Michal Harty

Background: The Joint Engagement Rating Inventory (JERI) can be used to measure response to early autism intervention. However, little is known about the utility of the JERI outside the United States, where it was developed. A South African study found the JERI to be a reliable and accurate measure of joint engagement and communication between young autistic children and their caregivers. The next step was to determine if the JERI could be used to detect changes in the behaviours of child and caregiver in response to intervention. Objectives: This proof-of-principle study aimed to evaluate whether the JERI could detect signals of change in the behaviours of child and caregiver in response to 12, 1-h naturalistic developmental behavioural intervention-informed caregiver coaching sessions. Method: A single-arm pre–post design was utilised. Standardised video-recorded caregiver–child interactions were completed before and after intervention. Two raters, blinded to intervention time-point, coded the JERI. Ten dyads completed coaching and video-recorded assessments. Data analysis included inter-rater reliability, Wilcoxon signed-rank test for paired samples and visual summaries. Results: Weighted Kappa values for 13 of the 16 JERI items indicated moderate to strong inter-rater agreement. Significant changes in symbol-infused joint engagement (z = −2.46, p = 0.01) and expressive language (z = −2.156, p = 0.03) were detected. Visual summaries showed change signals in 15 JERI ratings. Conclusion: Findings suggest that the JERI has the potential to detect change in the context of a caregiver-mediated intervention. Contribution: The JERI was shown here, for the first time in an African context, to be a potential outcome measure for early autism intervention research.

Communication partners are instrumental in the successful use and implementation of augmentative and alternative communication systems (AAC), especially in schools, but stakeholder views from low- and middle-income countries (LMICs) are not well represented in the literature. Focus group interviews with seven professionals and three caregivers from South Africa were conducted to understand their perceptions and experiences of AAC use and implementation. The results highlighted additional issues which practitioners in LMICs need to consider when implementing AAC in under-resourced schools for learners with special education needs. Although some challenges overlap with those experienced in high-income countries, such as support and training, high staff turnover and burnout, large caseloads and language and codeswitching differences, these challenges present differently in low-income contexts, requiring alternative solutions. High-income countries do not often need to consider the risk a high-tech AAC device places on the child and their family due to the risk of crime in low-income contexts, the device affordability, the device features and the range of accents available when introducing an AAC system. This exploratory study suggests that LMICs, like South Africa, could make great strides towards providing appropriate AAC technology for all if i) strategic partnerships between governmental and non-governmental groups were put in place, ii) appropriate communication, training and support systems were established, and iii) evidence-based core-language AAC systems were created.

Background: Children with cerebral palsy (CP) often experience feeding and/or swallowing difficulties (FSD), which are lifelong, necessitating long-term care by caregivers, particularly in resource-constrained contexts like South Africa. This ongoing responsibility can lead to burden and reduced quality of life (QoL) for the caregiver and child. Exploring caregivers’ experiences is required for planning and implementation of effective support services. Objectives: The study aimed to explore the experiences of caregivers of children with CP who have FSD, regarding the burden, QoL and support needs. Method: A qualitative case study design was used, involving eight mothers of children aged 2–8 years, recruited from a hospital-based CP clinic. Participants (aged 25–42 years) engaged in semi-structured telephonic interviews conducted in English and isiXhosa. Thematic analysis was conducted to generate themes and sub-themes. Results: Thematic analysis yielded seven main themes: Worry; Feeding is everything; Identified support needs; What helps me cope?; Cost of caregiving; Hopeful caregiving and Shortfalls of healthcare system and society, reflecting emotional strain, the centrality of feeding, specific support requirements, caregiver resilience, multifaceted burden and hope. Conclusion: Caregiver burden and QoL are closely linked and shaped by the emotional, physical, social and financial demands of caregiving. While caregivers described their unmet support needs, they also identified positive aspects of caregiving, including a sense of purpose and connection with their child. Contribution: The findings offer insight into caregiver experiences in South Africa and underscore the need for tailored, contextually relevant interventions to improve caregiver well-being and child outcomes.

It is well-known that children with expressive communication difficulties have the right to communicate, but they should also have the right to do so in whichever language they choose, with a voice that closely matches their age, gender, and dialect. This study aimed to develop naturalistic synthetic child speech, matching the vocal identity of three children with expressive communication difficulties, using Tacotron 2, for three under-resourced South African languages, namely South African English (SAE), Afrikaans, and isiXhosa. Due to the scarcity of child speech corpora, 2 hours of child speech data per child was collected from three 11- to 12-year-old children. Two adult models were used to "warm start" the child speech synthesis. To determine the naturalness of the synthetic voices, 124 listeners participated in a mean opinion score survey (Likert Score) and optionally gave qualitative feedback. Despite limited training data used in this study, we successfully developed a synthesized child voice of adequate quality in each language. This study highlights that with recent technological advancements, it is possible to develop synthetic child speech that matches the vocal identity of a child with expressive communication difficulties in different under-resourced languages.

Background: Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT’s fit or what adaptations might be needed to improve its applicability within a resource-constrained setting. Objectives: To explore stakeholders’ perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT’s contextual fit. Method: We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components. Results: Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families’ available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa. Conclusion: Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit. Contribution: This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.

Background: Early classroom communication supports are critical in influencing oral language development and emergent literacy skills. It is both support from peers and adults, as well as the environment that impacts the quality and efficacy of language learning. Schools in particular play a key role in communication development, which will be further explored in this article. Objectives: To describe how communication was being supported in the classroom by teachers in the areas of language-learning environment (LLE), language-learning interactions (LLIs) and language-learning opportunities (LLOs) to focus on classroom communication supports to strengthen literacy outcomes for Grade R learners. Method: A cross-sectional descriptive survey of classrooms was conducted using a structured observation method in 136 classrooms. The Communication Supporting Classroom Observation Tool was used to make 223 observations across classrooms of LLE (19 items), LLI (20 items) and LLO (5 items). A descriptive analysis of frequency of occurrence of items was conducted for each domain. Results: Language-learning environment had more frequently occurring observations, with 12 out of 19 items being observed with a frequency of occurrence greater than 65%, indicating that the environment had adequate basic resources (e.g. good light). Language-learning interactions scores indicated that 3 out of 20 items were observed frequently, while 17 out of 20 items were observed less frequently (56.5%), including interactive strategies (e.g. turn-taking). Language Learning Opportunities scores indicated that teacher-led behaviours (e.g. including children in small group activities) were infrequently observed on all items. Conclusion: While the physical environment was generally supportive, the behaviours in the interactive domains of LLI and LLO were observed less frequently. There is potential for speech–language therapists to work collaboratively with teachers to develop communication supporting classrooms as a critical primary-level intervention for language-literacy learning.

(1) Background: Speech synthesis has customarily focused on adult speech, but with the rapid development of speech-synthesis technology, it is now possible to create child voices with a limited amount of child-speech data. This scoping review summarises the evidence base related to developing synthesised speech for children. (2) Method: The included studies were those that were (1) published between 2006 and 2021 and (2) included child participants or voices of children aged between 2–16 years old. (3) Results: 58 studies were identified. They were discussed based on the languages used, the speech-synthesis systems and/or methods used, the speech data used, the intelligibility of the speech and the ages of the voices. Based on the reviewed studies, relative to adult-speech synthesis, developing child-speech synthesis is notably more challenging. Child speech often presents with acoustic variability and articulatory errors. To account for this, researchers have most often attempted to adapt adult-speech models, using a variety of different adaptation techniques. (4) Conclusions: Adapting adult speech has proven successful in child-speech synthesis. It appears that the resulting quality can be improved by training a large amount of pre-selected speech data, aided by a neural-network classifier, to better match the children’s speech. We encourage future research surrounding individualised synthetic speech for children with CCN, with special attention to children who make use of low-resource languages.

