Remarks y For children who stutter, the direct instruction approach involved speech-language therapists working with parents to deliver a behaviour modification programme with a strong reinforcement contingency component. Both studies included in the meta-analysis by Brignell et al. (2021) included data at follow-up time points that showed treatment gains had been maintained, suggesting lasting effects of treatment (65). y For improving expressive phonological skills in children with developmental speech disorders, the intervention approach involved expressive phonological tasks, phonological awareness, and auditory discrimination and listening activities.

Implementation considerations y The location of intervention sessions can vary from structured settings (e.g. school, typically used in early treatment) to less structured naturalistic settings (e.g. home, used later in treatment). y Treatment of school-age and older children may require modifications to ensure the treatment is developmentally appropriate. y The available evidence involved instruction from speech and language therapists in high-resource settings; implications for adaptations in lower resource settings may be needed.