how do caregivers perceive their child’s a study of

HOW DO CAREGIVERS PERCEIVE THEIR CHILD’S LANGUAGE DISORDER?

A STUDY OF QUALITY, COMPETENCE, AND OUTCOMES

by

Jennifer Selin, B.S.

A THESIS

IN

SPEECH-LANGUAGE PATHOLOGY

Submitted to the Graduate Faculty

of Texas Tech University Health Sciences Center in

Partial Fulfillment of

the Requirements for

the Degree of

MASTER OF SCIENCE

Approved

Mary Beth Schmitt, Ph.D., CCC-SLP

Chair of Committee

Melinda Corwin, Ph.D., CCC-SLP

Tobias Kroll, Ph.D., Intern-SLP

Carolyn Perry, M.S., CCC-SLP

Lori Rice-Spearman, Ph.D.

Dean of the School of Health Professions

May 2016

Texas Tech University Health Sciences Center, Jennifer Selin, May 2016

ii

Acknowledgements

I would like to thank my committee chairperson Dr. Mary Beth Schmitt for her

encouragement and continuous support during this thesis process. You have guided,

instructed, and encouraged me to explore some of my clinical questions through research,

and I will always be grateful for the way you helped me shape this project and change my

own perceptions. To my committee members, Dr. Melinda Corwin, Dr. Tobias Kroll, and

Mrs. Carolyn Perry, this project would not have produced the results it did without your

creative collaboration and dedicated support. I am thankful for each of your unique

perspectives and the enrichment you brought to this process. I would like to thank my

family, Jim, Mary, Aaron, and Jamie, for their unfailing love and encouragement. Finally,

I thank my husband Cory for the patience, love, and grace that you have generously given

me and for the continuous support you have always shown me.


iii

Table of Contents

Acknowledgements .......................................................................................................... ii

Abstract ............................................................................................................................. v

List of Tables .................................................................................................................. vii

I. Introduction .................................................................................................................. 1

II. Literature Review ....................................................................................................... 4

Theoretical Framework .......................................................................................... 6

Bioecological Theory. ................................................................................ 6

Family Systems Theory. ............................................................................ 7

Caregiver Perceptions ............................................................................................ 8

Quality of communicative interactions. ..................................................... 9

Competence in communicative abilities. ................................................. 11

Outcomes of communicative improvement. ............................................ 15

Alignment ............................................................................................................ 19

Caregiver- and Child-Level Factors..................................................................... 21

Caregiver-level factors. ............................................................................ 21

Maternal education. ................................................................................. 21

Caregiver self-efficacy. ............................................................................ 22

Child-level factors. ................................................................................... 23

Language disorder severity...................................................................... 24

Gender...................................................................................................... 25

Summary and Research Aims .............................................................................. 25

III. Methodology ............................................................................................................ 28

Participants ........................................................................................................... 28

Procedures ............................................................................................................ 29

Measures .............................................................................................................. 30

Design Analysis ................................................................................................... 32

IV. Results ....................................................................................................................... 34

Research Aim One: Characterizing Caregivers’ Perceptions .............................. 34

Research Aim Two: Alignment ........................................................................... 35

Research Aim Three: Caregiver and Child Factors ............................................. 37



iv


V. Discussion .................................................................................................................. 41

Characterizing Caregivers’ Perceptions ............................................................... 41

Alignment of Perceptions .................................................................................... 46

Predictive Factors of Perception .......................................................................... 49



Research Limitations ........................................................................................... 53

Future Direction ................................................................................................... 54

Conclusion ........................................................................................................... 56

References ...................................................................................................................... 57

Tables .............................................................................................................................. 63

Appendices ..................................................................................................................... 70

A: Caregiver Perceptions of Language Disorders Questionnaire ........................ 70

B: SLP Perceptions of Language Disorders Questionnaire ................................. 75


v

Abstract

Theoretically, caregiver perceptions (beliefs, opinions, and feelings regarding

their child’s language disorder) matter because a child’s interactions are bi-directionally

influenced by his environment. Caregiver perceptions may influence the nature of those

interactions and by extension, impact children’s language development. This study

addressed three aims: (a) To characterize caregivers’ perceptions of their child’s language

disorder with regard to quality of communicative interactions, competence in

communicative abilities, and outcomes of communicative improvement; (b) To determine

the extent to which caregivers’ perceptions align with speech-language pathologist (SLP)

report; (c) To determine the extent to which caregiver and child factors predict alignment.

Twenty-five caregivers and four SLPs completed this study. Eligible caregivers

had 3- to 4-year-old children with language disorders who were currently receiving

language treatment. Caregivers and SLPs were recruited from the Texas Tech University

Health Sciences Center (TTUHSC) Speech-Language and Hearing Clinic and Head Start

campuses in Lubbock, Texas. Caregiver and SLP questionnaires were created to gather

data for perceptions, caregiver factors (maternal education and self-efficacy), and child

factors (gender and language disorder severity). Descriptive analyses were run to answer

the first and second study aims, and regression analyses were run to answer the third

study aim.

Caregivers’ perceptions were more positive and more variable than SLPs’

perceptions. Caregivers’ perceptions of outcomes (potential for their child’s

improvement) were greater than for quality (importance placed on communication) or

competence (language performance), which was consistent with SLPs’ perceptions.


vi

Caregivers were aligned with SLPs for an average of 24.2 statements of perception (SD =

4.26; range: 15 – 33; 54%). Finally, none of the factors examined in this study were

significant predictors of alignment. Given the variability in caregiver perceptions, future

research should explore the role of perceptions in children’s language intervention across

ages and disorders.


vii

List of Tables

1. Descriptive Data for Aggregated Study Variables............................................... 63

2. Alignment Between Caregivers’ and SLPs’ Perceptions ..................................... 64

3. Descriptive Statistics for Caregiver and Child-Level Factors ............................. 65

4. Descriptive Statistics for Children’s Language Disorder Severity ...................... 66

5. Correlations Between Disorder Severity Measures ............................................. 67

6. Correlation Coefficients Among Perception Factors ........................................... 68

7. Regression Analyses for Alignment Models ....................................................... 69


1

Chapter I

Introduction

The American Speech-Language-Hearing Association (ASHA) defines a

language disorder as an impairment of the ability to understand or use a symbol system in

oral, verbal, or visual forms. This disorder may manifest as a deficit in content (i.e.,

semantics), form (i.e., phonology, morphology, syntax), or use (i.e., pragmatics), or any

combination thereof (ASHA, 1993). Language disorders may present anywhere on a

spectrum ranging from mild (i.e., impacts performance, but does not limit participation)

to profound (i.e., child requires maximal assistance during all activities of daily living;

Paul & Norbury, 2012). Early developmental language disorders can persist into later

childhood in the form of other developmental and functional difficulties (Shevell,

Majnemer, Webster, Platt, & Birnbaum, 2005). As a result, much emphasis has been

placed on early intervention for preschoolers with language disorders including caregiver

involvement (Miedel & Reynolds, 1999; Pancsofar and Vernon-Feagans, 2006), quality

classrooms (Justice, Mashburn, Hamre, & Pianta, 2008), and evidence-based language

therapy (Law, Garrett, & Nye, 2004). One factor that may contribute to the success of

early intervention is caregiver perceptions.

Caregiver perceptions are defined as caregivers’ beliefs, opinions, and feelings

regarding their child’s communication. Specifically, this study will characterize

caregivers’ perceptions of their child’s language disorder across three categories: quality

of communicative interactions, competence in communicative abilities, and outcomes of

communicative improvement. Hereafter, these categories are referred to as quality,

competence, and outcomes. From a theoretical stance, caregiver perceptions matter


2

because a child is influenced by bi-directional interactions with his environment,

including his family and caregivers. Therefore, caregiver perceptions may influence the

nature of those interactions understood to be critical for language development. From a

research stance, caregiver perception is a malleable quality that is significantly associated

with intervention (Baker-Henningham & Walker, 2009; Baxendale, Lockton, Adams, &

Gaile, 2013; Chien & Lee, 2013; Huttunen & Välimaa, 2012; Jindal-Snape, Douglas,

Topping, Kerr, & Smith, 2005; Romski et al., 2011; Sadler, 2005). From a conceptual

stance, perception may influence the extent of caregiver involvement in children’s

therapy, which is known to have significant impacts on children’s outcomes (Foster,

Lambert, Abbott-Shim, McCarty, & Franze, 2005; Miedel & Reynolds, 1999; Rodriguez

et al., 2009). As an example, a retrospective study involving 704 parents of inner city

children found that when children participated in more activities with their parents during

the preschool and kindergarten years, their reading achievement was higher, grade

retention rates were lower, and fewer years of special education services were reported

(Miedel & Reynolds, 1999). Understanding caregivers’ perceptions of the language

disorder may provide insight to caregiver involvement (or lack thereof) with their child

with a language disorder. In fact, previous literature not only supports the role of

caregiver involvement for informing outcomes, but it suggests that caregiver perceptions

improve following intervention (Baker-Henningham & Walker, 2009; Baxendale et al.,

2013; Chien & Lee, 2013; Huttunen & Välimaa, 2012; Jindal-Snape et al., 2009; Romski

et al., 2011; Sadler, 2005).

To date, much of what we understand about caregiver perceptions comes from

medically-based literature (e.g., Amillategui, Mora, Calle, & Giralt, 2009; Salvador,


3

Carla, Martins, Santos, & Canavarro, 2014; Selkirk, McCarthy Veach, Lian, Chimmenti,

& LeRoy, 2009), adolescent-based studies (e.g., Hughes, Turkstra, & Wulfeck, 2009;

Joffe & Black, 2012), or examines caregiver perceptions as one of several factors

included in intervention studies (e.g., Baker-Henningham & Walker, 2009; Baxendale et

al., 2013; Jindal-Snape et al., 2009; Romski et al., 2011). No studies of which we are

aware have characterized caregiver perceptions of prechoolers with language disorders

receiving typical language intervention.

Given the emphasis on early intervention to help circumvent the long-term effects

associated with language disorders (ASHA, 2008) and the potential influence of

caregivers’ perceptions on involvement and subsequent children’s outcomes, it is

important to fully understand caregivers’ perceptions regarding their children’s language

disorders and the extent to which these perceptions align with speech-language

pathologists’ (SLP) perceptions. The literature supports the role of caregiver perception

in the intervention process, but it does not explain caregivers’ perceptions of language

disorders in the preschool population. Gaining a better understanding of caregivers’

perceptions may help predict caregiver involvement, and thus, children’s prognosis and

intervention outcomes. To address this need, the current study characterized caregivers’

perceptions of their child’s language disorder, determined alignment of their perceptions

with SLPs’ reports, and determined to what extent caregiver- and child-level factors

predict alignment.


4

Chapter II

Literature Review

Caregivers of children with language disorders play an instrumental role in their

intervention (Kaiser & Roberts, 2013), and the degree of caregiver involvement is a

significant predictor of a child’s prognosis for improved outcomes (Hall & Segarra, 2007;

Miedel & Reynolds, 1999; Pancsofar & Vernon-Feagans, 2010). This may be especially

critical for preschoolers with language disorders, given the risk of long-term impacts

associated with language disorders (ASHA, 2008). One factor that may significantly

influence caregiver involvement – and subsequently children’s progress – is caregiver

perceptions of their child’s language disorder.

Perception, as documented in existing research, varies according to the field of

study. In the Autism Spectrum Disorder (ASD) literature, perception loosely refers to

caregiver satisfaction (Jindal-Snape et al., 2005) or point-of-view (Pondé & Rousseau,

2013). In the hearing impairment literature, perception is defined as caregiver satisfaction

and expectations of habilitation (Huttunen & Välimaa, 2012). In the hearing impairment

and language disorders literature, perception is implicitly described as reported

observations (Hsing & Lowenbraun, 1997; Joffe & Black, 2012) or ratings of behaviors

(Wittke, Spaulding, & Schechtmana, 2013). For the purposes of this study, caregivers’

perceptions are defined as caregivers’ beliefs, opinions, and feelings regarding their

child’s communication. Specifically, this study will characterize caregivers’ perceptions

of their child’s language disorder across three categories: (a) quality of communicative

interactions, (b) competence in communicative abilities, and (c) outcomes of


5

communicative improvement. Hereafter, these categories are referred to as quality,

competence, and outcomes.

