Award Title: E-PLAYS-2 (Enhancing Pragmatic Language skills for Young children with Social communication impairment) trial; evaluation of a computerised intervention to promote communicative development and collaborative skills in children
Funder: Department of Health and Social Care

Abstract: Many children experience difficulties with social communication (also known as pragmatic language ability); that is, the use of language for social purposes. These children struggle with conversational tasks such as appropriate use of greetings, conversational turn-taking, understanding of non-literal language such as jokes, irony or sarcasm, social conventions like politeness, taking the perspective of the other person and responding with relevant information. These difficulties have profound effects on children’s social development, mental health, and education and are strongly associated with bullying, isolation and school exclusion. There is a lack of available interventions for such children. _x000D_
We have developed E-PLAYS (‘Enhancing Pragmatic Language skills for Young children with Social communication difficulties’) a fun computer game for children 5-7 years-old with social communication difficulties. It is played by children in pairs. Games designers, teachers, speech and language therapists and children helped us to develop E-PLAYS, and young people with communication difficulties gave feedback._x000D_
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Previous studies by our team showed that children receiving E-PLAYS scored better on language tests, used more appropriate verbal communication and showed more enjoyment of social interaction than a similar group of children who didn’t receive E-PLAYS. These studies also showed that enough children agreed to take part, that schools' teaching assistants could deliver the E-PLAYS programme faithfully to the manual and that teaching assistants and children rated the game as fun and enjoyable. _x000D_
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Our two previous studies were run with small numbers. We now want to run a large trial with 504 children. We want to follow these children up to find out whether E-PLAYS delivered by teaching assistants in schools is effective and whether it is good value for money. We will ask schools to take part in the study and will measure children's language skills before and after they have used E-PLAYS for 10 weeks with their teaching assistants and a partner child from their class. Their teachers will observe classroom behaviours to see if they notice any differences. We will observe and interview children to see whether they like using E-PLAYS. We will also observe and interview teaching assistants and ask them to complete a survey and take part in a focus group to see how they use E-PLAYS, if it fits well into their school day, if they feel confident with it and if they think the instructions are clear._x000D_
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If we show that E-PLAYS is effective for children with social communication difficulties, we will make it available, together with an online manual, to all schools in the UK. Against a backdrop in 2020 where children’s socialisation with peers, communication skills and peer relations have suffered and the most deprived individuals have been hit the hardest, E-PLAYS aims  to develop children’s social and collaborative skills by making novel use of technology. It is likely to be welcomed by schools, parents and children.

Lay Abstract: BACKGROUND_x000D_
A number of children experience difficulties with social communication (also known as pragmatic language ability). These difficulties can include initiating conversation and responding appropriately, problems with varying communication to match the context or listeners' needs, recounting a coherent narrative and understanding non-literal language.  Whilst such children may have adequate or even advanced vocabulary and grammar, they can struggle with everyday conversational tasks. There is a lack of evidence-based, cost-effective interventions for children with social communication difficulties; in fact, language therapies as a whole have attracted little research funding. Language disorders remain little known by the public and under-researched by comparison to conditions with similar prevalence and impact, such as ADHD, childhood obesity and dyslexia. Furthermore, the limited take up of technology in this field is widely regarded as a missed opportunity. We therefore plan to conduct a study to evaluate the effectiveness of a digital intervention for children with social communication difficulties. _x000D_
INTERVENTION_x000D_
The E-PLAYS (Enhancing Pragmatic Language skills for Young children with Social communication difficulties) intervention is a novel technology in the form of a fun computer game. E-PLAYS is played by children in pairs and comprises 10 weekly sessions of 30 minutes each, supervised by a teaching assistant. E-PLAYS will be delivered in special and mainstream primary schools in the UK. This study builds on a previous pilot study and feasibility trial (E-PLAYS-1). The pilot study showed some indication of efficacy with regard to language improvement; the feasibility trial showed acceptable recruitment and response rates._x000D_
OBJECTIVES_x000D_
The primary objective is to examine the impact of E-PLAYS on children’s social communication skills within a school setting. Secondary objectives are to investigate the effect of E-PLAYS on classroom behaviour and peer relations. _x000D_
DESIGN_x000D_
A two-arm pragmatic cluster-randomised controlled trial, with allocation at the school level, with an internal trial, comparing care as usual plus E-PLAYS with a control group receiving care as usual, outcomes up to 40 weeks, in primary schools. The trial will include embedded economic and process evaluations._x000D_
PARTICIPANTS_x000D_
We will recruit 84 schools and 504 children aged 5-7 years-old who will be selected by teachers using the Social communication Questionnaire. _x000D_
OUTCOME MEASURES:	_x000D_
The primary outcome will be a measure of pragmatic language ability as assessed using the Test of Pragmatic Skill by blinded research assistants. Secondary outcome measures, also administered by blinded research assistants, include measures of narrative production, perspective-taking and recall. Other secondary measures of communication, classroom behaviour and peer relations will be provided by teachers. Parents will provide data on quality of life and resource use to inform the economic evaluation.  _x000D_
Interviews, observations and focus groups will establish teaching assistants' views on training and E-PLAYS’ ease of use. _x000D_
IMPACT_x000D_
We will definitively test E-PLAYS and plan for implementation, if effective. One of the strengths of this study is that E-PLAYS could be rolled out nationally immediately and at no charge. Dissemination will take place through practitioner networks, social media and public engagement events as well as academic outputs.

Research Activity Codes: 6.7 PHYSICAL
Health Categories: MENTAL HEALTH