Clinical practices in Swedish speech-language pathology for children with (developmental) language disorder

ABSTRACT

In Sweden, treatment for children with (developmental) language disorder ((D)LD) is traditionally carried out at a speech-language pathology (SLP) clinic, and based on formal language tests, which may not entirely represent the child’s everyday language and communication skills. SLP services that include video recordings have shown positive outcomes in terms of providing information about children’s linguistic and communicative abilities in everyday life, but little is known about the use of video in clinical practice. The aim of this study is therefore to investigate how Swedish SLPs link their clinical practices (assessment, treatment, and evaluation of treatment outcome) to the everyday language and communication abilities of children with (D)LD. A further aim is to explore SLPs’ utilisation of video recordings as a part of their clinical practices with the target group. A web-based questionnaire was distributed to SLPs in Sweden, who work with children with (D)LD. Results demonstrate that Swedish SLPs perceive that their intervention is in alignment with children’s everyday language and communication needs to a fairly high degree. However, an exception is assessment, which is considered to have a weaker alignment with children’s everyday communication abilities. The use of video recordings for clinical purposes is very limited. It is suggested here that incorporating video recordings from children’s everyday life would be an easy and time-efficient way to strengthen the ecological validity of SLP practices for children with (D)LD.

KEYWORDS:

• Language disorder
• speech-language pathology practices
• developmental language disorder
• video
• ecological validity

Introduction

Children with (developmental) language disorder (D)LD form a heterogenous cohort with varying severity and make up a considerable part of the caseload in Swedish speech-language pathologists’ (SLPs’) clinical practice. In Sweden, SLPs traditionally work within the healthcare system, in which the SLP assesses, diagnoses, carries out indirect and direct treatment, and evaluates treatment outcome (Hansson et al., 2019). SLP services for children with (D)LD aim to improve language and communication skills, and to minimise the negative consequences in everyday life (Ebbels et al., 2019). Even if there are different ways of including children’s everyday language use in clinical practice, SLPs tend to highly rely on standardised tests when assessing children, and in clinical decision making (Fulcher-Rood et al., 2019; Selin et al., 2019). One way to include everyday language use is to collect video recordings from the child’s home environment. It has been demonstrated that the use of video recordings adds important information to SLP services (e.g. van Balkom et al., 2010). To what degree, and how SLPs in Sweden work to include children’s everyday language and communication abilities in their clinical practices has not yet been explored. In addition, it is not known if and how SLPs use video recordings for this purpose. These aspects motivate the current study.

SLP practices for children with (D)LD

Language disorder is one of the most common neurodevelopmental disorders in children, with a prevalence of around 8% (Norbury et al., 2016). Significantly impaired language abilities regarding comprehension as well as production, characterise language disorders, but different areas of language may be affected and the severity of the difficulties varies (Bishop et al., 2017). Treatment for children with (D)LD should be individualised and focus on making a positive impact on everyday life (Ebbels et al., 2019). Collaboration with caregivers in treatment and decision-making is essential for individualising care (Roulstone, 2015), and the use of caregiver-directed treatment in SLP services has increased over the years (Law et al., 2019). However, caregivers’ engagement in, and their expectations on SLP treatment might vary (Levickis et al., 2020). Evidence-based interventions efficient for children with (D)LD are available, and both child-directed and caregiver-directed interventions have proven effective (e.g. Rinaldi et al., 2021; Roberts et al., 2019). However, research has demonstrated that practitioners tend to rely more on experience than scientific evidence in clinical decision making for the target group (Forsythe et al., 2021). One important barrier for implementing new, evidence-based practices appears to be lack of time for SLPs to read and get up to date about new research, and to implement new ideas (Fulcher-Rood et al., 2020; Greenwell & Walsh, 2021; O’Connor & Pettigrew, 2009).

