Evaluation of speech and language therapy for children using communication aids

To document the variety in amount and type of speech and language therapy intervention provided during one school year for children with motor impairments who use communication aids

To make preliminary analysis of the relationship between parameters of intervention and outcomes in terms of children's use of aids and progress in communication skills.

A detailed qualitative cohort study, with preliminary quantitative analysis of relationships between child characteristics, environment characteristics, therapy process and outcome. Data sources included direct observation, interview with children and adults, and record-keeping.

Twenty-three children using a communication aid incorporating at least 20 symbols, with language understanding at least at the two word level, and receiving speech and language therapy at school in 6 London boroughs, were studied over the period of one school year. Five were at mainstream school, and one more transferred from special school during the year.

1. Amount, structure and session objectives of therapy for each child, documented by speech and language therapists.

2. Observations made on five occasions spread over the year of children's communications in classrooms and break times, coded for initiator, content, mode and assistance.

3. Therapy goals set termly and level to which they were achieved.

The amount of therapy received was determined by the type of school attended, ie mainstream children all received less and almost all of it happened outside the classroom. The amount, structure and content of therapy received was found to be related to the practice of particular special schools rather than to child characteristics; for example, children at the school receiving the most provision were more likely to have voice output aids.

The amount of therapy received was positively related to achievement of therapy goals, but not to the amount of aid use by children in communication as observed in schools. Once again it was environmental factors which determined aid use, and how children communicated more strongly than individual characteristics. Children in mainstream settings hardly every used their aids, despite their problems with speech intelligibility. Comparable children in special school settings did use their aids, and for most children aid use paralleled effective communication in terms of taking the initiative more and communicating content beyond 'yes' or 'no'. Adult assistance was important in helping children (in special school) to use their aids.

There is a clear necessity for greater levels of speech and language therapy provision for children in inclusive educational settings, to include more training and liaison with teaching and support staff.

Clarke, M.T., McConachie, H.R., Price, K. and Wood, P. (2001) Speech and language therapy provision for children using augmentative and alternative communication systems, European Journal of Special Needs Education, 16: 41-54

Clarke, M.T., McConachie, H.R., Price, K. and Wood, P. (2001) Views of young people using augmentative and alternative communication systems, International Journal of Language and Communication Disorders, 36: 107-115

Clarke, M.T. and Price, K. (1998) Back into the broom cupboard? Some findings from discussion with users of augmentative and alternative communication systems. Communication matters, 12: 13-16

Clarke, M.T., Wood, P, Price, K. and McConachie, H.R. (2000) Success in AAC: Does speech and language therapy make a difference? Communication Matters 14: 5-7