What works, how and in which contexts when using digital health to support parents/carers to implement intensive speech and language therapy at home for children with speech sound disorder? A realist review
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Purpose: Digital health solutions to support parent-implemented interventions alongside direct speech and language therapist (SLT) input could help increase intervention intensity for children with speech sound disorder (SSD) to meet evidence-based recommendations. This realist review explores the factors which could make intensive parent-implemented digital interventions for children with SSD effective, and how this complex intervention might work in different contexts. Methods: Realist review methodology was adopted to explore what works, why, how, for which parents/carers, and in what circumstances. Realist methods aimed to understand the active ingredients, contexts, and associated outcomes of this complex intervention. Preliminary theories were developed to describe how and why digital parent-implemented interventions work for children with SSD. Data was extracted from 43 papers to test and refine preliminary theories. Behaviour change theories were used to explain how the intervention works in practice. Results: A set of 20 explanatory theories were developed to depict how and why digital parent-implemented interventions work in different contexts. Theories covered five areas: child-participation; the child-parent-SLT dynamic; parent-training; partnership and collaboration; intervention intensity. The theories describe mechanisms of the intervention and how these are responded to in different situations. Findings highlight the importance of intensive intervention for children with SSD. Conclusions: This realist review adds new in-depth insight into how digital parent-implemented interventions work, for whom, and why. This new understanding has potential to support future successful digital parent-implemented interventions and increase intervention intensity for children with SSD globally. Implications for services and the potential of emerging digital health approaches to promote parent-implemented interventions are discussed.
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Home-based, parent-delivered training can be a viable way to achieve the intervention intensity needed to promote speech change in children with SSD.
“Indeed, home‐based, parent‐delivered training can be a viable way to achieve the intervention intensity needed to promote speech change in children with SSD (Leafe et al. 2025; Tosh et al. 2017).”
From Self‐Supervised App‐Based Speech Training for Children With Speech Sound Disorder—A Single‐Case Experimental Design Study (2026) · cites this paper as Leafe et al. 2025
Digital speech-training tools may provide a route to overcoming barriers to intervention.
“Digital speech‐training tools may provide a route to overcoming barriers to intervention (Leafe et al. 2025).”
From Self‐Supervised App‐Based Speech Training for Children With Speech Sound Disorder—A Single‐Case Experimental Design Study (2026) · cites this paper as Leafe et al. 2025
Parental involvement in speech intervention can integrate practice into everyday life activities and increase training intensity.
“One potential benefit of parental involvement in speech intervention, as well as a key to increased training intensity, is the opportunity to integrate practice into everyday life activities (Bowen and Cupples 2004; Sugden et al. 2016; Leafe et al. 2025).”
From Self‐Supervised App‐Based Speech Training for Children With Speech Sound Disorder—A Single‐Case Experimental Design Study (2026) · cites this paper as Leafe et al. 2025
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Baker, Z. A., Snodgrass, T. D., Benway, N. R., & Preston, J. L. (2026) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2026_persp-25-00301
Rodgers, L., Botting, N., & Herman, R. (2026) · Health Expectations · doi:10.1111/hex.70855
Systematic mapping of AI-based speech therapy apps and their pedagogical design
Afrin, K. S., & Mahmud, S. (2026) · Journal of Speech Sciences · doi:10.20396/joss.v15i00.21036
Mtabvuri, D., Donga, S., & Quarkume, A. Y. (2026) · International Conference on Information Technology for Social Good (GoodIT) · doi:10.1145/3794786.3830734
- Authors
- Leafe, N., Pagnamenta, E., Taggart, L., Donnelly, M., Hassiotis, A., & Titterington, J.
- Affiliations
- University of Ulster (GB)
- University of Reading (GB)
- University College London (GB)
- Corresponding author
- Leafe, Naomi
- Venue
- PLOS One
- Publisher
- Public Library of Science (PLoS)
- Published
- 2025-05-07
- Volume
- 20
- Issue
- 5
- Pages
- e0321647
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC12057862
- OpenAlex
- W4410153156
- Cited by
- 10
- References
- 89
- Citations by year
- 2026: 8 · 2025: 2
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (publishedVersion, cc-by)
- Ulster University Research Portal (Ulster University) (acceptedVersion, cc-by)
- CentAUR (University of Reading) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Department for the Economy, Northern Ireland
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
- Health Sciences › Medicine › Physiology › Voice and Speech Disorders
- Social Sciences › Psychology › Clinical Psychology › Stuttering Research and Treatment
- Keywords
- speech sound disorders, digital health interventions, intensive intervention, children, behaviour change theory, parent training, children's participation, parent-therapist collaboration, intervention intensity, complex interventions
- MeSH terms
- Digital Health, Child, Humans, Language Therapy, Parents, Speech Therapy, Caregivers, Speech Sound Disorder
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