that they provide a ‘scaffold’ that guides and structures the interaction between children (for a review, see ). Properly designed, use of a computer game can support communication by structuring collaboration between children so that they solve problems within a fun environment together in partnership [33,34,35]. Typically, in collaborative activities, children with social communication disorders either participate very little, lacking the confidence to become involved or, alternatively, may attempt to dominate and run the activity solely according to their own agenda . Managing these behaviours presents a serious challenge for speech and language therapists, teachers and teaching assistants . Technology can be used to regulate turn-taking, ensuring equal participation between all players and preventing exclusion of any children. Furthermore, rule enforcement and reward-giving (such as virtual ‘prizes’) by a computer, rather than an adult, is viewed by children as more consistent, fairer and less arbitrary . The flexibility afforded can also be harnessed to sustain children’s interest and concentration by adding surprises, colourful animations and unusual sounds and keeping the game flowing at a suitable pace [31, 38].
We have developed and carried out initial testing for a computer game intervention which aims to improve pragmatic language skill and the ability to collaborate in children with social communication impairments. Preliminary efficacy testing for ‘E-PLAYS’ (formerly known as the ‘Maze Game’) is described in Murphy et al. [29, 39] on 32 children randomised either to the intervention or to usual school practice. Children who received the computer game intervention showed significant increases on communication test scores, in the use of high-quality questioning and listening skills and in their positive ratings about collaborative work with peers . It is important to note that for these studies, the intervention was delivered to the children by a trained, post-graduate psychology research assistant who was supervised by the research team. This represents an ‘ideal’ scenario for intervention and it is likely that results would differ from implementation in ‘real-life’ by professionals who would not have the benefit of intensive supervision, time and training. Successful implementation by the National Health Service (NHS) speech and language teams throughout the UK would require the E-PLAYS intervention to translate to a setting in which speech and language therapists and teaching assistants could learn to use it together without research team input or supervision.
Following on from our preliminary work with E-PLAYS [29, 39] therefore, the aim of the present study is to establish the feasibility of running a full-scale clinical trial to evaluate its clinical- and cost-effectiveness when implemented within the National Health Service (NHS) in the UK. Speech and language therapists are employed by and work within the NHS, but their day to day work frequently takes place in the school setting, rather than in clinics, particularly for young children.
This feasibility study will explore potential challenges and aim to develop a protocol for a follow-on large-scale RCT. Specific objectives include testing the recruitment procedure and recording the number of participants recruited over time. An important aspect will focus on determining treatment fidelity; E-PLAYS will be delivered by teaching assistants who have been trained by NHS speech and language therapists. We will also aim to establish the acceptability of E-PLAYS with speech and language therapists and with teachers, teaching assistants, parents and children and also explore the acceptability of randomisation to a control group. We will also seek to determine the feasibility of collecting resource-use data and quality of life measures for the purpose of calculating relative cost-effectiveness.
The design is a two-arm feasibility cluster-randomised controlled trial (cRCT) with randomisation at the level of the speech and language therapist (SLT). Each particip