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Lookup NU author(s): Dr Wanwuri Akor
This is the final published version of an article that has been published in its final definitive form by John Wiley & Sons Ltd, 2018.
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Background Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facialexpression (or a combination of these), making their communication difficult to understand. Parents may be offered training to helprecognise and interpret their child’s signals and to stimulate their children’s development of new communication skills.ObjectivesTo assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual orclinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have nonprogressivemotor disorders.Search methodsWe searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. Wealso searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies.Selection criteriaWe included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication interventionwith no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders upto five years of age.Data collection and analysisWe used the standard methodological procedures expected by Cochrane.Main resultsThis review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and theirmothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected theirgestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or threehome visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took placeat an intervention centre in Canada and the other in South Korea.Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending ortherapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated onestudy at high risk of attrition bias, and both studies at low risk of reporting bias.There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children’s initiationof conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became moreresponsive to their children’s communication, but there were no differences in the extent to which they controlled conversation bydirecting their children.Missing data meant that we were unable to evaluate the effects of training on children’s frequency of communication,frequency of spoken language in conversation, speech production, or receptive or expressive language development. There wereno effects on maternal stress.We found no reports of the effects of parent training on children’s use of individual communication skills,such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports ofmothers’ satisfaction with treatment, its acceptability or their compliance with it.Authors’ conclusionsThere is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvementsin interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples andhigh risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lackof detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy ofmovements underpinning spoken or gestural communication. Some speech and language therapists currently provide communicationtraining for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures,coupled with detailed reporting of children’s baseline skills, is needed to test whether communication training for parents can helpthem to promote the communication development of their young children with movement disorders.
Author(s): Pennington L, Akor WA, Laws K, Goldbart J
Publication type: Article
Publication status: Published
Journal: Cochrane Database of Systematic Reviews
Online publication date: 24/07/2018
Acceptance date: 02/04/2018
Date deposited: 23/06/2017
ISSN (electronic): 1469-493X
Publisher: John Wiley & Sons Ltd
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