Specialist provision for language disorder: Staff and service user views of a preschool language unit

Abstract

Language units are specialist educational settings that provide integrated speech and language therapy and curriculum delivery for children with severe language disorders within mainstream schools. This study presents an account of a preschool language unit (PLU) from the perspectives of children with language disorders currently in attendance, their parents, and teaching staff. Six child-led, multi-modal interviews, six parent questionnaires, and interviews with three members of staff were analysed using Framework Analysis (Ritchie et al., 2003). Results showed that staff and parents perceive that attending the PLU positively impacts the children, but raised concerns that accessing PLUs can be difficult due to number restrictions. Children valued play and friendships within the PLU, while parents valued the PLU’s role in supporting communication and socialization. This study offers a unique account of how a PLU supports children with language disorders from the perspectives of children, parents and staff.

Keywords

children’s voices collaborative practice parents preschool language units teacher views

I Introduction

Language units are spaces in mainstream schools where intensive speech and language therapy (SLT) assessment and intervention takes place alongside schooling provided by teachers with a high level of training and expertise in language disorders. This article highlights the main features of one preschool language unit (PLU) from the perspectives of children, teaching professionals, and parents; and discusses the themes which arise in the context of current educational provision.

1 Language disorders

Children with language disorders have an impaired ability to acquire language, leading to functional impairments in social interaction and education (Bishop, 2017). Children with language disorders are a heterogeneous group, and may have difficulties in relation to phonology, syntax, pragmatics, verbal learning and memory, reading and writing (Bishop et al., 2017). Language disorders can occur without a known cause or alongside a wider profile of impairment (e.g. with autism spectrum disorder, hearing impairment, genetic conditions, intellectual disability). The terminology and identifying psychometric and functional criteria for diagnosis have been discussed in the CATALISE project, which aims to reach international consensus for researchers and clinicians working with children with language disorders (Bishop et al., 2016, 2017). In line with the CATALISE project, we use the term ‘language disorder’ in relation to children in the PLU, as they have significant, functional difficulties with language, and the nature of their impairments is investigated during their time in the PLU.

2 Early intervention

Predicting the trajectory of language disorder is limited in preschool years (Bishop et al., 2017), and delaying intervention has been common practice in many services (Whitehouse et al., 2011). A combination of biological, cognitive and environmental factors contribute to risk for language disorders (Conti-Ramsden and Durkin, 2015), including biological sex (Conti-Ramsden and Botting, 2004), poor language comprehension skills (LaParo et al., 2004) and socioeconomic status (Paul and Weismer, 2013). Currently, differentiating risk for persistent versus transient language disorder is challenging (Reilly et al., 2010). However, language disorder in early childhood is a risk factor for long term difficulties (Dale et al., 2003; Tomblin et al., 2003; Ukoumunne et al., 2012) and early identification and intervention is important to maximize early communication (ASHA, 2008; Gascoigne, 2006), facilitate school readiness (Archibald, 2017), and reduce the likelihood of long term poor psychosocial outcomes (Snowling et al., 2006). Researching preschool specialist services adds an essential perspective to the debate about the suitability of intensive early intervention.

3 Language units

Language units (also known as specialist resource bases) are situated within mainstream educational settings, designed to support and develop communication and improve curriculum access for children with severe and complex language disorders (Simkin and Conti-Ramsden, 2009). Little is known about the role of language units in supporting children with language disorder and the nature of such provision (e.g. the age of children attending, the duration of placement in the unit), access (e.g. how many education authorities provide language unit placements), or eligibility. It is thought that there are no formal criteria for access to language units, with decisions generally made on the basis of individual need, suitability, and local targets (Botting et al., 1998; Dockrell and Lindsay, 1998; Lindsay et al., 2005b). There is currently no record of how many children are attending language units in the UK. It is reported that in some areas, children can only access language unit provision between the ages of 4–7 years (Rannard and Glenn, 2009), though this may now be outdated. Reduced language unit provision beyond age 7 may reflect the focus on inclusion within junior school mainstream classroom settings (Conti-Ramsden et al., 2002; Law et al., 1999). Anecdotal reports within our professional networks suggest that language units are not present in some counties in England and that funding cuts have resulted in many closures. However, to our best knowledge, there is no empirical evidence to give an overview of current access or related changes to language units.

Whilst language units vary in the nature of provision, a typical unit accommodates approximately ten pupils in order to keep a high staff to pupil ratio (Lindsay et al., 2002). The National Curriculum (Department for Education, 2013) is delivered by teachers who receive specialist training in working with language disorders, in order to enable and enhance pupils’ access to learning material (Dockrell et al., 2006). Collaboration between teachers and speech and language therapists (SLTs) is central to how language units provide inclusion and intervention. Ideally, staff train each other in their respective expertise through consultation and exchange models, as outlined by McKean et al. (2017). In a recent review of collaborative classroom practice, Archibald (2017) presents convincing evidence for the effectiveness of this approach for targeting vocabulary and phonological awareness, and highlights the need for SLT instruction to take place in natural environments such as classrooms so that new skills can generalize. Conducting intervention in the classroom has been found to be a greater predictor of response than intensity (Tambyraja et al., 2015), and new evidence suggests collaborative practice is a key element of successful intervention (Ebbels et al., 2017). Although the extent to which this occurs in language units is unknown, such findings illustrate key issues and priorities in supporting preschool children.

There are exceptions to the lack of research into language units, with some studies focusing on attendees (Conti-Ramsden et al., 2001, 2009; Lyons and Roulstone, 2017, 2018; Rannard and Glenn, 2009; St Clair et al., 2011) and a small number examining parental views (Rannard et al., 2004; Roulstone and Lindsay, 2012b; Simkin and Conti-Ramsden, 2009). The longitudinal Manchester Language Study investigated a cohort of 242 children who attended language units in primary schools (Conti-Ramsden and Botting, 1999), following them up through childhood and into early adulthood (e.g.Gina Conti-Ramsden et al., 2001; St Clair et al., 2011). This study provides detailed information about these young people, their language and cognition trajectories and psychosocial outcomes but did not focus on language unit provision itself.

4 Children’s experiences of language units

Listening to the perceptions of children with language disorders is valuable and important (Roulstone et al., 2012; Roulstone and Lindsay, 2012a). Simkin and Conti-Ramsden (2009) interviewed 139 adolescents who had attended a language unit at age 7. The majority (71%) reported that attending a language unit had been a positive experience. Negative views generally related to separation from mainstream peers. The study offers a rare insight into the lived experience of attending a language unit, with a large cohort from across England, although the retrospective nature of data collection may have influenced findings.

