Title: A new speech and language therapy intervention for children who have Social Communication Disorder: feasibility and acceptability to service users and practitioners
Funder: Department of Health and Social Care

Abstract: Background: Children who have Social Communication Disorder (SCD) have persistent difficulty with the structural and pragmatic aspects of language in addition to mild autistic traits. These children have poor long-term mental health/social restrictions in later life with implications for high-cost psychiatric interventions and societal support. In our work with these children, their parents/carers have told us repeatedly that early, specialist communication intervention is essential in helping their children to express themselves and to be able to talk with friends. Parents call for better provision of speech and language therapy (SLT) services to support their children s complex communication needs and better training for themselves to be able to support their children. Systematic reviews, however, have indicated that the quality of evidence in this field is poor and recommend a change in routine practice supported by larger trials. An innovative, manualised SLT intervention, The Social Communication Intervention Programme (SCIP), has been developed that provides methods and individualised intervention routes/content for targeted programmes of therapy for children who have SCD aged 6-11 years. A preliminary study of SCIP intervention, carried out in mainstream schools and delivered by a research SLT, indicated that there were improvements in social communication associated with the intervention. Further research, including refinement of individualised outcome measures and study of the acceptability of the intervention to families and NHS practitioners is required if SCIP is to be adopted into routine practice. A feasibility study is required to derive more precise estimates of key parameters for such a trial, particularly the choice of a valid outcome measure for individualized routes through a complex intervention. Aims: The principal aim is to estimate specific parameters for a substantive randomized controlled trial of a new speech and language therapy intervention (SCIP) for 6-11 year old children who have SCD. Specific aims are to study and refine aspects of the intervention procedure and outcome measurement, i.e., to estimate sample size by studying variability of a modified goal attainment scaling (GAS) as primary endpoint; to explore the feasibility of key recruitment and participant factors for a substantive trial; and to explore factors associated with training and acceptability of the intervention to all stakeholders. Plan of investigation: Work Package 1: A survey will be sent to paediatric NHS SLT services in England via national services contacts and networks to address practitioner participation, obtain eligibility/recruitment rates and to scope current routine practice, training needs and feasible contexts for intervention. Work Package 2: Fifteen children who meet inclusion criteria for SCD, their parents/carers and SLT practitioners, based in England, will be recruited to a small-scale feasibility trial of SCIP intervention. Practitioners will receive a SCIP manual and training by a specialist SLT followed by ongoing support/supervision. Children will receive twenty sessions of SCIP intervention over a three-month period in the practitioner-chosen context. Outcome measures (primary endpoint plus secondary language/pragmatics measures) will be taken at baseline (T1), and at 3 months (T2), within two weeks of completion of intervention. T1 assessments will be followed by identification of individual, weighted therapy targets (GAS) using a mapping procedure. Parents/carers will contribute ratings and commentary to outcome measures and participate in intervention sessions. Work Package 3: Semi-structured interviews will be undertaken after T2 with purposive samples of the participating SLTs and parents/carers of children. Perceptions of the participating SLTs will be captured via intervention audio diaries. Perceptions of the children receiving the SCIP intervention will be elicited using multi-modal tasks at T1 and T2. Interview data will be analysed using a thematic network approach which will contribute towards recommendations for methodology and for parent/carer support in a full-scale trial.

Lay abstract: Children who have social communication disorder (SCD) find it hard to understand and use language, eespically in social situations. They may show some mild features of autism. This can affect how well they learn at school, their friendships and emotional/mental health as they grow up. This has a substantial impact on families and is expensive for the NHS and social services. An effective communication intervention may be able to prevent some of these problems but there is currently no research to support this. In our previous work, we developed and gave a new speech and language therapy intervention called the Social Communication Intervention Programme (SCIP) to children who have SCD in their schools. Parents and teachers felt that the intervention led to improvements in social communication. A bigger study with more children and NHS speech and language therapists (SLTs) is now needed to show if SCIP intervention really does work. In this research, we want to find out how best to do this by: 1) Finding out how many children and families in England would be able to take part in a bigger study 2) Training SLTs to give SCIP intervention to 15 children (aged between 6 and 11 years) who have SCD, using a novel way of measuring each child s progress against a set of individualised aims. This will help us to develop effective measures of progress for a bigger study 3) Speaking to the children, parents and SLTs to ask them about their experience of SCIP intervention. Children who have SCD and their parents have already helped in developing this research and will continue to advise researchers. We will share our findings with people who work in, design and pay for SLT services and families affected by SCD through reports, presentations and research articles.

Research activity codes: 6.7 PHYSICAL
Health categories: MENTAL HEALTH