When assessing children with speech, language and/or communicative difficulties, standardised tests are traditionally important tools in SLP clinics, and SLPs tend to rely on test results when setting treatment goals (Fulcher-Rood et al., 2019; Selin et al., 2019). Results from language tests are considered vital information when diagnosing children with (D)LD but reveal little of the children’s everyday abilities. A study by McGregor et al. (2023) shows that results from language tests do not predict the impact that the difficulties have on everyday life. Researchers have emphasised the importance of adding language sampling (LS) for enabling analysis of the children’s language and communication skills in everyday life (Hewitt et al., 2005; Voniati et al., 2021) and for identifying treatment goals (Owens et al., 2018). LS offers a way to collect and analyse a more ecologically valid sample of the child’s everyday skills, where all aspects of language (phonology, morphology, syntax, semantics, and pragmatics) are integrated and represented in a naturalistic way. In contrast, standardised language tests, are largely developed to examine and assess specific language domains.

Despite the fact that language sampling analysis (LSA) is promoted as an important tool in SLP practices for children with suspected (D)LD, many clinicians do not use it regularly (e.g. Heilmann, 2010; Klatte et al., 2022; Pavelko et al., 2016). One of the main barriers is that it is considered too time consuming. Another prominent obstacle seems to be a lack of knowledge amongst SLPs about what LSA entails and how to conduct it (Klatte et al., 2022; Pavelko et al., 2016). Amongst the SLPs using LSA, many tend not to use evidence-based methods when collecting and analysing the samples. Common ways to save time appear to be to transcribe the child’s utterances in real time, or simply listen to recordings without transcribing or analysing the sample (Klatte et al., 2022; Westerveld & Claessen, 2014).

When SLPs do use LSA, audio recordings seem to be the most common method to collect samples of children’s everyday speech, language, and communication skills (Pavelko et al., 2016). However, another way to collect LS is to use video recordings from children’s everyday reality. Video recordings of children in interaction, offer the possibility to analyse nonverbal information, for example the use of gestures and gaze, in addition to the analysis of verbal contributions. Multimodal samples of this kind contribute important information for setting treatment goals as well as for the evaluation of treatment outcomes (Samuelsson et al., 2016). They can also form parts of the treatment (Gardner, 2006; Samuelsson & Plejert, 2015).

Video recordings as a part of SLP practices

Some treatment methods in Swedish SLP practices for young children with substantial language problems include video recordings. Two examples are The Hanen Program It Takes Two to Talk (Weitzman, 2017) and AKK tidig intervention [AAC early intervention] (AKKtiv, Thunberg et al., 2011), both of which are parental programmes provided to caregivers in groups. The programmes include, for example, lectures and homework assignments in addition to the video recordings. The latter is primarily used as a basis for caregiver coaching. Individual caregiver-directed treatment methods that utilise video recordings as a tool also exist, but ordinarily, these tools are developed for other diagnostic groups. One example is Parent-Child Interaction Therapy (PCI, Kelman & Nicholas, 2020), which is developed for children with stuttering. In addition, other treatment methods that are based on video recordings from the child’s everyday life might be used by SLPs, as well as other professions. One such example is Marte Meo (Aarts, 2008), which is primarily used to enhance interaction and positive development in children with neurological, cognitive, or psychological difficulties and their caregivers. The method has been successful in decreasing acting-out behaviours in children with behavioural problems (Axberg et al., 2006).

Hence, video recordings are utilised in extensive parental programmes for children with (D)LD in SLP services, but there seem to be few methods developed for the use of video recordings as a tool in other areas of SLP practices for the target group. Some previous studies have explored the possible usage of video recording as a part of individual treatment (see Bellon-Harn et al., 2020 for a review). Furthermore, results from Gardner’s Talking About Speech (Gardner, 2006), Samuelsson et al. (2016) and van Balkom et al. (2010), have demonstrated several benefits of using video recording as a tool in SLP practices. Results indicate that caregivers’ engagement in their child’s treatment is enhanced, and important information about the child’s linguistic and communicative abilities is also easily accessible for everyone involved. However, the use of video recordings within SLP practices for children with (D)LD) is still an area of a surprisingly limited amount of research (Bellon-Harn et al., 2020).

