Identifying appropriate symbol communication aids for children who are non-speaking: enhancing clinical decision making

Principal Investigator: Prof Janice Murray

Project Fact File

Start DateJune 2018
End DateOngoing
Funded by

National Institute for Health Research (NIHR) HS&DR (Project ID 14/70/153)

Project TeamProf Janice Murray
Prof Juliet Goldbart
Yvonne Lynch
Stuart Meredith
Elizabeth Moulam
External Providers and CollaboratorsSimon Judge, Barnsley Hospital NHS Foundation Trust
David Meads, University of Leeds
Stephane Hess, University of Leeds

Principal Investigator

Meet Prof Janice Murray

Prof Janice Murray


Phone +44 (0)161 247 2570

Project Details


Children who need to use symbolic communication aids are the most challenging population accessing specialised communication aid services. Currently there is a lack of understanding of the most valuable aspects of clinical expertise and a poor understanding of patient values within the clinical decision process (Scherer et al, 2007). Without research evidence to reinforce clinical expertise there is no means of determining the actual quality of provision (Batorowicz & Shepherd, 2011; Dietz et al, 2012).

Aims and Objectives

The overall aim is to improve the outcomes for children with little or no intelligible speech, who need symbol communication aids to communicate.

The specific aim is to influence current practice to improve the consistency and quality of clinical decision making in the provision of symbol communication aids.


Through five related work packages and a purposive recruitment process, health and educational professionals, family members and young people who use symbol communication aids will be interviewed and surveyed (a minimum of n=400). Respondents will be sought from the well-established AAC (specialised) centres across the UK and leading charitiable organisations, ensuring appropriate and sufficient respondents.

Informed by focus groups and interviews with all stakeholder groups, two Discrete Choice Experiments (DCE) will be conducted. Experiment A) symbol communication system choice, where a child with communication difficulties is described along with 2 or more attributes from a symbol communication system and the respondent chooses which to provide; and Experiment B) Recipient/Child choice, where a symbol communication system is described along with 2 or more children with communication difficulties and the respondent has to choose which child is the best match for the symbol communication system.

Analysis will use choice modelling techniques to identify the importance of each device and child attribute in the choices of respondents.


These experiments and the qualitative findings from the other work packages will inform the development of a clinical decision making heuristic.

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