexts, where linguistic and cultural diversity and limited resources may influence clinical practice. This study explored the current CPT practices of Latin American Spanish-speaking speech and language therapists (SLTs), identifying barriers, facilitators, and needs to inform the future cultural adaptation of the Better Conversations with Aphasia program. An existing CPT practice survey was adapted and distributed to SLTs in six Latin American countries (Chile, Argentina, Colombia, Peru, Mexico, and Costa Rica). The survey included demographic questions, closed-response items analysed with descriptive statistics, and open-ended items analysed thematically using a codebook approach. Although many respondents reported training families to use strategies such as gestures and simplified speech with PwA, many of these practices appear to involve elements of communication support rather than the structured components typically associated with formal CPT programmes. These practices were mainly implemented informally and without structured training principles, goal setting, or outcome evaluation-key components of evidence-based CPT-largely due to barriers such as limited time, training, and resources. Facilitators included strong professional motivation and willingness to involve family members in therapy. Findings underscore the need for culturally adapted CPT interventions in Latin America. Developing accessible training and institutional support will be crucial to strengthening CPT implementation and enhancing communicative participation for PwA and their CPs across the region. What is already known on the subject Communication Partner Training (CPT) is an evidence-based intervention shown to improve communicative participation for people with aphasia, but most research and implementation data come from English-speaking, high-income countries. Very little is known about how CPT is understood or delivered in Latin America, where limited resources, diverse sociolinguistic contexts, and inconsistent access to training may affect the uptake of evidence-based practice. No prior studies have systematically examined CPT practices among Latin American SLTs or documented region-specific barriers and facilitators to implementation. What this paper adds to the existing knowledge This study provides the first cross-regional description of CPT-related practices among Speech and Language Therapists in Latin America, revealing that although many clinicians report teaching communication strategies to families, these practices often lack the structured components characteristic of internationally defined CPT. The findings identify key behavioural, organisational, and contextual factors influencing CPT implementation, including strong professional intention and positive attitudes toward CPT, contrasted with limited training, organisational support, and culturally relevant materials. The study offers an evidence base to inform the cultural and linguistic adaptation of CPT programmes, including Better Conversations with Aphasia, for Spanish-speaking populations. What are the potential or actual clinical implications of this work? Enhancing CPT implementation in Latin America will require targeted SLT training, institutional recognition of partner-focused intervention, and development of culturally adapted resources aligned with regional linguistic diversity. Strengthening CPT practice has the potential to improve communicative participation and family involvement in rehabilitation for people with aphasia across the region. The results support the need for coordinated regional efforts and cross-national collaborations to embed CPT within routine clinical practice in Latin America.
In the United Kingdom, cleft care is provided across 14 regional NHS cleft units. Although all units assess speech at age 3, no speech assessments have been designed specifically for 3-year-old children with cleft palate ± cleft lip (CP ± L). Existing speech samples for older children are often too complex for this age group, while generalised samples may contain an excessive number of nasal consonants, influencing listener judgements of resonance and nasal airflow. The lack of a standardised assessment for 3-year-olds prevents meaningful comparisons of speech outcomes across UK cleft units before age5. This paper describes the first stage in developing a valid and reliable speech assessment protocol for 3-year-old children with non-syndromic CP±L. This stage involved creating and piloting the West Midlands Assessment of Speech-Preschool (WAS-P) speech samples with 3-year-olds both with and without CP±L. The study aimed to: (1) design age-appropriate speech samples that assess speech parameters associated with CP±L, suitable for both routine clinical assessment and the evaluation of speech outcomes. (2) evaluate the completion rates and clinical usability of these speech samples, including the views of speech and language therapists (SLTs). Two English-language speech samples were developed, considering linguistic, lexical, and practical factors. Sample A combined spontaneous speech with single-word picture naming (59 words, including a cross-linguistic sample), while Sample B involved the repetition of 24 short sentences. The speech samples were piloted with 20 children with non-syndromic CP±L and five children without CP±L. Completion rates and completion times were recorded. Seven cleft-specialist SLTs analysed video recordings of the sessions and provided feedback on acceptability and usability. All children without CP±L completed both speech samples, compared to a 70% completion rate among children with CP±L. More children with CP±L attempted the single-word picture-naming task than the sentence-repetition task, even if they did not complete it fully. The duration of the sentence-repetition sample was completed in significantly less time than the spontaneous speech and single-word naming sample. SLTs reported that the 3-year-olds were generally well engaged and indicated that both samples would be suitable for clinical practice. The first stage of developing the WAS-P speech samples demonstrates the feasibility of standardising speech