Effective support for children's speech, language, and communication development is essential to prevent long-term negative outcomes. Parental behaviours play a critical role in whether children are referred to and receive speech-language therapy. This study aimed to identify predictors of parents receiving Speech-language Therapy using longitudinal data from Growing Up in New Zealand. Data were drawn from the Growing Up in New Zealand study, which is representative of the national child population. The analysis focused on children with reported speech concerns by age 54 months (N = 771). The primary outcome was whether speech-language therapy had been received for speech concerns by that age. Logistic regression showed children had significantly higher odds of receiving speech-language therapy if their mothers experienced low socioeconomic deprivation during pregnancy (OR = 2.31, p < 0.01) and if family doctors were perceived as highly helpful when the child was nine months old (OR = 3.77, p < 0.05). In contrast, children whose mothers identified Māori as their prioritised ethnicity were significantly less likely to receive speech-language therapy than those identifying as European/Pākehā (OR = 0.40, p < 0.001). Findings highlight persistent ethnic and social inequities in access to speech-language therapy in New Zealand. Parental information-seeking may play a role but requires further research. These results support the need for targeted policies and early engagement strategies to ensure equitable receipt of speech-language therapy for children with speech, language, and communication needs. What is already known on this subject Less than half of children with speech concerns receive speech-language therapy. Socio-economic and ethnic disparities are known to contribute to this gap. However, the specific factors influencing access to speech-language therapy, and the role of healthcare providers in supporting service uptake, are not well understood. What this study adds to the existing knowledge This study identifies key factors associated with non-receipt of speech-language therapy, including socio-economic deprivation, ethnicity, and perceived helpfulness of support. It underscores the important role of healthcare providers in early identification and in improving access to speech-language therapy services for children in at-risk groups. What are the actual clinical implications of this work? The findings highlight the need for targeted strategies to overcome barriers to speech-language therapy access. Strengthening collaboration between healthcare providers, such as general practitioners and early childhood professionals, may improve early intervention and service uptake among underserved populations.
Clinical supervision is a key component in the professional development of speech-language pathology students. However, little is known about the quality of supervision in Spanish undergraduate programs, the pedagogical strategies employed, and the extent to which clinical placements meet students' expectations for competency development. To evaluate clinical supervision during pre-professional internships in Speech-Language Pathology degrees in Spain from the perspective of graduates, analyzing the most valued aspects, areas for improvement, and the gap between lived experience and perceived importance. A total of 503 graduates completed a 20-item questionnaire assessing experience and perceived importance across five dimensions: supervisory strategies, supervisory style, autonomy, feedback, and therapeutic context. The instrument underwent content validation, internal consistency analysis, test-retest reliability, exploratory factor analysis, and comparisons between experience and importance. All importance ratings were significantly higher than experience ratings (p < 0.001). The largest discrepancies were observed in feedback and therapeutic context, followed by supervisory style and strategies; autonomy showed a smaller but still significant gap. Only 32% of participants felt professional at the end of their internships. Healthcare and social-healthcare settings were rated higher than educational settings. Results highlight a systematic mismatch between what graduates experienced and what they consider essential for high-quality training. Improving clinical placements requires strengthening structured and reflective feedback, promoting rich and interprofessional learning environments, and adjusting supervisory style and strategies to levels of student autonomy. Findings support the implementation of evidence-based supervision models to enhance clinical training in speech-language pathology. What is already known on this subject Clinical supervision is a critical component of speech-language pathology training, and high-quality supervision supports the development of clinical competence and professional identity. However, limited empirical evidence exists regarding the structure, quality, and characteristics of supervision in Spanish-speaking undergraduate programs, particularly from the perspective of graduates. What this study adds to existing knowledge This study provides large-scale evidence-based on data from 503 graduates-of a systematic and substantial mismatch between the supervision students experienced and the importance they attribute to key supervisory dimensions, using a newly developed and psychometrically validated graduate survey. It identifies the dimensions with the largest discrepancies (feedback, therapeutic context, and supervisory style) and offers clear, empirically grounded priorities for improving supervision in speech-language pathology education. What are the clinical implications of this work? Findings emphasize the need for supervision practices that provide structured and specific feedback, ensure diverse and supportive clinical environments, and adapt supervisory approaches according to students autonomy levels. These insights can guide program development, supervisor training, and quality assurance processes to improve clinical learning experiences and better prepare students for professional practice.
