Past BSLTRU Research

An exploration of evidence of deficits and theories of therapy for specific-receptive language impairment in children

Children with specific receptive language impairments (SRLI) have been found to be vulnerable to negative outcomes later in life, in terms of mental health, behaviour and literacy.  Currently there is little evidence of the efficacy of speech and language therapy in this area, and a dearth of studies that have investigated interventions for receptive language.  Following recommended steps from the Medical Research Council’s guidance for the development of complex interventions, this research focused on identifying and developing evidence and theory for interventions for SRLI.

The research found that; SLTs did not often refer to explicit theories underpinning their intervention for SRLI and had difficulty describing processes of change.  However, core therapy components, and common approaches for selecting targets across groups were identified.  Data indicated that the interventions SLTs describe often focus on children’s participation and functioning rather than impairment.

This research was undertaken in partial fulfillment of a PhD by Dr Lydia Morgan.  A copy of her thesis can be downloaded from the University of the West of England.

A summary of this research can be downloaded from this PDF:

A feasibility study to investigate the usefulness of language analysis software in speech & language therapy

Speech and Language Therapists regard language sampling as an essential part of the assessment process because it provides the most clinically rich information about children’s expressive language.  This study piloted the employment of a Speech and Language Therapy Assistant who was trained to transcribe language samples using a computer program (SALTsoftware).

The results showed that the SLT Assistant could transcribe language reliably and efficiently using SALT, indicating that this would be a cost-effective service innovation. 

Further studies are needed to determine the usefulness and reliability of computerised language sampling in measuring efficacy and to further develop software so that it more closely matches the needs of SLTs in clinical practice.

More about this research can be read in this PDF:

Aphasia Software Finder

In this information age we are now living in, many people are looking to find computer software which can help people with aphasia.  More and more aphasia software

programmes are coming onto the market.  Knowing which to choose can be an uncertain, expensive and chancy process as there has been no central point that links to all the available software.  Also it is often difficult to determine whether a given piece of software is suitable for an individual person just by looking at the suppliers’ sites.  The Tavistock Trust for Aphasia commissioned the Bristol Speech & Language Therapy Research Unit to create a free, online resource that aims to meet this need, designed for people with aphasia, their carers, as well as for Speech & Language Therapists.

It enables them to specify their area of language difficulty and immediately be given a list of available relevant treatment software programmes.  Detailed information is then provided regarding each programme, enabling an informed choice to be made.  This tool will make the search and selection process quick, simple and objective thus helping avoid inappropriate purchases.

The resource can be accessed at

For information about the project download the PDF below.


Better Communication Research Programme

The Better Communication Research Programme (BCRP) followed the Bercow Review of services for children and young people with speech, language and communication needs in 2008 and was funded by the Department for Education. 

The Programme involved researchers from across the UK working on 5 strands of research examining evidence for interventions, prevalence of SLCN, costs of services, families’ preferred outcomes and factors influencing socio-emotional outcomes.

Bristol Speech and Language Therapy Research Unit (BSLTRU) was primarily involved in the following strands of the Programme:

  1. Best Evidence – understanding the effectiveness and cost effectiveness of different interventions and understanding factors that influence their effectiveness and efficiency
  2. Children’s and parent’s preferred outcomes
  3. A stammering cohort study

Interim and full reports for all studies can be found on the BCRP website.

More details of how BSLTRU were involved in this research can be downloaded here:


Bilingualism Phonology

A substantial proportion of the World’s population is bilingual or multilingual. In the UK, the number of bilingual children appears to be rising, with 15.2% of children in primary schools in the UK speaking a language other than English at home, up 1% in 12 months.  This has implications for the identification of speech and language impairments as many of the assessment tools have been developed and tested on monolingual populations.  Consequently there has been a history of both over and under diagnosis of speech and language impairments in bilingual populations.

To understand more about how speech develops when children are exposed to more than one language in their everyday lives, a review of the literature was conducted.

Findings from the review emphasise the importance of taking a careful case history and assessing speech sound production in both languages of a bilingual child.  They also point towards the use of nonword repetition tasks to assist in the diagnosis of disorder in bilingual children.