Services for children with (D)LD aim to have a positive impact on their everyday lives, but how do SLPs act to ensure this goal? To what degree and how SLPs in Sweden work to include children’s everyday language and communicative abilities in their services are not yet explored. To use video recordings have generated important information for SLP practices, but it is so far unknown to what extent this method is used as an instrument for these purposes for children with (D)LD).

Aim

The aim of this study is to further understand how Swedish SLP services align with the everyday language and communication skills of children with (D)LD, and to explore SLPs’ utilisation of video recordings as a part of their clinical practices. The study is guided by the following research questions:

1. How do Swedish SLPs link their assessment, treatment, and evaluation of treatment outcome to children’s everyday language and communication abilities?

2. How do SLPs perceive the alignment between their current practices and children’s everyday language and communication abilities?

3. To what extent do Swedish SLPs use video recordings in their clinical practices, and how are the video recordings being used?

Material and method

Questionnaire

A web-based questionnaire was designed to collect information about existing clinical SLP-practices regarding children with (D)LD, in terms of the alignment to the children’s language and communicative abilities in everyday life, and the use of video recording. The questionnaire, which was produced in Survey&Report (Artisan Global Media, 2018), consisted of multiple-choice questions and free-text questions, the latter of which included both open-ended, follow-up questions and the opportunity to comment on a multiple-choice question. The first section of the questionnaire included questions regarding background information about the responding SLPs. The questionnaire thereafter consisted of three sections with questions concerning working methods and routines for: (1) Assessment, (2) Treatment, (3) Evaluation of treatment outcome (see Appendix for the full questionnaire).

Procedure

A pilot version of the questionnaire was sent to two clinically practicing SLPs who provided their feedback on comprehensibility, the relevance of questions, and the layout etc. The questionnaire was then revised according to their comments. When finalised, a link to the web-based questionnaire was sent out by email to SLP clinic unit managers in all 21 regions in Sweden. A web link was also posted in different social media networks. The questionnaire was open between 26 May and 2 July in the year 2021. The questionnaire was open for all SLPs in Sweden, who work clinically with children with (D)LD.

Participants

A total of 163 SLPs from 20 of the 21 regions in Sweden responded to the questionnaire. A majority of the clinicians (67.9%) stated that they worked in a clinic run by the region, and most of the SLPs worked with children in the preschool age. In Sweden, this means children who are between 1 and 6 years old. The number of years of experience as an SLP working with children with (D)LD ranged between 0.5–47 years (mean 9 years, median 7 years). Demographic information for the participants is presented in Table 1.

Table 1. Description of the percentage of participating SLPs regarding work setting, year of graduation, and the typical age range of the children in their clinic.

Work setting		Year of graduation		Age range of children*
Clinic run by the region	67.9%	2016–2021	33.1%	0–2	13.7%
Private clinic	9.9%	2011–2015	29.4%	2–4	73.9%
Preschool/School	7.4%	2006–2010	19.4%	4–6	78.3%
Central position	6.8%	2001–2005	10.0%	6–8	39.1%
Habilitation centre	4.3%	2000-	8.1%	older than 8	29.2%
Specialist preschool/school	3.1%

*Multiple answers were possible; hence the total exceeds 100%.

Data analysis

For the multiple-choice questions, descriptive statistics were calculated by the software programme Survey&Report (Artisan Global Media, 2018). Responses to the free-text questions were analysed qualitatively to identify patterns of meanings in relation to each posed question. The analysis was manually conducted using thematic analysis (TA), following the steps outlined by Braun and Clarke (2006). TA was considered suitable as it enables an inductive analysis with a semantic, surface-level approach for identifying patterns in the data (Braun & Clarke, 2006). However, the questionnaire’s specific and targeted questions resulted in responses that were relatively concise and straightforward, and a comprehensive TA was therefore not considered feasible.