Lyons and Roulstone (2017) used narrative enquiry to investigate the views of children who were currently or had previously attended language units. Interviews with 11 children aged 9–12 years revealed that one participant strongly disliked being associated with the unit, and two participants considered themselves no different from mainstream peers and therefore rejected the need for additional school support. Difficulties with social relationships and academic achievement negatively impacted perceptions of wellbeing, but positive relationships increased resilience (Lyons and Roulstone, 2018). Children with language disorders often speak positively about their experiences. Key issues include social acceptance, wellbeing, and ability to learn in the classroom (Lyons and Roulstone, 2017; Merrick and Roulstone, 2011; Roulstone and Lindsay, 2012a). Very little research – if any – has investigated the views of children currently attending a PLU regarding their educational experiences.

Gathering the views of preschool children with language disorders may be a challenge due to the nature of their impairments and young age (Dockrell and Lindsay, 2011; Morris, 2003). However, it is important to include children’s perspectives on their own lived experiences (McLeod, 2011; Spencer and Clegg, 2018) in order to: uphold their rights (United Nations, 1989); empower and enhance self-esteem; and improve the services which are intended to benefit them (Sinclair, 2000). Increasing research has shown that strategies such as using drawings, pictorial questionnaires, signing, symbols, direct observations and interviews with Talking Mats can be used to include children with language disorders’ perspectives in research (Coad and Hambly, 2011; McLeod et al., 2011; Murphy et al., 2004), even with very young children (Press et al., 2011).

5 Parent views

It is also important to consider family perspectives. Roulstone and Lindsay (2012a) used data from four consultations with a total of 37 parents of children with speech language and communication needs (SLCN). Focus groups centred on the children’s positive achievements and valued outcomes. Findings indicated that those with children in language units were generally more positive and had greater awareness of the support provided than those with children in exclusively mainstream settings. Parents valued open channels of communication with the language unit.

There is very little research on parent views of PLU provision. However, research has demonstrated that parents value early intervention (Campbell and Glogowska, 2000; Lyons et al., 2010) and are concerned about the difficulties accessing specialist support in the preschool years (Clegg et al., 2012). When parents originally part of the Manchester Language Study were retrospectively interviewed about language unit experiences, many expressed frustration about initially accessing support (Simkin and Conti-Ramsden, 2009). A practice case study provides some insight to parent views on one PLU, although is a descriptive case rather than peer-reviewed research (NHS-Evidence, 2011). An intensive 1 week package of SLT provided twice each week in a PLU was discontinued and replaced by intensive support in a clinical setting. When asked to compare experiences, parents reported that the PLU was their preferred model of intervention, owing to better integration with peers.

6 Staff perceptions of language units

There has been very little research investigating the perspectives of teaching staff working in language units. Lindsay et al. (2005b) note the lack of specialist training for teachers of mainstream classrooms working to support children with language difficulties, a concern of SLT service managers. One local education authority reported that teachers felt ‘out of their depth’ (Lindsay et al., 2005a).

In a study of a specialist resource base for children with Asperger syndrome, Landor and Perepa (2017) interviewed teaching staff, and administered questionnaires to eight parents. Having a safe space to teach social skills was valued, but a lack of awareness from mainstream peers caused problems with inclusion. Teachers reported that many parents had chosen the school specifically to access the resource base. Despite the small sample size, the results provide insight to a unique environment, which can be used to raise awareness of such provision, identify important elements, and contribute to continued improvement of educational resources.

In light of such limited research examining the role of language units in supporting preschool aged children, consulting with staff and service users about their experiences is important to profile and support the development of provision (Enderby et al., 2009; McKean et al., 2017). The current study aims to investigate staff, parent, and child perspectives regarding one PLU.

II Method

1 Setting

This study used qualitative research methods to explore the perceptions of staff, family members, and children associated with one PLU. The PLU is situated within a mainstream nursery and infant school, and follows the Development Matters in the Early Years Foundation Stage curriculum (Department for Education, 2012). Placements are allocated based on joint decisions between teaching staff and the Local Education Authority about the appropriateness of the provision for individual needs. Children must have features of severe language disorders in the absence of any other significant developmental delay, as determined by an educational psychologist or SLT.

The children attend the PLU every weekday, 9:00–12:00, for the full academic year prior to starting compulsory education in the Reception year. Children aged between 3;0–4;10 can attend the PLU. The sessions follow a routine: free choice of play, whole-class circle time, the register, teacher-led introduction of daily activities using a visual timetable, followed by physical activity, outdoor play or cookery. Small group work and individual SLT run alongside the main activity. At the end of each session, children walk to the mainstream nursery and spend 20 minutes engaging in play with 25 peers. PLU staff support interactions with children in the mainstream class. Children then return to the PLU for the final 30 minutes where they have a snack and a goodbye song. Children have at least 30 minutes of individual SLT per week and are regularly assessed using the Living Language tool (Locke and Bowes, 1989).

2 Design

This study adopts a qualitative, phenomenological approach, which accounts ‘the meaning of the lived experiences for several individuals about a concept’ (Creswell, 1998, p. 51), in order to address the under-researched topic of experiences of language unit support for preschool children. Qualitative methods offer dynamic ways to meet the ever-changing nature of research contexts (Barbour, 2001). Many of the strategies advised by Mays and Pope (1995) to enhance rigor and reduce bias were adhered to: interview questions were open-ended for participants to interpret, analysis was conducted separately by both researchers, the interviewer (HH) was a member of the research team, reflexivity was acknowledged, and a framework for analysis was created using NVivo10 (NVivo 10, 2014).

3 Materials

Interviews were designed using a General Interview Guide Approach which allows flexibility in wording depending on the respondent, as outlined by Gall, Gall, and Borg (2003). A semi-structured format enabled participants to expand upon chosen topics whilst facilitating comparison (Barriball and While, 1994). Methods of data collection differed between participant groups in order to match their strengths and meet their needs (see Table 1).

Table 1.

Data collection methods.

Participant group	Method(s) of data collection
Children	One to one interviews Picture book containing visual aids Drawing
Parents	Written qualitative questionnaires
Teachers	One to one interviews

Children’s interviews followed the lead of the child but contained three basic questions:

Can you tell me about your class?

What is good about your class?

What is bad about your class?

There are many challenges associated with interviewing young children with language disorders, including difficulties with verbal understanding and expression (Roulstone and McLeod, 2011) and it is necessary to work flexibly to accommodate individual needs. Creative prompts such as drawing materials and pictures of the PLU were provided as communication aids.

