Evaluating ‘enhancing pragmatic language skills for young children with social communication impairments’ (E-PLAYS): protocol for a feasibility randomised controlled trial study
Pilot and Feasibility Studies volume 5, Article number: 75 (2019)
A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The proposal presented in this article describes a feasibility study for a trial to test an intervention (‘E-PLAYS’) aimed at supporting children with social communication impairments. E-PLAYS harnesses technology in the form of a novel computer game in order to develop collaborative and communication skills. Preliminary studies by the authors show that when E-PLAYS was administered by the research team, children with social communication impairments showed improvements on communication test scores and on observed collaborative behaviours. The study described here is a pragmatic trial to test the application of E-PLAYS delivered by NHS speech and language therapists together with schools.
This protocol outlines a two-arm feasibility cluster-randomised controlled trial of the E-PLAYS intervention with treatment as usual control arm, with randomisation at the level of the speech and language therapist. The aim of this study is to ascertain whether it will be feasible to progress to running a full-scale definitive trial to test the effectiveness of E-PLAYS in an NHS setting. Data relating to recruitment and retention, the appropriateness of outcomes and the acceptability of E-PLAYS to participants will be collected.
Speech and language therapists will select suitable children (ages 4–7 years old) from their caseloads and deliver either the E-PLAYS intervention (experimental group) or treatment as usual (control group). Assessments will include blinded language measures and observations, non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. There will also be a qualitative process evaluation.
The findings of this study will inform the decision as to whether to progress to a full-scale definitive randomised controlled trial to test the effectiveness of E-PLAYS when delivered by speech and language therapists and teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions.
ISRCTN 14818949 (retrospectively registered).
Children with social communication impairments experience difficulties with using linguistic context to understand speakers’ meanings and, more broadly, with applying conventional norms and expectations from the wider society to relate to others . To illustrate, children with social communication impairments are likely to find it difficult to take turns during conversation, maintain a topic of conversation appropriately, recount coherent narratives, respond contingently, make inferences, understand non-literal language such as jokes, irony or sarcasm, repair communication breakdowns and generally follow conversational conventions. Pragmatic language skill may be defined as selection of the appropriate message or interpretation in relation to the communicative context . The terms ‘social communication’ and ‘pragmatic language’ are commonly used to refer to similar skills.
Recent systematic reviews of interventions for ‘social communication impairments’ or ‘pragmatic language impairments’ [3, 4] have adopted broad definitions for these terms encompassing both verbal and nonverbal aspects of communication to include abilities such as facial expression recognition and production . Whilst the terms ‘social communication’ and ‘pragmatic skill’ have often been used interchangeably in the research literature , for the current proposal, we follow the suggestion by Matthew et al.  and define ‘pragmatics’ more specifically as the linguistic component (excluding facial communication and other non-verbal communication) of social communicatio