The existing corpus of research focuses on caregivers’ perceptions of their

child’s performance or abilities with respect to a diagnosis or following a treatment

protocol; however, much of these data are inconsistent or inconclusive regarding how

caregivers perceive their child’s language disorder diagnosis and the intervention process

(Goodman & Glenwick, 2012; Joffe & Black, 2012; McCormack, McLeod, Harrison, &

McAllister, 2010; Pondé & Rousseau, 2013; Smith, Romski, Sevcik, Adamson, & Barker,

2014). For example, one body of research suggests caregivers show agreement in their

perceptions (Hall & Segarra, 2009; Hughes et al., 2009), yet other studies report more

discrepancies across respondents (e.g., Selkirk et al., 2009). Additionally, while several

studies compared perceptions across caregivers and between caregivers and professionals

(e.g., Baxendale et al., 2013; Hughes et al., 2009; Joffe & Black, 2012; Romski et al.,

2011; Smith et al., 2014; Wittke et al., 2013), most do not account for professional

perceptions, including SLPs, which may offer a professional, subjective measure by

which to interpret perceptions of disorders (but see McCormack et al., 2010).

Furthermore, caregivers’ perceptions have not been conclusively correlated with

predictive factors. This study will characterize caregiver perceptions of their children’s

language disorders, determine alignment of their perceptions to SLP report, and identify

how caregiver and child-level factors predict alignment. Justification for this study is

explained in the following sections: (a) theoretical foundation for the study, (b) critical

review of existing knowledge regarding caregiver perceptions, (c) review of existing


6

knowledge on alignment, and (d) discussion of possible factors that may predict

alignment with SLP report.

Theoretical Framework

Bioecological Theory. Urie Bronfenbrenner argued that child development

research should be completed in the context of the child’s environment to obtain a more

accurate representation of the child’s abilities and relationships (Lerner, 2002). His

theory has four interrelated components: the child’s developmental process; the child,

being composed of cognitive, behavioral, emotional, and biological characteristics; a

system of nested environments or systems; and the multidimensionality of time (Lerner,

2002). Bronfenbrenner described the nested levels as an interconnected system of

environments that influence each other bi-directionally (Bronfenbrenner, 1986). Each

individual can be viewed as having immediate interactions within the microsystem,

which may contain the child, caregivers, and siblings in their home or the child with

teachers and peers in an educational setting (Bronfenbrenner, 1977). The child exists

within the microsystem, and his interactions with others are influenced by his biological,

emotional, cognitive, and behavioral characteristics (Lerner, 2002). Bronfenbrenner

(1986) explained that there is a reciprocity that occurs between different microsystems in

the child’s environment, meaning that events or interactions at home may influence

interactions at school, and vice versa; he termed these mesosystems. The exosystem

includes the overarching systems that indirectly influence the child, such as government

or religious systems. There exists another system in which the child does not directly

interact, but by which he is influenced: the macrosystem. The macrosystem embodies the

cultural norms and overarching principles by which all other systems interact, thus


7

impacting the child’s more immediate and intermediary environments (Bronfenbrenner,

1986).

Bronfenbrenner added a fifth component to this theory, the chronosystem,

which is composed of the child’s experiences throughout life that create transitions to the

child’s other systems (Bronfenbrenner, 1986). Bronfenbrenner’s ecological systems are

constructed around rules and norms that shape the child’s development. Adler-Tapia

(2012) wrote that in the field of psychotherapy, it should be paramount that the therapist

addresses the child in the context of each of these systems. This can be easily applied to

the field of speech-language pathology, as the focus of therapy is not only to treat the

pathology, but to also examine the communicative competence and contexts in which the

disorder may cause impairment of function or performance (ASHA, 2007). For the

current study, the most immediate context in which the child interacts, the microsystem

(e.g., home interactions with family or school interactions with teachers and peers), will

be the focus of determining how a child with a language disorder may influence the

perceptions of caregivers. Because Bronfenbrenner’s ecological systems are affected by

the child’s development, it is possible that a child’s language disorder shapes those

systems by influencing caregivers’ perceptions, thereby impacting interactions within the

microsystems and mesosystems.

Family Systems Theory. Murray Bowen’s family systems theory can be

employed to take a closer look at the microsystem within the nested levels of

Bronfenbrenner’s bioecological theory. Family systems theory is comprised of eight

concepts: triangles, scale of differentiation of self, nuclear family emotional system,

multigenerational emotional system, family projection process, sibling position, cutoff,


8

and societal emotional process (Gilbert, 1999). For the purposes of this study, the nuclear

family emotional system will be used as a framework by which to examine caregivers’

perspectives of their child’s language disorder. This concept states the family is a social

system in which each individual has an effect on the family unit. In other words, changes

in an individual effect changes in the family unit (Burack, 2001; Gilbert, 1999). Schiff

(2006) further delineates such changes that may affect the family by describing four

dysfunctional emotional patterns by which families operate. These include marital

conflict, dysfunction of one spouse, child impairment, and emotional distance (Schiff,

2006). Of most relevance to language disorders is that an impairment in one child results

in an increase of caregiver stress (Schiff, 2006). As stress increases, caregivers may

develop negative perceptions of their child’s ability to communicate and function within

the family dynamic. As negative perceptions increase, caregiver-child interactions may

also be negatively impacted, as research indicates that children with language disorders

have lower quality interactions with caregivers than typically developing children

(Skibbe, Justice, Zucker, & McGinty, 2008). As such, it is important to fully understand

the nature of caregivers’ perceptions of their children’s language disorders and identify

factors that may influence those perceptions.

Caregiver Perceptions

Several fields have examined the role of perception; the following sections

include perception research across disorders most relevant to the current study (i.e., ASD,

learning disabilities, behavior regulation, hearing loss, and language disorders). The

following sections discuss perceptions across three primary categories: caregivers’ and


9

professionals’ perceptions of quality, competence, and outcomes in the presence of

disorders.

Quality of communicative interactions. For the purposes of this study, quality is

defined as the degree to which caregivers or SLPs value or place importance on

communicative interactions with the child. The literature base involving caregivers’

perceived quality is minimal, but research outside of language disorders reveals some

insight regarding what caregivers may perceive as a important with respect to disorders.

An examination of existing research indicates that caregivers often perceive education

about the disorder as an important component of perceptions of quality regarding the

disorder. Interestingly, when perceptions of education are negative, caregivers have

reported more negatively based perceptions regarding childhood disorders. For example,

in the ASD literature, Selkirk et al. (2009) examined caregivers’ perceptions as related to

education (i.e., genetic counseling, causes of ASD) and whether their perceptions

influenced family planning decisions. Although the results indicated that few caregivers

received genetic counseling regarding their child with ASD, most caregivers perceived

the etiology of ASD to be genetic and felt a high risk of conceiving another child with

ASD. They perceived a lack of education regarding the disorder, which contributed to

their negative perceptions regarding their child’s ASD. This study suggests that the

presence of a disorder may change caregivers’ perceptions in such a way as to affect

future decisions.

Regarding the professionals’ perceptions of education, an intervention study in a

Jamaican preschool indicated that increased education resulted in more positive

perceptions of student behavior, which translated to improved student-teacher


10

interactions (Baker-Henningham & Walker, 2009). These findings suggest that

perceptions of quality are malleable and that increased education about the disorder

improved teachers’ perceptions.

A more in-depth study by Chien and Lee (2013) found a positive correlation

between caregivers’ perceived lack of information and overall negative perceptions of the

educational needs of their children with learning disabilities in Hong Kong. Overall,

caregiver-perceived concerns were categorized into information needs, health concerns,

lack of psychosocial support, and a perceived stigma attached to their child’s illness.

Surprisingly, most of the caregivers reported perceived gaps in their understanding of

their child’s diagnosis, which coincided with their perceived inability to teach their child.

In addition, more than half expressed a desire to receive help to assist their child succeed

academically and at home. The authors categorized caregivers’ perceptions of health

concerns into physical, social, and psychological concerns. Caregivers reported general

fatigue, exhaustion, and lack of sleep, which contributed to their concerns about the

future of their children and perceived failure in regulating their children’s conduct

problems.

Separate from their educational concerns, caregivers also indicated a myriad of

social and psychological problems stemming from their children’s learning disability,

which suggest that caregivers place importance on social interactions and psychological

support when facing their child’s diagnosis (Chien & Lee, 2013). Chien and Lee found

that mothers perceived negative interactions with friends because of their increased

demands as caregivers and self-blame for their children’s illness. Their study also

indicated that a majority of caregivers indicated a lack of social support as caregivers.


11

Although they perceived social support as important, they reported apprehension about

seeking assistance from people beyond the family (Chien & Lee, 2013). Most caregivers

also reported embarrassment or feelings of shame because of a perceived stigma of the

child’s illness or behavior problems. Half of the caregivers reported their psychological

concerns were rooted in anxiety and caused negative perceptions of quality in their daily

lives.

The existing literature suggests that for children with disorders, caregivers report

information and education regarding the disorder are important, and provision of such

information is positively correlated with improved perceptions of quality. However,

research to date has focused primarily on children with ASD and children who live

overseas in countries where disorders may be more socially stigmatized; more research is

needed to fully understand caregivers’ perceptions related to quality with respect to their

children’s language disorders in the United States.

Competence in communicative abilities. For the purposes of this study,

competence is defined as the level at which a child is able to use each domain of

language in a functional environment. The majority of existing research in this field has

investigated caregivers’ and professionals’ perceptions of the child’s overall competence

with a particular disorder. This may include perceptions of the child’s social interactions,

ability to function in daily activities, or general performance. For language disorders,

perceptions of competence expand to include perceptions of the child’s performance in

each of the five areas of language (i.e., semantics, morphology, phonology, syntax,

pragmatics). By investigating caregivers’ and professionals’ perceptions in several areas,

researchers have identified varying perceptions relating to pragmatics, including social,


12

behavioral, and emotional interactions, yet perceptions of other areas of language have

not been fully assessed.

In descriptive studies for ASD, researchers often examined perceptions related to

child difficulties and competencies. Pondé and Rousseau (2013) instructed caregivers to

attribute their perceptions of their child’s overall difficulties as follows: due to ASD

diagnosis, due to a language delay/disorder, or not applicable/absence of difficulty. While

their findings were inconsistent, most caregivers attributed their child’s difficulties to the

ASD diagnosis, although some caregivers viewed the origin of the difficulties as an

overall developmental delay. Still others perceived that their child had no incompetency.

Other studies focused more on the dynamics within the family as a result of a child’s

diagnosis of ASD. Goodman and Glenwick’s (2012) study focused on caregiver-child

interactions by describing the relationships between caregivers’ perceived attachment to

their child with ASD and the child’s attachment to the caregiver. Their results indicated

that children with ASD were able to form attachments to their caregivers, which was not

a widely held perception previously in the literature (Sakaguchi & Beppu, 2007).

In the hearing impairment research, Hsing and Lowenbraun (1997) reported on

the role professional perceptions play in providing services for children who are hearing

impaired. In a study performed in Taipei, Taiwan, teachers’ perceptions of their own

competency became more positive (i.e., they reported feeling more effective) when they

interacted with students with a hearing impairment while using the teachers’ preferred

communication method. Their perceptions of competence were more negative when they

were required to communicate using less familiar methods of sign language.


13

In the area of language disorders, the literature is vague on specific

characterizations regarding competence regarding children, but studies have reported

general findings regarding caregivers’ and professionals’ perceptions. Hall and Segarra

(2007) sought to determine the accuracy of caregiver perceptions for predicting later

academic outcomes in a longitudinal study. They used standardized measures to collect

data for 35 children in preschool and then later as 9-year-olds and administered a

caregiver report instrument, the Vineland Adaptive Behavior Scales Communication

Domain (Vineland; Sparrow, Balla, & Cicchettic, 1984), to determine caregivers’

perceptions of their child’s current competence and caregivers’ ability to predict

outcomes. The results of the study suggested that caregivers provided information not

obtainable from standardized measures, and caregivers’ perceptions of competence were

predictive of later academic abilities. When accounting for severity of the language

disorder, McCabe (2005) found that teachers and caregivers reported more negative

perceptions of behavior and pragmatic language as a result of more severe language

disorders as compared to typically developing children of the same age or children with

less severe disorders.

Some studies focused on perceptions of behavior or executive functioning

abilities of children with language disorders. Hughes, Turkstra, and Wulfeck (2009)

compared perceptions of caregivers against those of their adolescent children. One group

represented adolescents with executive functioning impairments as a result of a language

disorder and one group included typically developing adolescents. Caregivers of the

adolescents with language disorders reported more negative perceptions of their child’s

executive function abilities than did caregivers of typically developing adolescents.


14

Furthermore, the adolescents with language disorders reported that their deficits in

executive functioning negatively impacted their daily living activities.