The aim of the staff interviews was to attain views relating to the role of the PLU, what works and potential areas for development. The full interview schedule is provided as Appendix 1. Parental questionnaires (Appendix 2) were designed to elicit views on having a child in the PLU, what works, and potential areas of development.

4 Participants

Participants were staff who worked in a PLU, children who were currently attending the PLU, and their families. At the time of the study there were seven children attending. One child was away during data collection. The six other children agreed to participate, and their parents consented to children being interviewed and to provide information about their own experiences and views regarding the PLU.

The six participating children had an age range of 3;11–4;8. Three were male and three were female. All had a diagnosis of language disorder from a speech and language therapist and educational psychologist. Two had additional secondary diagnoses: speech sound disorder and developmental verbal dyspraxia, and one was being assessed for autism spectrum disorder. Two were from simultaneous bilingual homes, where parents spoke to them in English and one other language, and they experienced difficulties in both languages. All children had been attending the PLU for nine months when the study took place. Three children answered questions and drew items to portray elements of the PLU that they were referring to. Two provided data by referring to symbols representing PLU activities in a resource book. One child provided no verbal data, but was able to indicate favourite areas and toys by leading the researcher around the space. The researcher’s field notes were used to build a profile of the children’s multi-modal responses to questions.

From families of children currently attending the PLU, five mothers and one father participated. The PLU staff who participated were the classroom teacher, teaching assistant (TA), and Special Educational Needs Coordinator (SENCo). The SLT, who has a part time role in the PLU, did not agree to participate in the study.

5 Procedure

Ethical approval was obtained from the University of Sheffield.

a Child interviews

Each interview took place in the SLT room inside the PLU where there are limited distractions. Children were able to lead the researcher into the main PLU area during their interview, to aid their explanations and descriptions of their experiences. The teacher decided when interviews occurred. Interviews were audio recorded, and children were offered the opportunity to control the recording device. Each child was interviewed following question prompts and encouraged to also draw responses, as this can aid expression (Holliday et al., 2009). Pictures of class activities were also presented, so that children could point to what they enjoy and do not like, a strategy adapted from Markham (2011). Any gesture use or Makaton signing was recorded in field notes.

b Parental questionnaires

Questionnaires were designed based on themes that had arisen from the literature review of families’ experiences of specialist educational settings (e.g.Campbell and Glogowska, 2000; Clegg et al., 2012; Lyons et al., 2010). Questions were open-ended to provide maximum opportunity for discussion. Parents were invited to contribute to the study either through a 1:1 interview or by completing a questionnaire. They were also offered the option of a telephone interview. All parents chose to fill in the written questionnaire which may have been due to the distance involved in travelling to the PLU, as families accessed the provision from a broad catchment.

c Staff interviews

Staff were interviewed individually with the researcher at a time convenient for them, in quiet spaces within the school. Interviews lasted 25–70 minutes and were audio recorded for later transcription.

d Analysis

Framework Analysis (FA), a method outlined by Ritchie et al. (2003), was used to perform an inductive and thematic style analysis, owing to its flexibility working with different types of data (Ward et al., 2013). FA has a focus on description rather than interpretation (e.g. Baxendale et al., 2013; Glogowska and Campbell, 2004; Markham et al., 2009) and themes are extracted from salient topics occurring in the data (Ritchie et al., 2003). Themes are then organized to facilitate comparison between individual and group responses. A ‘theme’ in this context refers to ideas, attitudes, concepts or opinions that recur across the data.

All data (interviews, questionnaires and pictures) were stored using NVivo 10 (NVivo 10, 2014). Extracts were filed under nodes which correlate with themes to retain contextual factors. This maintains strong links with the data throughout analysis, complementing the philosophy of FA (Ritchie et al., 2003). The initial stage involved reading each transcript several times and highlighting recurring clauses. From initial observations, a checklist of overarching themes was formulated, which became a framework of codes. Other interviews were cross-referenced against this, and codes were modified as new subtopics emerged. Themes were compared across participant groups by plotting quotes onto a chart of refined codes.

Although preconceptions can influence analysis, this is generally not considered equivalent to scientific bias (Malterud, 2001; Tong et al., 2007). The preconceptions held by the researchers are rooted in individual experiences of SLT research and practice. Based on this, it is possible that assumptions were made regarding interview responses as most studies report mixed views from parents and staff (e.g.Clegg et al., 2012), and we worded questions and approached analysis with the aim of attaining results which demonstrated contrastive views. In order to enhance reflexivity, researchers analysed the results separately, and staff were offered the opportunity to review and change interview transcripts, though no changes were made to transcripts.

III Results

Four main themes – inclusion, the importance of relationships, challenges of access and school readiness – were identified, with ten subthemes, as shown in Table 2. Themes are presented with illustrative extracts from transcripts. Quotes from staff members are given alongside job role. Names are replaced with pseudonyms, and the class name is replaced by ‘PLU’. Data are otherwise presented as transcribed verbatim.

Table 2.

Themes and subthemes across interview data.

Themes	Subthemes	Where occurring
1. Inclusion	Time in mainstream nursery	2 children; 4 parents; 3 staff
	Social development and friendships	6 children; 2 parents; 2 staff
	Outside space	5 children; 4 parents; 3 staff
2. The importance of relationships	Relationship between parents and staff	2 parents
	Pupils and their teachers	4 children; 3 parents
	Staff collaboration	3 staff
3. Challenges of access	Funding places	3 staff
3. Challenges of access	Number of pupils	3 staff; 3 parents
4. School readiness	Routine	1 parent; 2 staff
4. School readiness	Transition to school	3 parents; 2 staff

1 Inclusion

a Time in mainstream nursery

For 20 minutes of each session, the PLU pupils play in the mainstream nursery with 25 peers. The teacher and TA stated that this facilitates inclusion in the wider school community and that this was important for language development and confidence. The teacher commented on the need for integration:

‘Because the thing with special needs is that I think it’s really important that they stay a part of what everybody else is doing.’ (Teacher)

Some parents were concerned about the pressure of interacting within a large group. Two parents stated that their children enjoyed it, but that it had taken time to adapt.

‘I think that she found [mainstream nursery] a little daunting at first but she likes that part now and playing with the other children.’ (Parent 3)

Two children pointed to images of children in the nursery when indicating their ‘likes’. One used the Makaton sign for ‘friend’ in relation to the mainstream nursery. One child found it too ‘loud’; another preferred being in the PLU.

‘What’s bad about nursery time?’ ‘Loud ones’ (Child A: pointing to mainstream nursery)

‘Do you like going to nursery or do you like being in here [the PLU]’ ‘I love being in here.’ (Child R)

b Social development and friendships

Several parents commented on the friendships that their children had formed whilst in the PLU. All staff commented on the importance of gaining social confidence.

