Health Evidence Bulletins - Wales

Date of Completion: 13.09.99

2: Communication

This bulletin is a supplement to, not a substitute for, professional skills and experience. Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation.

The Statements The Evidence
2.1 Communication in Children
2.1a. Early Intervention has been shown to be important in fostering the development of communication skills in childreni,ii,iii,iv.
(Health gain notation – 2 "likely to be beneficial")
i. Guralnick M. (ed.) The Effectiveness of Early Intervention. Baltimore: Brooks, 1997
(Type V evidence – expert overview of early intervention studies that concludes that there is a consensus from the research that early intervention makes a difference)
ii. Rogers SJ. Brief report: Early intervention in Autism. Journal of Autism and Developmental Disorders 1996; 26(2): 243-6
(Type III evidence - Meta-analysis examining six published studies showing positive outcomes with children with autism. None were randomised controlled trials)
iii. Jordan R, Jones G, Murray D. Educational Interventions for Children with Autism: A Literature Review of Recent and Current Research. Sudbury: Department for Education and Employment, 1998
(Type V evidence – expert review of educational interventions for children with an autistic spectrum disorder indicating sufficient consistent evidence to suggest that early intervention is effective)
iv. Girolametto LE. Improving the social conversational skills of developmentally delayed children: an intervention study. Journal of Speech and Hearing Disorders 1988; 53: 156-67
(Type II evidence – randomised controlled trial of 20 mother-child dyads. Following 11 weeks of intervention the experimental group showed greater improvement in communication skills than the control group)
2.1b. An extensive range of interventions has been proposed for children with autistic spectrum disorders over recent years. A number of approaches have some evidence of their effectiveness but this is variable in quality. There is no study with rigorous control of variables such as intensity. Thus the effectiveness of any single approach cannot be precisely isolatedi.
(Health gain notation – 4 "unknown")
i. Jordan R, Jones G, Murray D. Educational Interventions for Children with Autism: A Literature Review of Recent and Current Research. Sudbury: Department for Education and Employment, 1998
(Type V evidence – expert review of interventions for children with an autistic spectrum disorder concluding that "No approach has yet been entirely successful in producing a methodologically sound evaluation of its work.")


2.2 Communication in Adults and Children
2.2a. Advice and Training for parents and carers on how to facilitate communication skills is important in enabling people with intellectual disability to communicatei,ii,iii,iv.
(Health gain notation – 2 "likely to be beneficial")
i. Girolametto LE, Greenberg J, Manolsen HA. Developing dialogue skills: the Hanen Early Language Parent Program. Seminars in Speech and Language 1986; 7(4): 367-82
(Type III evidence - 78% of parents completing pre, post, and follow-up attitude questionnaires indicated that the group training enabled them to create a positive language- learning environment, and to continue as language facilitators after the training programme had ended)
ii. Money D. A comparison of three approaches to delivering SLT services to people with learning disabilities. European Journal of Disorders of Communication 1997; 32: 449-66
(Type III evidence - 36 carer-client dyads were randomly assigned to 3 intervention approaches: direct therapy, teaching carers, and a combination approach. The combination approach demonstrated statistically significant improvements following intervention. There was not a ‘no treatment’ control group)
iii. Granlund M, Terneby J, Olsson C. Creating communicative opportunities through a combined in-service training and supervision package. European Journal of Special Needs Education 1992; 7(3): 229-51
(Type III evidence - a case controlled cross sectional study of 102 adults with a profound intellectual disability. The evidence supports the use of a combined staff training and supervision format in communication intervention)
iv. Hodgkinson P. Communication in ALD- What do carers think? Speech and Language Therapy in Practice 1998; Spring: 5-7
(Type IV evidence - Structured interviews of 12 staff support the need for an approach which combines a consultative role to carers with direct intervention)


2.2b. A primary focus of intervention should be to ensure:
  • that a person with intellectual disability has maximum opportunities to communicate;
  • that all communicative initiatives, responses to communication and interactions should be rewarding experiencesi,ii,iii.

(Health gain notation – 2 "likely to be beneficial")

i. Bradshaw J. Assessing and intervening in the communication environment. British Journal of Learning Disabilities 1998; 26: 62-65
(Type IV evidence – an observational single case study. The data presented is limited but supports the notion that the quality of communication improves when staff know how to enable a person with intellectual disability to communicate meaningfully)
ii. van der Gaag AD. The view from Walter’s window; social environment and the communicative competence of adults with a mental handicap. Journal of Mental Deficiency Research 1989; 33: 221-7
(Type IV evidence - case controlled observational study of 120 learning disabled adults. Community settings were more effective in facilitating communication and clients in the community were significantly better communicators)
ii. Leuder I. Communicative Environments for Mentally Handicapped People. In M Beveridge, G Conti Ramsden, I Leuder (eds.) Language Communication and Mentally Handicapped People. London: Croom Helm, 1988
(Type IV evidence - cross sectional study suggesting that that the communicative environments of mentally handicapped persons become distorted and limit opportunities for communication)
2.2c. Intensive interaction approaches are shown to be effective in promoting early communication skills in adults and childreni,ii,iii,iv.
(Health gain notation – 2 "likely to be beneficial")
i. Nind M. Efficacy of intensive interaction: developing sociability and communication in people with severe and complex learning difficulties using an approach based on care-giver infant interaction. European Journal of Special Needs Education 1996; 11(1): 48-66
(Type IV evidence - observational study of six subjects suggesting that communication skills may be enhanced using intensive interaction based on typical care-giver - infant interaction)
ii. Burford B. Action cycles: rhythmic actions for engagement with children and young adults with profound mental handicap. European Journal of Special Needs Education 1988; 3(4): 189-206
(Type IV evidence - cross sectional observational study. Analysis of video records identifies crucial common timing factors in effective interaction behaviours)
iii. Prevezer W. Evaluation of an Alternative Approach. Musical Interaction with Children who were Considered Unable to Benefit from Conventional Speech and Language Therapy. Nottingham: Nottingham Community NHS Trust, 1994
(Type IV evidence - overview of 6 case studies)
iv. Wimpory DC, Nash S. Musical Interaction Therapy - therapeutic play for children with autism. Child Language Teaching and Therapy 1999; 15(1): 17-28
(Type IV evidence - a single case study. Video-taped evidence suggests that musical interaction therapy enables interactive patterns that are intrinsically rewarding and self perpetuating beyond therapy sessions)


2.2d. Alternative and augmentative (AAC) communication systems (high and low technology) may be helpful to adults and children with intellectual disabilityi,ii,iii.
(Health gain notation – 2 "likely to be beneficial")
i. Jago JL, Jago AG, Hart M. An evaluation of the total communication approach for teaching language skills to developmentally delayed preschool children. Education and Training of the Mentally Retarded 1984; 19(3): 175-82
(Type III evidence - a case controlled study of 24 children supports the use of total communication with pre-school, language delayed children)
ii. Bondy AS, Frost LA. The Delaware autistic program. in Harris SL, Handleman JS. (eds.) Pre-School Education Programs for Children with Autism. Austin: Pro-Ed, 1994
(Type IV evidence - three case studies of pre-school children with autism)
iii. Park K. How do objects become objects of reference?: A review of the literature on objects of reference and a proposed model for the use of objects in communication. British Journal of Special Education 1997; 24(3): 108-14
(Type V evidence - expert opinion)
2.2e. Focussing on functional communication, social and pragmatic aspects of communication is effective whatever approach is used or whether AAC support is providedi,ii,iii.
(Health gain notation – 2 "likely to be beneficial")
i. Angelo DH, Goldstein H. Effects of a pragmatic teaching strategy for requesting information by communication board users. Journal of Speech and Hearing Disorders 1990; 55: 231-43
(Type IV evidence - observational study of 4 non-speaking children. Independent rater perceived significant differences when viewing before and after training video tapes)
ii. Calculator SN. Evaluating the effectiveness of AAC programmes for persons with severe handicaps. Augmentative and Alternative Communication 1998; 14: 177-9
(Type V evidence - expert opinion. A position paper which stresses the importance of teaching useful communication skills and in providing opportunities to express choice and preference)
iii. Murphy J, Markova I, Collins C, Moodie E. AAC systems: Obstacles to effective use. European Journal of Disorders of Communication 1996; 31(1): 31-44
(Type IV evidence - cross sectional study of 93 AAC users. Results indicated the importance of: aids being accessible; opportunities for a wide range of social contacts; training which focuses on the communication partner; useful vocabulary; and encouragement for spontaneous modes of communication)


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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk