Call time on non-evidence based practice: Dr Sean Pert asks how we can keep striving to achieve best practice

Press/Media: Expert comment


SLTs are required to ‘engage in evidence-based practice’ so that we can work more efficiently and effectively for our service users (HCPC, 2023). We know that this means we need to be continually challenging our practice and identifying aspects that are no longer appropriate. No one would really argue with this, until we start thinking about terminology, approaches and clinical practice that we ourselves rely on.

An example of a model which is still widely used, despite being highlighted in Bulletin as problematic, is the ‘communication pyramid’. Morgan and Dipper highlighted that “... the pyramid appears to suggest that each layer represents a stage of development that is completed before the next layer, which is clearly untrue. It could mislead people to think that the development of all receptive language skills must be completed before expressive language skills can emerge” (2018). A quick internet search shows that it is still widely used despite its misleading nature.

Similarly, the concept of ‘information carrying words’ (ICWs) from the Derbyshire Language Scheme (DLS) (Knowles and Masidlover, 1979) has been shown to be problematic, especially for speakers of languages other than English (LOTE). The clinical guidance on bilingualism states: “Although the concept of ICWs may work for English, which, at sentence level has a very ‘bare’ morphological structure, the concept of ICWs breaks down for most other languages” (RCSLT, 2024).

Since children who speak LOTE must be assessed and treated in their home language (HCPC, 2023), the use of ICWs cannot be applied to home language clinical practice. The emergence of language packages based on the Constructivist language acquisition model challenge the ICW. Ambridge and Lievan highlight that “...children’s language acquisition is emergent from their use of language as a social tool. Children are not “trying” to learn syntax... they are using language, to cajole, to control and to communicate” (2015).

The LIVELY randomised control trial compared DLS with the ‘Building Early Sentences Therapy’ (BEST) which uses a play-based usage-based approach. This found that BEST was more effective, with carry-over to language structures that were not targeted (McKean et al, 2023). Comprehension does not always precede expression.

It’s only human to want to stick to the tools you are familiar with, but taking time to question your practice offers big rewards for you and your clients. Which frequently used concept, model or idea in your practice, or your team’s care pathways needs to be re-evaluated in the light of recent research?

DR SEAN PERT, RCSLT Chair of Trustees
[email protected]

Period1 Jul 2024

Media contributions


Media contributions


  • Evidence Based Practice (EBP)
  • Information Carrying Words (ICWs)
  • Building Early Sentences Therapy
  • Bilingualism
  • Multilingualism
  • Clinical Practice