assessments for 3-year-old children in the UK. Both samples were considered appropriate for use with 3-year-old children with non-syndromic CP±L, balancing ease of administration with clinical usefulness. These speech samples have now been incorporated into a further research study to establish a standardised protocol for evaluating speech outcomes at age three in the UK. What is already known on this subject Although all UK NHS cleft units assess speech at age 3, there is no single standardised speech sample used, and no speech sample has been specifically designed for 3-year-olds with CP±L in the UK. The development of tailored speech samples for this population would facilitate cross-unit comparisons of speech outcomes in UK cleft units. What this paper adds to the existing knowledge This study introduces the West Midlands Assessment of Speech-Preschool (WAS-P), comprised of two newly developed speech samples specifically designed to assess speech in 3-year-olds with CP±L. It demonstrates the integration of existing speech samples-originally intended for cross-linguistic assessments-into these newly designed samples, thereby enhancing the capacity for speech outcome comparisons across different languages. Additionally, the study underscores the critical role of linguistic, lexical, and practical/pragmatic factors, alongside feedback from SLTs, in informing the development of effective speech samples for this age group. What are the potential or actual clinical implications of this work? The development and piloting of the WAS-P for 3-year-olds with CP±L offers a significant advancement in the standardisation of speech assessments across UK cleft units. These new speech samples could facilitate consistent speech assessments at age 3, enabling the comparison of speech outcomes across different clinical settings. Additionally, the inclusion of a restricted word list for cross-linguistic assessments opens the possibility for international comparisons of speech outcomes.
Communication barriers significantly impact the quality of care for people with aphasia (PWA). To address this, training healthcare professionals (HCPs) who interact with PWA is essential. The Health Professionals and Aphasia Questionnaire (HPAQ) assess the effectiveness of such training by measuring changes from pre- to post-intervention. This study aimed to translate and validate the HPAQ into European Portuguese (HPAQ-EP) and to analyse the effectiveness of the Communicative Training in Aphasia program by examining changes in HCPs' communication skills at a clinical centre in Portugal using the newly developed HPAQ-EP. A pre-post intervention study was conducted in two phases. Phase 1 involved translating the HPAQ-EP and validating it through expert panel review, in accordance with international guidelines. Content validity was assessed using the Content Validity Index (CVI). In Phase 2, the HPAQ-EP was administered to HCPs at a clinical centre before and after a training session based on the Supported Conversation for Adults with Aphasia (SCA) approach. The HPAQ-EP demonstrated strong content validity (CVI > 0.80) and good internal consistency (α = 0.912), comparable to the original tool. Following implementation of the Communicative Training in Aphasia program (n = 23), significant improvements were observed, as reported by the HPAQ-EP, in items related to 'Knowledge', 'Skills', 'Attitudes and Emotions' (items 8 and 9) and 'Environment (item 14). Participants found the aphasia simulation the most challenging part and it was particularly insightful for understanding the lived experience of PWA. This study shows that targeted communication training significantly enhances HCPs' readiness to engage with PWA, highlighting its clinical value. The findings also confirm the HPAQ-EP as a valid and reliable tool for assessing HCPs' attitudes toward aphasia and for guiding the implementation of such training. Future efforts should emphasise long-term follow-up and broader implementation across healthcare settings. What is already known on this subject PWA often experience communication barriers that negatively affect their healthcare experiences and outcomes. HCPs frequently lack the specific training needed to effectively communicate with PWA, leading to frustration, miscommunication, increased medical errors and reduced patient involvement in their healthcare process and decisions. Communication Partner Training (CPT), particularly SCA, is an evidence-based approach shown to improve HCPs communication skills. In Portugal, there is a lack of validated tools to assess the impact of such training and few interventions have targeted HCPs directly within clinical settings. What does this study adds to existing knowledge The HPAQ was translated and validated into European Portuguese (HPAQ-EP), demonstrating high content validity and internal consistency. It was used to evaluate the effectiveness of a theoretical-practical Communicative Training in Aphasia program for HCPs. Post-training results showed statistically significant improvements in knowledge, communication skills and attitudes towards PWA. Despite its limitations, this study offers a culturally adapted and psychometrically robust tool for Portuguese-speaking HCPs, while also providing evidence of the short-term effectiveness of communication training for multidisciplinary teams working with PWA in clinical settings. What are the potential or actual clinical implications of this work? The findings support integrating targeted communication training into routine professional development for HCPs who interact with PWA. By improving HCPs knowledge, confidence and communicative strategies, such training fosters more inclusive, patient-centred care and reduces the risk of marginalisation and medical errors. The validated HPAQ-EP enables ongoing evaluation of training impact in Portuguese-speaking settings. Broader implementation and long-term follow-up are recommended to maximise benefits and promote sustainable changes in clinical practice. This study advocates for the inclusion of aphasia-specific communication modules in healthcare curricula to better prepare future HCPs.
