背景:社会劣势加剧了早期语言延迟。诸如父母识字率低等因素,自信和自我认知会影响根据收到的建议采取行动的能力,对赋权至关重要。在社会不利的临床人群中实现成功健康结果的方法可能需要加强。
目的:比较标准的基于父母的干预(PBI)对有言语的幼儿增强PBI的影响,语言和沟通需求(SCLN)及其生活在社会弱势群体中的家庭。
方法:采用一项多中心成群盲法随机对照试验,比较了以父母为基础的团体干预措施改善儿童(平均年龄27.5个月)早期语言发育的效果,这些儿童的社会弱势人群的表达词汇为40个或更少。干预会议由言语和语言治疗师进行,超过20周的时间。参与者接受了两种干预措施之一:(1)标准护理-间接组PBI-(PBI)(2)增强护理:间接组增强PBI-(EPBI)。标准化和非标准化措施都被用作结果。家长参与干预是通过分析出勤和家长激活措施-言语和语言治疗(PAM-SLT)(InsigniaHealth,2014).PAM衡量一个人的知识,管理自己健康和福祉的技能和信心(NHS英格兰,2018)。在这项研究中,激活指的是父母的知识,技能和信心来管理孩子的语言发展。
结果:150名参与者在基线时被随机分组。两组儿童在麦克阿瑟-贝茨交流发展清单句子长度的结果上都有了显着改善,从干预前到干预后以及干预后6个月(p<0.05)。词汇和表达语言技能的变化更加模棱两可,显示两组的置信区间差异很大。在父母参加至少一次干预会议的情况下,几乎所有效果大小都赞成EPBI干预。两组父母的激活水平均显着增加(EPBIp<0.001,PBIp=0.003),具有适度的效应大小,有利于EPBI(对冲\'G0.37,置信区间-0.02至0.76),尽管发现了广泛的差异。
结论:该试验提供了一些证据,证明通过支持照顾者,促进来自社会弱势群体的SLCN儿童的语言发展。然而,我们发现结果存在差异;一些孩子取得了出色的进步,而其他人没有。进一步探索父母参与及其与儿童语言结果的关系将有助于更多地了解涉及父母的干预措施的变化机制。
结论:关于该主题的已知内容演讲,语言和沟通需求(SLCN)对情绪健康有连锁反应,学校准备,识字和学业成绩,使儿童面临长期后果的风险增加,如识字不良,心理健康问题和失业。在贫困地区,语言障碍的患病率高于其他地方。诸如父母识字率低等因素,自信和自我认知会影响根据收到的建议采取行动的能力,对赋权至关重要。本文对现有知识的补充来自社会弱势群体的SLCN儿童可以通过父母干预来改善他们的语言发展,尽管发现了广泛的个体差异。有一些证据表明,儿童通过EPBI取得了更好的结果,采用了机构间合作的方法。父母的参与度(激活水平)随着时间的推移而显著增加,EPBI的增幅是EPBI的两倍。这项工作的潜在或实际临床意义是什么?这项试验提供了一些证据,表明有可能通过支持照顾者来促进来自社会弱势群体的儿童的语言发展。进一步的研究将有助于确定父母参与度的增加是否与坚持干预和改变儿童结局有关。
BACKGROUND: Early language delay is exacerbated by social disadvantage. Factors such as parents\' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing.
OBJECTIVE: To compare the impact of standard parent-based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations.
METHODS: A multicentre clustered blind randomised controlled
trial was used to compare the effect of parent-based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20-week period. Participants received one of two interventions: (1) Standard Care - indirect group PBI - (PBI) (2) Enhanced Care: indirect group enhanced PBI - (EPBI). Both standardised and non-standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure - Speech & Language Therapy (PAM-SLT) (Insignia Health, 2014). The PAM measures a person\'s knowledge, skills and confidence to manage their own health and well-being (NHS England, 2018). In this
study, activation referred to parents\' knowledge, skills and confidence to manage their child\'s language development.
RESULTS: One hundred fifty-five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur-Bates Communicative Development Inventories Sentence Length, from pre-intervention to post-intervention and 6 months post-intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents\' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges\' G 0.37, confidence interval -0.02 to 0.76), although wide variation was found.
CONCLUSIONS: This
trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents.
CONCLUSIONS: What is already known on the subject Speech, language and communication needs (SLCN) have a knock-on effect on emotional well-being, school readiness, literacy and school attainment, putting children at increased risk of long-term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents\' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent\'s engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work? This
trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes.