Background: Children with Social Communication Disorder (SPCD) have significant, heterogeneous social communication difficulties (similar to autism) and persistent language impairment. An innovative, manualised speech and language therapy intervention, the Social Communication Intervention Programme (SCIP) (Adams & Gaile 2015) provides therapy methods and content for SPCD. A feasibility study is required to derive more precise estimates of key parameters for a future trial of SCIP.
Aims: To survey current provision of therapy and to assess the feasibility of conducting a substantive randomized controlled trial of SCIP for children who have significant social communication needs and to scope key factors including sample size, recruitment/retention rates and acceptability to practitioners and service users.
An online questionnaire was distributed to SLTs (NHS and independent) and NHS SLT service leads in England. 76 complete survey responses were obtained (51 NHS, 23 non-NHS, 2 both NHS and non-NHS). Survey questions addressed routine service provision and dosage per child, numbers of eligible children per case load, therapy methods currently used and issues around recruitment into a trial. In the second phase of the study, 15 UK SLTs (NHS and non-NHS) who identified 20 children aged 5-11 years with SPCD defined as having social communication difficulties on a pragmatics checklist. SLTs received SCIP training and six hours of supervision from a Research SLT (RSLT). Children received 20 direct SCIP therapy sessions. Primary endpoint SCIP-GAS: At Time 1 (T1) parents provided three prioritized communication goals. Expected steps in each goal were defined by RSLT at T1. After intervention (T2) parents and SLTs (independently) rated each goal compared to T1 baseline ability on a scale of -1 (got worse) to + 5 (greatly exceeded). Parents provided a commentary on outcomes. Two RSLTs compared parent comments with SCIP-GAS scores to derive guidance about clinical significance for a future trial. Practitioners audio-recorded commentaries on therapy content, adaptations and progress over the intervention period. Post-intervention interviews were conducted with 6 SLTs and 6 parents of children about their participation and of SCIP intervention. An expert panel completed a two-round Delphi consultation on potential design of a clinical trial.
Routine practice in terms of service provision and dosage for children with SPCD in England varies widely. Seventy-five percent of SLT practitioners delegate therapy to school teaching assistants. The number of intervention approaches used in current practice was very large. It was not possible to estimate the number of eligible children per caseload as SPCD tends to be embedded in autism services. Willingness to participate in a future trial was well-supported by survey participants. In the intervention study, SCIP-GAS outcomes analysis indicates all children except one made some progress on parent ratings; all children made progress on practitioner ratings. Practitioner ratings tended to be higher than parents. An analysis of parent narrative comments associated with SCIP-GAS ratings was completed. A power analysis for a future trial was carried using SCIP-GAS as putative primary endpoint. Analysis of practitioners’ audio-diaries indicated a need for substantial training and supervision in a future trial. SCIP-GAS and therapy methods were acceptable to practitioners and parent. Suggestions for adaptation of the manual and training procedures were made.
The feasibility study has indicated the potential of a novel outcome measure that captures meaningful change in social communication skills for this group of children and is supported by practitioners and service users. Analysis suggests that there is likely to be sufficient eligible children in England to support a study and a power calculation has indicated a feasible framework for a trial within a realistic period of time. It is likely that children with high-functioning autism will benefit from SCIP intervention which would substantially increase the pool of eligible children. We recognise the training needs of practitioners may be considerable since SCIP is a novel procedure. An analysis of clinically meaningful change associated with SCIP-GAS and the measure itself has the potential to be of use with other heterogeneous groups of children with communication needs.