Communication, language, and speech disorders are highly prevalent in children with cerebral palsy (CP) and substantially impact social, educational, and community participation. However, few studies have systematically characterized communicative and linguistic profiles using standardized assessments. This paper outlines the work of the 'Italian CP & Language Network' over the last two years, focusing on identifying research priorities, developing specialized assessment protocols, and proposing a shared classification system for speech and language disorders in children with CP. A survey was sent to 11 specialized centers to investigate clinical practices and assessment tools. Based on the results and an extensive literature review, the group developed three age- and complexity-based diagnostic protocols and a shared classification system. The survey highlighted high variability in test selection, especially for speech and pragmatic assessment, and a significant need for ad hoc tools for augmentative and alternative communication (AAC). Three standardized protocols were defined: (1) early language (<48 months), (2) school-age language and pragmatics (4-12 years), and (3) minimally verbal children (6-12 years). A multi-level classification system for language and speech disorders was proposed to improve diagnostic consistency. Standardizing assessment is a critical step toward early identification of communicative vulnerabilities to guide tailored interventions and promote participation and quality of life across developmental stages. The group provides a framework for prospective multicenter data collection to correlate linguistic and speech phenotypes with neuroradiological features and motor outcomes.
Referrals to speech and language pathology are infrequent for people with Parkinson's disease (PD), despite speech and communication being often affected and greatly impacting their quality of life. This study investigated the knowledge, self-competence and challenges faced by speech and language pathologists (SLPs) in Malaysia when managing PD cases. Participants self-administered an online-survey in a cross-sectional study design. The survey consisted of 14 questions on current practices of SLPs with their patients with PD, self-perceived competence when assessing and managing PD and perceived barriers for catering to patients with PD. Inferential statistics were run on self-perceived competence across domains and their relationship with demographic/current practice factors. Descriptive statistics were used to analyse perceived barriers. The survey was administered in English through Google Forms. 54 Malaysian SLPs with at least one active case of PD in their caseload were invited via email and WhatsApp Messenger. These contacts were obtained from the Speech-Language Therapists Association of Malaysia (SPEAK), and snowball sampling was encouraged to recruit additional SLPs through other social networks. To quantify Malaysian SLPs' self-perceived competence levels (assessed on 5-point Likert scales) in assessing and managing five key domains in patients with PD: speech, language, oro-motor skills, cognition and swallowing; and to identify the frequency and types of barriers encountered in clinical practice with patients with PD through structured multiple-choice questions. Secondary outcomes included quantifying current service delivery patterns (frequency of PD referrals, stage at referral, caseload size), multidisciplinary consultation patterns and confidence levels in managing rehabilitation risks associated with PD, all measured through structured survey items with categorical or ordinal response options. Most participants had 1-5 patients with PD in their active caseload, referred at a middle or advanced stage of the disease. The majority of participants felt competent in assessing and managing motor speech and language in patients with PD. Conversely, most of them did not feel competent in assessing and managing cognition in these patients, regardless of demographic factors or current practices. This difference was significant. Most participants also reported facing barriers such as health conditions or comorbidities, family expectations on the therapy outcome and the unavailability of a multidisciplinary approach. The study reveals that SLPs working in Malaysia feel competent in working with motor speech and language in individuals with PD. However, it highlights a need for additional training to address cognitive assessment and management as a crucial tool to boost functional communication in people with PD. The study also reveals a need for promoting a multidisciplinary approach.
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.
Generative artificial intelligence (AI) tools such as ChatGPT are increasingly used for health information seeking. However, little is known about how the adoption of generative AI is socially patterned, particularly in pediatric rehabilitation contexts. This study aimed to examine the prevalence and sociodemographic determinants of ChatGPT use among parents of children with speech and language disorders (SLDs) in Türkiye and to explore its association with engagement in formal speech and language therapy services. This cross-sectional study included 204 parents of children with SLDs recruited through online parent networks between October and November 2025. Data were collected using a structured questionnaire assessing sociodemographic characteristics, therapy attendance frequency, and ChatGPT use for SLD-related information. Bivariate associations were analyzed using chi-square tests, and multivariable logistic regression was conducted to identify independent predictors of ChatGPT use. Overall, 28.4% of participants reported using ChatGPT to seek information related to their child's speech or language disorder. ChatGPT use was significantly associated with gender, age group, and educational level. In multivariable analyses, male gender (aOR = 3.09; 95% CI: 1.36-7.02) and postgraduate education (aOR = 5.20; 95% CI: 1.56-17.27) were independently associated with higher odds of ChatGPT use, while undergraduate education did not reach statistical significance (aOR = 1.55; 95% CI: 0.70-3.42; p = 0.277). Attending therapy several times per year (aOR = 4.01; 95% CI: 1.08-14.92) and monthly or weekly (aOR = 2.75; 95% CI: 1.01-7.48) were both associated with higher odds of ChatGPT use relative to never attending therapy. Generative AI use among parents of children with SLDs appears relatively common but socially stratified. Educational attainment, gender, and engagement with formal therapy services significantly influence AI adoption. Without equity-oriented strategies and digital health literacy initiatives, the diffusion of generative AI tools may reinforce existing informational disparities in pediatric rehabilitation.
Rural populations face distinctive challenges that may hinder their ability to access health services, including speech-language pathology and audiology. To address this, our speech-language pathology program partnered with local agencies and traveled to neighboring rural communities to provide speech and hearing services in central Pennsylvania for a minimal investment.