The first step of the analysis was to get familiarised with the data, and the responses were therefore read through several times and initial thoughts were noted. As a second step, the responses were marked in different colours and coded based on their explicit content. Subsequently, all codes were scrutinised and organised into potential themes, based on describing similar aspects in relation to the question at hand. For example, concerning a question why the recipient did not use video recordings in assessment, a response, such as: Never reflected on the fact that you could do that was coded as ‘not thought about it’ and: Has happened on a few occasions; should become more frequent was coded ‘no habit’. Both these codes were then grouped into one theme. After this construction into themes was completed, all responses, codes, and themes were reviewed and revised once more. These steps were carried out one question at a time by the first author. All codes and themes were thereafter discussed and reviewed by all authors. The members of the research group hold extensive experience in conducting qualitative studies, and the analysis was considered finalised when consensus was reached between all authors. Responses from the free-text questions are presented in continuous text and quotes from the responses, translated into English, are provided to illustrate prominent themes. The responses to the multiple-choice questions are reported in percent.

Results

Current SLP practices for children with (D)LD

The participating SLPs were asked questions about their current clinical practices, and more specifically how they linked assessment, treatment, and evaluation of treatment outcome to everyday language and communication for children with (D)LD. Regarding assessment, a majority (79.5%) of the SLPs considered that the results from standardised tests provided a satisfactory picture of children’s difficulties to a fairly high degree, see Figure 1. One of the responding SLPs commented: ‘In combination with anamnestic information, conversations with preschool/school [staff], and observation of the child, you get a pretty good picture’. A vast majority (94.4%) of the participants complemented or replaced standardised tests with other kinds of information sources, primarily through anamnesis from caregivers, information from teachers at the children’s preschool/school and informal assessment of the child’s spontaneous speech at the clinic. To assess children’s language and communicative abilities in everyday life, the SLPs collected information from the caregivers (96.9%), observed the child at the clinic (74.1%), and used forms for the caregiver to fill in (56.8%). Furthermore, 36.4% of the SLPs observed the children at their preschool and/or in the children’s home and 29.6% used video recordings from the preschool and/or home. When setting treatment goals, 23.8% of the SLPs reported they departed from results from language tests to a high degree, and 58.1% to a fairly high degree (see Figure 1). A comment from one of the SLPs was: ‘This especially applies to children with grammatical difficulties and children with speech sound disorders’.

Figure 1. The participating SLPs’ answers regarding their view on test results, and their utilisation of test results.

Cooperation with caregivers during treatment was usually carried out through home-training tasks (89.9%), through counselling (88.1%), through individual visits at the clinic without the children (62.3%), and through parental programmes/courses (52.2%). The most common parental programmes offered were Sign as AAC (81.9%) and Akktiv (62.7%, Thunberg et al., 2011). Other programmes that were commonly offered focused on information about language stimulation (47.0%), or (D)LD (30.1%).

Treatment outcome was mainly evaluated in discussion with the caregivers and/or teachers and occasionally with the child, or through language tests. Other ways to evaluate treatment outcome were to use exercises or informal assessment. Relatively unspecific methods were also described, for example: ‘After completing the treatment round, I decide whether they [the treatment goals] have been achieved and make a note in the journal’. Some SLPs also stated that they did not, or very seldom set treatment goals or evaluated the treatment goals. Moreover, the SLPs were asked when the treatment goals were considered to be reached. The SLPs stated this was when the child was able to use the target of the goal in treatment/during tasks, or when the goal structure occurred in the child’s spontaneous speech. However, it was also expressed to depend on the goal or that it was reached in coherence with the caregivers/teachers. When rating their way of evaluating treatment outcome, many of the SLPs (37.9%) graded their methods as neither good nor bad, and almost as many (36.6%) stated that their way of evaluating treatment outcome worked fairly well. 16.3% rated their methods as fairly bad, 4.6% as very bad and an equal number (4.6%) as very good. The ways of evaluating treatment outcome were, in the free-text questions, described as uncertain and unclear, and a need for more structured methods for setting and evaluating treatment goals was expressed: ‘Would like more structured methods. You have to improvise a lot’.

