{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T15:57:35Z","timestamp":1788191855398,"version":"build-2803163510"},"reference-count":71,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["223500\/Z\/21\/Z"],"award-info":[{"award-number":["223500\/Z\/21\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Although frequently seen in clinical services, there are few interventions which have been developed specifically to meet the needs of pre-school children with co-occurring features of a phonological speech sound disorder (P-SSD) and developmental language disorder (DLD). This study aims to achieve consensus on the core elements of a novel intervention for pre-school children with co-occurring features of P-SSD and DLD (\u201cSWanS\u201d- <jats:underline>S<\/jats:underline>upporting <jats:underline>W<\/jats:underline>ords <jats:underline>an<\/jats:underline>d <jats:underline>S<\/jats:underline>ounds), where expressive vocabulary and speech comprehensibility are joint outcomes of interest.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Forty-seven potential core intervention elements, based on a priori findings and the wider literature, were generated by a diverse steering group of professionals and people with lived experience within a systematic co-design process. This was followed by a modified, two round, e-Delphi with expert Speech and Language Therapists (SLTs) to achieve consensus on the elements. Consensus was defined as over 75% of participants (minimum 30 SLTs) rating the elements as either appropriate or very appropriate on a Likert of 1\u20135, with an inter-quartile range of one or below. If consensus was not achieved in round 1, free text comments were used to generate amended statements for the second round.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Consensus was achieved on 42\/47 statements in round 1. During the revision process, one statement was discarded; six statements which did not achieve consensus were re-worded; two statements which required further clarity had examples added; four statements were merged into two statements. Consensus was reached on 8\/8 statements presented in round 2, resulting in 44 final statements achieving consensus in total.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Core elements of a novel intervention have been identified through co-design with a diverse group of stakeholders followed by consensus with expert SLTs. Additional flexibility was required within some core elements in order to achieve consensus. Implications for future implementation are discussed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0326072","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T17:45:25Z","timestamp":1750268725000},"page":"e0326072","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Co-design to consensus: Identifying the core elements of a novel intervention for pre-school children with co-occurring phonological speech sound disorder (SSD) and developmental language disorder (DLD) using a modified e-Delphi approach"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6585-7206","authenticated-orcid":true,"given":"Lucy","family":"Rodgers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Botting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7470-2166","authenticated-orcid":true,"given":"Helen","family":"Stringer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Abdo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meriem","family":"Amer-El-Khedoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Franks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Harford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrycja","family":"Salimi-Tabar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Temple","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ros","family":"Herman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"issue":"8","key":"pone.0326072.ref001","doi-asserted-by":"crossref","first-page":"2750","DOI":"10.1044\/2018_JSLHR-L-18-0061","article-title":"Early risk factors and emotional difficulties in children at risk of developmental language disorder: A population cohort study","volume":"62","author":"MC St Clair","year":"2019","journal-title":"J Speech Lang Hear Res"},{"issue":"4","key":"pone.0326072.ref002","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1111\/1460-6984.12385","article-title":"Quality of life in children with developmental language disorder","volume":"53","author":"P Eadie","year":"2018","journal-title":"Int J Lang Commun Disord"},{"issue":"4","key":"pone.0326072.ref003","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/1460-6984.12719","article-title":"Interventions for pre-school children with co-occurring phonological speech sound disorder and expressive language difficulties: A scoping review","volume":"57","author":"L Rodgers","year":"2022","journal-title":"Int J Lang Commun Disord"},{"issue":"6","key":"pone.0326072.ref004","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1111\/dmcn.12635","article-title":"Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children","volume":"57","author":"P Eadie","year":"2015","journal-title":"Dev Med Child Neurol"},{"key":"pone.0326072.ref005","first-page":"1","article-title":"The Delphi technique: making sense of consensus","volume":"12","author":"CC Hsu","year":"2007","journal-title":"Pract Assess Res Eval"},{"issue":"11","key":"pone.0326072.ref006","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1111\/jcpp.12573","article-title":"The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study","volume":"57","author":"CF Norbury","year":"2016","journal-title":"J Child Psychol Psychiatry"},{"issue":"10","key":"pone.0326072.ref007","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1111\/jcpp.12721","article-title":"Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology","volume":"58","author":"DVM Bishop","year":"2017","journal-title":"J Child Psychol Psychiatry"},{"issue":"2","key":"pone.0326072.ref008","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1111\/jcpp.12648","article-title":"When does speech sound disorder matter for literacy? 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