Existing direct measures of vocabulary for ages 2-3 years are insufficient as vocabulary increases to include nouns, verbs, adjectives and adverbs, reflecting qualitative changes that support emerging grammatical abilities. The present study aims to establish the psychometric properties and validate a lexical screening tool for 19-36-month-old British English-speaking children, the WinG (Words in Game) test. Specifically, it examines gender differences in internal consistency, concurrent validity and predictive gender invariance across comprehension and production tasks. In addition, the study evaluates the diagnostic accuracy of the tool by establishing clinical cut-off scores to distinguish children with typical versus at-risk language development. Finally, it presents developmental trends in toddlers' aggregate lexical comprehension and production scores, reported in percentiles and stratified by gender. Participants were 336 English-speaking children aged 19-36 months. Sub-set of 85 children were screened with the Words in Game (WinG) test and the Preschool Language Scale (PLS-4). The PLS-4 scores were used as reference tests to ascertain psychometric properties and estimate the sensitivity and specificity of the WinG comprehension and production tasks. Girls outperformed boys on both comprehension and production tasks. The WinG comprehension and production tasks showed strong concurrent validity, with scores positively and highly correlated with the PLS-4 reference measures. Predictive gender invariance was also demonstrated, as both WinG dimensions predicted PLS-4 scores equivalently across genders. Using the 15th percentile as a cut-off, the WinG test demonstrated fair sensitivity for comprehension and good sensitivity for production, though specificity was below the desirable threshold for both tasks. The tool provides a valuable starting point for identifying early receptive and expressive lexical difficulties through direct assessment by speech and language therapists (SLTs). Clinical implications and limitations are also discussed. What is already known on this subject Lexical receptive and expressive abilities emerge and expand rapidly in the second and third years of life. Clinicians and Speech and Language therapists (SLTs) need a systematic, reliable tool to observe the early lexical skills of toddlers. What this study adds to existing knowledge This study established the psychometric properties and validated the Words in Game (WinG) test from a large sample of 19-36-month-old British English learning children to measure the receptive and expressive nouns and predicates (verbs, adjectives and adverbs). The PLS-4 scores were used as a reference standard test. The WinG comprehension and production tasks showed strong concurrent validity, with scores positively and highly correlated with the PLS-4 reference measures. The developmental trends in toddlers' lexical comprehension and production scores are reported in percentiles and stratified by gender. The diagnostic accuracy of the WinG test was ascertained, performing receiver operating curves (ROC) on comprehension and production WinG tasks, entering the 15th percentile clinical cut-off scores, as indicated by the PLS-4 reference measures. What are the clinical implications of this study? The WinG test is a valid tool designed to screen the comprehension and production of words of British English children in the second and third years of life. The WinG test is a tool to be administered by professionals with expertise in language development, such as SLTs. Thanks to its systematic, direct observation approach and validation against established measures, the WinG test demonstrates fair psychometric properties. It provides SLTs with a reliable tool for early screening of toddlers' lexical skills to identify language delays or disorders.
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.
Community awareness of swallowing and dysphagia plays a significant role in improving early-referral behavior. Literature reports that community awareness of swallowing and dysphagia in the Western countries to be low. Conversely, India has a diverse cultural, linguistic and healthcare-related factors which may influence the health-seeking behavior and early-referral of dysphagia. Hence, it becomes difficult to generalize the findings of existing literature. The primary objective of this study was to analyze the knowledge, attitudes and practices (KAP) related to swallowing and dysphagia among the community dwelling adults of South India. The secondary objective was to evaluate if age, sex and education levels were associated with these factors. Community dwelling adults were recruited from Mangalore city, India for a cross-sectional survey using a convenience sampling design. A purposive built content validated 27-item questionnaire was distributed using Google Form and/or hard copies to the participants for data collection. Participant's responses were independently analyzed by two Speech Language Pathologists using open content analysis. The responses were summarized as percentages and categories and chi square test was administered to examine the association between age, sex and education levels and KAP enquiries at 0.05 level. A total of 372 participants aged 20-79 years (mean age = 46.26; SD = 15.63) participated in the study. Participants demonstrated limited knowledge of signs, causes, complications and professional management of dysphagia. Aspiration was widely recognized as unsafe, yet only one-tenth correctly identified pneumonia as a complication of dysphagia. Less than one-fifth knew the treatment options for dysphagia. Attitudes reflected fear of choking, discomfort towards nasogastric-tube feeding and moderate willingness to seek help from healthcare professionals. Practices suggested low awareness of Heimlich maneuver, inconsistent food-texture modification and reliance on water to manage dry mouth. Age, sex and education levels were significantly associated with knowledge (saliva is important for chewing, avoid eating in public space to overcome stigma, early intervention helps regain swallowing abilities, age range frequently associated with dysphagia), attitude (fear of choking, preference to non-oral feeds), practices (using internet to find solutions for dysphagia, drinking water before meals or moistening food using water, changing food consistencies, using straw over cup) at p > 0.05 level. Community dwellers demonstrated insufficient knowledge, predominantly negative attitudes and unsafe self-management practices related to swallowing and dysphagia. Strengthened public education, early-referral pathways and inclusion of basic life-support skills are highly warranted to improve community awareness on swallowing and dysphagia. What is already known on this subject Community awareness of dysphagia is low in Western countries. Cultural beliefs, literacy, superstition and access to healthcare influence what people know, how they respond and when they seek help. Understanding knowledge, attitude and practices (KAP) of swallowing and dysphagia in India is critical for reducing self-management risks and improving early-referral behavior. What this study adds to existing knowledge The study provides the first structured KAP analysis on swallowing and dysphagia in an Indian community . Participants recognized aspiration as dangerous, yet lacked awareness of critical signs, causes, treatment options and responsible team members. Fear of choking was high, and most were uncomfortable with tube-based feeding. The public seldom employed safe compensatory strategies and very few were familiar with Heimlich maneuver or food-texture modification. Age, sex and education levels were significantly associated with multiple KAP variables. What are the clinical implications of this work? There is an urgent need to conduct more public awareness programs on prevention, early identification and intervention of dysphagia by healthcare professionals involved in dysphagia care. Efforts must be scaled to provide basic life support (BLS) skills training programs, including training in Heimlich maneuver, to the public.
