What criteria were used for identifying eligible children?

Children:

• Were monolingual speakers of English who were not reaching age-related expectations
• Scored ≤ 16th centile on the New Reynell Developmental Language Scales (NRDLS) expressive and/or receptive subscales (this is one of the baseline assessments)
• Had no reported sensorineural hearing impairment, severe visual impairment or diagnosed learning disability.
• Were identified as having primarily language difficulties. This may present as difficulty putting words together to form phrases, difficulty using appropriate language structures or difficulty understanding instructions. Children who only had pronunciation difficulties (difficulties pronouncing certain sounds) were not suitable for this project.

How old were the children?

We worked with children aged between 3 years 5 months and 4 years 5 months. This was their age at the start of the project when we carried out their baseline assessment.

What was the rationale behind the age range?

The BEST intervention approach is designed for this age range, older children would need different interventions. Having a specific age range meant we were comparing similar children when analysing the results. If children were of differing ages it could be seen as comparing apples with pears.

It is always possible to make changes and schools hadn’t missed the opportunity to work with older children but the interventions in this study would probably not be the best fit.

What does sensorineural hearing impairment mean?

Children need to be able to access the interventions and assessments so need to be able to hear the instructions given. Sensorineural hearing impairment is hearing loss that results from damage in the inner ear or with the connection from the inner ear to the brain. Depending on the loss, a child may have some difficulty hearing some sounds. This will affect their ability to access the interventions and assessments. If a child can hear, then they were eligible to take part.

What does severe visual impairment mean?

Severe visual impairment means that your vision is significantly impaired, and it may be referred to as blindness. This can be in one or both eyes and may affect all or part of your vision. For this research project, children needed to be able to access the interventions and assessments so needed to be able to see the pictures and toys being used. If they could do this, they were eligible to take part.

If a wave started in September some of the children had just started and settings may not know if they are eligible, did they have to identify them straight away?

There was an initial recruitment phase built in, baseline assessment for most children gave settings time to get to know the children.

How many children could settings put forward for the project?

This was a difficult question to answer as we knew it would vary between schools. We did our best to work with all children put forward for the project, but only had a limited time to carry out assessments. We found that most teachers have a good understanding of which children would benefit most from the type of support the project provided and we used the baseline assessments to evaluate the children and check their eligibility. 

We only had a certain amount of time to work with each school and we were not always able to work with children who attended the setting at a different time to most of their peers. 

How do you judge if children are eligible?

We used baseline assessments to evaluate the children and check their eligibility. We found that most teachers have a good understanding of which children would benefit most from the type of support the project provides.

The children needed to score equal to or less than the 16th centile on the New Reynell Developmental Language Scales (NRDLS) expressive and/or receptive subscales (this is one of the baseline assessments) to be eligible for the project.

Do the research team need to know which children are receiving external SLT support?

We asked teachers to let us know if any of the participating children were already receiving support for their speech and language. We did not need to know any details about what type of support they were receiving.

Have the researchers had safeguarding training?

All members of the team have undergone DBS checks. They have all had safeguarding training.

Safety during COVID-19

Our main priority is to keep everyone safe so we have produced a risk assessment which was shared with schools and families. 

What are the research team doing about infection control?

Please see our LIVELY infection control policy document (link to pdf)

How is personal data stored?

All data gathered during the study will be kept securely within Newcastle University and only be accessible by the research team. Only the consent forms will have names. These will be stored separately from other data and destroyed at the end of the study.

Newcastle University will act as the data controller for this study. You can find out more about how Newcastle University uses your information at http://www.ncl.ac.uk/data.protection and/or by contacting Newcastle University’s Data Protection Officer (Maureen Wilkinson, rec-man@ncl.ac.uk).

If you wish to raise a complaint on how we have handled your personal data, you can contact our Data Protection Officer who will investigate the matter. If you are not satisfied with our response or believe we are processing your personal data in a way that is not lawful, you can complain to the Information Commissioner’s Office (ICO).

At the end of the study the data collected will be de-identified and made available as “open data” through a research data repository [https://research.ncl.ac.uk/rdm/sharing]. This means the de-identified study data will be publicly available and may be used by other researchers for purposes not related to this study. It will not be possible to identify the children or schools from the “open data”.

Who will assess the children?

Assessments are conducted by members of our research team; they are qualified Speech and Language Therapists.

How long will researchers be in school?

