Systematic Review

Name of Study:

A Systematic Review

Introduction

Language Testing for children

Assessment means "the ongoing procedures used by qualified personnel to identify the child's

unique strengths and needs and the early intervention services appropriate to meet those needs

throughout the period of the child's eligibility...and includes the assessment of the child...and the

assessment of the child's family.” (IDEA, Part C, Section 303.321) The assessment of the child

must include a review of the results of the evaluation conducted, personal observations of the

child, and the identification of the child's needs in each of the developmental area. Identification

of children with potential delays/disorders and early intervention are both dependent on

assessment. Early intervention in a child's development can help to promote and stimulate the

growth of developmentally appropriate skills. Assessment can indicate whether language

development that presents outside the norm is due to a disorder or just a distinction resulting

from the acquisition of multiple languages, particularly in multilingual children. As a result, a

lack of access to formal assessments might hinder the development and advancement of overall

communication abilities, especially in preschool-aged and bilingual children. "Speech and

language assessments should measure language production, language comprehension, nonverbal

communication and gestures (including gaze and joint attention in young children), pragmatic

and figurative language, prosody, rhythm, volume, and content of speech (Paul, 2005). Language

assessments are individually administered tests used to assess a child's receptive and expressive

language skills. The receptive language portion is used to evaluate how much language a child

understands. The expressive language portion is used to determine how well a child

communicates with others.

Teletx testing looks like

Due to the recent issues such as the global pandemic of Covid-19, lack of qualified clinicians,

and accessibility of speech and language services in rural communities, telehealth has provided

clinicians with a viable option for providing speech pathology services to children with speech

and language disorders through internet-based applications. It has been shown to be an

acceptable and viable alternative to face-to-face speech–language services in a range of

specialties, including dysphagia assessment and intervention (Collins et al. 2017, Ward et al.

2013, Sharma et al. 2013), stuttering therapy (O’Brian et al. 2014, Bridgman et al. 2016), and

assessment and intervention for speech-sound disorders, including childhood apraxia of speech

(GroganJohnson et al. 2013, Thomas et al. 2016, Waite et al. 2012). However, providing reliable

and feasible standardized language evaluations via telehealth to determine children's intervention

requirements and track development is still a work in progress. Furthermore, there is a scarcity of

data on how children react to telehealth. Some studies used method comparison designs to

analyze the use of telehealth in the delivery of standardized language-based assessments. The

authors of the studies reported good reliability scores between face-to-face and online scoring of

participant responses in all investigations. The demand for telehealth services has risen

dramatically in the recent year as a result of the COVID-19 outbreak. For both clinicians and

families, providing services remotely is a safe, convenient, and timely alternative to face-to-face

services. Validation of telehealth language-based assessments is necessary for telehealth to

become a reliable alternative mode of assessing a child.

Research Aims

This systematic review aims to determine the reliability and feasibility of conducting

language-based assessments via telehealth versus face-to-face for typically-developing children,

non-typically developing children (speech, language, hearing, and learning disorders), and

children with autism, ranging in ages from 3-13 years old. This review also looks at the

behavioral observations noted while conducting the language-based assessments via telehealth

versus face-to-face. Telehealth has the ability to make speech-language pathology services more

accessible to children. Validation of telehealth applications, such as the assessment of childhood

language disorders, is required before telehealth can be considered as a viable alternative means

of service delivery.

Research Question

The leading question throughout this systematic review is to discover what factors may

impact the feasibility and reliability of language-based assessments conducted via telehealth such

as environmental factors (e.g., noise level, siblings, etc.), child-related factors (e.g.,

distractibility, bathroom breaks, etc.), and technology-related factors (e.g., audio, Wi-Fi, screen

sharing, etc.). This review also looks to examine parental satisfaction with telehealth

administration and behavioral implications in participants throughout assessment administration.

Methods

Inclusion/exclusion criteria

To be included in this review, studies had to meet predetermined inclusion criteria. The

inclusion criteria for this review was as follows: (1) the study had to include preschool or

elementary pediatric participants , and (2) the study had to involve the delivery of language-

based assessments via telehealth. In an effort to understand the recent evolution of the delivery of

pediatric language-based assessments via telehealth, the publication year was restricted to

include studies dated 2010 onwards. Additionally, the search was limited to studies written in the

English language and published in scholarly, peer-reviewed journals. This literature review was

conducted during December of 2020. Exclusion criteria disqualified studies that were published

in a language other than English, dated prior to 2010, not peer-reviewed or existing systematic

reviews..

