Title: Exploring language, behaviour and wellbeing outcomes of a user co-designed digital vocabulary intervention for child language disorder
Funder: Health Education England

Abstract: BackgroundEvidence suggests that almost ten percent of primary school-aged children present with a language disorder. In England alone, this could be characterised in up to a quarter of a million children by a vocabulary difficulty restricting the ability to find the words to express wants, needs and ideas. Around a third to half of these children may have co-occurring wellbeing issues resulting from problems with emotional, psychological and/or social aspects of behaviour. Without specialist help, issues can escalate and persist into adulthood. Despite this, there is little research simultaneously considering impact of support provisions on language and wellbeing. This is likely due to low awareness across health, education and social care of the co-morbidity leading to poor multidisciplinary collaboration during both intervention and research design. Intervention studies showing greatest potential for improving vocabulary with some mention of behaviour gains are those employing word-webs i.e. diagrams resembling mind-maps for organising sound and meaning information and those delivered on mobile tablets. Whilst both approaches support multi-sensory learning, as preferred by children with language disorder, there are no therapies combining techniques by using interactive digital word-webs to search, record and store information. Aims This project aims through service-user co-design to develop and test the feasibility of a digitally-enhanced vocabulary intervention and explore tools for measuring impact on language and wellbeing. Study objectives and methods Review intervention studies with primary school-aged participants employing vocabulary and wellbeing outcome measures (9 months).Systematic review with meta-analysis to compare effectiveness of existing interventions and identify outcome measures used. Create intervention protocol using logic modelling (1 month)Use systematic review findings to inform core components of the novel intervention. Develop intervention software with service-users (9 months)Run co-design workshops involving children with weak vocabulary in line with a language disorder and concerns with aspects of behaviour. Refine intervention with stakeholders (10.5 months)Analyse feedback from parents, academics and practitioners from health, education and social care and use to improve the intervention. Plan and implement feasibility study (15 months)Two-arm trial involving children with weak vocabulary and behaviour profiles based on standardised assessment allocated randomly to 6-weeks digital (n=12) or paper-based (n=12) vocabulary intervention delivered by qualified Speech and Language Therapists. Collect data to investigate: Process evaluation: Reach (recruitment/compliance/follow-up rates), Fidelity, Impact of delivery mode (digital/paper-based). Intervention outcome measures: Primary vocabulary and secondary behaviour measures analysed at pre-intervention, post-intervention and 6-week follow-up for sensitivity to and direction of change. Primary outcomes to guide sample-size estimates for subsequent randomised controlled trial. Impact and dissemination Project outputs will encourage multidisciplinary management of co-occurring language and wellbeing needs; provide a model of co-designing with service-users and give a clear route for future work evaluating intervention impact and cost-effectiveness. Dissemination will be through website and social media channels; community/public-service meetings in conjunction with the Project Steering Group; peer-reviewed journal publications and presentations at professional events. The Steering Group consisting of two parents and two professionals have supported the project from the start helping to ensure that patient-benefit is central to all activities.

Lay abstract: Background It is estimated that almost ten percent of the UK's 5 million primary school-aged children could have a disorder where language does not develop as expected. For up to a quarter of a million children in England this language disorder could affect vocabulary, which means the children struggle to find the words to explain their wants, needs and ideas. This can often lead to problems with concentration, independence, managing negative emotions and other behaviours which affect wellbeing and make coping with day-to-day life difficult.Without specialist help, these language and wellbeing needs can become worse and continue into adulthood. However, there is currently little research which looks at how support for vocabulary can also improve wellbeing. This is mainly because professionals in health, education and social care do not always understand the impact of poor vocabulary on wellbeing and so rarely work together to study and support these needs. The types of support also known as interventions that show most promise for improving vocabulary with some signs of improved behaviour and wellbeing are ones that use word-webs. These are diagrams consisting of lines that connect sound and meaning information about a word. The diagrams resemble what is commonly known as mind-maps and are widely used by UK Speech and Language Therapists to help children with language difficulties. Interventions delivered on mobile-tablets such as iPads have also been found to improve vocabulary with some improvement in behaviour. However, no-one has previously researched the effect on vocabulary, behaviour and wellbeing when children use word-webs on tablets to search, record and store information. Aims This project will work directly with children who struggle with language and aspects of behaviour together with their parents and expert professionals to jointly develop and test a vocabulary intervention designed for use on tablets. Method The project will: Review and learn from all available research for primary school-aged children that looks at impact of interventions on vocabulary and wellbeing. Work with a group of children who have language and behaviour needs to design a vocabulary intervention that uses word-webs on iPads. Improve the intervention using feedback from parents and a range of professionals from health, education and social care. Test the new intervention with children who have language and behaviour needs to see how well it works for them and the professionals that support them.The design of the project has and will continue to be supported by a Steering Group of parents and professionals who make sure that patient-benefit is always the priority. The group includes two parents of children with language disorder, one special educational needs/disability coordinator who oversees additional support in schools and one wellbeing professional who helps children manage their emotions and behaviour. Sharing Findings The Steering Group will help share information about the project at community-events and meetings. Information and updates during the project will also be shared on a website that includes a blog, regular newsletters and links to a twitter account, all of which will be easily accessible to the public and those involved in the research. Results of the project will be presented in research journals and at professional events. It is hoped that this project will: Encourage professionals to work together to support language and wellbeing needs. Provide a model of designing interventions with the children who are most likely to benefit. Help plan a larger project looking into the effect the intervention has on children's vocabulary, behaviour and wellbeing and whether it offers value for money.

Research activity codes: 6.7 PHYSICAL
Health categories: MENTAL HEALTH