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.

Table 3. Quality Assessment Tool and Scoring Guidance Notes

Criteria	0 = Not at all	1 = Very slightly	2 = Moderately	3 = Complete
Explicit theoretical framework	No mention at all.	Reference to broad theoretical basis.	Reference to a specific theoretical basis.	Explicit statement of theoretical framework and/or constructs applied to the research.
Statement of aims/objectives in main body of report	No mention at all.	General reference to aim/objective at some point in the report including abstract.	Reference to broad aims/objectives in the main body of report.	Explicit statement of aims/objectives in the main body of report.
Clear description of research setting	No mention at all.	General description of research area and background, e.g. ‘in primary care’.	General description of research problems in the target population, e.g. ‘among GPs in primary care’.	Specific description of the research problem and target population in the context of the study, e.g. nurses and doctors from GP practices in the east midlands.
Evidence of sample size considered in terms of analysis	No mention at all.	Basic explanation for choice of sample size. Evidence that size of the sample has been considered in study design.	Evidence of consideration of sample size in terms of saturation/information redundancy or to fit generic analytical requirements.	Explicit statement of data being gathered until information redundancy/saturation was reached or to fit exact calculations for analytical requirements.
Representative sample of target group of a reasonable size	No statement of target group.	Sample is limited but represents some of the target group or representative but very small.	Sample is somewhat diverse but not entirely representative, e.g. inclusive of all age groups, experience but only one workplace. Requires discussion of target population to determine what sample is required to be representative.	Sample includes individuals to represent a cross section of the target population, considering factors such as experience, age and workplace.
Description of procedure for data collection	No mention at all.	Very basic and brief outline of data collection procedure, e.g. ‘using a questionnaire distributed to staff’.	States each stage of data collection procedure but with limited detail, or states some stages in details but omits others.	Detailed description of each stage of the data collection procedure, including when, where and how data were gathered.
Rationale for choice of data collection tool(s)	No mention at all.	Very limited explanation for choice of data collection tool(s).	Basic explanation of rationale for choice of data collection tool(s), e.g. based on use in a prior similar study.	Detailed explanation of rationale for choice of data collection tool(s), e.g. relevance to the study aims and assessments of tool quality either statistically, e.g. for reliability & validity, or relevant qualitative assessment.
Detailed recruitment data	No mention at all.	Minimal recruitment data, e.g. no. of questionnaire sent and no. returned.	Some recruitment information but not complete account of the recruitment process, e.g. recruitment figures but no information on strategy used.	Complete data regarding no. approached, no. recruited, attrition data where relevant, method of recruitment.
Statistical assessment of reliability and validity of measurement tool(s)	No mention at all.	Reliability and validity of measurement tool(s) discussed, but not statistically assessed.	Some attempt to assess reliability and validity of measurement tool(s) but insufficient, e.g. attempt to establish test–retest reliability is unsuccessful but no action is taken.	Suitable and thorough statistical assessment of reliability and validity of measurement tool(s) with reference to the quality of evidence as a result of the measures used.
Fit between stated research question and method of data collection	No research question stated.	Method of data collection can only address some aspects of the research question.	Method of data collection can address the research question but there is a more suitable alternative that could have been used or used in addition.	Method of data collection selected is the most suitable approach to attempt to answer the research question.
Fit between research question and method of analysis	No research question stated.	Method of analysis can only address the research question basically or broadly.	Method of analysis can address the research question but there is a more suitable alternative that could have been used or used in addition to offer greater detail.	Method of analysis selected is the most suitable approach to attempt to answer the research question in detail, e.g. for qualitative IPA preferable for experiences vs. content analysis to elicit frequency of occurrence of events, etc.
Good justification for analytical method selected	No mention at all.	Basic explanation for choice of analytical method.	Fairly detailed explanation of choice of analytical method.	Detailed explanation for choice of analytical method based on nature of research question(s).
Evidence of user involvement in design	No mention at all.	Use of pilot study but no involvement in planning stages of study design.	Pilot study with feedback from users informing changes to the design.	Explicit consultation with steering group or statement or formal consultation with users in planning of study design.
Strengths and limitations critically discussed	No mention at all.	Very limited mention of strengths and limitations with omissions of many key issues.	Discussion of some of the key strengths and weaknesses of the study but not complete.	Discussion of strengths and limitations of all aspects of study including design, measures, procedure, sample & analysis.

Table 4. Characteristics of included studies

	Authors, Year, & Country	Study Aim	Study Design	Sample & Setting	Intervention	Findings/ Outcomes
Article 1 Article 2 Article 3 Article 4 Article 5 Article 6 Article 7	Alt, M. and Humphrey, M. (2012). US Sutherland et al. (2017). Australia Sutherland et al. (2019). Australia Waite et al. (2010). Australia Hodge et al. (2019). Australia Manzanares, B. and Pui, F. K. (2014). US Raman et al. (2019). India	To determine if there is alternate form’s reliability for paper- and computer- administered standardized vocabulary tests and to determine whether the behavioral ratings of children with autism spectrum disorders (ASDs) would improve during the computer-administered testing sessions secondary to a decreased need for social interaction. To determine whether, within an existing service, a web-based telehealth application using consumer grade, commercially available computer equipment could be used to provide a formal language assessment that is feasible, reliable, and well-tolerated by participants and their families. To investigate the reliability of language assessments for children on the autism spectrum, delivered via telehealth and to explore the feasibility of the use of telehealth with children with autism, exploring their behavioral responses to tele-health and face-to-face assessment conditions. To examine the validity and reliability of an Internet-based telehealth system for assessing childhood language disorders on the core components of a standardized assessment tool. To determine the feasibility and reliability of telepractice assessments, using consumer-grade technology, in children with reading difficulties. To explore the effects of using videoconferencing to assess children's language skills. To (1) compare receptive and expressive scores obtained on a language screening tool through in-person testing and telemethod among children and (2) to assess technology- and child-related factors influencing screening via telemethod.	Non- randomized Method comparison Method Comparison Non- randomized Non- randomized Non- randomized Non- randomized	18 children with a diagnosis of ASD (5 female/ 13 male) and 18 NT children as a control group. Children were between 5 and 13 years of age with English as their first language. Setting not discussed. 23 children (5 female/ 18 male) aged 8-12 years with a history of reading difficulties and known/ suspected language impairment. All participants were attending mainstream schools. Participants had not had a language assessment using the CELF-4 within the previous six months. The assessments were conducted from the metropolitan telehealth site in Westmead, NSW, to the three hub sites in rural NSW (Hub 1 and Hub 3) and suburban Sydney, NSW (Hub 2). 13 children (3 female/ 10 male) between 9;5 to 12;3 years of age with autism and attend mainstream schools or support classes. Face-to-face administration took place in a remote location in Westmead, NSW and telehealth assessment was delivered remotely from Melbourne, VIC. 25 children (8 female/ 17 male) between 5 to 9 years of age with a previous diagnosis of language impairment or identified as having difficulties in language by a parent or teacher but has not been formally assessed. Primary language of participants was English. Assessments were conducted between two rooms within the same building at the University of Queensland. 37 children between 8 to 12 years of age with a diagnosis of Specific Learning Disorder with impairment in reading. Children were located remotely (in Dubbo, Wagga Wagga, Westmead, or Manly) and accompanied by local staff (face-to-face teacher). 6 typically developing children (2 female/ 4 male; mean age = 4;0) whose primary language was English and came from middle class families. Both face-to-face and videoconferencing conditions were conducted in dedicated rooms of the Speech, Language, and Hearing Sciences building at the University of Colorado, Boulder. 32 children (mean age = 6;3) in first grade were selected from a primary school in Tirupur town. 15 children were identified by teachers as having concerns in one or more areas of hearing, speech, language, or academic performance. The remaining 17 children had no specific concerns and were randomly selected from the same classrooms. The in-person and telemethod language screenings were carried out in a single dedicated space allocated within the school premises.	Two versions (i.e., paper vs. computer) of the Expressive One-Word Picture Vocabulary Test (EOWPVT–2000; Brownell, 2000a) and the Receptive One-Word Picture Vocabulary Test (ROWPVT–2000; Brownell, 2000b). Also used a behavioral rating instrument created for this study that was used to record observable negative behaviors and to record overall impressions of the testing session. Two versions (i.e., paper vs. computer) of the CELF-4. Children in the 5–8-year-old range were administered the Concepts and Following Directions, Word Structure, Recalling Sentences and Formulated Sentences subtests. Children in the 9–12-year-old range were administered the same subtests with the addition of word classes. Subtests (Concepts and Following Directions, Recalling Sentences, Formulated Sentences and Word Classes) of the Clinical Evaluation of Language Fundamentals 4th Edition, Australia & New Zealand (CELF-4; Semel et al. 2003) were used in both the telehealth and face-to-face assessment conditions. Also used a behavior observation rating scale that was adapted from the Clinical Evaluation of Language Fundamentals—Preschool, 2nd edition, Australian and New Zealand (CELF-P2; Wiig et al. 2006) behavior checklist. Clinical Evaluation of Language Fundamentals- Fourth Edition (CELF–4), Australian adaptation (Semel, Wiig, & Secord, 2003). The four-core language subtests for children ages 5 to 8 years (Concepts and Following Directions, Word Structure, Recalling Sentences, and Formulated Sentences) were administered. Assessments delivered via a web-based application by a remotely located research assistant. Subtests from the Woodcock Reading Mastery Tests-Third Edition (WRMT-III), including Word Identification, Word Attack, and Passage Comprehension. The Phonemic Decoding Efficiency subtest from the Test of Word Reading Efficiency-Second Edition (TOWRE-2). The MultiLit Sight Words Test and the Dalwood Spelling Test. Also had parents complete a brief survey indicating the perceived comfort level of their child during the assessment as well as their own comfort level. Story-retell task in both videoconferencing (VC) and face-to-face (F2F) conditions using a story, along with a wordless book. In addition, 4 unfamiliar words were embedded within the story. The Assessment of Language Development (ALD; Lakkanna, Venkatesh, & Bhat, 2008) using digitized picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site. Technology and child related factors influencing screening were documented using an inventory.	No significant difference between Standard scores for both versions of the tests for both groups of participants. No significant difference in behavioral ratings between the two methods of test presentation. Determined system for telehealth delivery was feasible and presented adequate reliability with high levels of agreement between telehealth and face-to-face delivery. Parent and child reactions to the use of telehealth were largely positive and supportive of using telehealth to assess rural children. High agreement between assessment scores obtained via telehealth and face-to-face SLPs suggested that scores obtained in each setting were similar. Regarding behavioral measures, this study suggests that the responses of children with ASD to telehealth are likely to be highly individual. However, there was no clear difference between the conditions at the group level. No significant difference was found between the online and face-to-face total raw and scaled scores in each subtest. Found strong agreement between telepractice and face-to-face rated scores. Parents reported high degree of comfort with the telepractice assessments. No significant difference in narratives between videoconferencing and face-to-face conditions. Also found that children learned target words in both conditions equally well. No significant difference in receptive and expressive domains between videoconferencing and face-to-face conditions. Found that using multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod. Additionally, trained facilitators were essential in overcoming child-related factors (e.g., poor speech intelligibility, poor audibility of voice, motivation, interaction with SLP, and need for frequent breaks).