Norwegian Child and Adolescent Mental Health Services (CAMHS) use the World Health Organization's (WHO) multiaxial diagnostic system based on the International Classification of Diseases, Tenth Revision (ICD-10); however, analysis of prescribing patterns among axes I-III is underexplored in electronic health records (EHRs) with intertwined patient, episode of care, and contact information. This study aimed to develop and demonstrate an analytic pipeline for mining and mapping information from EHRs to facilitate understanding of clinical processes and support informed decision-making. This study used the Norwegian CAMHS EHR data to identify common diagnoses, comorbidities, and medication use across axes I-III per individual contact. We extracted records of patients ≤19 years old with a primary mental health diagnosis on axes I-III and one or more medications per individual contact. Diagnoses were categorized according to ICD-10 and medications according to the Anatomical Therapeutic Chemical (ATC) classification system. Descriptive analyses quantified contact counts, diagnosis frequency, comorbidity rates, and medication frequency within each diagnostic category. Next, we mapped the medications used across all the contacts and noncomorbid contacts separately along each axis. Of 7214 prescribing contacts (axis I: n=7179, 99.51%; axis II: n=821, 11.38%; axis III: n=65, 0.90%), comorbidity was present in 12.06% (n=866) contacts in axis I, 96.10% (n=789) contacts in axis II, and 96.92% (n=63) contacts in axis III. Leading diagnoses were behavioral-emotional disorders (ICD-10 codes F90-F98) in axis I, school skills and learning difficulties (ICD-10 code F81) in axis II, and mild mental retardation (ICD-10 code F70) in axis III. Most observed comorbidities were F90-F98 with speech and language development disorder (ICD-10 code F80), ICD-10 code F81, and mixed specific skills development disorder (ICD-10 code F83). Psychostimulants predominated across all diagnosis axes, with methylphenidate being the most common. For other ATC categories, the most commonly prescribed medications were antidepressants (sertraline and fluoxetine), antipsychotics (risperidone and aripiprazole), hypnotics and sedatives (melatonin), antiepileptics (lamotrigine), anxiolytics (diazepam), and nonpsychotropics (laxatives, vitamins, and supplements). Medication profiles varied minimally by axis or comorbidity status. We demonstrated a mining and mapping analytic pipeline for EHRs to analyze diagnoses, comorbidities, and prescribing practices at the individual contact level. In the Norwegian CAMHS, axis I diagnoses are common, often behavioral-emotional disorders. Among the medications, psychostimulants and antidepressants are common. Beyond characterizing diagnoses and medication prescribing patterns, the study presents an approach for mining and mapping EHR data to analyze and provide service-level metrics, as well as clinical practice insights.