In similar studies involving executive functioning and behavior, Wittke,

Spaulding, and Schechtmana (2013) administered a rating scale to teachers and

caregivers to assess their perceptions of preschool children with language disorders as

compared to age-matched typically developing children. Caregivers’ and teachers’

perceptions were not significantly different, but both indicated more negative (i.e., lower)

ratings for competency of children with language disorders as compared to typically

developing children. The authors reported that adult perceptions strongly correlated with

children’s language abilities. Additionally, Joffe and Black (2012) examined perceptions

of students’ social, emotional, and behavioral difficulties by administering a

questionnaire to students, teachers, and caregivers. Initially, teachers identified

neurotypical secondary school students with suspected language disorders based on

academic performance. Those students were formally assessed and diagnosed with a

language disorder and then categorized based on the severity of the disorder. Students,

teachers, and caregivers perceived greater difficulties in social, emotional, and behavioral

areas for students who presented with more severe language disorders. This information

may translate to more negative perceptions, or positively correlated data, regarding

children with a more severe language disorder: the more severe the disorder, the more

negative the perceptions of students who have the disorder, their teachers, and their

caregivers.

The research regarding children with ASD, hearing impairments, and language

disorders supports the role of perception in characterizing disorders, but it largely reflects


15

perceptions related to social and behavioral aspects of childhood disorders. While the

reported perceptions of caregivers and professionals were mainly negative in the

language disorders literature, caregivers of children with ASD reported mixed

perceptions. Also, because language disorders can involve any combination of five areas

(i.e., semantics, morphology, phonology, syntax, pragmatics), further research is needed

to create a more comprehensive characterization of caregivers’ perceptions of language

disorders specific to a child’s competence in daily activities.

Outcomes of communicative improvement. The third component to perception,

outcomes of communicative improvement, is defined as the level of improvement or

progress a caregiver or SLP expects or anticipates for a child’s communication as a result

of intervention. Research in language disorders and related fields indicates general

improvements in perceptions following intervention. For example, Jindal-Snape et al.

(2005) interviewed caregivers of children with ASD to determine caregivers’ perceptions

of teachers’ abilities to effect positive change for children with ASD in the classroom.

The basis for examining caregivers’ perceptions of the classroom setting, the authors

explained, was to connect the child’s environments (e.g., home, school) in a functional

way, per Bronfenbrenner’s mesosystems theory. Their study found that caregivers’

perceptions of teachers’ abilities, and therefore, their children’s educational outcomes,

improved when the teachers were given adequate training. Specifically, caregivers

reported higher perceptions with their child moving into a mainstream classroom if an

educator with extensive experience with children with ASD had trained the classroom

teacher.


16

As suggested by the ASD research, some intervention studies have demonstrated

changes in perceptions, potentially as a result of training. Baker-Henningham and Walker

(2009) conducted a qualitative study to characterize teacher perceptions of students’

behavior following a behavior-based program for Jamaican preschool children with a

goal to increase positive interactions between children and teachers. This study was

predicated on the fact that teachers in Jamaica receive less training and experience poorer

educational conditions than do those in more developed countries. Three preschools were

targeted in piloting a behavior-prevention curriculum. Teachers were asked how they

used newly learned strategies and to explain their perceptions of the training program, as

well as their perception of student responsiveness following implementation of the

program. In general, teachers reported a greater understanding of child development, less

frequent disciplinary action involving students’ behavior, and perceived improvements in

teacher-child and teacher-caregiver interactions when strategies from the program were

implemented (Baker-Henningham & Walker, 2009). They reported more positive

perceptions of children’s behavior, as evidenced by an increased use of positive behavior

strategies. Some teachers indicated that behavior regulation skills generalized to the home

setting resulted in better interactions between caregivers and children. Although the

authors did not specify the directionality of the intervention and perception relationship,

it may be true that both influence the other. The research was inconclusive regarding

whether perceptions affected the intervention or the intervention affected teachers’

perceptions. However, perceptions changed during their intervention study. More

research is needed to understand adult perceptions regarding intervention for other areas,

such as language disorders.


17

Huttunen and Välimaa (2012) suspected that understanding caregiver perceptions,

defined as their expectations of and satisfaction with cochlear implantation and

habilitation, is a key element in providing beneficial speech and language therapy to

children with hearing impairments. In their longitudinal quantitative study, caregivers and

SLPs reported more positive than negative perceptions regarding children’s implantation

and habilitation. Furthermore, while caregivers reported that services were difficult to

obtain, they perceived an increase in their child’s quality of life as a result of increased

communication following intervention, suggesting that intervention improved caregivers’

perceptions. SLPs’ most positive perceptions involved improvement in the child’s social

life and easier communication with the family in daily activities. The authors

demonstrated that perceptions may become more positive following intervention, but

further research is needed to investigate the bi-directionality of this relationship.

In the language disorders literature, studies suggest that professionals’ perceptions

of children’s expected improvement were related to their level of education and training.

Sadler (2005) studied the perceptions of teachers who work with preschool children

diagnosed with a moderate to severe language disorder. In general, the teachers reported

positive perceptions regarding including these children in mainstream classrooms, but

had negative perceptions about their training and education for teaching children

diagnosed with a language disorder. They reported gaps in communication with other

professionals, and that a lack of training contributed to overall negative perceptions of

their abilities to affect positive change in the classroom. Thus, teachers perceived

negative outcomes as a result of their negative perceptions of their own adequacy.


18

Regarding caregivers’ perceptions of intervention, Romski et al. (2011) used an

experimental questionnaire in a language intervention study to determine caregivers’

perceptions before and after participating in a caregiver-coached intervention program.

All children in the study had a significant risk of a language disorder, minimal

communication abilities, sufficient gross motor skills to touch a speech-generating device,

and a concomitant diagnosis other than a communication disorder or hearing impairment.

The children either received intervention with the use of augmentative and alternative

communication (AAC) or with spoken communication only. The results of the study

revealed that caregivers’ perceptions became overall more positive after administering

treatment to their children (Romski et al., 2011). With respect to severity, caregivers of

children who used AAC devices reported more positive perceptions of intervention, and

caregivers of children who used spoken communication only in therapy reported more

negative perceptions of intervention. This study examined cognitive impairments and

concomitant diagnoses; therefore, more research is needed with respect to language

disorders.

Baxendale, Lockton, Adams, and Gaile (2013) gathered information about

teachers’ and caregivers’ perceptions of communication outcomes for children two

months following completion of the Social Communication Intervention Project (SCIP).

Caregivers and teachers perceived SLPs as important in the intervention process, and

they perceived positive changes in the child as a direct result of the intervention program.

Caregivers perceived both a greater understanding of intervention targets and positive

changes in family dynamics upon completion of the intervention program. Caregivers’

perceptions improved following treatment, and they perceived speech-language therapy


19

to be important, demonstrated by their carry-over of strategies at home. While this study

explains the relationship between intervention and outcomes, it is specific to the SCIP

model. Caregivers’ general perceptions of language disorders and intervention is lacking

in this research.

Overall research regarding outcomes involves a treatment or education

component. Generally, perceptions improved following intervention, but much of the

literature relates to other disorders (e.g., ASD), is specific to particular intervention

programs (e.g., Baxendale et al., 2013), or is restricted to a certain level of severity (e.g.,

Romski et al., 2011). More research is needed to characterize caregivers’ perceptions

specific to outcomes across the range of language disorders.

Alignment

The extent to which caregivers’ perceptions align with those of professionals,

including SLPs, may be especially salient for understanding caregivers’ roles in the

intervention process. While several studies in the existing literature demonstrate that

caregivers’ perceptions are consistent with professionals’ perceptions (e.g., Hughes et al.,

2009; Wittke et al., 2013), other studies demonstrate a significant mismatch between

caregivers’ and professionals’ perceptions (Hsing & Lowenbraun, 1997; Huttunen &

Välimaa, 2012; Joffe & Black, 2012; McCormack et al., 2010).

Hughes et al. (2009) compared caregivers’ perceptions to those of their adolescent

children. Their results demonstrated that caregivers’ and children’s perceptions of

executive functioning were consistent with the child’s diagnosis. Likewise, when

examining executive functioning abilities in preschool children, Wittke et al. (2013)


20

reported alignment between caregivers’ and teachers’ perceptions. Furthermore,

caregivers’ perceptions correlated with their children’s language competence.

Similar findings occurred when Joffe and Black (2012) compared perceptions of

teachers, caregivers, and their students diagnosed with language disorders across three

areas (i.e., social, emotional, behavioral). Their findings indicated discrepancies between

respondents, despite unanimous reports of negative perceptions across each targeted area.

Caregivers and students reported more emotional problems than did teachers; students

reported more conduct problems than teachers and caregivers; teachers reported fewer

prosocial behaviors; and caregivers reported more prosocial behaviors. Overall, the study

found that poor language abilities correlated with lower social, emotional, and behavior

disorders in adolescents, based on caregiver, student, and teacher reports. Similarly,

McCormack, McLeod, Harrison, and McAllister (2010) examined caregivers’ versus

SLPs’ perceptions of phonological disorders in preschool- aged children by using the

World Health Organization International Classification of Functioning and Health-

Children and Youth (ICF-CY; World Health Organization, 2007) as a framework.

Perhaps as expected, SLPs more accurately identified children with a phonological

disorder than caregivers. Also, although SLPs and caregivers reported the same two areas

of greatest difficulty (i.e., verbal communication and interpersonal interactions), their

reported perceptions of all other areas (i.e., advanced learning, basic learning, applied

learning and general tasks, and non-verbal communication) were different.

Alignment between caregivers’ and professionals’ perceptions may be a key

component in understanding caregivers’ interactions in intervention. Across each area of

research, whether comparing caregivers to caregivers, caregivers to children, or


21

caregivers to professionals, the data are inconsistent regarding whether or not perceptions

align and the extent to which alignment matters. Such inconsistencies, even in the

language disorders literature, indicate a need for further study to determine caregivers’

perceptions of competence as compared to perceptions of professionals.

Caregiver- and Child-Level Factors

Caregiver-level factors. Research indicates that caregivers’ perceptions of their

children’s disorders vary dramatically from negative to positive (Baxendale et al., 2013;

Baker-Henningham & Walker, 2009; Huttunen & Välimaa, 2012) and from aligning with

professional report to misalignment (Hsing & Lowenbraun, 1997; Huttunen & Välimaa,

2012; Joffe & Black, 2012; McCormack et al., 2010). Perception research in medical

sciences suggests that caregiver demographic factors, including education, may

contribute to caregiver perceptions. However, to date, the extent to which caregiver and

child-level factors explain variation in caregivers’ perceptions of their children’s

language disorders is unknown. To contribute to this growing body of knowledge, the

current study will investigate the extent to which caregiver factors (maternal education

and self-efficacy) predict alignment between caregivers’ perceptions of their children’s

language disorder and SLP report.

Maternal education. Maternal education, an indicator of family socioeconomic

status (SES), is commonly identified as a significant predictor of success across studies

involving language disorders and other childhood impairments (Downer & Pianta, 2006;

Hall & Segarra, 2007; Mistry, Benner, Biesanz, Clark, & Howes, 2010; Rindermann &

Baumeister, 2015). For example, Ayoub et al. (2009) examined the effects of maternal

education and other risk factors on cognitive and language performance in a


22

comprehensive study designed to advocate for policy changes. The authors reported a

significant decrease in cognitive and language skills in 3-year-old children as compared

to national norms as a result of decreased language stimulation in the home and low

levels of maternal education.

Maternal education has also been shown to be an indicator of risk in a child’s

academic readiness, behavior management, and language performance (e.g., Dilworth-

Bart, 2012; Leijten, Raaijmakers, de Castro, & Matthys, 2013; Vallotton, 2012).

Vallotton (2012) researched the effects of a gesture-based intervention program on

maternal responsiveness and perceptions of infants in lower SES families. She discovered

that maternal perceptions improved as a result of implementing this intervention, which

suggests that SES may play a role in caregivers’ initial perceptions with regard to their

children.

Caregiver self-efficacy. Self-efficacy is a person’s perception of how well he or

she can perform a given task and the extent to which one has have influence over his or

her situation/environment (Bandura, 1989). Self-efficacy refers to one’s ability to

examine the information and act accordingly, completing the tasks regardless of obstacles

or self-doubt (DesJardin, 2005). For the purposes of this study, self-efficacy relates to

caregivers’ level of influence in their children’s language development as adapted from

Bandura (1989). Theoretically, caregivers who feel highly effective in promoting positive

change in their child (i.e., have a high level of self-efficacy) would also demonstrate

more positive perceptions of their child’s language disorder than caregivers with lower

self-efficacy. Given the variability of caregivers’ perceptions regarding childhood


23

disorders, it is important to understand the extent to which caregivers’ self-efficacy

relates to their perceptions of their children with language disorders.