This review explored cognitive-communication disorders (CCD) in speakers of Berber languages residing in Morocco and abroad. It emphasized the unique interplay between neuropsychological, linguistic, and cultural factors relevant to Berber languages, which belonged to the Afroasiatic language family and included three main varieties in Morocco: Tachelhit, Tarifit, and Central Atlas Tamazight. A narrative review has been carried out of studies from MEDLINE, Web of Science, and Scopus, summarizing the demographic and clinical characteristics of the participants. The analysis of six remaining studies, comprising a combined sample size of over 923 participants, identified the diversity of Berber-speaking populations in Morocco and the Netherlands. These studies used cross-sectional designs and validation protocols for assessment tools. However, challenges included the significant scarcity of published articles, the suitability of standard tools for low-literacy or culturally diverse populations, limited sample sizes, and socio-cultural barriers. These studies provided a foundation for evidence-based practice using validated neuro-cognitive instruments in accordance with international standards. Therefore, clinicians should prioritize Amazigh cultural and linguistic awareness in diglossic contexts, as the growing prominence of these understudied languages underscored the need for fair, standardized cognitive-linguistic assessment tools.
This study assessed multilingual individuals' attitudes toward stuttering and cluttering, using Chinese university foreign language majors as a sample. It employed the standardized Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) and the Public Opinion Survey of Human Attributes-Cluttering (POSHA-Cl). It further examined whether multilingual background and survey format influenced participants' attitudes. A total of 222 foreign language majors from three northeastern Chinese universities participated. Each university's cohort was randomly assigned to complete either the POSHA-S, POSHA-Cl, or a combined version of the instrument. The questionnaires, validated in Simplified Chinese, assessed participants' attitudes toward stuttering and cluttering by measuring domains such as beliefs and self-reactions. Statistical analyses included descriptive statistics and group comparisons, referencing published data from other Chinese student groups and international databases. Foreign language majors generally held less positive and less informed attitudes toward stuttering and cluttering than international averages. Knowledge and experience related to stuttering and cluttering were relatively limited, and Accommodating/Helping scores ranked near the bottom of the international POSHA-S database and POSHA-Cl database, with misconceptions about the causes of these conditions and appropriate sources of help also evident. These patterns were reflected in this sample's consistently low scores and percentile rankings when compared with international benchmarks. Attitudes among foreign language majors were similar to those reported for other Chinese university students in general majors but were less positive than those of Chinese speech-language pathology students reported in previous domestic studies. The survey format (separate vs. combined POSHA-S and POSHA-Cl) had no effect on attitude scores. Multilingual education alone may not foster greater acceptance of communicative diversity; broader cultural and educational factors, such as societal emphasis on standard language and limited exposure to neurodiversity, may play a more influential role. The findings highlight the need for targeted education and greater inclusion of neurodiversity concepts in higher education to reduce stigma and promote acceptance.
Globally, there is still limited understanding of how Speech-Language Pathologists (SLPs) assess and treat multilingual people with aphasia (MPWA). This article presents results from the Multilingual Aphasia Practices (MAP) survey-an extensive international study involving 407 SLPs working across 60 countries. The MAP survey explored: 1) the multilingual background of SLPs and the languages they incorporate into service delivery, 2) their knowledge and professional training related to multilingualism and multilingual aphasia, and 3) their workplace contexts and client profiles. A large proportion of respondents (79.7%) identified as multilingual and reported using numerous languages in their practice. However, formal training in multilingualism was often minimal. Only 25.06% had completed a course focused on multilingualism, and just 10.07% took a full course specific to multilingual aphasia. Most participants (87.2%) reported major gaps in knowledge and training, particularly regarding best-practice recommendations, supervised clinical experience, and guidance on assessment and intervention for MPWA. Many expressed a strong desire for additional professional development in these areas. Clinical exposure to MPWA varied widely. While 27% of respondents reported daily contact, 26.1% encountered MPWA once or twice per week, and 22.8% indicated that they worked with MPWA only a few days per month. Overall, our findings point to persistent and widespread global gaps in training, resources, and clinical readiness for working with MPWA. The results underscore an urgent need to enhance multilingualism-focused education in SLP programs, establish international best-practice frameworks, develop and disseminate culturally and linguistically appropriate assessment and treatment materials.