More information on this project can be downloaded from this PDF:

Child Talk

Primary speech and language impairments affect 7.4% of primary school children.  Early intervention by speech and language therapists (SLTs) is crucial to lessen their impact on these children’s life chances; however, there is wide variation in how families are assessed and interventions implemented.

The aim of the research was to improve speech and language therapy services by developing a framework that speech and language therapists could use to inform the clinical decisions they make regarding which interventions to use with children.  The framework was developed from published evidence, experiences of children and families and knowledge of the practitioners.

A copy of the report can be downloaded for FREE from the National Insitute for Health Research.

More information on this project can be downloaded from this PDF:

Children's, parents', peers' and professionals' experiences of language impairment: a multi-perspective study to identify psychosocial goals for intervention

Children with language impairment (LI) can experience a wide range of social and emotional difficulties in addition to linguistic difficulties, but there is limited understanding about how LI impacts on these broader, psychosocial aspects of children’s lives. Furthermore, psychosocial outcomes for children are not assessed routinely in speech and language therapy research and practice. The study sought to uncover psychosocial features of LI and identify goals for support.

For children, LI was predominantly relational, that is, it was mainly experienced in relationship with others. Psychosocial goals for intervention include addressing attitudes, understandings and behaviours of professionals and peers towards children, in addition to children’s understanding and use of language; promoting children’s experience of agency; and addressing children’s emotional wellbeing and risk for bullying. Good communication and understanding between children, families and professionals is essential for intervention.

This research was undertaken in partial fulfillment of a PhD by Dr Helen Hambly.  A copy of her thesis can be downloaded from the University of the West of England.

A summary of this research can be downloaded from this PDF:

Early language delay : a study of the evolving language environments of preschool children

Primary language impairment (PLI) affects approximately one in 20 young children, who may have difficulties with language in later life. The importance of parent-child interaction (PCI) for language development has been well established. Many early speech and language therapy interventions have focused on modifying characteristics of PCI to enhance opportunities for language learning. However, the success of such programmes is mixed. Furthermore, there is a dearth of literature examining the developmental nature of the relationship between parent and child language with children who have PLI.

Using a case study methodology, the study aimed to understand the dynamics of the relationship between PCI and the trajectories of vocabulary growth of children with PLI. Four case studies were developed using data from preschool children and their families.

Following baseline assessments, data were collected at four time points across 9-10 months. Vocabulary development was examined using MacArthur-Bates Communicative Development Inventories. Children wore a LENA (Language ENvironment Analysis) recorder at home, which collected naturalistic all-day audio, used to sample PCI for transcription and analysis. The LENA audio was coded to examine how talk varied across everyday activities.

In addition, mother-child dyads were video-recorded looking at a picture-book to examine parent teaching behaviours. Semi-structured interviews were carried out with parents to get their perspectives on having a child with PLI.

The findings demonstrated cross-case differences in the trajectories of children’s vocabulary growth, which were consistent with differences in maternal talk. Across cases, mothers were generally found to dominate interactions. There was no clear pattern in maternal responsiveness that suggested change over time. However, there was a trend for increased responsiveness during picture-book sharing compared to the naturalistic PCI samples. Mother-child play was infrequent during the LENA recordings.

These findings challenged previous research that observed PCI in single, researcher-defined settings such as toy play and its representativeness for understanding PCI more broadly.

Further research is discussed, including evaluation of PCI interventions in naturalistic settings to assess integration of strategies. The interviews with parents identified factors to improve engagement and satisfaction with interventions. Understanding individual differences in response to interventions is essential for improving the effectiveness of support for children.

This research was undertaken in partial fulfillment of a PhD by Dr Anna Blackwell.  A copy of her thesis can be downloaded from the University of the West of England.


HKAT - Development of a speech analysis algorithm

Speech sound disorder (SSD) is one of the common problems that children face in their childhoods.  According to research, between 2% and 25% of children aged 5 and 7 years old have SSD (Law et al, 2000). When children learn to say new words, most children make some speech errors, which should diminish as they get older. SSD occurs when these errors continue beyond the age when we expect a child to have mastered specific speech sounds.  Most speech errors occur when the speech sounds are substituted, omitted or distorted.  The errors may affect how well a child is understood and can potentially limit his/her interactions with other people and negatively impact on the child's social and emotional development.

SSD is usually diagnosed by speech and language therapists using formal articulation tests and oral mechanism assessments.  As children make age-appropriate and age-inappropriate mistakes during their development, it can be difficult for parents or teachers to identify if there is a problem. Therefore, a request may be made for a formal assessment by a speech and language therapist to determine if a problem with speech exists.  This can lead to delays in accessing intervention.

Not all children need a formal articulation assessment. Some can be assessed using a screening tool which can be used to identify those children who need a more complete and thorough assessment from those who need advice only. The purpose of a screening tool is to quickly identify those children whose speech is within normal limits and those who may have SSD. People identified as falling outside normal limits can be seen or referred for complete formal evaluation in a timely fashion.

In recent years, computerised digital sound analysers have started to be widely used in speech sound analysis in detecting voice disorders, speech and audio-signal processing, etc.  Ms Ng Wing Yee (Chief investigator of this study) has recently developed a Cantonese speech sound analyser in order to make speech screening more accessible to parents and teachers in Hong Kong.  The speech sound analyser is a computer algorithm which carries out acoustic analysis of speech sounds. Now this analyser has been developed in Cantonese, we want to assess its application in an English speaking population.

Thus, the primary purpose of this study was to determine:
1) If a test which has been developed to screen children’s speech is accurate enough to be used as a screening tool to identify children with speech sound disorder.
2) How accurate the algorithm which has been developed to analyse speech sounds is when compared to a speech and language therapist.

Data collection has been completed. The research team at the Bristol Speech and Language Therapy Research Unit (BSLTRU) have been phonetically transcribing the speech of 200 native English speaking children aged 3 to 6 years old. At the end of the data collection, the transcriptions and audio recordings were be sent to the Chinese University of Hong Kong for analysis in order to answer the research questions above.

An additional concern with regards to speech development in children today is the anecdotal evidence from teachers that children are starting school with weaker speech and language skills than twenty years ago, and that this is having an impact on their developing literacy skills.

The data collected in this study will also be compared with that collected in a previous community population study and will enable us to investigate whether this is indeed the case. We will therefore explore:

3) How parent report of children’s intelligibility compares to that of teachers’ for children aged 3 years to 6 years, 11 months.
4) How parents and teachers reports of intelligibility correlate with measures of speech production collected during assessment by a speech and language therapist.
5) What patterns of speech production are observed in a sample of children aged 3 years to 6 years, 11 months today and how this compares with the speech of child participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) in the 1990s.

Identifying & Supporting Children's Early Language

Public Health England (PHE) has commissioned Speech and Language Sciences at the University of Newcastle to develop and evaluate a new process for early identification of children at risk of developing speech and language disorders, in collaboration with Bristol Speech and Language Therapy Research Unit and the Institute of Health Visiting.

Why is this important?

Speech and language are critical to children’s development, and speech, language and communication needs (SLCN) can affect their educational attainment, social and emotional development and opportunities later in life. It is therefore essential that children with SLCN are identified early to ensure they receive the right support and reduce the risk of problems in the long term.

However, the Bercow 10 Years On Report published in 2018 found that “more than half of young children in school are not having their needs identified, often due to insufficient knowledge and skills in the workforce” (p30). The report also showed that the screening tools which are currently used do not feature important ‘red flags’, which could provide early signs of SLCN.

How the project worked?

PHE have developed a programme to improve identification of SLCN, including training health visitors, providing better guidance to local authorities and provision of an early assessment tool. The University of Newcastle has been selected to create this tool, led by Professor James Law in collaboration with Dr. Cristina McKean.

The new screening tool was conducted alongside the Ages and Stages Questionnaire (ASQ), which is commonly employed by health visitors and early years practitioners at children’s 2-year developmental checks. The screening tool was tested and evaluated by health visiting teams in five areas around England, working with a total of 1280 preschool children. The project also developed resources to foster understanding of SLCN among health visiting teams and parents, and to help them to support children with their speech and language.

How BSLTRU was involved?

There are four strands to the project:
1)      Development of the early assessment tool
2)      Public and Patient Involvement (PPI) Groups
3)      Evaluation and Feedback
4)      Co-Design

The team at BSLTRU, led by Professor Sue Roulstone in collaboration with Caitlin Holme, were responsible for evaluation and feedback. They gathered parent and professional perspectives of the new process and contribute this insight to the development of the tool, with the objective of ensuring acceptability for those who will be using and receiving the assessment in future.