A study by DesJardin (2005) examined the self-efficacy of mothers of children

with hearing aids versus those of children with cochlear implants. The results revealed

that the mothers who reported a greater sense of self-efficacy were more involved in their

children’s intervention than were mothers with lower self-efficacy. Specific to the current

study, sparse research reveals mixed findings between self-efficacy and perception of

children’s language disorders. For example, Sadler (2005) found that teachers of children

with moderate to severe language disorders felt less confident (i.e., had lower self-

efficacy) providing appropriate services to their students due to negative perceptions of

the children’s language disorders. However, a study by Harty, Alant, and Uys (2007)

found a different pattern. Their study examined maternal self-efficacy as related to their

perceptions of their school-aged child’s language disorder. They reported high self-

efficacy levels for mothers of children with language disorders, despite severity and age

variations within the study population. The authors suggest that individuals in middle-

class neighborhoods have greater accessibility to services, which may have contributed to

such high self-efficacy reports. The authors reported weak correlations between self-

efficacy and caregivers’ perceptions, but further research is needed to determine the

strength of this potential correlation. The current study will bridge this gap by including

caregiver self-efficacy as a possible predictor of caregiver perceptions.

Child-level factors. Child development research and language disorder research

have suggested that child-level factors, such as severity (e.g., Joffe & Black, 2012) and

gender (Nelson, O’Brien, Calkins, & Keane; 2013) may influence professionals’ and


24

caregivers’ perceptions of behavior and social interactions for children with language

disorders. Thus, it is hypothesized that children’s language disorder severity and gender

may be predictive factors of perceptions. However, few studies have examined how

child-level factors predict caregivers’ perceptions of their child’s language disorder in

general.

Language disorder severity. Language disorders exist with varying levels of

severity (Paul & Norbury, 2012) and across any combination of the five areas of

language (ASHA, 1993). Some perceptions studies in language disorders included

diagnostic factors in the construct of their research to examine the extent to which

perceptions change as a function of the severity of the language disorder. Joffe and Black

(2012) and McCabe (2005) both found that caregivers’ and teachers’ perceptions of

social and behavioral problems were more negative for children with more severe

disorders. Additionally, Sadler (2005) indicated teachers had negative perceptions of

working with preschool children with moderate to severe language disorders due to the

disorder and their perceived lack of ability to effect positive change.

A study by Smith, Romski, Sevcik, Adamson, and Barker (2014) is an example of

inconsistent perceptions between caregivers of children with similar language disorder

diagnoses. Caregivers of children with Down syndrome and caregivers of children with

other developmental disabilities were given the Parent Perception of Language

Development (PPOLD) to characterize stress and their perceptions of the child’s

diagnosis. Both groups reported positive perceptions regarding their success in effecting

change in their child’s language disorder, but caregivers of children with Down syndrome

reported fewer negative perceptions of their child’s language disorder despite equal


25

scores on expressive and receptive language tests (Smith et al., 2014). This study

determined that the child’s diagnosis was a significant predictor of language development,

as well as caregiver stress. Although caregiver stress was shown to impact perceptions,

examining perceptions apart from stress factors could bridge a gap in the research.

In another study, Harty et al. (2007) found maternal perceptions to be more

positive for receptive language when compared to expressive language. Based on the

constructs and findings reported by these studies, diagnostic factors influence perceptions,

but the aforementioned studies mainly examined perceptions of social and emotional

interactions. Further research is needed to fully understand the role language disorder

severity plays on their caregivers’ perceptions, specifically in the preschool population.

Gender. Preliminary data in behavior regulation research indicate that child

gender is a predictive factor for caregiver perceptions. Nelson, O'Brien, Calkins, & Keane

(2013) researched differences in caregiver perceptions of behavior based on gender

differences and found that mothers perceived males’ behavior problems more negatively

than females. In addition, caregivers often reported more frequent behavior problems for

their sons than for daughters (Nelson et al., 2013). While this study involved cognitive

and behavioral aspects of child development, the significance of child gender may also

translate to a predictor of perception for language disorders, given that perceptions of

language disorders often involve a behavioral component (Joffe & Black, 2012; McCabe,

2005).

Summary and Research Aims

Caregiver perceptions may be linked to child outcomes as a function of a bi-

directional interaction between children and individuals in their environments (e.g.,


26

caregivers, professionals). Previously cited studies in ASD, behavior regulation, learning

disabilities, hearing impairment, and language disorders literature demonstrate that

caregivers often have negative perceptions as a result of limited education about the

disorder (e.g., Baker-Henningham & Walker, 2009; Chien & Lee, 2013; Selkirk et al.,

2009), or social implications of having a child with a disorder, possibly due to different

cultural norms (Chien & Lee, 2013).

Research demonstrates that caregivers’ perceptions improve (i.e., become more

positive) with provision of information (e.g., Chien & Lee, 2013), training (e.g., Jindal-

Snape et al., 2005), or as a result of intervention (e.g., Baker-Henningham & Walker,

2009; Selkirk et al., 2009). Furthermore, when examining caregivers’ perceptions of their

child’s competence in the presence of a disorder, some studies indicate that caregivers

perceive greater problems in children’s behavior and social interactions (Hall & Segarra,

2007; Hughes et al., 2009; Joffe & Black, 2012; McCabe, 2005; Wittke et al., 2013), yet

other studies report that caregivers perceive no deficits in competence (e.g., Pondé &

Rousseau, 2013). The third component of perception, outcomes, has been described as a

function of intervention. In general, caregivers’ perceptions change as a result of

intervention (Baker-Henningham & Walker, 2009; Baxendale et al., 2013; Huttunen &

Välimaa, 2012; Romski et al., 2011), but the exact nature of this relation is unknown.

Alignment between caregivers’ and professionals’ perceptions is inconsistent

(Hsing & Lowenbraun, 1997; Huttunen & Välimaa, 2012; Joffe & Black, 2012;

McCormack et al., 2010), with some researchers suggesting that caregivers’ perceptions

align closely with professionals’ perceptions, while others document misalignment

between the two. Furthermore, some research indicates that caregiver information, such


27

as maternal education and self-efficacy, and child-level factors regarding gender and

disorder severity may be predictive for determining caregiver perceptions (DesJardin,

2005; Harty et al., 2007; Joffe & Black, 2012; McCabe, 2005; 2012; McCormack et al.,

2010; Sadler, 2005; Vallotton, 2012).

While the literature makes a compelling case for the role of caregiver perceptions

in the intervention process, much of the data involve older children (Hughes et al., 2009;

Joffe & Black, 2012), cover a broad range of disorders (Hsing & Lowenbraun, 1997;

Jindal-Snape et al., 2005; Smith et al., 2014), were collected overseas (Chien & Lee,

2013; Hsing & Lowenbraun, 1997), and demonstrate inconsistencies in findings

(Goodman & Glenwick, 2012; Joffe & Black, 2012; McCormack et al., 2010; Pondé &

Rousseau, 2013; Smith et al., 2014). Further research is needed to adequately understand

the role of caregivers’ perceptions of preschool children with language disorders.

Therefore, this proposed study will address the following aims:

1. To characterize caregivers’ perceptions of their child’s language disorder with

regard to quality, competence, and outcomes

2. To determine the extent to which caregivers’ perceptions of their child’s

communication align with SLP report

3. To determine the extent to which caregiver (i.e., maternal education and self-

efficacy) and child factors (i.e., gender and language disorder severity) predict

a. Overall alignment

b. Alignment across quality, competence, and outcomes


28

Chapter III

Methodology

Participants

For this study, four SLPs were recruited from local Head Start campuses and the

Texas Tech University Health Sciences Center (TTUHSC) Speech-Language and

Hearing Clinic, following permission from their respective directors. SLPs were

considered eligible if they possessed a current state license, Certificate of Clinical

Competence, and were currently serving children with language disorders. Consenting

SLPs provided study information to potential caregivers of preschool children. A total of

31 caregivers of children with language disorders consented to the study, and 25

completed the study. One caregiver had twins participating in the study and completed

two separate questionnaires for a total of 26 caregiver questionnaires. The remaining six

caregivers were either unavailable to complete the questionnaire or did not return the

questionnaires to the investigator. To be eligible for study participation, each caregiver

spoke English as their primary language and was the caregiver of a child with the

following inclusionary criteria: between the ages of 3 and 4 years with an existing

diagnosis of language disorder, spoke English as a primary language, and was currently

receiving speech-language therapy. Of the 26 children, only one had been diagnosed with

a concomitant disorder (i.e., dyspraxia). Of the 25 respondents, 20 reported to be primary

caregivers, two reported that they were not primary caregivers, and four did not respond

to that item. Caregivers were comprised of 22 mothers, two fathers, and one grandmother.

Their children included fourteen 3-years olds and twelve 4-year olds.


29

Procedures

For the first step of this study, permission was received from the Head Start

directors in Lubbock, Texas, and the director of the Speech-Language and Hearing Clinic

at TTUHSC to conduct the study on their campuses. Once the study was approved, the

Head Start directors and clinic director provided a list of names and contact information

(i.e., email addresses and phone numbers) of potentially eligible SLPs. The primary

investigator (PI) provided the SLPs with information regarding the proposed study via

email or phone and received consent for all interested SLPs for the study. Participating

SLPs presented information about the study to potential caregivers of children with a

language disorder who fit inclusionary criteria. The investigator meet with all interested

caregivers at their child’s respective school or therapy clinic to answer questions and

obtain oral and written consent for the study. Following consent, the primary caregiver

for each child completed a questionnaire at the child’s school or therapy clinic, which

took an estimated 15- 25 minutes. Caregivers provided demographic information and

answered questions about the child’s language disorder, communication abilities, and

intervention program, as well as the caregiver’s self-efficacy. Note that if the child had

two primary caregivers, only one completed the questionnaire. Also, if a caregiver

requested to complete the questionnaire at home, he or she was given an envelope in

which to return the questionnaire to the child’s SLP. Once the questionnaire was

complete, the investigator sealed the questionnaire in an envelope and took it

immediately to the TTUHSC Pediatric Language Disorders Lab within the Department of

Speech, Language, and Hearing Sciences where all documents were de-identified and

stored in a locked cabinet in a locked room.


30

To obtain information from the consenting SLPs, the PI delivered a questionnaire

to the SLP for each child at the convenience of the SLP. The SLP completed the

questionnaire at her school or clinic. Upon completion of the questionnaire(s), the SLP

sealed the questionnaire(s) in an envelope provided by the investigator. The SLP then

notified the investigator, who retrieved the sealed envelopes and took them immediately

to the TTUHSC Pediatric Language Disorders Lab within the Department of Speech-

Language, and Hearing Sciences where all documents were de-identified and stored in a

locked cabinet in a locked room.

Measures

For the purposes of this study, two questionnaires were created: one for caregivers

(see Appendix A) and one for SLPs (see Appendix B). Each questionnaire was a 5-point

likert scale questionnaire that was adapted from the Bilingual Input Output Survey

(BIOS; Peña, Gutierrez- Clellen, Iglesias, Goldstein, & Bedmore, 2014), Parent

Perception of Language Development (PPOLD; Romski, Adamson, Cheslock, & Sevcik,

2000), and Self Efficacy Questionnaire (Bandura, 1997). The BIOS is a survey used in

conjunction with its larger measure, the Bilingual English Spanish Assessment (BESA;

Peña, Gutierrez- Clellen, Iglesias, Goldstein, & Bedmore, 2014), in order to determine a

bilingual child’s use of English and Spanish at school and at home. The PPOLD is a

questionnaire created to determine perceptions of a child’s language in areas such as

language development, use of language, and stresses that may impact the child’s

development. The two questionnaires used in this study are quite similar, except the SLP

version contains diagnostic-specific questions, and the caregiver version includes a

section devoted to self-efficacy.


31

The caregiver questionnaire included five sections: (a) identifying information

(e.g., caregiver’s name, caregiver’s age); (b) demographic information (i.e., maternal

education rated from high school to doctorate degree, relationship to the child); (c)

quality (Part I); (d) competency (Part II); (e) outcomes (Part III); and (f) self-efficacy

(Part IV). In Parts I, II, and III, caregivers read a statement (e.g., “Communicating with

my child is important to me”) and rated the truthfulness of that statement on a 5-point

likert scale (i.e., 1 = never true to 5 = always true). For the section on self-efficacy,

caregivers answered questions on a 5-point likert scale pertaining to their perceived level

of influence (i.e., 1 = no feeling of influence to 5 = strong feeling of influence) at

effecting change for the child in various situations (e.g., “How much can you influence

the decisions that are made about your child’s speech therapy?”).

The SLP version of the questionnaire included identifying information (e.g.,

SLP’s name, child’s name) as well as information regarding the severity of the child’s

language disorder. SLPs indicated the child’s level of severity across five domains of

language (i.e., semantics, syntax, morphology, phonology, pragmatics), as well as

Overall Expressive Language and Overall Receptive Language. For each domain, SLPs

ranked the child’s level of severity across a 5-point likert scale ranging from 1 = within

normal limits to 5 = profound. The remainder of the questionnaire included the three

sections found in the caregiver questionnaire pertaining to perceptions (i.e., quality,

competence, outcomes), but the wording of each question was slightly modified to reflect

“this child” as compared to caregiver statements described as “my child.” The 5-point

scale was identical to that of the caregiver’s form; SLPs rated the veracity of each

statement from never true (i.e., 1) to always true (i.e., 5).


