E-PLAYS-2 (Enhancing Pragmatic Language skills for Young children with Social communication impairment) trial; evaluation of a computerised intervention to promote communicative development and collaborative skills in children

BACKGROUND A number of children experience difficulties with social communication (also known as pragmatic language ability). These difficulties can include initiating conversation and responding appropriately, problems with varying communication to match the context or listeners' needs, recounting a coherent narrative and understanding non-literal language. Whilst such children may have adequate or even advanced vocabulary and grammar, they can struggle with everyday conversational tasks. There is a lack of evidence-based, cost-effective interventions for children with social communication difficulties; in fact, language therapies as a whole have attracted little research funding. Language disorders remain little known by the public and under-researched by comparison to conditions with similar prevalence and impact, such as ADHD, childhood obesity and dyslexia. Furthermore, the limited take up of technology in this field is widely regarded as a missed opportunity. We therefore plan to conduct a study to evaluate the effectiveness of a digital intervention for children with social communication difficulties. INTERVENTION The E-PLAYS (Enhancing Pragmatic Language skills for Young children with Social communication difficulties) intervention is a novel technology in the form of a fun computer game. E-PLAYS is played by children in pairs and comprises 10 weekly sessions of 30 minutes each, supervised by a teaching assistant. E-PLAYS will be delivered in special and mainstream primary schools in the UK. This study builds on a previous pilot study and feasibility trial (E-PLAYS-1). The pilot study showed some indication of efficacy with regard to language improvement; the feasibility trial showed acceptable recruitment and response rates. OBJECTIVES The primary objective is to examine the impact of E-PLAYS on children’s social communication skills within a school setting. Secondary objectives are to investigate the effect of E-PLAYS on classroom behaviour and peer relations. DESIGN A two-arm pragmatic cluster-randomised controlled trial, with allocation at the school level, with an internal trial, comparing care as usual plus E-PLAYS with a control group receiving care as usual, outcomes up to 40 weeks, in primary schools. The trial will include embedded economic and process evaluations. PARTICIPANTS We will recruit 84 schools and 504 children aged 5-7 years-old who will be selected by teachers using the Social communication Questionnaire. OUTCOME MEASURES: The primary outcome will be a measure of pragmatic language ability as assessed using the Test of Pragmatic Skill by blinded research assistants. Secondary outcome measures, also administered by blinded research assistants, include measures of narrative production, perspective-taking and recall. Other secondary measures of communication, classroom behaviour and peer relations will be provided by teachers. Parents will provide data on quality of life and resource use to inform the economic evaluation. Interviews, observations and focus groups will establish teaching assistants' views on training and E-PLAYS’ ease of use. IMPACT We will definitively test E-PLAYS and plan for implementation, if effective. One of the strengths of this study is that E-PLAYS could be rolled out nationally immediately and at no charge. Dissemination will take place through practitioner networks, social media and public engagement events as well as academic outputs.