Supporting the development of children with complex communication needs, including development of Augmentative and Alternative Communication (AAC) systems is a multifaceted process. Currently this support does not consistently meet the needs of multilingual families and there is little research to guide and improve practice. The present study sought to explore influences on Australian speech pathologists' practice in their work with children with complex communication needs, in multilingual families. Twenty-three (n = 23) Australian speech pathologists working with culturally and linguistically diverse families of children with complex communication needs were interviewed. Transcribed interview data was analysed with a Thematic Analysis approach. Four main themes were identified in this study: 1) Expectations of speech pathology services; 2) Pervasiveness of English; 3) Working to address challenges; and, 4) Reflecting on growth and constraints. Findings demonstrate that Australian speech pathologists share many challenges with the international community of speech pathologists in this aspect of service delivery. Speech pathologists navigated differences in their own and family's perspectives and expectations relating to communication, disability and AAC. Pervasiveness of English in Australian society also presented barriers. The wide range of cultural and language backgrounds in Australia raised challenges in access to and development of necessary and appropriate resources. Systemic restrictions impacted participants' ability to deliver services that meet families' cultural and linguistic needs. What is already known on this subject Australian society is multicultural, yet mainstream structures such as therapy services and schools are monolingual. Families who speak a language other than English face challenges in engaging with speech pathology services that meet their needs. What this study adds to existing knowledge This paper adds the perspective of Australian speech pathologists on their work to support children with complex communication needs in multilingual families, where existing research has not included an Australian perspective. What are the potential or actual clinical implications of this study? This expands our knowledge of issues and challenges relating to services for children with complex communication needs in Australia's culturally and linguistically diverse society, that in turn contributes to developing more appropriate services.
Myelomeningocele (MMC) is associated with significant alterations of the brain microstructure, which can impair long-term neurodevelopmental outcomes. By measuring the random displacement of water molecules within the brain, magnetic resonance imaging (MRI)-based diffusion-weighted imaging (DWI) can provide objective metrics, such as apparent diffusion coefficient (ADC) values, which allow the fetal brain microstructure to be characterized. The aim of this study was to compare prenatal brain ADC values, obtained using MRI-DWI, between infants with prenatally repaired MMC who had normal vs impaired neurodevelopmental outcomes, assessed ≥ 18 months of age. This retrospective study included children who underwent prenatal MMC repair using either a fetoscopic or open-hysterotomy surgical approach between July 2012 and June 2022, at a single tertiary hospital. A 1.5-Tesla MRI-DWI scan of the fetal brain was performed using standard departmental protocols 6 weeks after surgery. ADC values were measured in the right and left hemispheric white matter of the frontal, parietal, temporal and occipital lobes, as well as within the basal ganglia, pons, cerebellar hemispheres and vermis. Neurodevelopment was evaluated by a developmental pediatrician at or after 18 months of age, using the Capute Scales (Clinical Adaptive Test (CAT) for problem-solving skills and fine motor skills and Clinical Linguistic and Auditory Milestone Scale (CLAMS) test for language) and the gross motor domain of the Revised Gesell Developmental Schedules. The Developmental Profile-3 (DP-3) test was also conducted during parental interview at or after 18 months of age, which evaluates five qualities of development: physical, adaptive behavior, social-emotional, cognitive and communication skills. Developmental quotients were calculated as: (age equivalent on Capute Scales, gross motor or DP-3 test/age at assessment) × 100. A normal developmental quotient score was defined as ≥ 85 and a score of < 85 indicated neurodevelopmental impairment (NDI), compared with reference values. ADC values measured in each brain region were compared between children who later had a normal developmental quotient score vs those with a score < 85, using the Mann-Whitney U-test and logistic regression