Search Strategy

A systematic procedure was employed to identify studies for inclusion in this review. Computer

literature searches were conducted in four electronic databases covering the field of health and

human service – Education Resources Information Center (ERIC), Cumulative Index to Nursing

and Allied Health Literature (CINAHL), MEDLINE, and PsycINFO – using the search string

shown in Table 1 with keywords in Subjects. Searches were conducted in December 2020 and

included all results from January 1, 2010, forward. Prior to the review, key terms were

determined by the researchers through the use of synonyms and by exploring the subject’s of

relevant articles for additional applicable key terms.

Table 1. Example search strategy.

Databases Search String Keywords In

CINAHL, Medline, PsychInfo, ERIC

(teletherap* OR telemed* OR telehealth* OR “e- health” OR ehealth OR telerehab* OR telehab* OR video* OR telecar* OR telepract*) AND (test* OR assess* OR evaluat* OR measur*) AND (SLP OR “speech-language patholog*” OR speech OR language OR “speech therap*”) NOT (nurs* OR adult* OR pharmac* OR “virtual reality” OR “telephone” OR “video gam*” OR geriatric* OR “mental health” OR teacher* OR “middle age*” OR foreign OR adolescent* OR engineer* OR “Aged: 65+ years” OR “college student*” OR elderly OR athlet*)

SUBJECTS

Screening

The initial search conducted on December 8th, 2020 yielded a combined result of 894

research articles. In an effort to organize the obtained results, the researchers employed the use

of RefWorks (citation), a web-based research management tool that imports, stores, and screens

references for duplicates. After importing all references, RefWorks removed 84 duplicates

bringing the new total to 810 research articles. Subsequently, said articles were imported into

Covidence (citation), an online research screening tool that allowed the researchers to execute

the remainder of the screening process for the systematic review. An additional 11 duplicates

were identified through Covidence and were removed from the total, leaving 799 research

articles to be screened further. Subsequently, the researchers proceeded to screen the articles by

title and abstract relevance, yielding a total of 777 irrelevant articles. If the title or abstract failed

to provide enough information to determine eligibility, the researcher analyzed the full text of the

article for confirmation. Consequently, 22 articles met the established eligibility criteria and

therefore, advanced to the full-text review stage of the screening process. During this stage, 15

studies were additionally excluded, yielding a total of seven articles to be further analyzed

qualitatively for inclusion in the systematic review.

Each stage of the screening process described above involved two researchers

independently and blindly screening each article for the above mentioned inclusion/exclusion

criteria. In the event of a disagreement between the researcher’s screening findings, Covidence

permitted a third researcher to resolve the disagreement by providing them a tie-break vote.

Table 2. PRISMA Flow Diagram

Identification

Screening

Eligibility

Analyzed

Included

Records identified through database searches: Medline,

CINAHL, PsychINFO ERIC. (n= 894)

Records after duplicates removed (n= 799)

Titles/Abstracts Screened (n= 799)

Full-text articles assessed for eligibility

(n= 22 )

Records Excluded (n= 777)

Full-text articles excluded, with reasons

(n=15 )

Studies analyzed in qualitative analysis

(n=7 )

Records excluded due to lack of quality

(n= 0)

Studies included in qualitative analysis

(n=7 )

Synthesis of Results/Data

Upon completion of the screening process, the remaining seven articles were divided

amongst team members to evaluate their strength in relation to the purpose of this study using the

Quality Assessment Tool (QAT; found in table 3) developed by Sirriyeh, Lawton, Gardner, and

Armitage (2012). Each study was individually examined by two team members and, following

the guidelines of the QAT, were given a rating from 0 to 3 (0 = Not at all, 1 = Very Slightly, 2 =

Moderately, and 3 = Complete) for each of the fourteen criteria resulting in an overall score

range of 0 to 42. Once team members completed quality assessments for their assigned articles, a

separate meeting was held to discuss individual scores. Any discrepancies in scores were

discussed and scoring criteria was extensively reviewed to reach a consensus on a single score

and establish inter-rater reliability.

Study Quality and Potential Sources of Study Bias

Following the establishment of consensus on all seven articles, quality assessment data

was exported and scores for each of the fourteen criteria outlined in the QAT (Table 3)were

added up to obtain total scores for each article. It was then determined by the research team that

only articles obtaining a total score of 15 or above were of high quality, indicating they should be

included in this systematic review. All seven articles that underwent the extraction process met

this inclusion criteria with the lowest score being 17. No potential sources of study bias were

identified as all articles included in this systematic review were assessed by using the QAT,

meetings were held to reach consensus on score discrepancies to ensure inter-rater reliability, and

scores of 15 or above were obtained for all seven studies included in this review, indicating they

are of high quality.