Background: An increasing body of empirical evidence suggests that early intervention has positive outcomes for parents of children with neurodevelopmental disabilities. Parental self-efficacy has been used as an outcome measure in some empirical studies; however, there is a lack of evidence of the impact of parent training programmes on parenting self-efficacy beliefs.Objectives: This systematic review sought to assess the effectiveness of parenting interventions to increase parental self-efficacy levels in parents of young children with neurodevelopmental disabilities.Method: We conducted a broad literature search, which included grey literature, such as dissertations and unpublished conference presentations, to identify all relevant prospective studies reporting on our study objective. Articles were selected for inclusion using predefined criteria and data were extracted onto a purposely designed data extraction form. Twenty-five articles met our search criteria. We extracted parenting self-efficacy scores before, and on, completion of parenting interventions and performed a meta-analysis using standardised mean difference. We also conducted a risk of bias assessment for all the included studies.Results: Parent training programmes resulted in a statistically significant increase in parental self-efficacy levels (standardised mean difference, 0.60 [95% confidence interval {CI}, 0.38–0.83]; I2, 74%) relative to baseline measurements. Parents of children younger than 5 years demonstrated the highest increase in levels of parental self-efficacy after parenting interventions. Furthermore, this review showed that psychologists and other healthcare practitioners are successfully able to implement training programmes that enhance parenting self-efficacy.Conclusion: Parent training programmes are effective in increasing parental self-efficacy in parents of children with neurodevelopmental disabilities.

Background: Understanding how the cognitive, emotional and behavioural components of sibling attitudes interact with one another at various stages of a sibling’s lifespan will allow clinicians to provide better support to children with autism spectrum disorder (ASD) and their families. However, no research exists which focusses on describing the attitudes of adolescent siblings of children with ASD within the South African context towards their sibling with an ASD. The primary aim of this study was to investigate how typically developing adolescents recall their past attitudes and describe their present attitudes towards their sibling with an ASD.Methods: Thirty typically developing adolescents who have siblings with ASD were selected to complete the survey instrument, the Lifespan Sibling Relationship Scale, using a cross-sectional design.Results: Results indicate that the measure has internal consistency within this sample. Wilcoxon signed-ranks tests were used to test for significant differences between the mean values for the two self-reported time periods. Friedman analysis of variances (ANOVAs) was used to test for significant differences in the three components of attitudes, namely affect, behaviour and cognition. Results indicate that participants held more positive attitudes towards their siblings with ASD as adolescents compared with when they were younger and that adolescents rated their current emotions towards and beliefs about their sibling with ASD to be more positive than their current interaction experiences.Conclusion: As siblings’ attitudes appear to change over time, clinicians should use a lifespan approach to sibling attitudes when designing and implementing supports for siblings of children with ASD.

Background. Typically developing children who have a younger sibling with a disability often feel inadequately supported and excluded from family interactions. However, early intervention programmes often use family activities and routines as intervention settings. Siblings’ negative attitudes towards participation in such activities may therefore hamper intercession efforts. Objective. To determine the attitudes of typically developing children toward their younger siblings with severe speech and language disabilities in four everyday life situations identified by the World Health Organization’s International Classification of Functioning, Disability and Health: Children and Youth Version, namely communication, domestic life, interpersonal interaction and relationships, and major life areas. Methods. An adapted structured interview format was used to determine the attitude of the 27 participants, 6- to 10-year-old typically developing South Africans. Results. Typically developing peers were most positive towards participation in play activities with their sibling with a disability. They were also positive towards participation in household tasks. They were less positive towards communication participation and least positive about participation in interpersonal relationships. A significant difference between certain components of attitudes was reported for three of the four domains. Conclusion. The attitudes of typically developing children are generally positive towards participating with their younger siblings with severe speech and language disabilities. These results can be used to select activities for activity-based interventions and to guide interventions aimed at supporting the siblings of children with disabilities.