32

Design Analysis

As an initial step in investigating the first research aim, to characterize caregivers’

perceptions of their child’s language disorder with regard to quality, competence, and

outcomes, descriptive analyses were run on study measures (i.e., caregiver and SLP

questionnaires). Study measures included continuous variables (i.e., perceptions, self-

efficacy) measured at static points in time and categorical variables (i.e., severity, child

gender, maternal education) measured at static points in time. For all continuous

measures, means, standard deviations, and ranges were calculated and assumptions were

assessed. For all categorical variables, frequency counts were determined. Subsequently,

the appropriate descriptive measures were calculated for all aggregated study variables

(i.e., quality, competence, outcomes, and self-efficacy). Correlations were run and

analyzed for significance, directionality, and strength. Additionally, assumptions were

tested through statistical indices as well as evaluation of scatter plots and histograms.

Any violations identified were addressed prior to any additional analyses.

For the second research aim, to determine the extent to which caregiver

perceptions of their child’s communication align with SLP report, descriptive analyses

were run to compare caregivers’ perceptions (mean, SD) across quality, competence,

outcomes, and overall perceptions with SLPs’ perceptions. These analyses were

completed in two different ways. First, responses on the caregiver questionnaire were

compared with responses on the SLP questionnaire. All statements that were an exact

match were coded as “1” whereas statements that differed were coded as “0”. The total

number of exact matches across all statements was summed to determine overall

alignment. Second, the alignment for each category of perception (i.e., quality,


33

competence, and outcomes) was summed, and descriptive analyses were run to determine

any correlations for significance, directionality, and strength.

For the third aim, to determine the extent to which family and child factors predict

(a) overall alignment, and (b) alignment across quality, competence, and outcomes,

regression analyses were run with overall alignment, alignment of quality, alignment of

competence, and alignment of outcomes entered as the dependent variables (DV), and

predictor variables (i.e., self efficacy, maternal education, child gender, language disorder

severity) entered as independent variables (IV) in separate models.


34

Chapter IV

Results

The present study was an exploratory descriptive study, which examined

perceptions of caregivers and SLPs regarding children’s language disorders in the areas

of quality, competence, and outcomes. As an initial step in analyzing data for this study,

assumptions were tested through statistical indices as well as evaluation of histograms; all

assumptions were met. Findings for each aim are presented in the following sections.

Research Aim One: Characterizing Caregivers’ Perceptions

In answering the first research aim, to characterize caregivers’ perceptions of

their child’s language disorder with regard to quality, competence, and outcomes, any

negatively-worded statements were reverse scored prior to running descriptive statistics.

Caregivers’ responses revealed a range of values across study variables. Note that the

means, standard deviations, and ranges were based on the total number of statements in

each respective category (i.e., quality = 18, competence = 18, outcomes = 10). See Table

1 for complete findings.

Based on mean scores, caregivers’ perception of outcomes was the most positive

(m = 4.37; range = 3.70 – 5.00) of the three categories. Their perception of quality (m =

3.74; range= 2.78 – 4.44) was also positive, but closer to neutral. Caregivers reported a

wide range of responses in both of these categories, but their perception of competence

had the widest range and most negative average rating (m = 3.12; range = 1.89 – 4.06).

This suggests that although caregivers on average perceive their child’s competence in

communication most negatively, there was much variation across respondents. Also,

perceptions for all categories fell on the positive side of the scale. Caregivers’ overall


35

perceptions (i.e., perceptions across all three categories) were more positive than neutral,

but relatively reserved with a restricted range of responses (m = 3.41; range = 2.74 –

3.80). In other words, caregivers’ overall perception of their children’s language

disorders might best be described as “average” with no caregivers reporting extreme

values for their perceptions.

Research Aim Two: Alignment

As an initial step to answer research aim two, to determine the extent to which

caregivers’ perceptions of their child’s communication align with SLP report, descriptive

analyses were used to compare caregivers’ perceptions to SLPs’ perceptions of language

disorders in children. Alignment was calculated only for statements that corresponded

across both questionnaires, and each category of perception had a different number of

statements (i.e., quality = 17, competence = 18, outcomes = 10). That is to say, one

question from section I (quality) of the caregiver version was not included in alignment

analyses because it did not correspond to a question from the SLP questionnaire. Detailed

results are found in Table 1. SLPs’ perceptions followed a more reserved but similar

pattern as caregivers’ perceptions. SLPs’ perception of outcomes was the most positive

(m = 4.07; range = 3.00 – 4.88), suggesting that SLPs and caregivers have similar

perceptions regarding outcomes of their child’s communication to improve. The mean

and range of SLPs’ perception of quality was nearly identical to that of caregivers (m =

3.54; range = 2.65 – 4.35). SLPs’ perception of competence was the most negative with

the widest range (m = 2.96; range = 1.44 – 4.22). SLPs’ overall perception of children’s

language disorders was similar to those of caregivers’ (i.e., SLPs’ m = 3.30; caregivers’ m

= 3.41).


36

Second, each corresponding statement from the caregiver and SLP questionnaires

was compared. Each statement was ascribed a value based on exact agreement (i.e., 1 for

agreement, 0 for disagreement). For example, for the statement, “Speech therapy has

helped my child communicate,” if the caregiver and the SLP both chose the same value

(e.g., “4- agree”) alignment was coded as “1” (i.e., the caregiver and SLP responded the

same). However, if the caregiver chose any number other than what the SLP chose (e.g.,

SLP: “4- agree” and caregiver: “5- strongly agree”), alignment was coded as 0 for this

statement. The total number of aligned statements was summed for the entire

questionnaire (i.e., overall alignment) as well as for each category of perception. Thus,

larger values of alignment suggest that caregivers and SLPs had similar perceptions of a

child’s communication, whereas smaller values suggest their perceptions differ in that

area. These values of alignment (i.e., overall and per category) were used in all

subsequent analyses.

Next, descriptive statistics were run for each area of alignment. A summary of the

descriptive statistics is found in Table 2. The mean indicates the average number of

aligned statements between caregivers and SLPs across a given category (i.e., quality,

competence, outcomes), and the range represents the minimum to the maximum number

of statements in that category that were aligned for individual respondents. Caregivers

and SLPs were most aligned with their perceptions of quality (m = 13.3; 78% alignment;

range = 11.0 – 15.0), which indicates that caregivers’ and SLPs’ perceptions of the

importance or value of the child’s communicative interactions were very similar.

Responses for outcomes were less aligned between caregivers and SLPs (m = 4.04; 40%

alignment; range = 0.0 – 9.0). This suggests that caregivers and SLPs perceive outcomes


37

of the child’s communicative improvement as a result of intervention quite differently.

Caregivers and SLPs were least aligned for perceptions of competence (m = 6.85; 38%

alignment; range = 2.0 – 12.0), meaning caregivers’ and SLPs’ perceptions differed more

in terms of child’s abilities to use each domain of language in a functional environment

than for any other category (i.e., quality or outcomes). Overall alignment was variable

across respondents with an average of 24 out of 45 statements aligned (54%) between

caregivers and SLPs. Of the 45 statements, caregivers were aligned for as few as 15

statements or as many as 33 statements.

Correlation statistics, detailed in Table 2, indicated significant moderate to strong

positive correlations between overall alignment and alignment of quality (r = .606; p

= .001), alignment of competence (r = .879; p < .001), and alignment of outcomes (r

= .617; p = .001). Additionally, there was a significant positive correlation between

alignment of quality and alignment of competence (r = .535; p = .005). These correlations

suggest that as alignment in one category increased, the agreement between

corresponding statements in related, or correlated categories, also increased. Correlations

between alignment of quality and outcomes (r = .012; p = .952) and alignment of

competence and outcomes (r = .234; p = .250) were not significant.

Research Aim Three: Caregiver and Child Factors

Caregiver-level factors. For this study two caregiver-level factors were

investigated: maternal education and self-efficacy. The following information is detailed

in Table 3. The range of maternal education was 2.00 - 8.00, meaning that the maternal

education ranged from having a high school diploma to a doctorate degree. The majority

of caregivers had a bachelor’s degree (30.8%), with a range of high school (15.4%; n = 4)


38

to doctorate (3.8%; n = 1). Because maternal education included five or more categories

(i.e., seven), and responses fell on a normal distribution, maternal education was analyzed

as a continuous variable.

To determine caregivers’ self-efficacy, caregivers rated 20 questions (e.g.,

effecting change at home, helping the child communicate at school) on a scale of 1 to 5,

with 1 being no feeling of influence and 5 indicating strong feeling of influence.

Responses to each question were then averaged to create an overall mean for self-efficacy

for each caregiver. In general, caregivers reported high self-efficacy (m = 4.18), with a

range of 3.00 (i.e., average feeling of influence) to 5.00 (strong feeling of influence). This

suggests that caregivers have an overall positive feeling of influence with regard to

effecting change for their child.

Child-level factors. For this study two child-level factors were investigated:

language disorder severity and gender. To determine children’s language disorder

severity, SLPs ranked children’s skills across each domain of language (i.e., semantics,

phonology, morphology, syntax, pragmatics), as well as overall expressive language

(OEL) and overall receptive language (ORL) on a scale of 1 (i.e., within normal limits) to

5 (i.e., profoundly disordered). See Table 4 for complete findings. On average, SLPs

rated children’s language disorder severity for semantics, syntax, and morphology

identically (m = 2.58; range = 1-5). In contrast, phonology was ranked as more severe on

average than pragmatics (phonology: m = 2.81, range = 1 – 5; pragmatics: m = 2.12,

range = 1 – 5). Finally, OEL ratings were more severe than ORL ratings (OEL: m = 2.60,

range = 1 – 5; ORL: m = 2.28, range = 1 – 5). Said another way, ratings for phonology


39

were more severe than for the other four areas of language, and ratings for pragmatics

were least severe. Likewise, OEL ratings were slightly more severe than ORL ratings.

To empirically identify one representative measure of language disorder severity

for the present study, a three-step process was used. First, the average severity across

each of the five domains was determined (m = 2.53; SD = 1.08; i.e., semantics, syntax,

morphology, phonology, pragmatics). Second, a severity score was calculated by

averaging the ratings across the five domains, OEL, and ORL (i.e., five domains plus

OEL and ORL). Third, correlations were run for each of these variables (i.e., five

domains; five domains plus OEL and ORL; OEL; ORL). Correlations among each level

of severity were strong (r = .727 – .995; p < .001), as shown in Table 5. The five domains

plus OEL and ORL were strongly correlated to all other measures (r = .995; p < .001)

and represented the most comprehensive indicator of language disorder severity.

Therefore, the average severity of the five domains plus OEL and ORL was used as the

measure of language disorder severity for all subsequent analyses.

Descriptive and regression analyses were then used to answer research aim three,

to determine the extent to which caregiver (i.e., maternal education and self-efficacy) and

child factors (i.e., gender and language disorder severity) predict (a) overall alignment;

and (b) alignment across quality, competence, and outcomes. First, correlation statistics

were run for each area of alignment (i.e., overall, quality, competence, outcomes),

caregiver-level factors, and child-level factors. No caregiver or child-level factors were

significantly correlated with any category of alignment (see Table 6).

Following descriptive statistics, regression analyses were run in four separate

models with alignment values serving as dependent variables and each factor (e.g., self-


40

efficacy, language disorder severity) as independent variables. The results are detailed in

Table 7. First, overall alignment was entered as the dependent variable (DV), and each

caregiver- and child-level factor was entered as independent variables (IV) in separate

models. None of the IVs were significant predictors of overall alignment (see Table 7).

Second, alignment for quality was entered as the DV, and each caregiver- and

child-level factor was entered as IVs in separate models. None of the IVs were significant

predictors of alignment for quality (see Table 7). Third, alignment for competence was

entered as the DV with each caregiver- and child-level factor entered as IVs in separate

models. None of the factors were significant predictors of alignment of competence.

Finally, alignment for outcomes was entered as the DV, and each caregiver- and child-

level factor was entered as IVs. None of the IVs were significant predictors of alignment

of outcomes (see Table 7).


41

Chapter V

Discussion

Theoretically, caregivers’ perceptions may influence interactions with their

children, which may impact communication outcomes. This descriptive study

characterized caregivers’ perceptions of their child’s communication across three

categories: (a) quality of communicative interactions (i.e., quality), (b) competence in

communicative abilities (i.e., competence), and (c) outcomes of communicative

improvement (i.e., outcomes). The second aim of this study was to compare caregivers’

perceptions to the professional and diagnostic input provided by SLPs. Finally, child- and

caregiver-level factors were analyzed as predictors of caregivers’ perceptions and their

alignment to SLPs’ perceptions. The following sections detail specific discussion of each

research aim, study limitations, and future directions for research.

Characterizing Caregivers’ Perceptions

Caregivers’ perceptions of their child with a language disorder who was receiving

language intervention were generally positive across each category, with caregivers

indicating the most positive perceptions for outcomes and the least positive perceptions

for competence. This suggests that caregivers have positive perceptions for their child’s

outcomes and less positive perceptions regarding their child’s abilities to use language in

a functional environment. These findings correspond to research in related fields (e.g.,

ASD, behavior regulation). Research in these fields also found that caregivers have

positive perceptions regarding outcomes (e.g., Baxendale et al., 2013; Huttunen &

Välimaa, 2012; Jindal-Snape et al., 2005; Romski et al., 2011).


42

There are four possible explanations for why caregivers on average might

perceive outcomes positively. First, positive perceptions of outcomes may reflect trust in

their child’s service provider receiving disorder-specific training (e.g., Baxendale et al.,

2013; Jindal-Snape et al., 2005). Each caregiver in this study responded to questions

regarding intervention while his or her child was simultaneously receiving services from

an individual who had received disorder-specific training (i.e., the SLP). Current

enrollment in speech-language therapy was important to obtain relevant information

regarding the caregivers’ perceptions of outcomes for improvement. If the child had only

previously received therapy or would potentially enroll in therapy in the future,

perceptions of outcomes of improvement would likely be different as compared to those

currently enrolled in intervention. Furthermore, receiving these services from a

specialized, trained professional has been shown to improve perceptions of outcomes

because caregivers perceive a better understanding of their child’s intervention targets

and generalization of skills at home (e.g., Baxendale et al., 2013) following intervention.

A second reason may involve the role intervention plays in providing caregivers

with more information regarding their child’s disorder and intervention targets (e.g.,

Baxendale et al., 2013). Because participants were recruited from locations where

providing education is a primary goal (i.e., university clinic setting, public school system),

it is probable that caregivers received counseling at some point regarding their child’s

performance and treatment plan. Assuming caregivers received counseling specific to

their child’s individualized course of treatment, the likelihood is high that the caregivers

were given information that contributed to their positive perceptions of expected

improvement with therapy.


43

A third component that may contribute to such positive perceptions of outcomes

is that prior studies suggest that caregivers perceive direct benefits from their child

receiving therapy (e.g., Baxendale et al., 2013; Huttunen & Välimaa, 2012). Research

suggests that caregivers perceive improvements in their child’s communication as a direct

result of the child receiving intervention, which caregivers report has a positive impact on

their child’s quality of life. Finally, research indicates that caregivers perceive outcomes

more positively when they are able to administer treatment themselves (e.g., Romski et

al., 2011). It is unknown if caregivers in this study were given strategies or activities to

implement at home in conjunction with therapy in the child’s school or clinic, but it is

possible that administering home programs would improve the caregivers’ perceptions of

outcomes. The current study did not address each of these reasons, specifically, but the

consistency seen in the literature and in this study may invite future research to determine

if these factors do indeed relate to more positive outcomes.

In contrast, caregivers’ perceptions of competence were more negative than for

other categories, and the range of responses was highly variable. This indicates that while

caregivers have generally positive perceptions of outcomes, caregivers’ perceptions of

their child’s competence vary dramatically. There are two possible explanations for both

the nature and variability of caregivers’ perceptions of competence. First, caregivers’

perceptions of competence may not reflect true diagnostic information (Pondé &

Rousseau, 2013). Research suggests that some caregivers have perceptions based on their

child’s disorder or possible developmental delays, and some caregivers perceive no

difficulties. A second explanation is that caregivers’ perceptions of competence are

strongly related to the severity of the child’s disorder (e.g., Hughes et al., 2009; Joffe &


44

Black, 2012; McCabe, 2005; Wittke et al., 2013). Several studies have examined

caregivers’ perceptions of competence as compared to children with disorders (e.g., Joffe

& Black, 2012) and typically- developing children (e.g., Hughes et al., 2009; McCabe,

2005; Wittke et al., 2013. In either case, caregivers of children with disorders, more

specifically, severe disorders, have more negative perceptions than caregivers of children

who have milder disorders or of caregivers of children who are typically-developing.

This is a likely explanation, as the current study allowed participation of caregivers of

children diagnosed with a language disorder of any severity. Therefore, caregivers

represented children with a wide range of language disorder diagnoses, which would

likely lead to a wide range of competency perceptions. Because the measure used in this

study did not probe for underlying reasons of caregivers’ perceptions, it may be

beneficial for future studies to examine these relations further.

Finally, caregivers’ average perceptions of quality fell between those of

competence and outcomes, and the range of responses regarding quality was variable, not

unlike their perceptions of competence. While overall positive, some caregivers

responded with negative perceptions of quality. The lack of cohesion between caregivers

for this category may be explained by two reasons. Research in related fields indicates

that caregivers’ perceptions of quality improve (i.e., become more positive) when they

are provided with information or education regarding the disorder (e.g., Chien & Lee,

2013; Selkirk et al., 2009). This may suggest that respondents in the current study who

reported negative perceptions felt uninformed regarding their child’s language disorder,

and therefore perceived the importance or value of communicative interactions with their

child more negatively. It may also indicate that caregivers who reported positive


45

perceptions about the importance of their child’s communicative interactions felt more

informed or educated about the child’s disorder.

A second explanation is that some caregivers perceive social or psychological

difficulties in their own lives as a result of caring for a child with a disorder (e.g., Chien

& Lee, 2013). If caregivers in the present study believed that their child’s language

disorder negatively impacted the caregivers’ personal life, it would stand to reason that

their perceptions of communicative interactions with their child would be more

negatively-based. Likewise, it may be assumed that caregivers who do not perceive such

stigmas would perceive the importance of communicative interactions with a more

positive outlook, thus explaining the range of responses. However, some of the research

regarding these explanations is not specific to American culture; therefore, further

investigation is warranted to determine the cause of the variability in caregivers’

perceptions of quality in the U.S.

Regardless of the reasons for caregivers’ perceptions, whether positive or

negative, research does support that caregivers provide information not obtainable by

standardized measures, and their perceptions can be predictive of later outcomes (Hall &

Segarra, 2007). The results of the current study demonstrated that caregivers generally

have a positive outlook on their child’s communication. Furthermore, their most positive

perceptions are for outcomes, which may be explained by several reasons (i.e., the

professional’s level of training, provision of information, benefits of therapy, carryover at

home). Caregivers’ more negative perceptions of competence may be related to

caregivers’ inconsistencies or the inherent design of the study.


46

Alignment of Perceptions

Previous researchers have examined teachers’ and SLPs’ perceptions as a

diagnostic indicator against which to measure caregivers’ perceptions. The current study

found that caregivers’ and SLPs’ responses were similar in terms of averages and ranges,

but SLPs reported slightly more negative perceptions across each category. Also,

caregivers and SLPs were most aligned for quality and least aligned for competence.

Generally speaking, caregivers and SLPs had similar perceptions in terms of

average ratings and range of responses for each category of perception, as well as for

overall perceptions. More detailed analyses indicated that caregivers and SLPs were only

aligned for about half (54%) of the statements, revealing discrepancies between

perceptions in most of the categories. Previous research is mixed regarding alignment.

Some studies demonstrated that caregivers’ and professionals’ perceptions align (e.g.,

Wittke et al., 2013), and others reported misalignment between the two groups (e.g., Joffe

& Black, 2012; McCormack et al., 2010). Studies that reported alignment between

caregivers and others (e.g., teachers, children) did not involve perceptions of SLPs, which

was the professional indicator examined in the current study. Therefore, it may be that

although caregivers’ perceptions often align with teachers or their children, they do not

often align with SLPs. However, the current study is consistent with research that

reported misalignment (e.g., Joffe & Black, 2012; McCormack et al., 2010). Although

those studies were characterized by significant study design differences as compared to

the current study (e.g., disorder, sample size, measure), they found that caregivers’ and

SLPs’ perceptions were similar, but not statistically aligned. This suggests that despite


47

commonalities between perceptions, caregivers and SLPs do not align in their perceptions

of communication in the presence of the child’s language disorder.

Another explanation for misalignment is that the current study focused on

different categories of perception, which would possibly lead to discrepancies with the

previous literature. Prior studies were typically less specific regarding perceptions as

compared to the current study. That is to say that quality, competence, and outcomes

were not explicitly studied with regard to caregivers’ and SLPs’ perceptions or alignment.

If the current study had not categorized perceptions in this way, perhaps alignment would

have resulted more frequently, as the measure would have been less specific. Despite the

reasons for misalignment, discrepancies between caregivers and SLPs may inform

clinicians that caregivers often differ in their perceptions, which may help SLPs be more

effective in providing services.

Despite misalignment overall, caregivers and SLPs were moderately aligned for

their perceptions of quality. This indicates that caregivers and SLPs both perceive

importance, value, and benefit in communicating with the child. To date, no research has

compared caregivers’ and professionals’ perceptions of quality. However, understanding

this relation may be important clinically for planning treatment, because evidence-based

practice requires the SLP to consider the needs of the client (Johnson, 2008). When these

needs are aligned, as is the case for quality, it may be easier for the SLP and the caregiver

to agree on the course of treatment.

In contrast, the lowest level of alignment was seen for competence, suggesting

that caregivers and SLPs have different perceptions of children’s abilities to use each

domain of language in a functional environment. Previous research regarding alignment


48

for perceptions of competence is mixed. Consistent with current findings, some

researchers have reported misalignment for perceptions of competence (McCormack et

al., 2010), but others have reported alignment between caregivers’ perceptions and

diagnostic information (Hughes et al., 2009; Wittke et al., 2013).

Given the inconsistencies within the literature and with regard to this study, other

factors may explain the relation between caregivers’ and SLPs’ perceptions. One possible

explanation is the amount of time caregivers spend with the child as compared to SLPs.

Research has documented changes in perceptions of the child’s quality of life as a result

of interaction changes at home (e.g., Huttunen & Välimaa, 2012), which would be seen

more readily by caregivers than SLPs because these changes are seen at home. Therefore,

changes in perceptions may be more directly or frequently influenced for caregivers than

for SLPs. Another explanation may be the inherent nature of using SLPs as a professional

standard because they have more training specific to language disorders as opposed to

caregivers. Given that perceptions may be influenced by knowledge (e.g., Selkirk et al.,

2009) and training (e.g., Baker-Henningham & Walker, 2009), it is likely that differences

would be seen between two groups who have different levels of knowledge and training

specific to language disorders. Therefore, the level of knowledge SLPs have concerning

language disorders may prevent them from aligning frequently with caregivers who have

limited knowledge of such disorders. Inconsistent reports of alignment warrant further

investigation to determine causes of the misalignment in perceptions of competence

between caregivers and SLPs.


49

Predictive Factors of Perception

None of the factors investigated in this study were significantly correlated to

overall alignment. Furthermore, no statistically significant relationships were found

between the four factors in any model of regression analyses. That is to say that the

factors examined in this study were not predictive of alignment between caregivers’ and

SLPs’ perceptions. The lack of statistically significant findings provide insight regarding

what may or may not hold importance when predicting alignment between caregivers’

and SLPs’ perceptions, which may differ from previous research.

Caregiver-level factors. Maternal education, an indicator of family SES, has

been cited in the research as a significant predictor of success across studies involving

children with language disorders and other impairments (Downer & Pianta, 2006; Hall &

Segarra, 2007; Mistry, Benner, Biesanz, Clark, & Howes, 2010; Rindermann &

Baumeister, 2015) as well as a key indicator of changes in caregivers’ perceptions in

intervention studies (e.g., Vallotton, 2012). However, the results of the current study do

not support maternal education as a significant predictor of alignment between

perceptions of caregivers and SLPs. One possible explanation for this is that even though

maternal education was characterized by a normal distribution, some education levels

were limited in their representation. For example, while eight caregivers had a bachelor’s

degree and six had some college experience, only one caregiver each went to technical

school or had a doctorate degree. Another explanation may be that although maternal

education was measured for each respondent, perceptions were analyzed for three

caregivers who were not mothers (i.e., two fathers, one grandmother). Responses

regarding maternal education were analyzed jointly with responses from caregivers who


50

were not the mother in these three instances. Therefore, it is likely that the mother’s

education would not relate to the perceptions reported by other family members. Finally,

maternal education may not have captured family SES as accurately as another measure,

such as annual family income. Given these explanations, it is possible that maternal

education truly does not predict alignment between caregivers and SLPs. Perhaps

perceptions are more directly linked to the characteristics of the child than of the

mother’s education or family demographics. Further investigation should be completed

with maternal education and annual family income as SES indicators to determine what

role, if any, SES plays in predicting alignment.