Each child will be assessed twice. There are a number of different assessments that will be used across the two sessions. How long an assessment takes will depend on the child and the specific context, but we expect the first session to take between 30-35 minute and the second to take between 30-35 minutes.

The researchers are very experienced and, if necessary, will stop an assessment session early and arrange to come back to complete the assessment.

We will do our best to come at a time that is convenient for you and to not interrupt regular routines like breaks and PE sessions. However, in order to fit in all of the visits to all schools we will ask for your understanding and help to see as many children as possible during each visit to the school.

What assessments do school staff need to complete?

We are asking teachers to complete a Focus-34 questionnaire for each child. This is a list of questions which teachers should already know the answers to, you will not need to go and collect evidence. It should take no more than 10 minutes to complete each questionnaire.

What assessments are parents asked to complete?

We are asking parents to complete a Focus-34 questionnaire for their child. This is a list of questions which parents should already know the answers to. Some parents may need support to complete the questionnaire and we are asking schools to provide this support. It should take no more than 10 minutes to complete the questionnaire.

Can the school have a copy of any of the assessment materials to use with the older children?

Unfortunately, this is not possible. Many assessments, including some of those used in this study, need to be administered by trained professionals and the publishers do not make them available to other people.

For this research we want to ensure that there is no contamination. If schools are using assessments with other children, it may mean the children in the study are aware of the assessments and may perform differently than if this had not happened.

Will the children get a diagnosis?

With parental permission, we will share the results of the assessments with class teachers and they should help them to target future support to individual children’s specific needs. The researchers will be happy to talk to parents and/or teachers about the assessments, but it is beyond the scope of the research to provide a diagnosis. We recommend that parents and teachers talk to their usual Speech and Language Therapist if they have any concerns about the results of the assessments.

Not all of our nursery children stay in our school for Reception. What will happen for these children at follow up?

It is important for the project that we assess all children three times.

Baseline assessment happens at the start of the child’s involvement in the project. Outcome assessments happen immediately after the intervention period, even if the child did not receive an intervention. All children will also get a follow up assessment 3-4 months after the intervention period.

We know that most children will remain at the same setting but that some may move during the course of the project. We will ask parents for their contact details in case this happens. If possible, we will ask the new school if we can conduct assessments there or, if necessary, we can conduct assessments in the child’s home.

What groups have schools been allocated to?

The LIVELY study is comparing two different approaches to supporting children with language difficulties:

• Building Early Sentences Therapy (BEST)
• An adapted version of Derbyshire Language Scheme (A-DLS)

You can find more information about each arm on the interventions area of the website.

Can settings choose which arm they join / how was my school allocated to the group they are in?

Schools were randomly allocated by a statistician. This was done by an external company, so Newcastle University has no say in which group schools are allocated to, this is to avoid introducing any bias into the study.

What does ‘blinding’ mean?

The person who assesses your children does not know which group your school has been allocated to. This means that they will not be biased and unconsciously influence the results. Please do not tell the person who is assessing your children which group you are in.

Who will deliver the interventions?

A qualified Speech and Language Therapist will visit school to deliver the intervention. We ask that a teaching assistant is available to support the first two sessions and to help video one or two later sessions. Apart from these times we do not need support from school staff, but they would be welcome to observe some of the later sessions to see the interventions in practice.

How long do interventions take?

We expect sessions to last no more than half an hour and this would include the time needed to move children to the intervention space and get them settled. It is likely that the session would be closer to 15/20 minutes.

How often will the children get interventions?

Children in intervention schools will get interventions twice a week for 8 weeks.

Will the children be able to continue with their usual therapy either in or outside of school?

Yes, we do not expect schools or parents to stop doing anything. The interventions are in addition to any support children are already receiving and not a replacement.

How many children will be in each group?

Group sizes will depend on how many children are eligible to participate in the project. For BEST we expect to work with 3-4 children. For DLS the group needs to be made up of children of similar abilities, again we would hope to have 3-4 children in a group, but some groups may be smaller.

We prefer to work with groups of 3-4 as the interventions are designed to work with groups, they are not suitable for individual children, the children benefit from listening and talking to each other. Having groups means that children can talk to their peers, and once they leave therapy, they need to be able to talk to adults and children.

Does a TA need to stay with the children?

School staff are very busy, and we do not want to take them away from their usual work for longer than necessary. We do not expect them to be present for all of the intervention sessions. It might be useful for a TA, or other member of staff to stay with the children for the first couple of sessions to make sure they get to the quiet space and are introduced to the researcher. We also ask for a TA, or other member of staff, to video one of the intervention sessions so we can ensure all interventions are delivered consistently (in BEST and DLS schools only).