To validate and standardize the online application of the Scale of Self-Perception of Central Auditory Processing Skills (EAPAC) - expanded for Brazilian adults. The EAPAC was expanded and answered by 1,274 Brazilian individuals aged 18 to 59 years. Of these, 116 subjects underwent neuropsychological and auditory evaluation, and 63 were selected to answer the scale at a second time point. Those with any type and degree of hearing loss, history of speech-language-hearing therapy for central auditory processing disorder, and psychiatric and/or neurological alteration were excluded. Descriptive analysis of the variables, exploratory factor analysis, and ROC curve were performed for validation and standardization. The Wilcoxon test was used to compare the responses of the subjects who answered the scale at two time points. After exploratory factor analysis, five questions were excluded, as they did not correlate with the scale domains. The ROC curves, constructed considering the presence of auditory processing disorder and the result by auditory processes, did not indicate significant values. Thus, the scale presented fragile sensitivity and specificity values. There was no significant difference in the subjects' responses to the scale between the two time points. The expanded scale did not present adequate psychometric standards for identifying the risk for central auditory processing disorder, but it proved useful for investigating auditory complaints in everyday tasks, thus helping to select strategies to minimize the negative impact of the difficulties mentioned. validar e normatizar a aplicação on-line da Escala de Autopercepção de Habilidades do Processamento Auditivo Central (EAPAC) – expandida para adultos brasileiros. A Escala de Autopercepção de Habilidades do Processamento Auditivo Central foi expandida e respondida por 1274 indivíduos brasileiros com idade entre 18 e 59 anos. Desses, 116 sujeitos foram submetidos à avaliação neuropsicológica e auditiva e 63 foram selecionados para responder à escala em um segundo momento. Foram excluídos aqueles com perda auditiva de qualquer tipo e grau, histórico de terapia fonoaudiológica para o transtorno do processamento auditivo central e alteração psiquiátrica e/ou neurológica. Foi realizada a análise descritiva das variáveis, a análise fatorial exploratória e a curva ROC, para validação e normatização. O teste de Wilcoxon foi utilizado para comparar as respostas dos sujeitos que responderam à escala em dois momentos. Após a análise fatorial exploratória, cinco questões foram excluídas, pois não correlacionaram com os domínios da escala. As curvas ROC, construídas considerando a presença do transtorno do processamento auditivo e o resultado por processos auditivos, não apontaram valores significativos, sendo assim, a escala apresentou valores frágeis de sensibilidade e especificidade. Não houve diferença significativa entre as respostas dos sujeitos, na escala, em dois momentos diferentes. A escala expandida não apresentou padrões psicométricos adequados para identificação do risco para o transtorno do processamento auditivo central, mas mostrou-se útil para investigar as queixas auditivas em tarefas do cotidiano, e, assim, auxiliar na seleção de estratégias para minimizar o impacto negativo das dificuldades referidas. validar e normatizar a aplicação on-line da Escala de Autopercepção de Habilidades do Processamento Auditivo Central (EAPAC) – expandida para adultos brasileiros. A Escala de Autopercepção de Habilidades do Processamento Auditivo Central foi expandida e respondida por 1274 indivíduos brasileiros com idade entre 18 e 59 anos. Desses, 116 sujeitos foram submetidos à avaliação neuropsicológica e auditiva e 63 foram selecionados para responder à escala em um segundo momento. Foram excluídos aqueles com perda auditiva de qualquer tipo e grau, histórico de terapia fonoaudiológica para o transtorno do processamento auditivo central e alteração psiquiátrica e/ou neurológica. Foi realizada a análise descritiva das variáveis, a análise fatorial exploratória e a curva ROC, para validação e normatização. O teste de Wilcoxon foi utilizado para comparar as respostas dos sujeitos que responderam à escala em dois momentos. Após a análise fatorial exploratória, cinco questões foram excluídas, pois não correlacionaram com os domínios da escala. As curvas ROC, construídas considerando a presença do transtorno do processamento auditivo e o resultado por processos auditivos, não apontaram valores significativos, sendo assim, a escala apresentou valores frágeis de sensibilidade e especificidade. Não houve diferença significativa entre as respostas dos sujeitos, na escala, em dois momentos diferentes. A escala expandida não apresentou padrões psicométricos adequados para identificação do risco para o transtorno do processamento auditivo central, mas mostrou-se útil para investigar as queixas auditivas em tarefas do cotidiano, e, assim, auxiliar na seleção de estratégias para minimizar o impacto negativo das dificuldades referidas.
This study examined sound-shape matching performance (the bouba-kiki effect) in Turkish-speaking children with speech sound disorders (SSD) and their typically developing (TD) peers. Participants included 60 children aged 51-71 months: 30 with SSD and 30 typically developing (TD) peers, all of whom demonstrated normative language abilities as confirmed by standardized assessments. Language and speech skills were assessed using the Turkish Early Language Development Test (TEDİL) and the Articulation and Phonology Test (SET). Sound-shape matching was measured using the Kiki-Bouba Test administered with the "Martian language" protocol, and between-group comparisons were analyzed using chi-square tests, supplemented by multivariable logistic regression models to control for age and language ability. The analyses revealed a statistically significant difference between the groups in their sound-shape matching preferences [χ2 (1) = 4.286, p < .05; Cramer's V = .267]. While 60% of TD children exhibited the typical matching pattern (spiky-kiki), 66.7% of children in the SSD group showed a reversed tendency, labeling spiky shapes as "bouba" and rounded shapes as "kiki." No significant relationship was found between SSD severity and matching performance. These findings raise the possibility that SSD may involve differences in the multimodal representation of speech sounds that extend beyond motor output alone. Given the single-trial design and sample size, these interpretations should be regarded as preliminary. Pending replication with larger samples and multi-trial frameworks, the Kiki-Bouba Test may offer potential as a supplementary behavioral indicator within SSD assessment and triage protocols.