Perceived alignment between current practices and children’s everyday language and communication abilities

The SLPs were asked how they experienced the alignment between assessment, treatment goals, treatment, and evaluation of treatment outcome and children’s everyday language and communication skills. A majority rated all areas of their practices to be in fairly strong alignment with the children’s everyday language skills, with the exception of evaluation of treatment outcome, which was perceived to have a slightly weaker connection. When it came to communication, both treatment goals and treatment were graded to be in a fairly strong alignment with everyday communication skills. Assessment and to some extent evaluation of treatment outcome were, in contrast, considered to be less in alignment with children’s communicative abilities. See Tables 2 and 3 for a summary of the distribution of the SLPs’ responses.

Table 2. To what extent the SLPs (in percent) experienced different phases of their practices to be in alignment with children’s everyday communication skills.

	To a high degree	To a fairly high degree	To a neither low nor high degree	To a fairly low degree	To a very low degree
Assessment	3.8%	30.2%	30.8%	32.7%	2.5%
Treatment goals	6.4%	52.6%	24.4%	15.4%	1.3%
Treatment	7.1%	54.5%	28.2%	9.0%	1.3%
Evaluation of treatment outcome	5.5%	38.4%	43.8%	11.0%	1.4%

Table 3. To what extent the SLPs (in percent) experienced different phases of their practices to be in alignment with children’s everyday language skills.

	To a high degree	To a fairly high degree	To a neither low nor high degree	To a fairly low degree	To a very low degree
Assessment	4.4%	57.2%	24.5%	12.6%	1.3%
Treatment goals	11.5%	59.9%	22.9%	5.1%	0.6%
Treatment	11.5%	61.1%	21.0%	4.5%	1.9%
Evaluation of treatment outcome	5.4%	44.9%	37.4%	10.9%	1.4%

The use of video recordings in clinical practice

The SLPs were asked if they sometimes used video recording of the child as a tool in assessment, treatment, and evaluation of treatment outcome. For all three areas, a large majority (assessment: 64.1%, treatment: 82.6%, evaluation of treatment outcome: 91.0%) answered that they did not use video recordings. The participating SLPs’ responses are illustrated in Figure 2.

Figure 2. A summary of the SLPs’ responses when asked if they ever use video recording in clinical practice with children with (D)LD.

The SLPs who responded that they did not use video recording were asked ‘why not?’. The reasons provided by respondents varied, but certain factors were recurrent concerning assessment, treatment, as well as evaluation of treatment outcome. Time constraints were generally stated as a prominent barrier, along with the SLPs not seeing any need for using video, or what value utilising video would add to current practises. For instance, one participant stated: ‘[I] do not think it’s necessary in order to make a good enough assessment’, and another one responded: ‘[It’s] not part of my routine. [I’m] able to make assessments in conversation with the child.’. Additional factors stated for not using video as a tool in assessment and evaluation of treatment outcome, included the SLPs not having previously considered to do so, and uncertainties regarding technicalities and confidentiality. Concerning treatment, however, the expressed reasons were more related to the SLPs not having gotten around to it and uncertainty about how to implement it. For example, one participant stated: ‘[I] don’t know how it would look and what the structure would be like’.

