Addressing preschool language difficulties with meaningful outcome assessments


By Kim McCready

According to the Ontario Preschool Speech and Language Program, 1 in 10 children need extra help developing speech and language skills. If left unaddressed, these difficulties can make it harder for children to listen, speak, read and play with others.

BJ Cunningham, School of Communication Sciences and Disorders

BJ Cunningham, a professor from Western’s School of Communication Sciences and Disorders, is working to redefine how we approach these speech and language impairments. Enriched by years of clinical practice – she worked as a speech-language pathologist (SLP) in the Ontario Preschool Speech and Language Program for more than 10 years – her research bridges the gap between traditional approaches and measuring meaningful outcomes for preschool children who have accessed SLP services.

“Due to the potential for impacts of early intervention, I hope to affect change for preschool children,” Cunningham said. “The earlier you can intervene the better, in terms of projected outcomes.”

Based on real-world practice, Cunningham concentrates her research efforts on involving clinicians and families in the creation, assessment and enhancement of clinical tools to help her work have the most impact.

Traditional research has created intricate models to trace the growth of specific skills in children with speech and language issues. These models cover areas like language acquisition, grammar, vocabulary and pronunciation. While these models are informative, they have a narrow focus and emphasize skills related to the child's impairments rather than considering the broader picture of their communication abilities and how these abilities impact their interactions and engagement.

Cunningham’s insight emerged directly from families of children with language impairments – these families have expressed that they value functional outcomes like making friends, participating in classroom activities and enjoying social events. For the families, it’s not just about skills; it's about embracing life’s meaningful experiences.

“We organized six focus groups with families of preschool children experiencing communication difficulties,” Cunningham said. “Our goal was to uncover their preferences for outcome measurement. The results were enlightening, as families revealed some preferences that were different from our assumptions as SLPs.”

Cunningham, in collaboration with CanChild, is working to import the Computer-Based Instrument for Low motor Language Testing (C-BiLLT), a tool originally crafted in the Netherlands, to Canada. This tool revolutionizes the assessment of spoken language comprehension, particularly for children with severe motor impairments such as cerebral palsy. Through adaptable input methods, including input switches, eye gaze and touch screens, the C-BiLLT empowers these children to express themselves, transcending physical limitations.

"My goal is that every preschooler with a speech or language impairment will receive evidence-based individualized services that will support them in using communication to participate fully in life."

Standardization ensures that the C-BiLLT is calibrated against established norms, allowing a child's performance to be compared to peers of the same age. For children who lack verbal communication, this comparison becomes invaluable. It reveals whether a child's comprehension aligns with typical levels or if there are challenges.

“This holds great significance for nonverbal children, as some among them comprehend at a level equivalent to their peers, while others face greater challenges in terms of comprehension," says Cunningham. "Currently, there isn't a valid and reliable method for measuring language comprehension in these children."

Mistakes in assessment can lead to mismatched communication systems, causing children to either struggle or miss the chance to communicate at their true potential. The result? A child who cannot engage effectively in conversations or express themselves as they wish.

The C-BiLLT project actively involves parents of children with cerebral palsy (CP) as part of the research team. They attend team meetings, aiding in the development of proposals, research questions and surveys tailored to parents. They also help interpret survey results and co-present talks at conferences.

Significant to Cunningham’s vision for future progress will be the ability to curate an extensive and well-founded database from the Ontario Preschool Speech and Language Program. She expects this data could provide notable insights by assessing the real impact of interventions and offer valuable input for policymaking. For instance, Cunningham’s team has already introduced new clinical terms for SLPs based on research that became part of governmental required training.

Cunningham is committed to empowering children to communicate and she articulates her vision, clearly.

"My goal is that every preschooler with a speech or language impairment will receive evidence-based individualized services that will support them in using communication to participate fully in life," Cunningham said.