While there is no expectation that staff are present at other times, they would of course be welcome to observe sessions if they would find it useful. It may make sense to do this after a few sessions, once the children are settled.

What should the TA do during the intervention sessions?

TAs can be seen as a confounding variable; we need to ensure a similar approach in all schools so that the TAs do not influence the results. We are asking TAs to attend the first 2 sessions to help get the children and intervention room ready and accompany children to the intervention session to help with behaviour management. Organisation and behaviour expectations may be different to what the TA is used to. There are specific behaviour guidelines for the BEST intervention, the researcher will talk to the TA about these. TAs will have an opportunity to observe the intervention which could help their school with future implementation.

We use Makaton in school, do we need to start using Paget Gorman?

You do not need to start using Paget Gorman. We have chosen Paget Gorman Signed Speech (PGSS) over Makaton for the interventions as this sign system marks both content and grammar, aiming to be a visual representation to the spoken sentence, whereas Makaton only marks content.

You can continue to use Makaton signs in school as you normally would.

What are the principles behind the interventions?

BEST: BEST uses usage-based or constructivist linguistic theories to support more flexible understanding and use of a range of sentences. These theories suggest that children learn language by:

-        Listening to language spoken by others around them

-        Rote learning short, simple, inflexible spoken utterances in play and everyday routines

-        Building (or constructing) abstract categories and language structures, over time, through finding patterns in the language that they hear and the sentences they can use.

BEST aims to develop abstract representations of sentences in the child’s language system by:

-        Changing one element of the spoken sentence within a set

-        Pairing sentences with different verbs but similar sentence structures in a set

-        Giving visual cues (signing) and consistent sentence frames to highlight content and grammar in a sentence and help the child to spot patterns in the input

-        Giving the child repeated examples of the sentences in a meaningful context (in therapy and homework)

-        Presenting the child with different sentence types within a session and over the course of the 8 weeks

DLS:The DLS is a structured language teaching approach taking children incrementally through stages of word and sentence comprehension and expression with increasing levels of complexity and length. The approach taken is to design an activity to facilitate very specific aspects of language. The original project, which resulted in the development of the language scheme, involved teaching a large group of children with learning disabilities. Some of these children had very limited expressive language but their comprehension skills were far more advanced. We were thus forced to use methods of assessing and improving comprehension skills which did not rely on the child's ability to speak.

For the expression activities, a ‘role-reversal’ approach is taken. The "role-reversal" approach allows a child to hear short phrases which are appropriate to the equipment and, within a very short time, is allowed to use similar phrases to control the adult or another child. The teacher is likely to make only a few requests of similar type. You might say if the child could learn them in a short session, then his own use of them is really "deferred imitation". He does not fully understand them. He has learnt them by rote and has a vague idea that you will respond. At worst you might say this is really what is happening, you are teaching the child a small set of "stereotyped phrases" tied to limited equipment.

Typically developing children often learn phrases in a very similar way. A single phrase is learnt because it is repeated over and over again in a particular context.

For the LIVELY study, it was necessary to design a version of the DLS which could be delivered with high treatment fidelity and reliability and which ‘matched’ BEST as closely as possible in terms of dosage and delivery whilst retaining the key principles of the DLS. 

More information about the interventions

I can’t see much progress; how do I know the children are benefiting from the interventions?

You might not see any results until the end of the 8 weeks

Different children will respond differently to different types of therapy, this approach may not work for everyone

For BEST we are not expecting children to join in from the start. There is no expectation that they will talk in any one session, but we have found previously that by the end of the intervention period they are enjoying joining in with the session. The SLTs will leave gaps so children can join in, but it is ok if they don’t.

What are parents expected to do?

Parents are expected to aim to complete the homework daily between their child’s sessions in school. Homework activities are expected to take no longer than 10 minutes.

The homework games are designed to be fun and enjoyable for the child to complete with their parent. All of the homework resources will be provided to parents and written, and video instructions will also be provided.

BEST Homework activities and A-DLS Homework activities can be found in the interventions section of this website. 

We know some of our parents may find it tricky to do the homework with the children, should school staff do it instead?

We are asking schools not to do this during the research study so we can keep the school-based part of the intervention as similar as possible in all settings. We know that not all parents will do the homework with their children or they will do it in different ways. We would like to encourage them to do the homework, but it is not essential to the project if this does not happen.