Barriers and facilitators to the assessment of cognitive-communication disorders in children and adolescents after traumatic brain injury: a survey of Australian clinical practice

Abstract

Background. There is a lack of comprehensive clinical guidance for the measurement of paediatric cognitive-communication disorders (CCDs) following traumatic brain injury (TBI). This study aimed to (1) explore Australian speech-language pathologists' (SLPs') measurement practices when assessing CCDs in children and adolescents with TBI; and (2) to understand the barriers and facilitators to optimal assessment using the Theoretical Domains Framework. Methods. This study used an online, cross-sectional survey design, comprising both quantitative and qualitative questions, informed by behaviour change theory. Results were analysed using descriptive statistics and qualitative content analysis. Results. This study reports data from 111 Australian SLPs. SLPs reported measuring a range of constructs with 52 unique measurement instruments. SLPs' professional role, identity and optimism were the primary facilitators, whereas clinicians' behavioural regulation and emotion were found to be primary barriers. SLPs identified the need for greater tertiary training and professional development opportunities, regardless of workplace sector or years of experience. Conclusions. Australian SLPs considered themselves key professionals in the assessment of CCDs in children and adolescents with TBI and reported optimism for the value and benefits of this clinical activity. There was, however, a lack of consistency in measurement practices, as well as feelings of nervousness and difficulty associated with CCD assessment, which may further compound the under-diagnosis already prevalent in this population. Results from this study support the need for comprehensive guidance regarding best practice.