‘He has made great friends.’ (Parent 6)

‘With lots of friends she picked up lots of meaningful words.’ (Parent 5)

‘When they go into an infant school and into Reception they’ve got the language to be able to talk to their peers and make friends.’ (TA)

When asked about other children, three children used the word friend, and two named a best friend in the PLU. One child recalled an incident of being ‘hit’ by a peer.

‘Is there anything that you don’t like about coming to the PLU?’ ‘Um, when [name] hit me.’ (Child V)

c Outside space

There is a large outside space in the mainstream nursery which has a sensory garden, a slide, sandpit, playhouses and a track for bikes and scooters. Almost all children and parents commented positively on this space, with many citing it as a favourite aspect of attending the PLU. One child drew an image of the nursery’s cars (Figure 1). The TA commented that the children needed ‘time to run’ whilst the teacher emphasized the importance of encouraging social communication alongside physical play.

‘He’s happy because he likes playing outside the most.’ (Parent 5)

‘They need that time to just run, just to let out all of that excitement and energy.’ (TA)

‘Do you like nursery?’ ‘Yeah.’ ‘What do you like to do?’ ‘Play bikes and cars!’ (Child V)

Figure 1.

Depiction of nursery’s cars: Child V.

2 The importance of relationships

a Relationships between parents and staff

Parents commented on the importance of the support from teachers and two described them as ‘friendly’. In three responses, staff were referred to as a ‘team’.

‘The PLU team are very approachable and you can always discuss any needs or concerns with them.’ (Parent 2)

All staff commented that close contact with families was a key part of supporting children.

‘[Communication with parents] is really important – and where it works it can make a massive difference to the whole family. And the child tends to make better progress – the family is enabled to help promote that progress.’ (SENCo)

b Pupils and their teachers

All children were able to name or point to their teachers. One child wanted the TA to be in the room during the interview, and although the child offered no verbal responses, she pointed to images of the TA while laughing. The TA described the child as ‘shy’, but more confident with certain adults, including the teacher and her parents.

‘Can you tell me about your teacher?’ ‘Yeah. She gives my- our stickers.’ (Child R)

c Staff collaboration

Staff considered multidisciplinary practice to be essential. The SENCo stated that working together was fundamental, and named the SLT in particular. The SLT did not feature in data provided by children or parents.

‘The SLT comes in and we actually sit together with teaching. I know exactly what she’s teaching and we carry it on … so in other words they’re bathed in language.’ (Teacher)

However, the teacher described a lack of understanding from other staff in the school.

‘People think that we sit here and do something strange and play complicated language games that nobody else can do. And it’s not. (Teacher)’

3 Challenges of access

a Number of pupils

There were seven children in the PLU, which many parents and staff considered to be a small number. Opinions of staff and parents on this varied; some felt it was necessary, whilst others prioritized integration with bigger groups.

‘Bigger class would be lovely’ (Parent 1)

‘What was the process of starting the PLU like for you and your child? Easy because it’s a small group’ (Parent 6)

‘Well there are seven places virtually because you wouldn’t be able to fit any more in … because that size works – it’s manageable work-wise and assessment-wise. You could have ten children in a larger room but you’d have to run it differently … you could have two separate groups of five and then you’d need another qualified person – but how would you divide the room up?’ (Teacher)

b Funding places

Staff reported that the PLU is oversubscribed every year, with more children eligible for places than can be accommodated. Although there is funding available for ten pupils, only seven places are offered due to limited space and resources, and staff described difficulties with the selection process. The SENCo wanted more children each year, but the teacher explained that keeping the class size small was essential to prevent the children from becoming overwhelmed.

‘I would definitely expand the unit because we always have more children every year than we have spaces for.’ (SENCo)

‘They need more language units … we get a list of say 18 children – need to be here – but we can only have 7 of them.’ (TA)

4 School readiness

a Routine

The PLU keeps a daily schedule of activities that are displayed clearly to the children through visual timetables. The TA and teacher described maintaining a predictable sequence to sessions as key for the children’s learning, with emphasis placed on stability. Both reported that timetable adherence was more explicit compared to the mainstream nursery. The teacher described the experiences of several children who had found previous preschool settings difficult and attributed improvements to the visibility of the routine.

‘Everything is very very visual – visual timetables – it’s the only way to stop them being frightened by change … Like J, if he doesn’t know what he’s doing he’ll end up under the table with his hands over his ears screaming. Knowing exactly what they’re going to do is very important.’ (Teacher)

‘R’s language skills have improved dramatically in the PLU. Her difficult behaviours are under control as she is not as frustrated. Her confidence in all activities has improved with her ability to communicate.’ (Parent 3)

b Transition to school

The teacher explained that less structured time in the nursery prepared children for mainstream settings. The TA stated that the PLU aimed to encourage social interaction with a large group of peers, and ensure that children did not become dependent on adult support. One parent felt that the preparation for school was minimal. Some children had made significant progress and were transitioning to mainstream primary schools.

‘If they didn’t have very specific teaching they wouldn’t make the progress and their confidence would drop as a result. They would find it very hard to access the curriculum.’ (SENCo)

‘The PLU has partly/minimum helped for starting school like sitting and paying attention for longer time.’ (Parent 1)

They’ve all improved dramatically … Six out of seven have got areas covered in 30–50 months. Whereas when they came they were working in the 18 month bracket. (TA)

IV Discussion

The current study aimed to investigate staff, parent, and child perspectives regarding one PLU. The study involved: semi-structured interviews with three members of staff; child-led, multi-modal interviews with six children currently attending the PLU; and six parental questionnaires.

Data were analysed using Framework Analysis (Ritchie et al., 2003) to present a description of how participants view the provision. Themes occurring in the data were: inclusion, relationships, challenges of access, and school readiness. Participants were all generally very positive, though emphasis shifted from space (children), to progress (teachers), to enjoyment (parents). All children identified aspects which they liked, often related to outdoor play and friendships. This reflects the findings of Roulstone et al. (2012) regarding preferred outcomes of children with language disorders and their parents, who found that children valued fun and friendships. Children’s responses did not occur in all themes (e.g. they did not reflect on challenges to getting a place in the PLU) but they did present core themes of play, friendship, and space. All parents commented that children enjoyed the PLU, and focused on wellbeing and social aspects rather than outcomes related to language targets or academic aspects, similar to the findings of Roulstone et al. (2012). Staff perceived that providing specialist support in a mainstream environment encourages social development, reduces anxiety, and supports children and families in preparation for the next educational stage. In recognition of the disparate emphasis on these topics across groups, the discussion of themes is structured to reflect the key issues for participants.