Those who responded that they sometimes used video recordings were asked about which children they used it for. In assessment, video recordings were stated to be used with children with suspected childhood apraxia of speech (CAS) and/or to assess oral motor skills. Other prominent groups were children who were shy/quiet or, for other reasons, did not participate in the clinic. The SLPs who utilised video recordings in treatment primarily used it with children with communication difficulties and with young children. When it came to evaluation of treatment outcome, the SLPs mainly used video recordings when working with young children or children with CAS/oral motor disorders.

When asked how the video recordings were being used in assessment, the SLPs responded that they used it to assess children’s interaction, that they watched the video recordings together with the parents, to assess children’s language and/or to assess children’s pronunciation/speech motor skills. There were also single SLPs who video recorded the child’s visit at the SLP clinic and used the recording as a complement/support to the analysis of the formal test results. When it came to treatment, the video recordings were used for watching together with the caregivers and, occasionally, the children. In evaluation of treatment outcome, the SLPs used the video recording for comparison with a previous recording, or they watched it together with the caregivers/teacher/child.

When it comes to analysis of the video recordings, a vast majority of the SLPs did not use a specific method in either assessment (93.2%), treatment (92.9%) or evaluation of treatment outcome (92.9%). The SLPs who answered that they used a certain analytical method were asked which one they used. None of the SLPs reported any analytical method developed specifically for children with (D)LD. In contrast, several of the mentioned methods were protocols used to assess oral motor skills, rather than focusing on aspects of social interaction or language.

Discussion

The present study aimed to further understand how SLP practices in Sweden align with everyday language and communication skills in children with (D)LD, and thereby contribute to strengthening the alignment between SLP services and children’s everyday lives. Furthermore, the aim was to explore SLPs’ utilisation of video recordings as part of clinical practices since this has been proven useful in targeting everyday language and communication skills in previous research.

Alignment between clinical practices and everyday language and communication skills

The SLPs in this study reported that they used and had a high confidence in results from standardised tests in assessment of children, which is in line with results from previous international studies (Fulcher-Rood et al., 2019; Selin et al., 2019). Language tests offer information about the child’s linguistic abilities but do not predict the impact that the impairment has on everyday life (McGregor et al., 2023). Hence, SLPs must complement their assessments with other sources of data. To obtain information about children’s everyday skills and needs, the SLPs in this study primarily relied on information from caregivers/teachers and observations of the child in the clinic. Both sources contribute significant elements to the assessment but are still relatively sparse for enabling a well substantiated clinical decision about the child’s skills in everyday life. In the present study, collaboration with caregivers was reported as a central part of the SLPs routines in both assessment, treatment, and evaluation of treatment outcome. Cooperation and shared decision-making are essential for ensuring that the services align with the child’s everyday needs (Ebbels et al., 2019; Roulstone, 2015). However, the caregiver’s engagement in and attitudes towards participating in SLP services vary (Levickis et al., 2020) which inevitably have an impact on the planning and delivering of services. Regarding making observations in the clinic, this certainly offers a chance to obtain a sample of children’s language and communicative abilities in an easy way. LS collected in the clinic also seems to present representative samplings of children’s linguistic abilities (Voniati et al., 2021). Samples from the clinic offer little information, however, about the real-life situations that the child encounters, and any possible strategies being used in everyday contexts. Hence, collecting samples from the child’s daily life may provide additional information regarding challenges and skills that the child experiences on a daily basis, which is essential for individualising and optimising treatment. Such samples could serve as an efficient and powerful basis for deepening discussions and collaboration with caregivers, which are already being conducted today.

When it comes to evaluating treatment outcome, the results imply that the methods used in clinical practice are often rather unstructured and informal. Just over 20% of the participants rated their ways of evaluating as fairly bad, or very bad, and some stated that they did not set, or did not evaluate treatment goals. This lack of structured evaluation methods is problematic, both for being able to display potential progress to the children and caregivers, but also for evaluating the SLPs’ choice of treatment. Previous research has demonstrated that decisions regarding treatment approach tend to be highly influenced by the SLPs’ own experience (Forsythe et al., 2021). This fact further stresses the importance of evaluating the treatment that has been carried out. Several of the participating SLPs called for more structured methods for setting and evaluating treatment goals, which indicates that this is a challenging area of SLP practice that would benefit from more attention and development.