analysis, adjusting for the child's age at the time of neurodevelopmental testing, gestational age at the time of MRI-DWI and gestational age at delivery. A total of 50 children were included (39 that underwent prenatal fetoscopic repair and 11 that underwent prenatal open-hysterotomy repair). A prenatal MRI-DWI scan was performed after surgery at a median of 30.9 (interquartile range (IQR), 30.5-31.4) weeks' gestation. The Capute Scales and gross motor scores were available in 31/50 (62.0%) and 29/50 (58.0%) cases, respectively, and were obtained at a median age of 23.0 (IQR, 18.0-25.5) months and 23.0 (IQR, 21.0-26.2) months, respectively. Among these cases, 22/31 (71.0%), 19/31 (61.3%) and 3/29 (10.3%) scored ≥ 85 on the CLAMS test, CAT and gross motor test, respectively. The DP-3 test score was available in 42/50 (84.0%) children and was conducted at a median age of 24.5 (IQR, 19.0-26.7) months. Among these children, 18/42 (42.9%), 28/42 (66.7%), 38/42 (90.5%), 35/42 (83.3%) and 33/42 (78.6%) had a score ≥ 85 for the physical, adaptive behavior, social-emotional, cognitive and communication domains, respectively. After adjustment, fetal ADC values obtained 6 weeks after surgery were significantly higher in all fetal brain regions studied (P < 0.05 for all), except for the vermis (P = 0.12) and pons (P = 0.05), in infants who later had a CLAMS test score indicating NDI compared to those with a score ≥ 85. Additionally, fetal ADC values were significantly higher in all fetal brain regions, except for the left temporal lobe (P = 0.05), left occipital lobe (P = 0.06), pons (P = 0.30), right and left cerebellum (P = 0.55 and 0.24, respectively) and vermis (P = 0.76), in infants who later had a CAT score indicating NDI compared to those with a normal score. Fetal ADC values were also significantly higher in the parietal and temporal lobes as well as in the pons (P < 0.05 for all) in infants who later had a DP-3 cognitive and communication score indicating NDI compared to those with a normal score. There was no difference in fetal ADC values in any of the brain regions studied between children with scores indicating normal vs impaired neurodevelopment on the gross motor test, the DP-3 physical, adaptive behavior and social-emotional domains or the DP-3 general development score. Infants with NDI in problem-solving, cognitive and communication skills exhibited significant differences in their brain microstructure, as demonstrated by higher ADC values measured in utero 6 weeks after prenatal MMC repair, compared to those with normal neurodevelopmental outcomes as assessed at or after 18 months of age. These findings have significant clinical implications, especially for the early identification and management of children at risk for NDI after prenatal MMC repair. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
The aim of this study was to understand caregivers' preferences and experiences with diagnosis and treatment of childhood apraxia of speech (CAS). Caregivers of children with CAS completed a 70-item online survey that explored demographics, initial concerns, the CAS diagnostic process, speech therapy goals, and preferred and received speech therapy service delivery (session frequency, length, and context). Quantitative data were analyzed descriptively and with inferential statistics; qualitative data were analyzed using content analysis. One hundred sixty-one caregivers participated, mostly from the United States, Australia, and Canada. A total of 72% of caregivers had concerns about their child's speech by the time the child was 18 months old. Although most children had seen two or three speech-language pathologists (SLPs) by the time they were diagnosed with CAS, 23% had seen four or more SLPs. Caregivers expressed a preference for their children to receive individual, in-person sessions of 31-45 min three or more times per week, but they most commonly received individual, in-person, weekly sessions of 30 min or less. Analysis of the caregivers' open-text responses led to the construction of five themes: "roadblocks to service"; "pursuit of comprehensive and reliable information"; "SLPs: trial, error, and then trust"; "CAS-specific care"; and "family support beyond the session." Results of this study highlight the need for education and communication. The challenges families experience in accessing timely and sufficient CAS-specific care indicate that greater training is needed for SLPs, pediatricians, and other health professionals to ensure that caregivers' concerns about children's speech are addressed, their desire to understand their child's diagnosis and treatment are met, and their children receive evidence-based treatment. https://doi.org/10.23641/asha.31383226.