Data extraction and Outcomes Classification

Data from the seven articles that met predetermined inclusion criteria outlined by the QAT (Table 3) and passed the extraction portion of the screening process for further analysis was extracted and is presented in Table 4. Each article was broken down by authors, publication year, country, study aims, study design, sample size/setting, intervention, and findings/outcomes.

Statistical Analysis

The articles selected for this systematic review each utilized at least two methods for statistical analysis. Methods varied across studies and included the following: Analysis of Variance (ANOVA), Multivariate Analysis of Variance (MANOVA), simple linear regression, method comparison analysis, Pearson’s correlation, Bland-Altman analyses (limits/measures of agreement, plots), t-tests (independent and paired), Wilcoxon signed rank test, Kolmogorov-Smirnov Test for Normality, Bonferroni procedure, Cohen’s kappa (weighted and unweighted), Intraclass Correlation Coefficients (ICC), Spearman’s Rank Correlation Coefficient, Systematic Analysis of Language Transcripts (SALT), and power analysis. Only one study (article 3) specified using the Statistical Package for the Social Sciences (SPSS) software to perform statistical analyses procedures.

Interrater Reliability

Weighted percent agreement was used to calculate the interrater reliability of the researchers who independently completed the screening of titles and abstracts and then proceeded to review the full-text articles. Percent agreement for the screening of titles and abstracts was computed through Covidence, the online screening research tool utilized during this process. Weighted percent agreement for the titles and abstracts screening round was 96% and 73% for the full-text review round.

Results

Participant Characteristics

Majority of the studies (57%) focused on individuals with either suspected impairment in language, hearing, speech, and/or academic performance, previously diagnosed impairments (e.g., language impairment, Specific Learning Disorder with impairment in reading), or a combination of both (suspected and previously diagnosed). Two studies included in this review focused on individuals with Autism Spectrum Disorder (ASD) and one study only included typically developing children. Five of the seven studies specified the inclusion of both female and male participants, with the majority of participants being male in all five studies. Participant ages ranged from the youngest being 4-years-old to the oldest being 13-years-old (as reported). Sample sizes ranged between 6 to 37 participants with most studies (71%) including more than 20 participants. A more detailed breakdown of each study's specific participant characteristics can be found in Table 4.

