Doctor of Philosophy

dissertationResearchers estimate that roughly 7%-8% of children will enter kindergarten with deficits in language that cannot be attributed to comorbid conditions such as intellectual deficits or other neurodevelopmental disorders. Despite its prevalence, less than a quarter of children are identified and receive treatment. Children with language impairments who go unidentified, and consequently, untreated at the entry of kindergarten, are at cumulative risk for academic and social difficulties during their formative and later school years. Public schools play a central role in the identification of this population. A vast majority of public-school districts identify children with language delay using a referral-based format that relies heavily on referral sources such as general education teachers and parents. Research has shown that vulnerabilities may exist in such systems. Currently, there is no policy supporting universal screening for language impairment identification in public schools. The primary purpose of this study was to conduct a practice-based hybrid-implementation pilot research study with a local school district to assess the feasibility of annual screenings for language impairment. This was achieved by addressing two specific aims. The first aim assessed the usefulness of the Redmond Sentence Recall (RSR) measure as a universal screener. The second aim targeted the facilitators and barriers to the systematic uptake of an annual-based screening format specific to this school district. Regarding the first aim, 165 kindergarten students from two school sites were administered the RSR screening measure. Of these, 19 students failed the screening and participated in confirmatory testing. The positive predictive rate associated with the RSR measure was .74, representing an improvement over estimates of preexisting district-level general education teacher referral positive predictive rates of .35. Positive case rates associated with the screening (7.88%) aligned with well-accepted prevalence rates. Regarding the second aim, two focus groups were conducted with district teaching assistants who administered the screener (focus group 1) and district Related Services administrators, kindergarten teachers, and speech-language pathologists (focus group 2). A list of facilitators and barriers to a universal screening format was identified. Survey statements were then developed from this list to assess more broadly levels of agreement within the school district. Accordingly, 66 speech-language pathologists and 88 general education teachers participated in the survey. Key findings included: 1) Wide support for an annual- over referral-based identification format. 2) The negative impact of burden on key stakeholders under both referral- and annual-based formats. 3) The identification of speech-language technicians or teaching assistants as preferred personnel to administer regular screenings. 4) The important role Response to Intervention programs stand to play to reduce burdens associated with universal screenings. 5) The need for increased awareness/education with regard to child language development and impairment among general education teachers and the public at large