Children with speech, language and communication needs encompass a broad population in childhood and include children whose difficulties may or may not be associated with another primary neurodevelopmental diagnosis. Developmental language disorder (DLD) is one of the most prevalent neurodevelopmental disorders, where difficulties with language acquisition are not attributed to another cause such as for example, autism, intellectual disability or traumatic brain injury. DLD has significant implications for children’s or young people’s daily lives with risks of substantial negative consequences for health, education, employment, wellbeing and social inclusion across the life-course. Speech and language therapy led interventions for children with DLD seek to effect change in the child’s speech, language and communication through either direct intervention to build understanding and production of language, and/or modifying the child’s language learning environmental including caregiver inputs, and/or seeking to effect change in the learning and processing abilities that support speech and language.
Those in health and educational services worldwide seeking to provide effective intervention to mitigate the consequences of DLD and ensure best outcomes for children, may be hampered by current reporting of evidence in published intervention studies, with inconsistencies evident in the level of detail provided, including on intervention outcomes. Furthermore, reported outcomes may not comprehensively capture desired impacts of intervention, and may not reflect outcomes of importance across stakeholders groups, in particular outcomes important to children with or at risk of DLD and their families.
Sub-optimal reporting of interventions, means that service providers, policy-makers and people with DLD cannot find clear and consistent information to support informed decision-making, in turn limiting effective transfer and sustainment of effective interventions in the real world. To this end, The International Consensus for Language Disorders group (TICLD) convened by Professor Pauline Frizelle, University College Cork and Professor Cristina McKean, The University of Oxford have prioritised aspects of intervention to consider for the establishment of an international consensus on reporting guidelines. This includes the establishment of a Core Outcome Set for interventions for children with or at risk of DLD. To date there are no core outcome sets directly relevant worldwide to this group of children with childhood speech, language and communication difficulties. Work underway led by Wren et al (COMET Initiative | Maximising the Impact of Speech and Language Therapy for children with Speech Sound Disorder) focuses on children with speech sound disorders rather than developmental language disorders. Cahill et al (2024) identified important service level outcomes for school-based speech and language therapy services, focusing on aspects of service delivery, including for example how care is coordinated and accessibility of services; rather than outcomes specific to speech and language therapy interventions for children.
The TICLD core group members represent 7 countries around the world: Ireland, Australia, Austria, Croatia, Finland, the UK and the USA.
The overarching aim of TICLD is to ensure consistency of reporting on Language Disorder interventions by:
• Extending the existing EQUATOR guidelines to the context of speech-language therapy/pathology for children with (D)LD, and
• Providing more specific guidance on participants, interventions and outcomes within the context of (i) the CONSORT checklist (used to improve the reporting of randomised controlled trials), and (ii) the TIDieR (Template for Intervention Description and Replication).
As part of this work, we aim to produce evidence-based recommendations for the measurement of outcomes for children with or at risk of DLD within language intervention studies. The development of a Core Outcome Set within this, will be a significant contribution to furthering endeavours to achieve maximum benefits from intervention for children with DLD.
Dr. Carol-Anne Murphy. University of Limerick, carol-anne.murphy@ul.ie, Ireland (Core Outcome Set Work Package Development Lead)
Tom Braddon, University of Limerick, tom.braddon@ul.ie, Ireland
Clare Donnellan, University of Limerick, clare.donellan@ul.ie, Ireland
Dr. Christopher Fitzgerald, University of Limerick, christopher.fitzgerald@.ul.ie, Ireland
Sarah Buckley, University of Limerick, sarah.buckley@ul.ie, Ireland
Dr. Doris Murphy, University College Cork, doris.murphy@ucc.ie, Ireland
Leonard Fletcher, University College Cork, lfletcher@ucc.ie, Ireland
Norma Kerrisk, University College Cork, norma.kerrisk@ucc.ie, Ireland
Prof. Patricia Eadie, University of Melbourne, peadie@unimelb.edu.au, Australia
Dr. Susan Ebbels, Moor House Research and Training Institute, ebbelss@moorhouseschool.co.uk, United Kingdom
Dr. Melanie Ferk-Dornstauder, Logopadie, md@logopaedie-dornstauder.at, Austria
Johanna Jessenitschnig, Logopadie, J.Jessenitschnig@fh-kaernten.at, Austria
Dr. Silke Fricke, University of Sheffield, s.fricke@sheffield.ac.uk, United Kingdom
Assistant/Associate Prof. Maja Kelic, University of Rijeka, maja.kelic@uniri.hr, Croatia
Lea Dobrec, University of Rijeka, University of Rijeka, lea.dobrec@uniri.hr, Croatia
Prof. Sari Kunnari, University of Oulu, sari.kunnari@oulu.fi, Finland
Dr. Sini Smolander. University of Oulu, sini.smolander@uef.fi, Finland
Prof. Suze Leitão, Curtin University, S.Leitao@exchange.curtin.edu.au, Australia
Prof Karla McGregor, Boys Town National Research Hospital, Karla.McGregor@boystown.org, United States
Prof Amanda Owen Van Horne, University of Delaware, ajovh@udel.edu, United States
Dr. Maura O'Fallon, University of Delaware, mofallon@udel.edu, United States
Prof. Natalie Munro, Southern Cross University, nat.munro@scu.edu.au, Australia
Prof. Cristina McKean, University of Oxford, cristina.mckean@education.ox.ac.uk, United Kingdom
Dr. Maria Karampela, University of Oxford, maria.karampela@education.ox.ac.uk, United Kingdom
Natalie Waters, University of Oxford, natalie.waters@education.ox.ac.uk, United Kingdom
Cecilia Zuniga-Montanez, University of Oxford, cecilia.zunigamontanez@education.ox.ac.uk, United Kingdom
Prof. Pauline Frizelle, University College Cork, pauline.frizelle@ucc.ie, Ireland. Principal Investigator
Disease Category: Rehabilitation
Disease Name: Developmental Language Disorder
Age Range: 0 - 18
Sex: Either
Nature of Intervention: Any
- Clinical experts
- Consumers (caregivers)
- Consumers (patients)
- Families
- Journal editors
- Patient/ support group representatives
- Researchers
- Service providers
- Service users
- COS for clinical trials or clinical research
- COS for practice
- Consensus meeting
- Delphi process
- Nominal group technique (NGT)
- Systematic review
The COS development will involve three phrases, Systematic Reviews; Stakeholder Consultation; Consensus:
(1) Two systematic reviews:
a. of the literature on interventions for children with or at risk of DLD, to identify type and timing of all outcome measures reported
b. of studies involving standardised oral language measurement instruments to identify and synthesise available information on such instruments (including constructs, structure, scoring, availability of cultural/linguistic adaptations of identified instruments) combined with hand-searching for relevant instruments
(2) Data gathering from key stakeholder groups internationally, to identify a set of essential and desirable outcomes to be reported in oral language interventions to involve:
a. Children with DLD and family members; caregivers of children at risk of DLD; speech and language therapists (SLTs), educators and service managers involved in provision of services to children with or at risk of DLD; and researchers/editors in the area.
b. Data-gathering from children and families using the Nominal Group Technique (NGT) (Delbecq et al,1975) with an adapted version to be used with children.
c. Use of an E-Delphi method (MacEachren et al., 2005), to identify core outcomes of importance to SLTs/Educators/service managers working with people with/at risk of DLD and an international sample of DLD researchers/editors.
(3) Following the consensus work in step 2, a final consensus panel and international consensus meeting will take place with a subset of those involved in the e-Delphi, in order to generate a final list of outcome measures; with information from steps 1 and 2 informing the context for the core outcome set guidelines.