Self-efficacy refers to an individual’s perception of performance and the extent to

which he or she has influence over a situation or environment (Bandura, 1989). Self-

efficacy has also been referred to in the literature as a component of obtaining

information and acting accordingly, regardless of circumstances or intrinsic emotions

(DesJardin, 2005). Self-efficacy was not a significant predictor of alignment in the

current study, which may be explained by three reasons. First, the current study examined

self-efficacy in terms of the caregiver’s ability to influence his or her child’s outcomes

apart from any measure of the caregiver’s knowledge of the disorder. Therefore, this

assumption did not account for the caregiver’s level of understanding of the information

regarding the child’s disorder as explained by DesJardin (2005). Therefore, if another

definition of self-efficacy were used to determine predictions of perceptions (i.e.,

influence plus knowledge), a different outcome may have occurred. Second, although the

research indicates that caregivers’ perceptions change based on self-efficacy (e.g.,

DesJardin, 2005; Harty et al., 2007), these studies did not compare caregiver perceptions


51

to those of professionals. Thus, alignment between caregivers and SLPs was not studied

in conjunction with caregivers’ self-efficacy. It may be that self-efficacy predicts

caregivers’ perceptions, but this current study reveals that caregiver self-efficacy does not

predict alignment with SLPs’ perceptions. Finally, because caregiver self-efficacy is not

extrinsically known (i.e., it is a personal, intrinsic concept), and SLPs were not given

knowledge of caregivers’ responses, alignment with SLPs may not involve caregiver self-

efficacy.

Child-level factors. Language disorder severity was used as the indicator of

diagnostic information in the current study, but it was not found to be a significant

predictor of alignment between caregivers’ and SLPs’ perceptions. Although research

suggests diagnostic information influences caregivers’ and professionals’ perceptions

(e.g., Harty et al., 2007; Joffe & Black, 2012; McCabe, 2005), it has not assessed the

extent to which language disorder severity predicts alignment between these groups. The

lack of significance found in the current study may be explained by three reasons. First,

there may have been insufficient sampling of more severe disorders, which are shown to

be more salient for determining perceptions (e.g., Joffe & Black, 2012; McCabe, 2005). It

is possible that alignment occurs more frequently for children with more severe disorders

and less frequently for children with milder disorders. The sample population in the

current study was characterized by a greater representation of normal functioning to

moderate disorders and very little representation of severe to profound disorders. Such an

imbalance of the sample may have limited the extent to which perceptions of caregivers

and SLPs align. A second explanation may relate to findings from Smith et al. (2014),

who found that caregivers’ perceptions did not align with severity. The current study used


52

SLPs’ responses for measures of severity, so if caregivers’ perceptions do not align with

severity, it is unlikely that their perceptions would align with SLPs’ perceptions with

severity as a significant predictor. Finally, severity measures were obtained from a

different area of the questionnaire than statements pertaining to perceptions. A cross-

analysis was not performed to ensure that SLPs’ responses for perception statements

aligned with the diagnostic information provided (i.e., disorder severity levels) in the

beginning of the questionnaire. It was assumed that all SLP responses would be

consistent with any diagnostic information provided, but if any perception statements

were answered with more subjective rather than objective intentions, then caregivers’

perceptions were not compared to pure diagnostic information, and alignment would not

occur as a result of language disorder severity being a predictor.

Gender was not a significant predictor of alignment between caregivers’ and SLPs’

perceptions. Although the literature indicates that gender is an influential factor in

caregivers’ perceptions (e.g., Nelson et al., 2013), there are two reasons why it may not

be a significant predictor of alignment. First, Nelson et al. (2013) reported that caregivers

had more negative perceptions regarding their sons than their daughters, but the study

examined cognitive and behavior effects of child development and did not include

professionals’ perceptions. It is possible that gender influences caregivers’ perceptions,

but it may not be a predictor of alignment. Furthermore, Nelson et al. (2013) examined

perceptions of behavior, not language disorders. Although children with language

disorders often present with a behavioral component (e.g., Joffe & Black, 2012; McCabe,

2005), gender may not be a significant predictor of alignment between caregivers’ and

SLPs’ perceptions of language disorders in the same way that it is for behavior. The


53

second reason gender may not be a significant predictor of alignment may be explained

by the sample of participants. An overwhelming 80% of respondents provided

perceptions of male children, and only 20% were responding in reference to female

children. Such skewed data in the study may have limited the extent to which alignment

could be predicted by this child-level factor.

Research Limitations

As with all research, the current study had limitations that warrant discussion.

First the measures used were not standardized. The findings in this study cannot be

interpreted in the same ways standardized measures are, and as such, provide only

observational and descriptive data. However, the questionnaires were created from

measures used in previous research, which adds construct validity to the measures used in

the study. Additionally, researchers ensured that the caregiver and SLP questionnaires

corresponded to each other and also ensured that statements pertaining to each domain of

language were balanced so that the analyses and data were an accurate reflection of the

intended purposes of the study.

A second limitation to this study was the selection of participants. While the

caregivers represented an almost equal number of 3- and 4-year-olds, they responded on

behalf of an overwhelming 80% male to 20% female sample. Because child gender was

discussed in the research as having an effect in caregivers’ perceptions, it was selected as

a child-level factor in this study. Not surprisingly, gender was not found to be a

significant predictor of perceptions in alignment models (see Table 8), perhaps because

most of the caregivers were reporting perceptions of their sons. Future research should


54

make attempts to control for the population in this way, especially in cases where child-

level factors are included in analyses.

A related, yet different, limitation was the availability of SLPs. Because the SLPs

were recruited based on caregiver participation, and most SLPs provided services to

many children, the sample of SLPs was smaller than that for caregivers. Therefore, some

SLPs completed as few as one questionnaire, and one SLP completed 18 questionnaires.

It is possible that the data were skewed based on SLP participation. Future research

should include more SLPs to be able to account for factors associated with SLP’s

provision of services.

Future Direction

The current study provides information regarding what caregivers’ perceptions

are, how they align with SLPs’ perceptions, and whether they are predicted by caregiver-

and child-level factors. However, the way in which those perceptions are used clinically

remains primarily theoretical. Future research should examine how caregivers’

perceptions influence their involvement with their children and affect child outcomes.

This study categorized caregivers’ perceptions as negative or positive, but questions

remain regarding how those perceptions predict caregiver involvement and children’s

communication progress. Furthermore, because perceptions change as a function of

intervention (e.g., Huttunen & Välimaa, 2012; Romski et al., 2011), experimental studies

should measure caregivers’ perceptions over the course of an intervention period.

Characterizing caregivers’ perceptions while simultaneously measuring caregiver

involvement and children’s progress may be key to understanding how perceptions can

be considered for implementing therapy.


55

Another focus of future research should be conducted with caregivers of older

children. Because this study focused on 3- and 4-year-olds, the majority of the children

represented by this sample were recently diagnosed with a language disorder. The

perceptions of caregivers in this population may have been different if their children had

struggled with language disorders for a longer period of time. Caregivers’ perceptions

may differ from those discussed in this study if they had experienced more therapy (e.g.,

Romski et al., 2011), understood diagnostic information (e.g., Baxendale et al., 2013),

and had longer to communicate with their child (e.g., Huttunen & Välimaa, 2012). Also,

more time in therapy may change caregivers’ perceptions in each of the categories

examined in this study, which may translate to more consistent alignment with SLPs’

perceptions.

A third focus of future research would be to examine caregivers of a different

population of children. Another population change might include a sample involving

more children with concomitant diagnoses compared to children with language disorders

only. Anecdotal information provided from several SLPs revealed that some of the

children represented in this study were suspected to have concomitant diagnoses (e.g.,

Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder), but they were not

yet diagnosed by a physician due to their young ages. Therefore, it is possible that if these

children presented with other diagnoses, caregivers and SLPs would report different

perceptions than for children who only presented with language disorders. Perceptions

are malleable, and it may be that caregivers’ perceptions differ according to the

characteristics of different diagnoses.


56

Finally, future research should investigate factors that explain caregiver

perceptions. None of the factors from the current study were significant predictors of

alignment, but it is possible that they may explain caregivers’ perceptions of their child’s

language disorder. Gaining more understanding of how caregiver- and child-level factors

relate to caregivers’ perceptions may lead to a better understanding of how to inform

treatment and improve child outcomes.

Conclusion

Within the microsystem of Bronfenbrenner’s bioecological theory, caregivers

and children interact with a bi-directional influence (Bronfenbrenner, 1977), and those

influences may be affected by the presence of a child’s language disorder (Schiff, 2006).

Because caregivers’ perceptions may influence these interactions, understanding

caregivers’ perceptions may be integral in determining caregiver involvement, which is

related to child outcomes (Hall & Segarra, 2007; Miedel & Reynolds, 1999; Pancsofar &

Vernon-Feagans, 2010). This study indicates that caregivers’ perceptions of their child’s

language disorder are overall positive, specifically with regard to outcomes. Their

perceptions align with SLPs’ perceptions in terms of quality but not for competence.

Further, maternal education, caregiver self-efficacy, language disorder severity, and child

gender do not predict alignment between caregivers’ and SLPs’ perceptions. Caregivers’

perceptions, alignment with SLPs’ perceptions, and factors relating to those perceptions

are important for clinicians to understand because perceptions may provide insight

regarding communicative interactions between caregivers and their child. These

interactions are of value in the clinical decision making process and may provide

important information in determining caregiver involvement and child outcomes.


57

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63

Table 1. Descriptive Data for Aggregated Study Variables

Study Variable m SD Range

Caregivers’ Perceptions

Quality 3.74 0.38 2.78 – 4.44

Competence 3.12 0.61 1.89 – 4.06

Outcomes 4.37 0.41 3.70 – 5.00

Caregivers’ Overall Perceptions 3.41 0.25 2.74 – 3.80

Caregivers’ Self-Efficacy

4.18 0.56 3.00 – 5.00

SLPs’ Perceptions

Quality 3.54 0.53 2.65 – 4.35

Competence 2.96 0.80 1.44 – 4.22

Outcomes 4.07 0.43 3.00 – 4.88

SLPs’ Overall Perceptions 3.30 0.23 2.91 – 3.80


64

Table 2. Alignment Between Caregivers’ and SLPs’ Perceptions

Alignment Groups Range m SD 1. 2. 3. 4.

1. Quality 11.0 – 15.0 13.3 1.12 – .535** .012 .606**

2. Competence 2.0 – 12.0 6.85 2.68 – .234 .879**

3. Outcomes 0.0 – 9.0 4.04 1.99 – .617**

4. Overall 15.0 – 33.0 24.2 4.26 –

**Pearson correlation is significant at the 0.01 level (2-tailed, p < 0.01)


65

Table 3. Descriptive Statistics for Caregiver- and Child-Level Factors

Variable n Percent m SD Range

Maternal Education

High School 4 15.4%

Some College 6 23.1%

Technical School 1 3.8%

Associate’s Degree 3 11.5%

Bachelor’s Degree 8 30.8%

Master’s Degree 3 11.5%

Doctorate Degree 1 3.8%

Overall 26 4.69 1.87 2.00 – 8.00

Caregiver Self-Efficacy

26 4.18 .557 3.00 – 5.00

Child Gender

male 21 80.8%

female 5 19.2%

Severity

2.49 1.09 1.00 – 5.00


66

Table 4. Descriptive Statistics for Children’s Language Disorder Severity

Domain of Language n m WNL Mild Moderate Severe Profound

Semantics 26 2.58 8 (30.8%) 3 (11.5%) 8 (30.8%) 6 (23.1%) 1 (3.8%)

Syntax 26 2.58 8 (30.8%) 3 (11.5%) 8 (30.8%) 6 (23.1%) 1 (3.8%)

Morphology 26 2.58 8 (30.8%) 3 (11.5%) 8 (30.8%) 6 (23.1%) 1 (3.8%)

Phonology 26 2.81 5 (19.2%) 3 (11.5%) 12 (46.2%) 4 (15.4%) 2 (7.7%)

Pragmatics 26 2.12 12 (46.2%) 3 (11.5%) 8 (30.8%) 2 (7.7%) 1 (3.8%)

Overall Expressive Language 25 2.60 6 (23.1%) 5 (19.2%) 8 (30.8%) 5 (19.2%) 1 (3.8%)

Overall Receptive Language 25 2.28 11 (42.3%) 3 (11.5%) 5 (19.2%) 5 (19.2%) 1 (3.8%)

66

Tex

as Tech

Univ

ersity H

ealth S

ciences C

enter, Jen

nifer S

elin, M

ay 2

01

6


67

Table 5. Correlations Between Severity Measures

Severity Measures 1. 2. 3. 4.