Given limited research on patient perspectives of speech-language pathology (SLP) services in ALS care, this study aimed to assess the satisfaction with, and understanding of, SLP services by people with ALS (pwALS) and to examine the alignment between services received and patient-reported impairments. A cross-sectional survey assessing pwALS' perceptions of SLPs was distributed from October 2024 to January 2025 through electronic mailing lists of relevant professional organizations. A questionnaire examined pwALS' understanding of the SLP role, satisfaction levels, alignment between patient-reported impairments and SLP interventions, and perceived gaps in care. Responses were analyzed using descriptive statistics, with open-ended items analyzed using qualitative analysis. The 81 survey respondents consisted of pwALS (81.5%), caregivers (11.1%), family members (4.9%), and others (2.5%). Overall satisfaction with SLP care was high, though open-ended responses revealed gaps in understanding. Many were unaware of the full scope of SLP services; only 17.3% recognized cognitive evaluation and 8.6% cognitive therapy, compared with speech (77.8%) and swallowing (81.5%) evaluations. Reported services often did not align with communication and swallowing needs, but patients educated about a service were significantly more likely to use it. Overall satisfaction with SLP care was high; however, open-ended responses revealed gaps in understanding, unmet needs, and limited awareness of the full scope of SLP services. This misalignment highlights the need for improved patient and caregiver education regarding the role and timing of SLP involvement to enhance engagement, appropriate service use, and outcomes in ALS care.
Background. In Russian medical universities, the proportion of international students from Asian countries, Africa, and the Middle East enrolled in Russian-medium programs is steadily increasing. Even when they have formally achieved a B1-B2 level of Russian language proficiency, many of them still experience difficulties in perceiving spoken Russian in noise and under high cognitive load, which reduces the effectiveness of learning, complicates clinical communication, and increases the risk of errors when interacting with patients. To determine the relationship between questionnaire scores reflecting difficulties in communicative interaction and perception of spoken Russian and the results of audiological assessment and speech-in-noise tests. We examined 178 international students (18-30 years) who had been enrolled for at least 1 year in Russian-medium medical programs (Arab countries - 80, English-speaking African countries - 48, Asian countries - 50). The assessment protocol included otorhinolaryngological examination, audiological evaluation, and a structured questionnaire. The questionnaire assessed self-reported difficulties in communication in Russian (communication preferences, use of Russian with peers, understanding speech in the metro and in emotionally charged situations). Mild hearing impairment (predominantly grade I conductive hearing loss) was detected in 27.5% (n=22) of students in group 1, 25.0% (n=12) in group 2, and 40.0% (n=20) in group 3; early signs of cochlear dysfunction according to distortion product otoacoustic emissions (DPOAE) were significantly more frequent in the Asian group. Approximately one third of students with a normal audiogram and satisfactory speech audiometry nevertheless reported, in the questionnaire, pronounced difficulties in understanding spoken Russian in classrooms and in the metro («I hear but do not understand»), which was associated with lower speech-in-noise audiometry (SIN) scores and signs of cochlear dysfunction. The combination of speech audiometry in noise and targeted questionnaire-based assessment makes it possible to detect «hidden» deficits in understanding spoken Russian in international medical students that are not captured by standard pure-tone audiometry, which supports the need to include speech intelligibility questionnaires in routine screening of international medical students after completing Russian language courses. В российских медицинских вузах постоянно растет доля иностранных студентов из стран Юго-Восточной Азии, Африки и Ближнего Востока, обучающихся на русскоязычных программах. Даже при формально достигнутом уровне владения русским языком B1—B2 у многих студентов сохраняются трудности восприятия русской речи в шуме и в условиях высокой когнитивной нагрузки, что снижает эффективность обучения, осложняет клиническую коммуникацию и повышает риск ошибок при общении с пациентами. Определить взаимосвязь показателей анкетирования, отражающих трудности коммуникативного взаимодействия и восприятия русской речи, с результатами аудиологического обследования и речевых тестов в шуме. Обследовано 178 иностранных студентов (возраст 18—30 лет), обучающихся на русскоязычных медицинских программах не менее 1 года (арабские страны — 80, англоговорящие страны Африки — 48, Страны Юго-Восточной Азии — 50). Программа включала оториноларингологический осмотр, аудиологическое обследование, анкетирование. С помощью структурированной анкеты оценивали субъективные трудности общения на русском языке (предпочтения в общении, использование русского языка при общении с коллегами, понимание речи в метро и в эмоционально нагруженных ситуациях). Легкие формы слуховых нарушений (преимущественно кондуктивная тугоухость I степени) выявлены у 27,5% (n=22) студентов группы 1, у 25,0% (n=12) группы 2 и у 40,0% (n=20) группы 3, признаки начальной кохлеарной дисфункции по данным отоакустической эмиссии на частоте продукта искажений (DPOAE) чаще встречались у лиц группы 3. Около 30% студентов с нормальной аудиограммой и удовлетворительными данными речевой аудиометрии сообщали в анкете о выраженных трудностях понимания русской речи в аудиториях и метро («слышу, но не понимаю»). Это ассоциировалось с более низкими результатами речевой аудиометрии в шуме и признаками кохлеарной дисфункции. Комбинация проведения речевой аудиометрии в шуме и целевого анкетирования позволяет выявлять «скрытые» дефициты понимания русской речи у иностранных студентов-медиков, не фиксируемые стандартной тональной аудиометрией, что обосновывает необходимость включения опросников разборчивости речи в рутинный скрининг иностранных студентов-медиков после курсов обучения русскому языку.