1 Themes

a Inclusion

Inclusion had a variety of meanings in the data. The concept of inclusion ran through accounts of physically being in the mainstream nursery for part of each session, offering social development opportunities for wider friendship groups, and accessing outdoor space for play.

Inclusion in the mainstream nursery was important to staff and parents, though there was some tension between including the children in accessing early years’ education in the PLU and facilitating inclusion in the mainstream nursery in preparation for attendance in mainstream school next year. This tension is perhaps unsurprising: the complexity of the balance between providing specialist education and facilitating inclusion is well documented (Lindsay, 2018). Staff interviewees discussed the balance between providing a whole-school inclusive environment for language development, and the need for specialist, individually tailored interventions (Ebbels et al., 2017), which is a significant issue for commissioning services in the UK.

Children varied in how they perceived their inclusion with the mainstream nursery, with some children enjoying the access to a wider circle of friends and outdoor space, and others preferring the quiet in the PLU. Children focused on inclusion in relation to the physical aspects of the environment, such as outside space to play and access to their favourite toys. The relationship between children’s experiences of play and their physical environment has been shown to be important (McClintic and Petty, 2015), which was certainly reflected in our data. Play and friendships were found to be crucial to the overall preschool experience.

The model of inclusion in the PLU was supported inclusion, with staff working to enable peer-modelling of age-appropriate utterances through play. This helps to overcome potential concerns about segregation in language units from mainstream peers (Simkin and Conti-Ramsden, 2009) while accessing education in large class sizes (Blatchford and Webster, 2018). Studies investigating experiences of attending language units have demonstrated that some children feel socially isolated (Clegg et al., 2012; Simkin and Conti-Ramsden, 2009) with consequences for wellbeing (Durkin and Conti-Ramsden, 2007) and bullying (Savage, 2005).

Inclusion had a broad meaning in this study: it meant accessing learning, physically being in the mainstream space, and being supported to form friendships with children without language disorders. The latter is important (and overlaps with the theme Relationships), given the communication barriers that arise as a result of language disorders can disrupt access to social play, resulting in difficulties making and sustaining friendships (Hart et al., 2004). Children with language disorders value friendship (Roulstone et al., 2012). Children and parents talked positively about friendships, and staff emphasized the importance of supporting peer relationships. The nursery environment provides opportunities for supporting social development and was considered to prepare children for future mainstream placements.

b Relationships

Relationships were mentioned in all of the study’s data: Parents valued their own relationships with staff and the relationships their children built with teachers. Children valued their friends and their teachers. Staff focused on collaboration within the staff team. Parents described the role of staff in creating a positive environment and providing access to specialist support, which has been shown to be beneficial (Ebbels et al., 2017). Two parents felt there was good communication with staff, a priority put forward in the Bercow Report (10 years on) (ICAN, 2018). Parent-staff relationships have also been highlighted by parents in other studies of specialist educational provision (Clegg et al., 2012; Simkin and Conti-Ramsden, 2009).

PLU staff concurred that having a complete and communicative team of professionals was vital, with team teaching with a speech and language therapist resulting in the children being ‘bathed in language’. Multi-professional collaboration can be challenging due to issues such as differences in terminology and expertise (McKean et al., 2017). However, staff perceived that the co-professional collaboration worked at this micro-/interpersonal level within the PLU (Forbes et al., 2018) and the staff were referred to as one ‘team’ in three parent questionnaires. However, despite the PLU working closely with the mainstream school, the teacher felt that the expertise in the PLU was poorly understood by staff across the school (at the meso-/institutional level, Forbes et al., 2018). Staff also discussed the benefits of good communication with families, discussing this as a mechanism for language change to boost child outcomes.

c Challenges of access

The PLU has only seven pupils attending, and this low number and the pressures of funding were mentioned by both parents and staff (children did not consider issues around access in this study). Funding as a barrier to specialist educational resources is widely reflected in UK based reports relating to language disorders (ICAN, 2018; Long et al., 2018). Contextual factors were raised in this study, reflecting wider macro-level concerns of resource, and commissioning of places in the PLU by external agencies (McKean et al., 2017). The physical environment was raised in the interviews with staff, with seven places offered despite funding for ten places (and being oversubscribed) due to the impact that larger class sizes would have on the language learning environment (Dockrell et al., 2015).

d School readiness

Staff and parents considered the PLU as preparation for the transition to mainstream school. Staff described the importance of following a consistent daily routine by using visual timetables. Despite common usage in inclusive settings (Pampoulou, 2016), there is limited evidence documenting the benefits of graphic symbols and explicit routines (Millen et al., 2011; Roberts, 2012; Wild, 2016). Teachers and parents also discussed children’s progress in relation to the transition to school at the end of the academic year. This is an important transition for both parents and children (Dockett and Perry, 2003, 2004; Eskelä-Haapanen et al., 2017). Participants indicated the significance of the role of the PLU both in terms of supporting the children’s language in preparation to access the curriculum and delivering intervention within a school environment where specific skills can be simultaneously developed, such as sitting during carpet time. Moreover, children’s friendships may have positive impacts on the school transition phase (Ladd et al., 1996).

2 Study limitations and future directions

This study aimed to provide the first rich description of a preschool specialist resource for children with language disorders. The data reflect the perceptions of staff and service users in relation to just one PLU, which limits generalization to other settings. It is important to acknowledge the potential impact of social desirability bias, a phenomenon described by Chung and Monroe (2003) which may result in over-reporting of positive features, especially as data collection took place within the setting which fosters the ethos of generating beneficial outcomes for families. The current study would have been more thorough if it had included data from the SLT involved in the PLU, and if we had been able to recruit parents and children who had previously attended the PLU. There were challenges in collecting data from the children due to their age and the nature of language disorders, which impact comprehension, expressive language, attention span and working memory (Dockrell et al., 2011). More time in the PLU would have allowed more detailed exploration, e.g. working with children using arts-based or ethnographic approaches to chart their experiences over a longer period (Coad and Hambly, 2011; Holliday et al., 2009; McLeod et al., 2011; Press et al., 2011). Additionally, using a written questionnaire with parents potentially limited the data generated from this group (Bowling, 2005). Gaining the perspectives of the three groups enhanced the evaluation of the PLU, however using multiple methods to account for the differing needs of our participants reduced the opportunity for direct comparisons to be made across the data, thereby restricting the depth of analysis between groups.