Overall, the participating SLPs graded their clinical practices for children with (D)LD to be in fairly strong alignment with children’s everyday language skills. However, regarding alignment with communication, assessment was perceived to be in fairly weak alignment with children’s everyday skills, whereas both treatment goals and treatment were considered to be fairly strongly aligned with the same abilities. The contradiction in this result is interesting, considering that treatment goals, and thus treatment, derive from the previous assessment. Possibly, this reflects the increasing use of indirect treatment in SLP services (Law et al., 2019) where caregivers are coached to deliver language stimulation and targeted intervention at home. Even though the SLPs draw on different sources of information, assessment is still largely based on the results from language tests carried out at a clinic. Treatment, on the other hand, is intended to be carried out in the child’s everyday environment.

Thus, even though Swedish SLPs utilise various sources to align their services with children’s everyday communication and language, it appears that there is a lack of efficient assessment tools for examining everyday communication, and for evaluating treatment outcome in an efficient way.

The utilisation of video recordings

Previous studies have demonstrated that video recordings of children with (D)LD in their everyday environment may offer information that can be of great use in SLP services (e.g. Samuelsson et al., 2016; van Balkom et al., 2010). The participating SLPs were asked about the utilisation of video recordings, and it appeared that the use was scarce, especially regarding treatment and evaluation of treatment outcome. Some SLPs (36.6%) used video recordings in assessment, but many commented that it was mainly used with children with suspected CAS, or oral motor problems. Hence, a large group that SLPs use video recording for is children with problems that are not, by definition, a language disorder but a speech disorder. Another group with whom SLPs used video recording were children who, due to shyness or any other reason, did not cooperate in the assessment, indicating that video recording to a large extent was used when traditional methods, e.g. language tests, were not an option. Thus, to use video was not a first-hand choice during assessment. Furthermore, the large majority of the SLPs who utilised video recordings in either assessment, treatment, or evaluation of treatment outcome, used it occasionally and not as a routine. This also indicates that video recording is not a standard tool to any great extent, but mainly used as a tool in certain circumstances.

The scarce use of video recordings of the child in interaction is in line with results regarding LSA in general, which is not used regularly (e.g. Klatte et al., 2022; Pavelko et al., 2016) despite the fact that it has proven to provide valuable information about, for example, the child’s language skills in different contexts (Klatte et al., 2022). Hence, it seems as if SLPs do not routinely include samples and analysis of the effects that the speech- and language difficulties may have on interaction and social participation in everyday life in any systematic way. When asked about the reasons why the SLPs did not use video recordings, a shortage of time, and lack of knowledge of how to go about were expressed as prominent barriers. These are factors also recognised as obstacles for implementing LSA in clinical practice (e.g. Klatte et al., 2022; Pavelko et al., 2016). Other vital barriers that were visible in the answers were that the SLPs had not felt the need, or that they had never thought about using video recordings. This, in combination with the high confidence in standardised test demonstrated both in this and in previous studies (Fulcher-Rood et al., 2019; Selin et al., 2019), indicate the need for more training and methods targeting collecting and analysing real-life data. There seems to be a great uncertainty amongst SLPs about technicalities as well as procedures. This could possibly be solved with a method developed for the target group, with easy guidelines regarding data security and procedures for collecting and analysing video recordings. There are indeed methods that are used in Swedish SLP practice for children with (D)LD that include video recording, but these are mainly programmes given to caregivers in groups, for example Akktiv (Thunberg et al., 2011). It is quite possible that the distinct structure of these programmes facilitates the use of video recordings, since they, most often, offer a clear framework regarding what, when and how to record and use the recordings. It has been proposed that SLPs have a culture of using treatment-methods based on tradition rather than scientific evidence (Reilly et al., 2004), and barriers for implementing new methods have been the focus of several studies (e.g. Fulcher-Rood et al., 2020; Greenwell & Walsh, 2021; O’Connor & Pettigrew, 2009). Having a meticulous programme for the SLPs to rely on could be beneficial for implementing a new tool in SLP practice, both from an SLP and an organisational perspective. From an SLP perspective, one must always adapt to the workload, which usually includes managing one’s time and being time efficient. From an organisational perspective, a well-described programme may facilitate estimations of work efforts and resources, and the profits that a certain intervention brings. Using video recordings does not necessarily require extra time, if used in a structured way. In contrast, it may rather provide essential, complementary information about, and access to the child’s everyday needs and skills without the SLP leaving the workplace. Asking caregivers to record a video at home need not necessarily be a heavy task for the families, since most caregivers and children nowadays are used to recording with their mobile phones. Using this approach means that the SLP quite easily may get access to everyday material. However, there is currently a lack of methods for analysing and utilising video recording in any easy and systematic way, developed for individual SLP practice for children with (D)LD.