This prologue introduces the Language, Speech, and Hearing Services in Schools forum, Addressing Childhood Trauma and Maltreatment Through the Lens of the ICF. The goals of the forum are twofold: first, to draw attention to the prevalence of children who have experienced trauma and maltreatment and how it affects their language and literacy development, and second, to provide an overview of the International Classification of Functioning, Disability and Health (ICF) framework and how it can be used to conceptualize assessment procedures and tailor interventions to meet the individual needs of the child while providing compassionate trauma-informed care. This prologue provides an overview of the prevalence of childhood trauma and how it affects children's language and literacy development. By extension, this prologue also underscores why speech-language pathologists (SLPs) should carefully consider this topic. Importantly, SLPs treat children in context, and although other professionals such as psychologists or social workers are the professionals expected to provide direct services in this area, SLPs still have an obligation to provide compassionate trauma-informed care, and they have expertise in areas that can support children in being able to better benefit from and participate in therapeutic treatments. To this point, this prologue also provides an overview of the ICF and provides examples of how the ICF may be used to support children with histories of trauma or maltreatment. As such, this prologue introduces the topics covered by seven articles as well as the epilogue. These articles cover reviews, tutorials, case studies, clinician development, and professional programming. Children who have experienced trauma or maltreatment are at an increased risk for experiencing neurological disruptions that affect their language and literacy development, which increases the likelihood SLPs will encounter children with these experiences on their caseloads. The articles included within this forum underscore the various ways children might be affected by traumatic experiences and how SLPs can use the ICF framework to identify barriers and facilitators when engaging in assessments and developing interventions.
In healthy individuals, secretions are typically managed through reflexive swallowing or coughing. Impairments in sensory or motor function, however, may hinder laryngo-pharyngeal clearance, leading to hypopharyngeal secretion accumulation and compromised swallowing safety. This study aimed to translate the Murray Secretion Scale into Turkish (MSS-TR) and to evaluate its content validity and inter- and intra-rater reliability. The primary goal was to determine whether the Turkish version of the scale is a reliable and valid tool for clinical use in assessing pharyngolaryngeal secretion severity during fiberoptic endoscopic evaluation of swallowing (FEES). The study involved a multi-step process: (1) translation and back-translation of the original Murray Secretion Scale, (2) expert review to establish content validity using the Content Validity Index (CVI) and (3) reliability testing using 40 FEES recordings assessed by four experienced speech-language therapists. Intra-rater reliability was evaluated via the Wilcoxon signed-rank test and Kendall's τb, while inter-rater reliability was assessed using Fleiss' Kappa and percentage agreement. Content validity was confirmed with a CVI of 0.86 for the overall scale, with the highest agreement (CVI = 1.00) for the most severe score category. Intra-rater analyses showed no significant differences between repeated evaluations (p > 0.05) and demonstrated high ordinal consistency (Kendall's τb: 0.933-1.000). Inter-rater reliability was substantial to almost perfect for all score levels, with Fleiss' Kappa values ranging from 0.634 to 0.862 across sessions. The overall percentage agreement among raters was 94.4%. However, grade 2 on the MSS-TR showed slightly lower levels of compliance, indicating potential clinical uncertainty in this category. The MSS-TR showed strong content validity and high intra- and inter-rater reliability, supporting its use as a standardized instrument in Turkish clinical practice. These data indicate that the scale can reliably evaluate secretion severity during swallowing assessments, aiding clinical decision-making in dysphagia management. Additional research is necessary to investigate how it applies across various patient populations and clinical settings. What is already known on this subject The Murray Secretion Scale (MSS) is a widely used tool for assessing the severity of secretions during fiberoptic endoscopic evaluation of swallowing (FEES). Before this study, a Turkish version of the MSS with verified content validity for use in Turkish-speaking clinical settings did not exist. Standardized secretion severity ratings improve consistency in dysphagia evaluation and allow consistent reporting across studies and clinical environments. Consistent assessment of mid-range secretion levels may be challenging and could necessitate clinician training and calibration. What this paper adds to existing knowledge This study introduces the first Turkish translation and cultural adaption of the MSS (MSS-TR), addressing the lack of a standardized tool for assessing secretion severity among Turkish-speaking clinicians. The MSS-TR shown strong content validity and high intra- and inter-rater reliability, supporting its application as a reliable clinical and research tool during FEES. Findings suggest that moderate secretion severity (Grade 2) may present significant issues for clinical interpretation, highlighting the importance for clinician training and calibration in the use of the scale. The validated Turkish version of the MSS aims to improve standards in dysphagia evaluation, support clinical decision-making and facilitate international comparison of FEES-based research results. What are the potential or actual clinical implications of this work? The MSS-TR enables a systematic assessment of secretion severity in Turkish FEES practice, improving documentation and supporting clinical decision-making in dysphagia management. Routine use of MSS-TR may improve communication among clinicians and institutions, as well as support training, standardization and quality assurance procedures. A validated MSS-TR supports international comparison and multi-centre FEES research through standardized secretion reporting.
Hyperkinetic movement disorders, characterized by complex and overlapping motor patterns, present significant challenges in classification and treatment. The inconsistency in definitions and descriptors complicates both research and clinical communication. This study aims to provide an overview of current terminology and definitions related to spasticity and other hyperkinetic movement disorders associated with central nervous system lesions. We propose a unified terminology and classification system for spastic movement disorders (SMD). In this scoping review, definitions of spasticity, dystonia, tremor, chorea, hemiballismus, athetosis, myoclonus, and dyssynergia were reviewed, with emphasis on overlaps and diagnostic challenges among these disorders. The goal was to develop a consensus expert opinion on a phenomenological approach to SMD. The proposed classification system for spasticity includes clinical characteristics (Axis 1) and etiology (Axis 2). Axis 1 includes: age at onset, body distribution, disease course, phenomenological description, and impact on body function, activity, and participation. The phenomenological description allows sub-classification of SMD into: phasic reflex overactivity, stimulus-induced muscle overactivity, constant muscle overactivity, and lack of muscle selectivity. These categories clarify disabling phenotypes such as clonus, dysregulated co-contraction, muscle spasms, activity-induced muscle hypertonia, associated reactions, and persistent muscle hypertonia. This framework for classification of SMD aims to establish a common language for describing clinical phenotypes. By adopting a phenomenological approach, we underscore the importance of consistent descriptors and propose a systematic classification method for movement disorders, particularly spasticity. We hope this unified terminology will enhance clinical practice, research, and ultimately, patient care.
Human vocal expressions of emotion can be expressed nonverbally, through vocalizations such as shouts or laughter, or speakers can embed emotional meanings in language by modifying their tone of voice ("prosody"). Is there evidence that nonverbal expressions promote "better" (i.e., more accurate, faster) recognition of emotions than speech, and what is the impact of language experience? Our study investigated these questions using a cross-cultural gating paradigm, in which Chinese and Arab listeners (n = 25/group) judged the emotion communicated by acoustic events that varied in duration (200 milliseconds to the full expression) and form (vocalizations or prosody expressed in listeners' native, second or foreign language). Accuracy was higher for vocalizations overall, but listeners were markedly more efficient to form stable categorical representations of the speaker's emotion from vocalizations (M = 417ms) than native prosody (M = 765ms). Language experience enhanced recognition of emotional prosody expressed by native/ingroup speakers for some listeners (Chinese) but not all (Arab), emphasizing the dynamic interplay of socio-cultural factors and stimulus quality on prosody recognition which occurs over a more sustained time window. Our data show that vocalizations are functionally suited to build robust, rapid impressions of a speaker's emotion state unconstrained by the listener's linguistic cultural background.
Medical residency is a demanding training stage characterized by high levels of stress and burnout. As digital natives, current medical trainees (ie, residents) are frequent users of social media; however, little is known about how their personal (nonprofessional) use relates to burnout and social media addiction (SMA). This study aims to characterize the prevalence of SMA among Chinese medical trainees and explore its complex relationships with social media use patterns, occupational burnout, and related risk and protective factors. A nationwide cross-sectional survey was deployed through Wenjuanxing and disseminated via WeChat between August 29 and September 10, 2024. Data included demographics, physical and psychiatric health history, work variables (eg, training year and night shifts), personality traits, and social media use. SMA was assessed using the Bergen Social Media Addiction Scale. Logistic regression was performed to identify predictors of addiction, and mediation and moderation analyses were conducted to clarify the role of occupational burnout. Of 3621 medical trainees, 211 (5.8%) met the criteria for SMA (Bergen Social Media Addiction Scale ≥24, indicating addiction). Second-year medical trainees reported the highest addiction prevalence (92/1159, 7.9%). Logistic regression analysis revealed that higher burnout (odds ratio [OR] 1.41, 95% CI 1.23-1.62; P<.001), longer daily use (OR 1.39, 95% CI 1.23-1.56; P<.001), physical health problems (OR 1.56, 95% CI 1.13-2.16; P=.006), and psychiatric history (OR 2.00, 95% CI 1.41-2.84; P<.001) significantly increased the odds of addiction, whereas conscientiousness was protective (OR 0.92, 95% CI 