1. Overall Expressive Language (OEL) – .727**

(n = 25)

.927**

(n = 25)

.936**

(n = 25)

2. Overall Receptive Language (ORL)

–

.835**

(n = 25)

.877**

(n = 25)

3. Five Domains of Language – .995**

(n = 26)

4. Five Domains of Language + OEL and ORL –

**Pearson Correlation is significant at the 0.01 level (2-tailed, p < 0.01)


68

Table 6. Correlation Coefficients Among Perception Factors

Caregiver and Child Factors Overall

Alignment

Quality

Alignment

Competence

Alignment

Outcomes

Alignment

Maternal Education .193 -.124 .126 .315

Caregiver Self-Efficacy .067 .204 .187 -.223

Disorder Severity -.101 -.036 -.172 .036

*Pearson correlation is significant at the 0.05 level (2-tailed, p < 0.05)


69

Table 7. Regression Analyses for Alignment Models

Models and Variables β SE t p

Model 1: Overall Alignment

Caregiver Factors

Constant:

Maternal Education

Constant:

Self-Efficacy:

22.127

.440

22.044

.514

2.298

.456

6.576

1.559

9.628

.965

3.352

.329

.000

.344

.003

.745

Child Factors

Constant:

Gender:

Constant:

Severity:

23.952

1.248

25.171

-.392

.943

2.149

2.147

.791

25.412

.580

11.726

-.496

.000

.567

.000

.624

Model 2: Alignment for Quality

Caregiver Factors

Constant:

Maternal Education

Constant:

Self-Efficacy:

13.658

-.075

11.584

.412

.613

.122

1.701

.403

22.299

-.614

6.812

1.022

.000

.545

.000

.317

Child Factors

Constant:

Gender:

Constant:

Severity:

13.238

.362

13.401

-.037

.248

.566

.568

.209

53.370

.640

23.583

-.178

.000

.528

.000

.860

Model 3: Alignment for Competence

Caregiver Factors

Constant:

Maternal Education

Constant:

Self-Efficacy:

6.001

.180

3.085

.899

1.461

.290

4.070

.965

4.109

.621

.758

.932

.000

.540

.456

.361

Child Factors

Constant:

Gender:

Constant:

Severity:

6.714

.686

7.895

-.421

.593

1.353

1.336

.492

11.314

.507

5.910

-.855

.000

.617

.000

.401

Model 4: Alignment for Outcomes

Caregiver Factors

Constant:

Maternal Education:

Constant:

Self-Efficacy:

2.467

.335

7.375

-.797

1.038

.206

3.000

.711

2.377

1.625

2.459

-1.122

.026

.117

.022

.273

Child Factors

Constant:

Gender:

Constant:

Severity:

4.000

.200

3.875

.066

.443

1.010

1.007

.371

9.034

.198

3.850

.177

.000

.845

.001

.861


70

Appendix A

Caregiver Perceptions of Language Disorders Questionnaire

Name: _______________________________________ Child’s name: ______________________

Age: _______________________________________ Child’s age: ________________________

Relationship to child: Child’s gender: ☐ Male ☐ Female

☐ Mother ☐ Grandmother

☐ Father ☐ Grandfather Are you the child’s main caregiver?

☐ Other ___________________ ☐ Yes ☐ No

Caregiver’s occupation: _______________________________________

Child’s mother’s last grade completed: Child’s father’s last grade completed:

☐ middle school ☐ associate’s degree ☐ middle school ☐ associate’s degree

☐ high school ☐ bachelor’s degree ☐ high school ☐ bachelor’s degree

☐ some college ☐ master’s degree ☐ some college ☐ master’s degree

☐ technical school ☐ doctorate degree ☐ technical school ☐ doctorate degree

Indicate the extent to which each item applies:

Part I

1

never

true

2

rarely

true

3

sometimes

true

4

usually

true

5

always

true

1. It is easy to communicate with my

child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

2. Communicating with my child is

important to me. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

3. I want my child to talk more than

he/she currently does. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

4. I believe my child’s language will

improve if given time. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

5. It is difficult for me to understand

my child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

6. It is difficult for peers and teachers

to understand my child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

7. My child and I have developed

ways to communicate in ways that

I find satisfying. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

8. My child seems eager to

communicate with me. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

9. My efforts working on

communication with my child

seem to be paying off.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

10. I am concerned about my child’s

ability to communicate. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


71

1

never

true

2

rarely

true

3

sometimes

true

4

usually

true

5

always

true

11. I am increasingly confident that I

can help my child improve his/her

communication. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

12. It is often difficult to find the time

to make special efforts to help my

child learn to communicate. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

13. Helping my child communicate is

more work that I thought it would

be.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

14. The work it takes to help my child

communicate is worth it to me. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

15. My child still has a long way to go

before he or she communicates as

well as other children his/her age. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

16. My child misbehaves because

he/she does not have a way to tell

me what he/she wants. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

17. My child struggles to communicate

needs and wants. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

18. My child struggles with

understanding me. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

Part II

1

never

true

2

rarely

true

3

sometimes

true

4

usually

true

5

always

true

1. My child has difficulty using the

right vocabulary. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

2. My child has a large vocabulary. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

3. My child uses vocabulary similar

to others his/her age. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

4. My child is nonverbal. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

5. My child uses short phrases or 1-

word sentences. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

6. My child uses long, elaborate

sentences. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

7. My child uses correct grammar. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

8. My child has difficulty talking

clearly. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

9. My child uses a lot of jabbering or

jargon that is hard to understand. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

10. I am worried about my child’s


11. Others seem to have difficulty

understanding my child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


72

1

never

true

2

rarely

true

3

sometimes

true

4

usually

true

5

always

true

12. I have difficulty understanding my

child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

13. My child has difficulty


14. My child has difficulty following

directions. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

15. My child has difficulty

understanding his/her teachers. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

16. My child’s speech sounds like

other children his/her age. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

17. My child interacts and

communicates well with other

children. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

18. My child communicates well with

his/her teachers. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

Part III

1

strongly

disagree

2

disagree

3

neutral

4

agree

5

strongly

agree

1. Speech therapy has helped my

child communicate. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

2. Speech therapy will continue to

help my child communicate. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

3. My child has made significant

progress over the past three

months.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

4. My child has made great strides in

expressing his/her needs and wants. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

5. My child has made great strides in

understanding what other people

are trying to communicate.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

6. My child’s communication is likely

to get better. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

7. I am involved in my child’s

therapy. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

8. I respond well to therapeutic

recommendations. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

9. I make suggestions for improved

therapy. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

10. I consistently attend meetings and

activities that involve my child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


73

Part IV

1

no feeling

of

influence

2

very little

feeling of

influence

3

average

feeling of

influence

4

some

feeling of

influence

5

strong

feeling of

influence

1. How much can you influence the

decisions that are made about your

child’s speech therapy? ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

2. How freely can you express your

views about your child’s therapy? ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

3. How much can you do to get the

instructional materials and

equipment that you need for your

child’s communication?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

4. How much can you do to help set

speech therapy goals? ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

5. How much can you do to influence

how much therapy time your child

receives?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

6. How much can you do to get your

child to participate in speech therapy

at school?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

7. How much can you do to help your

child communicate at home? ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

8. How much can you do to help your

child communicate at school? ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


child to interact with the speech

therapist?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

10. How much can you do to use

therapy strategies at home with your

child?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

11. How much can you do to understand

your child? ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

12. How much can you do to support

progress when you feel a lack of

support?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

13. How much can you do to keep your

child focused on good

communication?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

14. How much can you do to motivate

your child to communicate at

school?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

15. How much can you do to motivate

your child to communicate at home? ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


child to interact and communicate

with others?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

17. How much can you do to impact

your child’s communication at

home?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

18. How much can you do to overcome

negative effects of your child’s

communication at school?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


74

1

no feeling

of

influence

2

very little

feeling of

influence

3

average

feeling of

influence

4

some

feeling of

influence

5

strong

feeling of

influence


child to practice communication

strategies at home?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


child to practice communication

strategies at school?

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

(adapted from: Bandura, 1997; Peña, Gutierrez-Clellen, Iglesias, Goldstein, & Bedmore, 2014; & Romski, Adamson, Cheslock, &

Sevcik, 2000)

Bandura, A. (1997). Self-efficacy: The exercise of control. New York: WH Freeman.

Peña, E. D., Gutierrez-Clellen, V. F., Iglesias, A., Goldstein, B. A., & Bedore, L. M. (2014). Bilingual English-Spanish Assessment.

San Rafael, CA: AR-Clinical Publications.

Romski, M. A., Adamson, L. B., Cheslock, M. & Sevcik, R. A. (2000) Parent Perception of Language Development (PPOLD). Unpublished manuscript, Georgia State University, Atlanta


75

Appendix B

SLP Perceptions of Language Disorders Questionnaire

Name: _______________________________________ Child’s name: ______________________

Child’s DOE: ___________________________________ Child’s age at initial diagnosis: _________

Indicate the level of severity for each of the following:

Areas of Language 1

WNL

2

Mild

3

Moderate

4

Severe

5

Profound

1. Semantics ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

2. Syntax ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

3. Morphology ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

4. Phonology ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

5. Pragmatics ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

6. Overall Expressive Language ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

7. Overall Receptive Language ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

Indicate the extent to which each item applies:

Part I: Communication

1

never

true

2

rarely

true

3

sometimes

true

4

usually

true

5

always

true

1. It is easy to communicate with this

child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

2. Communicating with this child is

important to me. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

3. I want this child to talk more than

he/she currently does. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

4. I believe this child’s language will

improve if given time. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

5. It is difficult for me to understand

this child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

6. It is difficult for peers and teachers

to understand this child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

7. This child seems eager to

communicate with me. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

8. I am concerned about this child’s


9. My efforts working on

communication with this child seem

to be paying off.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

10. I am increasingly confident that I

can help this child improve his/her

communication.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


76

1

never

true

2

rarely

true

3

sometimes

true

4

usually

true

5

always

true

11. It is often difficult to find the time

to make special efforts to help this

child learn to communicate in more

naturalistic environments.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

12. Helping this child communicate is

more work that I thought it would

be.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

13. The work it takes to help this child

communicate is worth it to me. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

14. This child still has a long way to go

before he/she has age-appropriate

communication.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

15. This child misbehaves because

he/she does not have a way to tell

me what he/she wants.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

16. This child struggles with expressive

language. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

17. This child struggles with receptive

language. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

Part II: Areas of Language

1

never

true

2

rarely

true

3

sometimes

true

4

usually

true

5

always

true

1. This child has difficulty using

appropriate vocabulary. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

2. This child has a large vocabulary. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

3. This child uses vocabulary similar to

others his/her age. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

4. This child is nonverbal. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

5. This child uses short phrases or 1-

word sentences. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

6. This child uses long, elaborate

sentences. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

7. This child uses correct grammar. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

8. This child has difficulty talking

clearly. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

9. This child uses a lot of jargon that is

hard to understand. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

10. I am worried about this child’s


11. Others seem to have difficulty

understanding this child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

12. I have difficulty understanding this

child. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

13. This child has difficulty



77

1

never

true

2

rarely

true

3

sometimes

true

4

usually

true

5

always

true

14. This child has difficulty following

directions. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

15. This child has difficulty

understanding his/her teachers. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

16. This child has an age-appropriate

phonemic inventory. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

17. This child interacts and

communicates well with other

children.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

18. This child communicates well with

his/her teachers. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

Part III: Intervention

1

strongly

disagree

2

disagree

3

neutral

4

agree

5

strongly

agree

1. Therapy has improved this child’s

communication. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

2. Therapy will continue to help this

child communicate. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

3. This child has made significant

progress over the past three months. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

4. This child has made great strides in

expressive language. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

5. This child has made great strides in

receptive language. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

6. This child’s communication is likely

to get better. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

7. This child’s primary caregivers are

involved in therapy. ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

8. This child’s primary caregivers

respond well to therapeutic

recommendations.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


make suggestions for improved

therapy.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5


consistently attend meetings and

activities that involve their child.

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

(adapted from: Peña, Gutierrez-Clellen, Iglesias, Goldstein, & Bedmore, 2014; & Romski, Adamson, Cheslock, & Sevcik, 2000)

Peña, E.D., Gutierrez-Clellen, V.F., Iglesias, A., Goldstein, B.A., & Bedore, L.M. (2014). Bilingual English-Spanish Assessment. San

Rafael, CA: AR-Clinical Publications.

Romski, M. A., Adamson, L. B., Cheslock, M. & Sevcik, R. A. (2000) Parent Perception of Language Development (PPOLD).

Unpublished manuscript, Georgia State University, Atlanta

how do caregivers perceive their child’s a study of

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