 in a ‘real-world’ context brings with it a number of challenges not immediately apparent in the closely controlled research setting of a pilot study. Thus, the study described here aims to investigate a number of important feasibility questions before proceeding to a full-scale trial. The context for the implementation of E-PLAYS is the NHS in the UK. NHS treatment for children with social communication disorders is the responsibility of SLTs. SLTs are specialist health professionals and frequently adopt a ‘consultation model’ whereby they provide training for teaching assistants in schools to deliver interventions rather than providing intervention directly themselves . Therefore, E-PLAYS will fit well within typical NHS service delivery if it proves effective when provided via the consultation model and exploring the means of evaluating this is the aim of the present study.
The first aim of the feasibility study is to establish whether sufficient participants can be recruited for a full trial. Recruitment is complex, involving as it does a number of the adults concerned with each child. We will aim to determine whether sufficient numbers of SLTs, children and their parents, teachers and teaching assistants can be recruited and over what period of time for a definitive large-scale RCT.
The second major potential challenge to implementation in the NHS concerns fidelity. E-PLAYS is fully manualised, but is the manual sufficiently clear and comprehensive to ensure faithful delivery? Unlike in our previous pilot studies, should E-PLAYS be distributed nationally, it would not be viable for the research team to train numerous speech and language teams throughout the country. A key research task therefore involves investigating aspects of the indirect delivery whereby training will be provided to teaching assistants by SLTs. This differs fundamentally from delivery by a trained and supervised RA as in our pilot studies and feedback from SLTs and teaching assistants will be crucial.
Other challenges relate more broadly to difficulties with research concerning children with social communication impairments. SCI is notoriously difficult to measure  as it generally manifests itself only during dynamic social interaction, thus rendering testing with standardised questionnaires largely unachievable. A number of different approaches have been used to address this issue . One approach is to ask teachers or another adult who knows the child to rate their pragmatic language. In this regard, the CCC-2  is the most commonly used research measure. However, it is possible that global reports from adults may not be sensitive enough to detect changes resulting from interventions . Furthermore, adult (particularly parent) report for conditions relating to autism and social communication may be especially susceptible to placebo effects [66, 67]. Another approach is to use an elicitation test, that is, to use a series of structured but naturalistic contexts which are designed to prompt particular communication behaviours for observation. The TPS is a well-validated elicitation measure for the age group targeted by E-PLAYS. Finally, observation and analysis of children’s spontaneous interactions using coding derived from conversation analysis  should provide an ecologically valid indication of any improvement. We will be video-recording children’s communications whilst playing with Magformers. The study will therefore incorporate all three of the approaches (adult report—CCC-2, TPS—elicitation test and video-observation) normally used to measure social communication to minimise the well-documented difficulties with measuring this construct. This is a particular strength of the study. In addition, the observational data from the Magformers task will provide a measure of generalisation, that is, an indication of whether the skills and strategies learned during the E-PLAYS intervention transfer to other, analogous collaborative contexts. Further, more distal measures of generalisation are included in the form of the SDQ which will measure the poten