• By Dartington SRU
  • Posted on Friday 30th March, 2012

It’s all about communication: the ACAMH Emanuel Miller Lecture 2012

A call for increased awareness in society of the centrality of speech, language, and communication. The potential of early intervention for those with difficulties. The responsibility of researchers and reporters to accurately communicate the impact of these interventions. These were the three main messages from a recent National Day Conference. Prevention Action was at the Association for Child and Adolescent Mental Health’s Emanuel Miller Annual Lecture and Conference held in London in March 2012. The theme of the day was speech, language and communication (SLC). The conference followed on from a UK “National Year of Communication” in 2011, which was itself a response to a 2008 review of services for children and young people with SLC needs.This review had been carried out by John Bercow MP, who delivered the conference opening address. He spoke of the need for government to become more aware of the way communication difficulties affect everyday life. His review recommended investment in early diagnosis and intervention of SLC difficulties, and called for a continuum of services – universal, targeted, and specialist – across the course of young people’s development in order to combat “noticeable dips in provision at points of transition.” The review also claimed that joint working and joint commissioning across government and service departments was an opportunity to improve SLC services. Emanuel Miller lecture: A “seduction” by neuroscienceNext up was the Emanuel Miller memorial lecture. Professor Dorothy Bishop, a neuropsychologist at the University of Oxford, explained how advancing technology, specifically brain scanning, has become a perverse barrier to understanding the true impact of SLC interventions. While we still lack conclusive behavioral experimental evidence of “what works,” we have, she says, “become seduced by neurosciency stuff.” So much so, that research has found we are more likely to believe causal explanations of events if they contain references to (fake) brain imaging findings, and we are more likely to buy into something on the basis of a brain scan rather than a graph. This can be witnessed in “scientists as well as lay people, even though they should know better.” A message from a dead fish in a brain imaging studyProfessor Bishop captivated the audience with a story about how a dead fish epitomizes the challenge to communicate, accurately, the results of speech and language interventions. The anecdote was used to illustrate one of many criticisms she made of a particular evaluation of a dyslexia intervention, Fast Forword. Brain scans before and after the intervention were assessed, the authors reported that the intervention had a positive effect, and published a highly influential paper in a peer-reviewed journal. However, when a dead salmon was placed in a brain scanner, and this dead fish was asked to “rate” pictures of human emotion, different areas of the dead fish’s brain were seen to light up on the scans after multiple testing. The lack of control group and statistical corrections in the Fast Forword study led the researchers to an inaccurate conclusion, Bishop charged: they attributed changes in brain imaging data to the intervention, not to chance, as in the case of the fish, and communicated this “effect” to others in the field who did not criticize it.Unsurprisingly, not only journal articles are guilty of misreporting findings from science. Bishop’s presentation also included headlines of widely circulated newspaper reports on the findings from brain scanning experiments – many of which were grossly inaccurate or misleading. Prevention Action aims to offer a bridge here through its high-quality reporting of scientific developments in the child development field, communicated in the plain language and accessible format of a newspaper.Professor Bishop ended by presenting some of her recent work with Oxford colleagues –including behavioral, rather than neurological, evaluations of children’s communication impairments.SLC interventions and trialsThere were several other reports on research into children and young people’s SLC impairments, particularly the way that interventions can help. Young offenders: Young offenders have a high prevalence of SLC difficulties, Professor Karen Bryan of the University of Surrey said. She claimed that young offenders need to be routinely screened, and services such as CAMHS should be more in tune to these potential difficulties. She described an intervention where young offenders with SLC needs came to understand their treatment programs better after a speech and language therapist was placed within a youth offending team – although, in the wake of Dorothy Bishop’s talk, she did have to apologize for the lack of control group in this study.Early oral language interventions: A number of oral language interventions designed to encourage literacy have been delivered by teaching assistants, and show promising benefits. These were discussed by Professor Maggie Snowling from the University of York. One intervention delivered in nursery classes and first year school classes, as part of the Language4Reading project, showed that when children with poorly developed language could be identified in nursery, their vocabulary improved and emergent literacy skills were more promising, at least in the short term.“Late talkers”: In the guest lecture, Professor Sheena Reilly of the University of Melbourne shared data on the trajectories of children with language impairments. The Early Language in Victoria Study (ELVS), a prospective longitudinal study of 1,910 children in Melbourne, found that almost 20% of two-year-olds were late talkers. Half of these had caught up by age four – but the challenge, Professor Reilly said, is “to identify the ones that don’t.” Social disadvantage explained some of the variance in outcomes at four years, but not all. Reilly reported on an RCT of a child-centered intervention, “Let’s Learn Language,” aiming to address early language delay in 18-month-olds. It was not found to improve language outcomes compared to a control group, but it was suggested that the six-week intervention may not have been intense enough.Language levels and behavior problems: Using data from the Avon Longitudinal Survey of Parents and Children (ALSPAC), Professor James Law from Newcastle University spoke about the mediating effect of communication on behavior. He first outlined the evidence showing an association between low language levels in children and their behavior problems in adolescence. This, he said, highlights the potential for interventions to target both communication skills and reducing behavior problems. Professor Law talked about a review he conducted of such interventions and revealed that “all reported positive results.”Selective mutism: Maggie Johnson, a speech and language therapist, concluded the day by looking to redefine the disorder of selective mutism, in which people are unable to speak in particular situations. Early identification is important for effective treatment of this disorder, but the way it has been defined in previous editions of the DSM has influenced the diagnosis and treatment pathways. She claimed that selective mutism should be classed as a “specific phobia” and reported excellent treatment outcomes when it is treated as such.It’s all about communicationThe take-home message of the conference was the importance of communication, in more ways than one. Firstly, the centrality of being able to communicate. Next, the idea that communication about SLC needs to be prominent, both in government and in research agendas in order to appropriately equip clinical practice. These were sentiments echoed by attendees of the conference, mainly practitioners such as speech and language therapists and educational psychologists. In addition, communication of research findings from well-designed studies needs to be accurate and clear; this is a responsibility for researchers and reporters. And those reading what is communicated must remember to be critical. Finally, interventions to improve speech, language and communication remain a key tool in alleviating difficulties, and should be more widely used following earlier identification of potential problems in childhood.********References and links:Bercow, J. (2008). The Bercow Report: A review of services for children and young people (0-19) with speech, language and communication needs. Available here Bryan, K., Freer, J., & Furlong, C. (2004). Speech and language therapy for young people in prison project: Third project report May - October 2004. Available here Hsu, H. J., & Bishop, D. V. M. (2011). Grammatical Difficulties in Children with Specific Language Impairment: Is Learning Deficient? Human Development, 53(5): 264–277. doi:10.1159/. Available here Language4Reading projectLaw, J., Plunkett, C., & the Nuffield Speech and Language Review Group. (2009). The interaction between behaviour and speech and language difficulties: does intervention for one affect outcomes in the other? Available here Reilly, S., Wake, M., Ukoumunne, O., Bavin, E., Prior, M., Cini, E., Conway, L., Eadie, P., Bretherton, L. (2010) Predicting language outcomes at 4 years of age: Longitudinal findings from the Early Language in Victoria Study. Pediatrics, 126(6), e1-e8.Selective Mutism Information and Research Association Wake, M., Tobin, S., Girolametto, L., Ukoumunne, O., Gold, L., Levickis, P., Sheehan, J., Goldfeld, S., Reilly, S. (2011) Outcomes of population-based language promotion for slow-to-talk toddlers at ages 2 and 3 years: The Let's Learn Language cluster randomised controlled trial. BMJ, 343 (d4741) (August).

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