Language development in early childhood varies considerably, making early detection of Developmental Language Disorders (DLDs) challenging despite their high prevalence and long-term effects on learning and mental health. In Italy, no culturally adapted, easy-to-use screening tools are currently available in primary care. To address this gap, a screening tool was developed to support the early identification of children aged 24-72 months at risk of DLD and other clinically relevant language difficulties. To evaluate the psychometric properties and accuracy of the Comunicazione e Linguaggio in Ambulatorio Pediatrico (CLAP), a brief age-specific screening tool designed for use in Italian paediatric outpatient settings. In this pilot validation study, children were recruited by primary care paediatricians during routine well-child visits and stratified into four age groups: 24-30, 36-42, 48-54, and 60-72 months. After administration of the CLAP screening tool, each child underwent a blinded speech-language pathologist (SLP) assessment. Psychometric evaluation included internal consistency, item-total correlations, confirmatory factor analysis, and item response theory indices (discrimination and difficulty). Diagnostic accuracy was assessed using ROC curves, area under the curve (AUC), sensitivity, specificity, and optimal cut-offs. Analyses were conducted separately for each age group. Fifty children were enrolled in each age group; overall, 24% of the sample fell into the pathological subgroup after the blinded SLP assessment. Internal consistency was acceptable in the 24-30-month (KR-20 = 0.695) and 36-42-month (KR-20 = 0.777) groups, but lower in older children. Factor analyses supported a mainly unidimensional structure in the younger groups. Item response theory showed good discrimination and informativeness for several items. ROC analyses indicated excellent diagnostic accuracy in the 24-30-month group (AUC = 0.93; sensitivity = 92%; specificity = 87%), fair accuracy in the 36-42- and 48-54-month groups (AUC = 0.75 and 0.74), and poor performance in the 60-72-month group (AUC = 0.46). The CLAP demonstrates promising psychometric properties and good-to-fair accuracy as a brief screening tool for identifying children aged 24-54 months at risk of clinically relevant language difficulties, including those who may need further assessment for DLD. Its age-specific design, quick administration, and non-invasive nature support its potential integration into routine primary care. For older children, an age-specific revision or an alternative tool might be required. A larger validation study is currently in progress. What is already known on this subject Developmental Language Disorder (DLD) is common in early childhood; however, early identification remains difficult due to variable developmental pathways and the absence of validated screening tools in primary care. Currently, no brief, culturally adapted instrument is available for routine use in Italian paediatric settings. What does this study add to existing knowledge This study demonstrates that the CLAP tool has promising psychometric properties, with good accuracy in the youngest age group and fair accuracy up to 54 months for identifying children at risk of clinically relevant language difficulties, including those who may later meet criteria for DLD. It provides the first evidence supporting an age-specific, feasible screening option that can be integrated into Italian primary care, while also identifying areas requiring revision for older pre-schoolers. What are the potential or actual clinical implications of this work? CLAP can assist paediatricians in the early detection of clinically relevant language difficulties in children during routine well-child visits. Its adoption could help standardize early language screening in Italy, leading to earlier referral for further diagnostic assessment and appropriate speech-language evaluation.
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.