Limitations and future directions

No information about the number of SLPs who work clinically with children with (D)LD in Sweden is attainable. This makes it difficult to estimate to what extent the sample size in the present study is representative for the group at large. However, the number of responding SLPs in this study (163) is equal to other surveys that aim towards the same respondent group (e.g. Wikse Barrow et al., 2021). Furthermore, there may be differences between the SLPs who answered the questionnaire and the non-respondents, which may limit the generalisability of the results.

Another limitation is the formulations of the questions in the questionnaire. Although the questions were altered after a pilot trial, some formulations might still have been interpreted differently by different SLPs. No specific variations in interpretations were apparent in the free-text questions, but it is harder to determine regarding the multiple-choice questions. In addition, further questions arose during the analysis of the results, which were not fully explored in the questionnaire. For example, it would have been interesting with more in-depth knowledge about how videos are recorded and being used in different parts of SLP services, and also about how SLPs go about to evaluate treatment outcome.

The importance of incorporating samples of the child’s everyday language and communication skills in SLP services has been emphasised in previous research, and significant studies have focused on the use of, and the barriers to utilising LSA. However, less attention has been paid explicitly on the use of video recordings as a tool in SLP services. Future studies should further investigate this matter, particularly by exploring the experiences and perspectives of SLPs who currently use video recordings, which could provide valuable insights into successful approaches. Additionally, future research should explore whether and how video recordings contribute additional value to traditional SLP practices. As already addressed in the discussion, there is a need for development and evaluation of methods for analysing and utilising video recordings in SLP practices for children with (D)LD. Since children with (D)LD form a large cohort, there are many who would benefit from such a work method.

Conclusions

The results of the present study show that Swedish SLPs consider the services they provide for children with (D)LD to be in fairly strong alignment with children’s everyday language and communicative abilities. An exception, however, is assessment, which is perceived to have a less strong connection to everyday communicative skills. Furthermore, several of the SLPs expressed a need for more structured methods for setting goals and evaluating treatment outcome. When asked about the utilisation of video recordings, results show that this was rarely used in any part of clinical practices.

Video recordings might be an efficient way to collect samples of the child’s strengths and needs, enabling the analysis of language skills, language use and possible strategies that the child and their conversational partners utilise in everyday life. Hence, video recordings could potentially serve as a useful tool in SLP practices for children with (D)LD.

Ethical approval

This study was approved by the Swedish Ethical Review Authority [Etikprövningsmyndigheten], Dnr 2020-07156.

Acknowledgments

The authors would like to thank all the SLPs who contributed to this study by answering the questionnaire, as well as everyone who helped spreading the questionnaire to recipients. An especial thanks is directed to the two SLPs who gave feedback on the pilot version of the questionnaire.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699206.2024.2373843.