Further studies that place the perceptions of children and the experiences of families at the centre of research are needed to further investigate the role of PLUs. Longitudinal studies of the process of gaining a place at a PLU, the impact of attendance on family life, and the transitions to mainstream or other schools after the placement in PLU are needed. Quantitative research is also needed to measure the outcomes of PLU intervention. For example, the preferable outcomes mentioned in our data and elsewhere (Roulstone et al., 2012), namely that families place high value on wellbeing, inclusion in mainstream education, accessing play, and quality of friendships, could be investigated using measures of psychosocial outcomes.

3 Concluding statement

The PLU in this study is perceived to provide positive early educational and social experiences. Important features include: the class size, consistent daily routine, supported interaction with mainstream peers, outdoor play, and approachable staff. Staff perceive that the PLU contributes to positive outcomes and parents also reported that children had made progress as a result of attending the PLU. We have learnt from previous research that accessing appropriate support at an early age is important to children with language disorders and their families (Clegg et al., 2012). It is clear that this PLU was highly regarded by those who used and ran it. We end on a quote from a parent:

The PLU has been life-changing. As parents it was hard to come to terms with at first, but G instantly loved it. We love the PLU and wish he could stay longer.

Supplemental Material

Appendix_A_CLT – Supplemental material for Specialist provision for language disorder: Staff and service user views of a preschool language unit

Supplemental material, Appendix_A_CLT for Specialist provision for language disorder: Staff and service user views of a preschool language unit by Hannah Harvey and Sarah Spencer in Child Language Teaching and Therapy

Footnotes

Acknowledgements

The authors would like to thank the Sheffield Undergraduate Research Experience scheme for providing the initial funding and research training, and Dr Judy Clegg for supervising the project in 2015 as an undergraduate dissertation.

Declaration of conflicting interest

The authors declare that there is no conflict of interest.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental material

Supplemental material for this article is available online.

ORCID iD

Hannah Harvey

References

Archibald

(2017) SLP-educator classroom collaboration: A review to inform reason-based practice. Autism and Developmental Language Impairments 2: 1–17.

ASHA (2008) Roles and responsibilities of speech-language pathologists in early intervention: Position statement. Ad Hoc Committee on the Role of the Speech-Language Pathologist in Early Intervention, Rockville, MD: American Speech-Language-Hearing Association. Available online: https://www.asha.org/policy/PS2008-00291 (June 2019).

Barbour

(2001) Checklists for improving rigour in qualitative research: A case of the tail wagging the dog? BMJ: British Medical Journal 322: 1115.

Barriball

While

(1994) Collecting data using a semi-structured interview: A discussion paper. Journal of Advanced Nursing 19: 328–35.

Baxendale

Lockton

Adams

Gaile

(2013) Parent and teacher perceptions of participation and outcomes in an intensive communication intervention for children with pragmatic language impairment. International Journal of Language and Communication Disorders 48: 41–53.

Bishop

(2017) Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD). International Journal of Language and Communication Disorders 52: 671–80.

Bishop

Snowling

Thompson

Greenhalgh

(2016) CATALISE: A multinational and multidisciplinary Delphi consensus study: Identifying language impairments in children. PLoS One 11: e0158753.

Bishop

Snowling

Thompson

Greenhalgh

(2017) Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry 58: 1068–80.

Blatchford

Webster

(2018) Classroom contexts for learning at primary and secondary school: Class size, groupings, interactions and special educational needs. British Educational Research Journal 44: 681–703.

10.

Botting

Crutchley

Conti-Ramsden

(1998) Educational transitions of 7-year-old children with SLI in language units: A longitudinal study. International Journal of Language and Communication Disorders 33: 177–97.

11.

Bowling

(2005) Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health 27: 281–91.

12.

Campbell

Glogowska

(2000) Investigating parental views of involvement in pre-school speech and language therapy. International Journal of Language and Communication Disorders 35: 391–405.

13.

Chung

Monroe

(2003) Exploring social desirability bias. Journal of Business Ethics 44: 291–302.

14.

Clegg

Ansorge

Stackhouse

Donlan

(2012) Developmental communication impairments in adults: Outcomes and life experiences of adults and their parents. Language, Speech, and Hearing Services in Schools 43: 521–35.

15.

Coad

Hambly

(2011) Listening to children with speech, language and communication needs through arts-based methods. In: Roulstone

McLeod

(eds) Listening to children and young people with speech, language and communication needs. Guildford: J & R Press, pp. 217–24.

16.

Conti-Ramsden

Botting

(1999) Classification of children with specific language impairment: Longitudinal considerations. Journal of Speech, Language, and Hearing Research 42: 1195–1204.

17.

Conti-Ramsden

Botting

(2004) Social difficulties and victimization in children with SLI at 11 years of age. Journal of Speech, Language, and Hearing Research 47: 145–61.

18.

Conti-Ramsden

Durkin

(2015) What factors influence language impairment considering resilience as well as risk. Folia Phoniatrica et Logopaedica 67: 293–99.

19.

Conti-Ramsden

Botting

Knox

(2001) Follow-up of children attending infant language units: Outcomes at 11 years of age. International Journal of Language and Communication Disorders 36: 207–19.

20.

Conti-Ramsden

Botting

Knox

Simkin

(2002) Different school placements following language unit attendance: Which factors affect language outcome? International Journal of Language and Communication Disorders 37: 185–95.

21.

Conti-Ramsden

Durkin

Simkin

Knox

(2009) Specific language impairment and school outcomes: I: Identifying and explaining variability at the end of compulsory education. International Journal of Language and Communication Disorders 44: 15–35.

22.

Creswell

(1998) Qualitative inquiry and research design: Choosing among five approaches. Thousand Oaks, CA: Sage.

23.

Dale

Price

Bishop

Plomin

(2003) Outcomes of early language delay: I: Predicting persistent and transient language difficulties at 3 and 4 years. Journal of Speech, Language, and Hearing Research 46: 544–60.

24.

Department for Education (2012) Statutory framework for the early years foundation stage. London: Department for Education. Available at: http://webarchive.nationalarchives.gov.uk/20130404045317/https://www.education.gov.uk/publications/eOrderingDownload/EYFS%20Statutory%20Framework.pdf (accessed June 2019).

25.

Department for Education (2013) The national curriculum in England. London: Department for Education. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/425601/PRIMARY_national_curriculum.pdf.

26.

Dockett

Perry

(2003) Children’s views and children’s voices in starting school. Australian Journal of Early Childhood 28: 12–18.

27.

Dockett

Perry

(2004) Starting school: Perspectives of Australian children, parents and educators. Journal of Early Childhood Research 2: 171–89.

28.

Dockrell

Lindsay

(1998) The ways in which speech and language difficulties impact on children’s access to the curriculum. Child Language Teaching and Therapy 14: 117–33.

29.

Dockrell

Lindsay

(2011) Cognitive and linguistic factors in the interview process. In: Roulstone

McLeod

(eds) Listening to children and young people with speech, language and communication needs. Guildford: J & R Press, pp. 143–52.

30.

Dockrell

Lindsay

Letchford

Mackie

(2006) Educational provision for children with specific speech and language difficulties: Perspectives of speech and language therapy service managers. International Journal of Language and Communication Disorders 41: 423–40.

31.

Dockrell

Lindsay

Roulstone

McLeod

(2011) Cognitive and linguistic factors in the interview process. In: Roulstone

McLeod

(eds) Listening to children and young people with speech, language and communication need. Guildford: J & R Press, pp. 143–52.

32.

Dockrell

Bakopoulou

Law

Spencer

Lindsay

(2015) Capturing communication supporting classrooms: The development of a tool and feasibility study. Child Language Teaching and Therapy 31: 271–86.

33.

Durkin

Conti-Ramsden

(2007) Language, social behavior, and the quality of friendships in adolescents with and without a history of specific language impairment. Child Development 78: 1441–57.

34.

Ebbels

McCartney

Slonims

Dockrell

Norbury

(2017) Evidence-based pathways to intervention for children with language disorders. International Journal of Language and Communication Disorders 54: 3–19.

35.

Enderby

Pickstone

John

et al . (2009) Resource manual for commissioning and planning services for SLCN. London: Royal College of Speech and Language Therapists.

36.

Eskelä-Haapanen

Lerkkanen

M-K

Rasku-Puttonen

Poikkeus

A-M

(2017) Children’s beliefs concerning school transition. Early Child Development and Care 187: 1446–59.

37.

Forbes

McCartney

McKean

et al . (2018) Co/productive practitioner relations for children with SLCN: An affect inflected agentic frame. Discourse: Studies in the Cultural Politics of Education. Electronic publication ahead of print version. Published online: 19 March 2018 (doi: 10.1080/01596306.2018.1451303).

38.

Gall

Borg

(2003) Educational research: An introduction: Volume 7. Boston, MA: A & B Publications.

39.

Gascoigne

(2006) Supporting children with speech, language and communication needs within integrated children’s services. RCSLT Position paper. London: Royal College of Speech and Language Therapists.

40.

Glogowska

Campbell

(2004) Parental views of surveillance for early speech and language difficulties. Children and Society 18: 266–77.

41.

Hart

Fujiki

Brinton

Hart

(2004) The relationship between social behavior and severity of language impairment. Journal of Speech, Language, and Hearing Research 47: 647–62.

42.

Holliday

Harrison

McLeod

(2009) Listening to children with communication impairment talking through their drawings. Journal of Early Childhood Research 7: 244–63.

43.

ICAN (2018) Bercow: Ten years on: An independent review of provision for children and young people with speech, language and communication needs in England. London: Royal College of Speech and Language Therapists. Available at: https://www.bercow10yearson.com/wp-content/uploads/2018/03/337644-ICAN-Bercow-Report-WEB.pdf (accessed June 2019).

44.

Ladd

Kochenderfer

Coleman

(1996) Friendship quality as a predictor of young children’s early school adjustment. Child Development 67: 1103–18.

45.

Landor

Perepa

(2017) Do resource bases enable social inclusion of students with Asperger syndrome in a mainstream secondary school? Support for Learning 32: 129–43.

46.

LaParo

Justice

Skibbe

Pianta

(2004) Relations among maternal, child, and demographic factors and the persistence of preschool language impairment. American Journal of Speech-Language Pathology 13: 291–303.

47.

Law

Durkin

Sargent

Hanrahan

(1999) Beyond early language unit provision: Linguistic, developmental and behavioural outcomes. Child Language Teaching and Therapy 15: 93–111.

48.

Lindsay

(2018) Inclusive education theory and practice: What does this mean for paediatricians? Paediatrics and Child Health 28: 368–73.

49.

Lindsay

Dockrell

Letchford

Mackie

(2002) Self esteem of children with specific speech and language difficulties. Child Language Teaching and Therapy 18: 125–43.

50.

Lindsay

Dockrell

Mackie

Letchford

(2005a) Local education authorities’ approaches to provision for children with specific speech and language difficulties in England and Wales. European Journal of Special Needs Education 20: 329–45.

51.

Lindsay

Dockrell

Mackie

Letchford

(2005b) The roles of specialist provision for children with specific speech and language difficulties in England and Wales: A model for inclusion? Journal of Research in Special Educational Needs 5: 88–96.

52.

Locke

Bowes

(1989) Living language. Windsor: NFER-Nelson.

53.

Long

Bate

Bellis

(2018) Speech, language and communication support for children. (CDP-0163). House of Commons Library Debate Pack 2 July 2018. London: House of Commons.

54.

Lyons

Roulstone

(2017) Labels, identity and narratives in children with primary speech and language impairments. International Journal of Speech-Language Pathology 19: 503–18.

55.

Lyons

Roulstone

(2018) Well-being and resilience in children with speech and language disorders. Journal of Speech, Language, and Hearing Research 61: 324–44.

56.

Lyons

O’Malley

O’Connor

Monaghan

(2010) ‘It’s just so lovely to hear him talking’: Exploring the early-intervention expectations and experiences of parents. Child Language Teaching and Therapy 26: 61–76.

57.

Malterud

(2001) Qualitative research: standards, challenges, and guidelines. The Lancet 358: 483–88.

58.

Markham

(2011) Designing a measure to explore the quality of life for children with speech, language and communication needs. In: Roulstone

McLeod

(eds) Listening to children and young people with speech, language and communication needs. Guildford: J & R Press, pp. 231–39.

59.

Markham

Van Laar

Gibbard

Dean

(2009) Children with speech, language and communication needs: Their perceptions of their quality of life. International Journal of Language & Communication Disorders 44: 748–68.

60.

Mays

Pope

(1995) Qualitative research: Rigour and qualitative research. BMJ 311: 109–12.

61.

McClintic

Petty

(2015) Exploring early childhood teachers’ beliefs and practices about preschool outdoor play: A qualitative study. Journal of Early Childhood Teacher Education 36: 24–43.

62.

McKean

Law

Laing

et al . (2017) A qualitative case study in the social capital of co-professional collaborative co-practice for children with speech, language and communication needs. International Journal of Language & Communication Disorders 52: 514–27.

63.

McLeod

(2011) Listening to children and young people with speech, language and communication needs: Who, why and how? In: Roulstone

McLeod

(eds) Listening to children and young people with speech, language and communication needs. Guildford: J & R Press, pp. 23–40.

64.

McLeod

McCormack

McAllister

Harrison

Holliday

(2011) Listening to 4- to 5-year-old children with speech impairment using drawings, interviews and questionnaires. In: Roulstone

McLeod

(eds) Listening to children and young people with speech, language and communication needs. Guildford: J & R Press, pp. 179–86.

65.

Merrick

Roulstone

(2011) Children’s views of communication and speech-language pathology. International Journal of Speech-Language Pathology 13: 281–90.

66.

Millen

Cobb

Patel

(2011) A method for involving children with autism in design. In: Proceedings of Proceedings of the 10th International Conference on Interaction Design and Children. Ann Arbor, MI: ACM, pp. 185–88.

67.

Morris

(2003) Including all children: Finding out about the experiences of children with communication and/or cognitive impairments. Children and Society 17: 337–48.

68.

Murphy

Cameron

Markova

Watson

(2004) Evaluating the effectiveness of Talking Mats as a communication resource to enable people with an intellectual disability to express their views on Life Planning. Final Report Form. Available online: https://www.talkingmats.com/wp-content/uploads/2013/09/Effectiveness-of-TM-and-LD-final-report.pdf (June 2019).

69.

NHS-Evidence (2011) Pre-school specific language impairment (SLI) specialist service: Early intervention to reduce levels of need. Quality and Productivity Example. Eastern and Coastal Kent Community Services. Available online: https://www.rcslt.org/news/homepage_news_2011/qipp_april (June 2019).

70.

NVivo 10 (2014) NVivo 10 (Version 10): QSR International. Doncaster, Australia: QSR International Pty Ltd.

71.

Pampoulou

(2016) Collaboration between speech and language therapists and school staff when working with graphic symbols. Child Language Teaching and Therapy 32: 361–76.

72.

Paul

Weismer

(2013) Late talking in context: The clinical implications of delayed language development. In: Rescorla

Dale

(eds) Late talkers: Language development, interventions, and outcomes. Baltimore, MD: Brookes.

73.

Press

Bradley

Goodfellow

et al . (2011) Listening to infants about what life is like in childcare: A mosaic approach. In: Roulstone

McLeod

(eds) Listening to children and young people with speech, language and communication needs. Guildford: J & R Press.

74.

Rannard

Glenn

(2009) Self-esteem in children with speech and language impairment: An exploratory study of transition from language units to mainstream school. Early Child Development and Care 179: 369–80.

75.

Rannard

Lyons

Glenn

(2004) Children with specific language impairment: Parental accounts of the early years. Journal of Child Health Care 8: 165–76.

76.

Reilly

Wake

Ukoumunne

et al . (2010) Predicting language outcomes at 4 years of age: Findings from early language in Victoria study. Pediatrics 126: e1530–37.

77.

Ritchie

Spencer

O’Connor

(2003) Carrying out qualitative analysis. In: Ritchie

Lewis

(eds) Qualitative research practice: A guide for social science students and researchers: Volume 2003. London: Sage, pp. 219–62.

78.

Roberts

(2012) Visualising daily routines. Early Years Educator 13: x–xi.

79.

Roulstone

Lindsay

(2012a) The perspectives of children and young people who have speech, language and communication needs, and their parents. London:. Department for Education. Available online: https://www.gov.uk/government/publications/the-perspectives-of-children-and-young-people-who-have-speech-language-and-communication-needs-and-their-parents (June 2019).

80.

Roulstone

Lindsay

(2012b) The perspectives of children and young people who have speech, language and communication needs, and their parents. London: Department for Education.

81.

Roulstone

McLeod

(2011) Listening to children and young people with speech, language and communication needs. Guildford: J & R Press.

82.

Roulstone

Coad

Ayre

Hambly

Lindsay

(2012) The preferred outcomes of children with speech, language and communication needs and their parents. Available online: https://www.gov.uk/government/publications/the-preferred-outcomes-of-children-with-speech-language-and-communication-needs-and-their-parents (June 2019).

83.

Savage

(2005) Friendship and bullying patterns in children attending a language base in a mainstream school. Educational Psychology in Practice 21: 23–36.

84.

Simkin

Conti-Ramsden

(2009) ‘I went to a language unit’: Adolescents’ views on specialist educational provision and their language difficulties. Child Language Teaching and Therapy 25: 103–21.

85.

Sinclair

(2000) Quality protects research briefing No. 3 young people’s participation. London: Department of Health.

86.

Snowling

Bishop

Stothard

Chipchase

Kaplan

(2006) Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment. Journal of Child Psychology and Psychiatry 47: 759–65.

87.

Spencer

Clegg

(2018) Young people’s own perspectives and experiences of living with a language disorder. In: Spencer

(ed.) Supporting adolescents with language disorders. Guildford: J & R Press, pp. 49–72.

88.

St Clair

Pickles

Durkin

Conti-Ramsden

(2011) A longitudinal study of behavioral, emotional and social difficulties in individuals with a history of specific language impairment (SLI). Journal of Communication Disorders 44: 186–99.

89.

Tambyraja

Schmitt

Farquharson

Justice

(2015) Stability of language and literacy profiles of children with language impairment in the public schools. Journal of Speech, Language, and Hearing Research 58: 1167–81.

90.

Tomblin

Zhang

Buckwalter

O’Brien

(2003) The stability of primary language disorder: Four years after kindergarten diagnosis. Journal of Speech, Language, and Hearing Research 46: 1283–96.

91.

Tong

Sainsbury

Craig

(2007) Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19: 349–57.

92.

Ukoumunne

Wake

Carlin

et al . (2012) Profiles of language development in pre-school children: A longitudinal latent class analysis of data from the early language in Victoria study. Child: Care, Health and Development 38: 341–49.

93.

United Nations (1989) Convention on the rights of the child: Volume 1577. New York: UN General Assembly, Treaty Series. Available at: http://www.refworld.org/docid/3ae6b38f0.html (accessed June 2019).

94.

Ward

Furber

Tierney

Swallow

(2013) Using framework analysis in nursing research: a worked example. Journal of Advanced Nursing 69: 2423–31.

95.

Whitehouse

Robinson

Zubrick

(2011) Late talking and the risk for psychosocial problems during childhood and adolescence. Pediatrics 128: e324–32.

96.

Wild

(2016) Developing a visual timetable. Early Years Educator 17: 38–44.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.12 MB