Gelişimsel Dil Bozukluğu Olan Vakaların Klinik Yönetimi: Nitel Bir Çalışma

Year 2023, , 219 - 267, 30.12.2023

Selin Tokalak , İbrahim Can Yaşa

https://doi.org/10.58563/dkyad-2023.63.1

Abstract

Amaç: Bu çalışma, gelişimsel dil bozukluğu (GDB) olan çocuklar için Türkiye’deki dil ve konuşma terapistlerinin (DKT) ayırıcı tanı ve müdahale konularındaki çözüm odaklı yaklaşımlarına ilişkin bilgi vermeyi amaçlamaktadır.

Yöntem: Araştırmada niteliksel bir paradigma içinde, yapılandırmacı bir yaklaşım kullanılmıştır. Fenomenoloji, DKT'lerin GDB'li çocuklara dil ve konuşma terapisi sağlamasını keşfetmek için ana araştırma metodolojisi olarak benimsenmiştir. Analitik yaklaşım olarak ise yorumlayıcı fenomenoloji seçilmiştir. Araştırmaya mesleki deneyim süresi 2 – 16 yıl arasında değişen 15 DKT katılmıştır.

Bulgular: Bulgular, DKT'lerin GDB'nin ayırıcı tanısı için formal bir değerlendirme yöntemi olarak sıklıkla geçerlik ve güvenirliği yüksek, standardize bir değerlendirme aracı olan Türkçe Erken Dil Gelişimi Testi (TEDİL) ile klinik içi gözlem ve genellikle vaka geçmişi ile tamamlanan çeşitli informal değerlendirmeler kullandığını göstermektedir. Müdahale seçimi, bireye neyin hitap ettiğine, yaşına neyin uygun olduğuna, spesifik tanı ve bozukluğun şiddetine göre belirlenmektedir. DKT'lere göre ebeveynler ayırıcı tanı ve müdahalede kritik rol oynamaktadır.

Sonuç: Bu bulgular, GDB alanında ayırıcı tanının açık ve tutarlı bir terminolojisine (a), günlük yaşama katılımı değerlendirmek için hızlı ve uygulaması kolay (b), kapsamlı bir ayırıcı tanı aracına, mevcut değerlendirme araçlarının güncellenmesine (c) ve GDB’ye yönelik kanıt temelli müdahale yaklaşımlarının tercih edilmesini teşvik edici uygulamaların (d) veya eğitimlerin yaygınlaştırılmasına olan ihtiyacı ortaya koymaktadır.

Keywords

Gelişim dil bozukluğu, Terapist yaklaşımları, Klinik değerlendirme, Müdahale, Klinik yönetim

Clinical Management of Developmental Language Disorders: A Qualitative Study

Abstract

Purpose: This study aims to provide insights into the solution-focused approaches of speech and language therapists (SLTs) in Turkey concerning clinical diagnosis and intervention for children with developmental language disorder (DLD).

Method: The qualitative research method was chosen aiming for an in-depth exploration of the mentioned subject and to reach different, previously unexplored areas. Employing a qualitative paradigm and a constructivist approach, phenomenology was adopted as the primary research methodology to explore how SLTs provided therapy to children with DLD. Interpretative phenomenology was selected as the analytical approach, as it went beyond describing the phenomena (i.e., descriptive phenomenology) and aimed to uncover the embedded, often unconscious, meanings in everyday life practices. 15 SLTs with professional experience ranging from 2 to 16 years participated in the research. The data for the research was collected through semi-structured interviews which were transcribed into written text to create the dataset. To ensure the consistency of data analysis, the data was analyzed by an expert in the field other than the researchers.

Results: The findings indicated that SLTs frequently used the Turkish version of the Test of Early Language Development (TEDİL), observations, and various informal assessments often complemented by the case history in the diagnosis of DLD. Among other formal assessment tools mentioned by SLTs for assessing DLD in their clinical practices were the Turkish version of the Test of Language Development-Primary (TODİL), Ankara Development Inventory (AGTE), Turkish version of MacArthur-Bates Communicative Development Inventory (TİGE), and Turkish Expressive and Receptive Language Test (TİFALDİ). In addition, a significant majority of the participants expressed dissatisfaction with formal assessment tools for evaluating DLD. In response to this situation, the suggestions were offered for the revision of existing tests in terms of the visuals included or for the development of formal assessment tools specifically targeting more specific age ranges for evaluation. The choice of intervention was determined according to whether the intervention appealed to the individual with DLD, the intervention was appropriate to the age as well as the specific diagnosis and severity of the disorder. According to SLTs, parents played a crucial role in the diagnosis and intervention process. However, the parents expressed that this critical role assigned to parents was often not provided at the desired level.

Conclusion: These findings underscore the need for a clear and consistent terminology of differential diagnosis in the field of DLD (a), a quick and easy-to-apply comprehensive differential diagnostic tool to assess participation in daily life (b), updating existing assessment tools (c), and the dissemination of practices or trainings (d) that encourage the adoption of evidence-based intervention approaches for DLD.

Keywords

Developmental language disorder, Therapists' preferences, Clinical assessment, Intervention, Clinical Management

Thanks

Yazarlar, yardımları için Bahçeşehir Üniversitesi Dil ve Konuşma Terapisi bölümü öğrencilerinden Berru Nur Demir’e, Duru Dicle Tatar’a, Ece Deniz Dönertaş’a, Ecem Altuner’e, Eda Nur Suluk’a, Yaren Güven’e ve araştırmaya gönüllü olarak katılmayı kabul eden DKT’lere teşekkürlerini iletmektedir.

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