The views of Speech and Language Therapists regarding the approaches to, and issues surrounding the diagnosis and treatment of Developmental Verbal Dyspraxia

Abstract

Background: There is currently no validated list of diagnostic features to determine the differential diagnosis of Developmental Verbal Dyspraxia (DVD), nor has there been any optimum assessment and management approaches recommended with this client group. Yet, the term DVD seems to provide clinicians with a category for children whose profiles differ from those with a speech delay or disorder, and who produce atypical and inconsistent speech patterns. In an online debate posted by Afasic, the validity of DVD as a childhood speech disorder is being questioned. Its surface phonological error patterns are similar to an Inconsistent Phonological Disorder, which makes the differential diagnosis difficult. Care pathways for these subcategories of speech impairment are the same, and therefore the question has been raised as to whether there is need for separate diagnoses, if the outcome for management is the same. Aims: To explore Speech and Language Therapists’ (SLTs’) typical practice when working with a child with suspected DVD, and secondly, to explore SLTs’ perspective on the process of diagnosis, and reflect on their practice. Methods and Procedure: Semi-structured interviews were carried out with 5 SLTs. The interviews were transcribed and later analysed using thematic analysis, where themes were discovered and later discussed. Outcomes and Results: The participants demonstrated their knowledge surrounding the characteristics of DVD, and discussed how they would approach diagnosis, assessment, and management. Despite the controversy surrounding its diagnosis, the SLTs interviewed felt able to manage DVD, and were comfortable in their ability to make the diagnosis, however there were other factors that contributed to the implications and motivations of labelling DVD. Participants were motivated to provide a diagnosis of DVD if the child would receive adequate service provision. Implications to providing a diagnosis included the impact of the diagnosis on the child, parent, and teachers, in terms of it being a lifelong difficulty, and the expectations imposed post diagnosis, and also service constraints. Conclusion: Finding it difficult to arrive at a diagnosis could be attributed to a lack of validated list of diagnostic features for DVD, however this did not seem to be the case for the SLTs interviewed in this particular study. Concern was raised over the lack of validated list of diagnostic features and optimum assessment and management strategies for DVD, with the reliance to guide clinical decision being influenced by literature, suggesting the need for further research and clarification of DVD. Service constraints in relation to DVD raise the question as to whether SLTs’ perspectives and behaviours towards diagnosis would change, given the availability of adequate service delivery models.