0.86-0.99; P=.02). Social media use showed significant U-shaped associations with burnout, physical health problems, psychiatric history, personality characteristics, and mental health outcomes. For example, medical trainees using social media 1 hour or less (104/404, 25.7% with psychiatric history) and more than 4 hours daily (97/419, 23.2% with psychiatric history) both had higher risk profiles than moderate users. Mediation analysis showed that occupational burnout explained 28.1% of the effect of psychiatric history and 29.6% of the effect of physical health problems on addiction risk. This large-scale survey provides the first systematic characterization of SMA among Chinese medical trainees and elucidates its associated risks and protective factors. Burnout consistently emerged as a key and pervasive predictor of SMA, functioning both as an independent risk factor and as a mediator amplifying the impact of health-related vulnerabilities. Moreover, the findings highlight that both minimal and excessive daily social media use may signal distinct behavioral manifestations of distress, potentially reflecting different clinical phenotypes: digital disengagement under acute stress versus compulsive engagement driven by chronic burnout. Notably, while mental health symptoms exhibited U-shaped associations with usage, SMA risk increased progressively with daily duration. These results underscore the need for interventions that extend beyond simply monitoring usage duration, emphasizing strategies to reduce burnout and enhance the overall well-being of medical trainees.
People with aphasia have a comprehensive range of needs due to their language impairment and its resulting impact on everyday life. Aphasia can be compounded by environments and contexts that are not aphasia friendly. This calls for a range of speech and language interventions targeting the language impairment and its consequences, as modeled by the International Classification of Functioning, Disability and Health. Intensive Comprehensive Aphasia Programs (ICAPs) aim to tackle this issue by providing a range of interventions in a time-limited schedule. However, when this service delivery model was developed, the rationale and evidence base for each component of the model was not clearly defined or mapped out. Applying theory of change (TOC) may be helpful in detailing how the therapeutic input is hypothesized to produce a desired change. A TOC is coconstructed with key stakeholders, people with aphasia in this instance. This process can be mapped on a logic model (LM), and potential negative or adverse outcomes (dark logic) can also be considered. This article provides an overview of ICAPs, key gaps in the literature, and provides a methodological example of how TOC, logic modeling, and dark logic can be applied to an ICAP despite some limitations with the approach. An extensive scoping of the literature and discussion with aphasia researchers produced an initial TOC, which was then refined by people with aphasia (n = 8) using focus group methodology. The focus group explored potential adverse outcomes of an ICAP using dark logic modeling. The TOC was mapped onto an LM. A provisional TOC and LM with dark logic for an ICAP was produced, though inclusion of other stakeholder groups is required for thorough application of a TOC to ICAPs. There are challenges in applying TOC, LM, and dark logic modeling to a service delivery model. However, this approach was useful in mapping an ICAP in a methodological manner and in identifying how the theoretical underpinning, design, outcome measurement, and evaluation of an ICAP including a consideration of risks might be enhanced. https://doi.org/10.23641/asha.31478488.
To date, there is no reliable and valid screening tool for paraphilic disorders (PDs) based on the diagnostic criteria of the International Classification of Diseases (ICD-11). The present study aimed to develop and cross-culturally examine the cross-cultural applicability of a new screening tool for PDs following the ICD-11 guidelines. Top-down item development was conducted with expert practitioners in the field. Data were collected in 26 languages across 42 countries (N = 82,243; 39.5% men; 57.0% women; 3.4% gender-diverse; Mage = 32.39 years, SD = 12.52). Cut-off scores were established per ICD-11 guidelines, and at-risk groups were compared with low-risk groups along theoretically relevant correlates (e.g., depression, anxiety). The Paraphilic Disorders Short Screen (PDSS) assesses seven paraphilias via 21 items. Voyeurism was most common paraphilic interest (PI) (19.42% of the total sample; n = 15,970), which also had the highest number of participants meeting the ICD-11 diagnostic cut-off (3.24%; n = 2,662). PI and PD groups consistently demonstrated more severe depression and anxiety symptoms than others. The PDSS is a reliable and valid screening tool that follows the latest ICD-11 guidelines; therefore, it has the capacity to enhance clinical practice and research by identifying individuals at risk.