Telepractice Technology

In general, most studies offered a description of their chosen telehealth technology. The researchers typically communicated with participants in real time using video conferencing software, either commercially produced (e.g., Adobe ConnectPro) or custom made for research purposes. In four out of seven studies, research teams used custom-made software programs. Commonly used hardware included commercially available computers, laptops, webcams, microphones, and/or comprehensive teleconferencing systems. Regarding the internet connection, a study utilized a 128-Kbs Internet link, while another study accessed the internet through plug-in dongles, mobile hotspots, wired LAN and/or Wi-Fi hotspot. The rest of the studies did not provide thorough details about their internet connection.

Feasibility/Language Outcomes

Most of the articles reviewed reported no significant difference between telehealth and face-to-face scores, three of them reported high agreement between telehealth and face-to-face scores. Alt, M. and Humphrey, M. (2012) reported no significant difference in behavioral ratings between the two methods. Regarding behavioral measures, Sutherland et al. (2019) suggests that the responses of children with ASD to telehealth are likely to be highly individual. Sutherland et al. (2017) determined the system for telehealth delivery was feasible and reported the reactions of the parents and children on the use of telehealth were largely positive and supportive to assess rural children. Raman et al. (2019) found that using multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod. Language outcomes through face-to-face and telehealth methods revealed no significant differences in both receptive and expressive domains. Additionally, trained facilitators were essential in overcoming child-related factors (e.g., poor speech intelligibility, poor audibility of voice, motivation, interaction with SLP, and need for frequent breaks). Overall, most of the articles reviewed reported no significant differences in score between telehealth and face-to-face methods and high satisfaction with feasibility and comfort level of parents and children via telehealth method.

Patient Satisfaction

Most of the studies did not report client and clinician satisfaction, only three of them reported on parent satisfaction and child’s comments. Overall, parents reported high satisfaction and comfort with the telehealth assessments. In addition, the parents reported positive behaviors in the children. No parents indicated that they felt uncomfortable with the telehealth assessments. Parents were asked to complete a survey in which the comments from parents reported that their child had a positive experience and many of the parents commented on their own positive experience or opinion of the telehealth assessments. However, in (add study here) “Two parents expressed concern: one parent felt their child lost concentration when he got a question wrong; the second parent stated their child ‘did like to use the computer and the videoconferencing.... but he would prefer to talk to a person face-to-face’.” Nevertheless, most parents reported that their children really enjoyed the experience and one parent commented that on the way home the child stated “it was awesome!” (study)

Discussion

A synthesis of studies examining the feasibility and reliability of conducting language-based assessments in children ranging in age from 3 to 13 years and with varying abilities (known/diagnosed disorder v. typical) was conducted to discover what factors (child and technology- related) may specifically impact assessment administration via telehealth in comparison to face-to-face administration. This systematic review also looks to investigate behavioral implications throughout assessment administration and parental satisfaction with telehealth alternatives.

Of the seven articles, only two were a method comparison study design (2, 3) as opposed to the other five which followed a non-randomized design(1, 4, 5, 6, 7). Majority of the studies were carried out in Australia (2, 3, 4, 5), two in the US (1, 6), and one in India (7). All of the studies were focused on determining the feasibility and/or reliability of administering a language-based assessment via telehealth. Articles 1, 3, and 7 also examined the behavioral implications of telehealth administration along with observing technology-related factors (7). Based on the results of this integrative review, a need for further research has been identified to determine the feasibility and reliability of conducting language-based assessments particularly in bilingual children between the ages of 36 to 47 months.

Limitations

Conclusion

Current research suggests that there is no significant difference between remote and face-to-face assessment administration. The results of the systematic review have demonstrated the current feasibility of administering assessments online, however, further research is necessary to determine the feasibility and reliability of conducting language-based assessments online particularly for bilingual children between the ages of 36 to 47 months.. This service delivery model has the potential to be used by speech-language pathologists (SLPs) to provide assessments to children in remote communities and those communities where access to bilingual SLPs is lacking. Future research should focus on the capacity to provide these telehealth assessments in schools or clinics.

References

Sirriyeh, R., Lawton, R., Gardner, P., & Armitage, G. (2012). Reviewing studies with diverse designs: the development and evaluation of a new tool. Journal of Evaluation in Clinical Practice, 18(4), 746–752. https://doi-org.ezproxy.fiu.edu/10.1111/j.1365-2753.2011.01662.x