Environmental factors and their associations with speech-language-hearing diagnostic hypotheses in children and adolescents

Abstract

Purpose: to analyze the associations between speech-language-hearing diagnostic hypotheses in children and adolescents and the Environmental Factors in the International Classification of Functioning, Disability, and Health. Methods: an observational, analytical, cross-sectional study carried out between 2016 and 2019 in an outpatient center with 5- to 16-year-old children and adolescents undergoing speech-language-hearing assessment and their parents/guardians. The Brazilian Economic Classification Criteria was used, and sociodemographic data were collected, along with speech-language-hearing diagnostic hypotheses and information on the presence of categories of the Environmental Factors, qualified as either barriers or facilitators. Descriptive and association analyses were made, using Pearson’s chi-square and Fisher’s Exact tests, with the significance level set at 0.05. Results: most participants had changes in oral language acquisition/development, written language, and oral-motor function. The most prevalent facilitators were in the categories of Services, Systems, and Policies; Support and Relationships; and Products and Technology, whereas the barriers were in the categories of Attitudes; Products and Technology; and Services, Systems, and Policies. The diagnostic hypotheses of “Change in cognitive aspects of language”, “Change in speech”, and “Change in voice” had a significant association with the codes present in chapters 3 - Support and Relationships, and 4 - Attitudes. Conclusion: this association shows that patients with communication changes need a comprehensive approach encompassing the Contextual Factors.

ICF and perception of functioning according to children/adolescents in follow-up with speech/language disorders

“…One study that addressed the importance of considering Environmental Factors in an outpatient service with children and adolescents in the speech-language pathology evaluation process reported that the most prevalent facilitators were Services, Systems, and Policies; Support and Relationships; and Products and Technology, whereas the barriers were in the categories of Attitudes; Products and Technology. The variable “Change in speech” had a significant association with the categories of chapter 3 - Support and Relationships, and 4 - Attitudes ( 21 ) .…”

“…ICF provides a unified language to describe health conditions, and allows elaboration of instruments to characterize functioning through different points of view. Analysis of the effects of the speech-language follow-up has been carried out mainly under the perspective of SLPs and parents of children and adolescents with speech and language disorders (12,14,(18)(19)(20)(21) . Examples, where speech-language pathologists and parents evaluated these changes have taken place in Canada using the Focus on the Outcomes of Communication Under Six (FOCUS) (12,15,18) .…”

“…Because the ICF contains relevant aspects to SLPs who work with speech and language disorders, it is important to study their use in the therapeutic process. Researches have addressed parents' and professionals' perception of speech disorders (12,14,(18)(19)(20)(21) , but few studies have investigated children's and adolescents' perception of their own difficulties. Therefore, the aim of this study was to characterize changes in functioning aspects as perceived by children and adolescents with speech and language disorders, under speech-language follow-up, using the ICF.…”