Evaluation of the parent and professional perspective comprised a parent survey, completed by all parents whose children have been assessed via the new process, as well as telephone interviews with parents and focus groups with health visitors and speech and language therapy teams.

BSLTRU also ran the PPI groups and co-design elements of the project, which aimed to include parents and professionals in the design of the assessment tool and further resources.

Mindfulness & Aphasia

Would mindfulness techniques enable the person with aphasia to minimise the impact of anxiety? 

Currently there is little existing research work in the area of mindfulness in relation to people with aphasia.  However, the techniques used in mindfulness would seem to lend themselves to being carried out by people with aphasia, as it is substantially based in non-verbal activities.

The development of this research was therefore being informed by asking people with aphasia about any current strategies they use to minimise anxiety and its impact on communication.  In addition to this the researcher is exploring mindfulness to consider how it may increase the ability of people with aphasia to cope with anxiety and to minimise the impact of their language difficulties in both 'comfortable' and more stress-inducing situations.

To find out more download the PDF below.


Origins & Outcomes of Persisting Speech Impairment

Problems making and using the sounds of speech in conversation is the most common reason for referral to speech and language therapy.  Children may have difficulties with this aspect of their development for a variety of reasons – for example hearing impairment, cleft palate or cerebral palsy.

This Medical Research Council funded project used data from the ALSPAC (Avon Longitudinal Study of Parents and Children).  Data showed that children could be broadly grouped into those showing mild articulation errors which are unlikely to impact on long term outcomes; children with a greater range of speech difficulties which may or may not affect their intelligibility but which is associated with poor life outcomes (SDiff group) and the rest of the cohort.

More about this research can be read in this PDF:

Parkinson Disease & Language

Developing a language protocol to support communication with people who have Parkinson’s.Parkinson Disease & Language.
Parkinson Disease & Language. At a recent PPI event in Bristol, people with Parkinson’s (PwP) expressed their desire to explore the language problems which arise from the disease and to have strategies and therapy that are specific to them. This desire fits with established research which indicates that the language impairment experienced by PwP differs to that seen more frequently in people with aphasia as a result of stroke or traumatic head injury.  The ‘Guidelines for Speech-Language Therapy in Parkinson’s Disease’ and the UK Parkinson’s Audit highlight the need for speech and language therapists (SLT) to ask PwP about any difficulty they might have finding words and participating in conversation but as yet it is not recommended to administer a formal language test.  Following the introduction of this question, local speech and language therapists report an increasing number of PwP affirming the presence of language impairment and the need to address it.

There is currently no validated or standardised language assessment for PwP nor agreed strategies to help alleviate the effects of those language problems. Stephanie Ticehurst is interested in developing a language assessment protocol alongside PwP to ensure that it is  meaningful,  effective, practical and efficient for SLT to use in clinic.

Prioritising Preschool Children for Speech & Language Therapy

Service resources for children with speech, language and communication needs are finite.  Inevitably SLTs make prioritisation decisions on a daily basis.  Decisions are not always easy and they often go on without explicit discussion.  The study investigated how therapists prioritise pre-school children for speech and language therapy.  Although other factors such as parental anxiety and family history are influential, this study specifically explored which speech and language behaviours displayed by young children raise a therapist’s concern and leads to their decision to refer a child on a particular care pathway.

More about this research can be read in this PDF:

Sound Start Study

The Sound Start Study was a research project funded by the Australian Research Council (ARC) Discovery Grant and conducted by researchers from Charles Sturt University, The University of Sydney, and The University of the West of England. 

The Sound Start Study focused on 4- to 5 year-old children who were attending preschool.  The main aim of this study was to investigate the speech skills of 4 to 5 year-old children and to determine the effectiveness of the innovative computer program, Phoneme Factory Sound Sorter (PFSS) as an intervention for preschool children with speech difficulties.

The primary researchers on this project were: Professor Sharynne McLeod, Dr Elise Baker, Dr Jane McCormack, Dr Yvonne Wren and Professor Sue Roulstone

A peer review journal article on this project has been published.

The project website is hosted by Charles Sturt University.

Speech Assistant Study

A preliminary investigation into the effectiveness and cost-effectiveness of speech & language therapist led interventions for children with speech sound disorder versus programmes delivered by assistants.
Speech and imagesChildren with speech disorder are the largest single client group referred to NHS speech and language therapy (SLT).  Whilst the speech problems for as many as 75% of children are known to resolve between the ages of 3 and 6, a substantial number have speech sound disorder (SSD) which continues beyond the age of typical development.  When SSD persists beyond age 5, children are at risk for poor life outcomes in terms of education, employment, relationships, criminal behaviour and mental health.

Many children receive NHS intervention for SSD at school.  In some areas this is typically delivered by SLTs, whilst in other areas NHS SLT provision for some children consists of providing a programme which is delivered by SLT assistants.  The decision regarding delivery of intervention by SLT or by assistant has been determined by service needs rather than research evidence.

Speech and images

Aims and objectives
To estimate the impact of SLT led versus assistant led intervention for children with SSD on outcomes in speech.  Specifically to:

  • Explore the efficacy of SLT led versus assistant led interventions
  • To examine the cost associated with SLT and assistant led interventions
  • To gather information that will help to inform a future clinical trial

Speech Development Delay in Typically Developing 13 Month Olds

Evidence suggests that differences in early childhood are associated with later speech and language development.  Specifically, patterns of interaction between parents and children have been shown to be associated with language development while very early speech behaviours are linked to later speech outcomes.  However, there is currently little research on the role of early language environment on speech development.

The purpose of this pilot study was to examine the relationship between patterns of interaction and early speech output, using LENA (Language ENvironment Analysis).  LENA is small recording device placed into a pocket of a vest worn by the child.

Thirteen month old infants and their parents were recruited for this study.  Recruited children wore a LENA vest, which recorded the child and their environment for 16 hours.  The LENA software provided numerical data on the child’s language environment; including the number of child and adult vocalisations as well as conversational turns.  This data was examined in relation to recordings of the children’s speech (for example, the sounds the children used and their babbling patterns).

The Bristol Project

The Bristol Project film is about five teenage boys.  These young people worked with Professor Sue Roulstone and Dr Clodagh Miskelly from the University of the West of England (UWE) and a film production company to explore the research question:

'What is it like to be a teenager with speech and language difficulties?'

The answers to that question were not what the researchers expected to hear. The young people challenged us to focus on their interests and their positive contributions rather than on their difficulties.  The film portrays these teenagers with affection and humour and gives them a chance to share their enthusiasms. Although the boys' difficulties with communication may be apparent in the film, we are challenged to consider our role in defining their difficulties.

More about this research can be read in this PDF:

The Communication Aid Dialogue Trainer

There is a recurrent problem that many people with communication difficulties are given communication aids but never use them to their full potential or even don’t use them at all.  One of the reasons for this is that it can be difficult for many people to get enough practice in using the aid to the extent that it becomes more effective than other strategies such as gesture, and thus is a functional improvement for them. 

This project developed a computer based dialogue practice system.  The thinking behind the project was that many people do not have a willing communication partner to practice with, and also in the early stages of learning to use an aid it can be tiresome and even embarrassing for both aid user and partner and thus the initial steep part of the learning curve in using the aid is never surmounted.

More about this research can be read in this PDF:

The Lidcombe Program

The study aimed to find out how the Lidcombe Program (LP) for stammering was used in clinics across the world and whether therapists, who do not work closely with the research team, obtained similar results to the expert LP practitioners.

More about this research can be read in this PDF:

The Lived Experience of Children with Primary Speech & Language Impairments

Primary speech and language impairment (PSLI) is a term used to describe children with a range of significant speech and language impairments, in the context of normal cognitive abilities. 

The aim of this research was firstly to explore identify construction in children with PSLI, and secondly to explore how these children made sense of their experiences.

This work contributed to the field of practice in four ways:

  1. Provided new insights into identify construction in children with PSLI
  2. Added to understanding of ways in which children conceptualise communication impairment
  3. Deepened understanding of the determinants of well-being and belonging in children with PSLI
  4. Highlighted the value of narrative inquiry as a means for listening to the voices of children with communication impairments

More about this research can be read in this PDF: