Childhood Speech Sound Disorders

The MISLToe_SSD study: collecting routine data for cost and clinical effectiveness

Maximising the Impact of Speech and Language Therapy for children with speech sound disorder (MISLToe_SSD) aims to revolutionise the way interventions for SSD are delivered in the UK. Speech and language therapy services across the UK currently record different data and outcomes. Collecting the same data will enable:

• comparison of different pathways and interventions within and across services 
• identification of the most cost and clinically effective interventions for different types of SSD

Professor Helen Stringer is working with Professor Yvonne Wren (Principal Investigator, Bristol University, North Bristol NHS Trust and Cardiff Metropolitan University), Professor Joanne Cleland (Strathclyde University), Dr Sam Harding (North Bristol NHS Trust) and Dr Sam Burr (Bristol University, North Bristol NHS Trust and Cardiff Metropolitan University) on the three-phase MISLToe_SSD study. 

MISLToe_SSD Phase 1

MISLToe_SSD Phase 1 was a NIHR Research for Patient Benefit funded project. The project successfully developed:

•  a Core Outcome Set (COS) and minimum dataset for SSD
•  a diagnostic protocol
•  agreed definitions of interventions

Publications

Stringer H, Burr S, Cleland J, Harding S, Wren Y, MISLToe_SSD Expert Panel (2026). Maximising the Impact of Speech and Language Therapy for Children With Speech Sound Disorder (The MISLToe_SSD) Study: Developing a Core Outcome Set (COS) for Routine Data Collection From UK NHS Speech and Language Therapy Services. Int J Lang Commun Disord, 61(1):e70188. https://doi.org/10.1111/1460-6984.70188.

Cleland J, Burr S, Harding S, Stringer H, Wren Y (2025). Towards an Agreed Labelling System and Protocol for the Diagnosis of Speech Sound Disorder Subtypes in the United Kingdom. Int J Lang Commun Disord, 60(3):e70052. https://doi.org/10.1111/1460-6984.70052.

Harding S, Burr S, Cleland J, Stringer H, Wren Y (2024). Outcome measures for children with speech sound disorder: an umbrella review. BMJ Open, 14(4):e081446. https://doi.org/10.1136/BMJOPEN-2023-081446.

MISLToe_SSD Phase 2

MISLToe_SSD Phase 2 is funded by NIHR Research for Patient Benefit and Health and Care Research Wales and will finish in 2027. Five NHS Trusts in England and seven Health Boards in Wales are piloting the COS and minimum dataset for SSD, a diagnostic protocol and agreed definitions of interventions. This phase is testing the feasibility of collecting routine data about SSD interventions and using that to inform service improvements. A wider roll-out will be tested in MISLToe_SSD Phase 3.

The EDII_SSD study: intervention dosage for speech sound disorders

The Evidence-based intensity of intervention of SLT services for children with SSD (EDII_SSD) study is funded by NIHR Research for Patient Benefit to finish in 2027. EDII_SSD is led by Dr Sam Harding and Professor Yvonne Wren at North Bristol NHS Trust. The team comprises Professor Helen Stringer, Dr Tomas Robinson (Newcastle University), Dr Emma Pagnamenta (Reading University), Dr Jill Titterington and Mrs Nichola McDonald (PPIE).

The EDII_SSD study will:

• investigate current SLT practice and costs relating to intensity of intervention for 3- to 8-year-olds with SSD of unknown origin
• co-create working standards and an implementation pathway for optimum evidence-based therapy intensity within existing NHS resources

Partnership Working: Speech and Language Therapy and Education

The Northumbria Healthcare NHS Foundation Trust-Newcastle University Universal, Targeted & Specialist (NNUTS) Framework was supported by funding from a Knowledge Transfer Partnership (KTP) and the Economic and Social Research Council.

Professor Helen Stringer worked with colleagues in the NHS and Education to develop and evaluate a three-tier model of universal, targeted and specialist (UTS) interventions for children with speech, language and communication needs (SLCN). The interventions are delivered by speech and language therapists, teachers and teaching assistants working in partnership.

This study drew on behaviour change theories and social capital models of collaborative practice to show that partnership working could effectively deliver interventions. These universal and targeted interventions support language development in pre-school children at risk of SLCN in areas of deprivation. 

Resources are freely available to Speech and Language Therapy Services on the NNUTS website. These resources support effective and sustained implementation of universal, specialist interventions in educational settings and schools promoting better outcomes for children.

Phonological awareness to support speech, language and literacy

Phonological awareness at syllable and phoneme (speech sound) level is an essential auditory skill for children’s speech and language development and for learning to read and spell. Up to 50% of children in areas of deprivation do not have phonological awareness skills ready to support phonics learning when they start school. This leads to reading difficulties with lifelong negative consequences. Up to 85% of children referred to Speech and Language Therapy services with speech and language disorders will have poor phonological awareness skills.

Professor Helen Stringer developed the evidence-based Newcastle Assessment of Phonological Awareness (NAPA) and the Newcastle Intervention for Phonological Awareness (NIPA). These are freely available to speech and language therapy and education staff (CC licence). 

Phonological awareness intervention is known to be effective in supporting speech sound and vocabulary development as well as reading and spelling.

The NAPA and NIPA are used widely across the UK and internationally. For example:

• Speech and Language UK have embedded the NIPA into their Pre-Phonics Boost programme.
• Stoke Speaks Out use the NAPA and NIPA. They have developed a series of training videos for their education partners to support phonological awareness for children across Stoke-on-Trent and Staffordshire.

The LIVELY study

This study investigated language intervention in the Early Years. This innovative research was funded by the Heather van der Lely Foundation. It aimed to evaluate the effectiveness of language interventions for children with language difficulties. 

Dr Christine Jack, Professor Helen Stringer, Dr Carolyn Letts and Dr Sean Pert (Manchester University) led by Professor Christina McKean (now at Oxford University) worked with a team of speech and language therapists, schools and early years settings to evaluate the effectiveness of language interventions for pre-school children with significant language difficulties.

Two interventions were evaluated:  

1. Building Early Sentences Therapy (BEST). BEST was developed by Newcastle University in partnership with speech and language therapists.
2. A modified version of the Derbyshire Language Scheme (DLS). 

BEST was also translated into Polish and Mirpuri and delivery of intervention in home language was evaluated. 

Find out more

• you can see our findings on the LIVELY website
• BEST resources are available on the BEST website

Researcher contact details

To find out more about any of the projects above, you can contact Professor Helen Stringer.