To analyze the contribution of the Labyrinth Scale in the differential diagnosis of children with Autism Spectrum Disorder (ASD) and Language Disorder (LD) aged between 2 and 4 years. The sample consisted of 38 children diagnosed with LD, 48 with ASD, and 28 with Typical Development (TD). The LD group, evaluated in private clinics and school clinics, consisted of children with language delays confirmed by the Dimensional Inventory of Child Development Assessment (IDADI), as well as speech-language pathology evaluation with instruments such as the Language Development Assessment (LDA), ABFW, among others. They were also evaluated using the Labyrinth Scale. Those responsible signed the Free and Informed Consent Term (FICT). Statistical analysis was performed using JASP software, version 0.15, one-way ANOVA test, and Scheffé post hoc tests. Differentiated scores were demonstrated between the LD, ASD, and TD groups both in general terms and in the subscales of the Labyrinth Scale. The Labyrinth Scale allowed differentiating the LD, ASD, and TD groups, showing that the instrument has specificity to perform the differential diagnosis. Analisar a contribuição da Escala Labirinto na realização do diagnóstico diferencial de crianças com Transtorno do Espectro Autista (TEA) e Transtorno de Linguagem (TL) com idade entre 2 e 4 anos. A amostra foi composta por 38 crianças com diagnóstico de TL, 48 com TEA e 28 com desenvolvimento típico (DT). O grupo TL, avaliado em clínicas particulares e clínicas-escola, constou de crianças com atraso de linguagem comprovado pelo Inventário Dimensional de Avaliação do Desenvolvimento Infantil (IDADI), bem como avaliação fonoaudiológica com instrumentos como Avaliação do desenvolvimento da linguagem (ADL), ABFW, entre outros. Também foram avaliadas pela Escala Labirinto. Os responsáveis assinaram o termo de consentimento livre e esclarecido. A análise estatística foi realizada por meio do software JASP, versão 0.15., teste ANOVA one-way e teste Post Hoc Scheffe. Demonstraram pontuações diferenciadas entre os grupos TL, TEA e DT tanto em termos gerais quanto nas subescalas da Escala Labirinto. A Escala Labirinto permitiu diferenciar os grupos TL, TEA e DT, evidenciando que o instrumento apresenta especificidade para realizar o diagnóstico diferencial. Analisar a contribuição da Escala Labirinto na realização do diagnóstico diferencial de crianças com Transtorno do Espectro Autista (TEA) e Transtorno de Linguagem (TL) com idade entre 2 e 4 anos. A amostra foi composta por 38 crianças com diagnóstico de TL, 48 com TEA e 28 com desenvolvimento típico (DT). O grupo TL, avaliado em clínicas particulares e clínicas-escola, constou de crianças com atraso de linguagem comprovado pelo Inventário Dimensional de Avaliação do Desenvolvimento Infantil (IDADI), bem como avaliação fonoaudiológica com instrumentos como Avaliação do desenvolvimento da linguagem (ADL), ABFW, entre outros. Também foram avaliadas pela Escala Labirinto. Os responsáveis assinaram o termo de consentimento livre e esclarecido. A análise estatística foi realizada por meio do software JASP, versão 0.15., teste ANOVA one-way e teste Post Hoc Scheffe. Demonstraram pontuações diferenciadas entre os grupos TL, TEA e DT tanto em termos gerais quanto nas subescalas da Escala Labirinto. A Escala Labirinto permitiu diferenciar os grupos TL, TEA e DT, evidenciando que o instrumento apresenta especificidade para realizar o diagnóstico diferencial.
Effective multidirectional and longitudinal communication is essential to patient- and family-centered care (PFCC) in the ICU. While communication technologies have the potential to facilitate effective communication, their utilization, especially during the COVID-19 pandemic, has been variable. This scoping review answers the following research questions: What communication tools, strategies, and programs have been used in ICUs? What are their reported effects on PFCC and multidirectional communication? To what extent do these studies consider equity, diversity, and inclusion principles? The scoping review followed Arksey and O'Malley's (2005) framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We conducted a search covering the period from 2007 to 2024, focusing on the concepts of communication, ICU, and PFCC in OVID Medline, EBSCO CINAHL, and OVID Embase. Relevant studies were screened and reported in this review. Searches identified 3280 unique sources, which were screened at a three-stage asynchronous review. A total of 131 articles were included in this review. Communication tools, strategies, and programs were categorized into technology-based and non-technology-based interventions. Technology-based interventions included eight subcategories such as data-enabled devices, electrolarynx, and eye trackers. Non-technology-based strategies included 13 subcategories such as family meetings, diaries, and dedicated personnel. Positive outcomes were reported in 82% of studies for both technology-based and non-technology-based communication tools, strategies, and programs on PFCC. Most technology and non-technology communication tools, strategies, and programs positively impact communication and PFCC in the ICU. However, only 4% of studies focused on equity, diversity, and inclusion in the evaluation, design, or development of their intervention, indicating a need for further research in this area.
Second victim effects refer to experiences of severe adverse events and errors in healthcare that have a negative impact on healthcare professionals. Speech and language pathologists and respiratory therapists are involved in treating patients with dysphagia in intensive care and stroke units and are thus exposed to possible severe incidents related to choking, aspiration, resuscitation, palliative care, and death. Evidence of the detectability of the second victim phenomenon in this professional group remains limited-a gap addressed in this study. Using convenience sampling, an online questionnaire was distributed among medical professionals involved in dysphagia therapy in German-speaking countries. Questionnaire components included screening tools and psychometric instruments. Data analysis involved descriptive statistics, regression analyses, and content analysis of free-text entries. Ninety-one of 127 speech and language pathologists and respiratory therapists (71,65%) reported having experienced a second victim phenomenon at least once in their lives. Twelve participants reported having experienced it for more than one year. Nine participants who denied having experienced a second victim effect initially described symptoms in line with the consensus-based definition later in the free-text entries. Qualitative analysis revealed new coping strategies, including support from first victims and educating others. Overall, second victim effects were detected among speech and language pathologists and respiratory therapists in German-speaking countries. The high prevalence and incidence rates found in this study are comparable to those reported in other studies on second victims in Germany. A newly identified dimension is the role of "silent victims," including those who do not remember or deny being affected indicating the high demand for institutional prevention, support programs, and refinement of tools for optimized detectability. There is a need to improve the accuracy of second victim screening tools to avoid false-negatives of identifying second victims.