Phonological disorders III: a procedure for assessing severity of involvement

Vocalizations of Infants with Hearing Loss Compared with Infants with Normal Hearing: Part II – Transition to Words

OBJECTIVE

By 24 mo of age, most typically developing infants with normal hearing successfully transition to the production of words that can be understood about 50% of the time. This study compares early phonological development in children with and without hearing loss to gain a clearer understanding of the effects of hearing loss in early-identified children. A secondary goal was to identify measures of early phonetic development that are predictors of later speech production outcomes.

DESIGN

The vocalizations and early words of 21 infants with normal hearing and 12 early-identified infants with hearing loss were followed longitudinally over a period of 14 mo (from 10 to 24 mo of age). Thirty-minute mother-child interaction samples were video recorded at 6- to 8-wk intervals in a laboratory playroom setting. Vocalizations produced at 16 and 24 mo were categorized according to communicative intent and recognizable words versus other types. Groups were compared on the structural complexity of words produced at 24 mo of age. Parent report measures of vocabulary development were collected from 10 to 30 mo of age, and Goldman-Fristoe Test of Articulation scores at 36 mo were used in regression analyses.

RESULTS

Both groups increased the purposeful use of voice between 16 and 24 mo of age. However, at 24 mo of age, the toddlers with hearing loss produced significantly fewer words that could be recognized by their mothers. Their samples were dominated by unintelligible communicative attempts at this age. In contrast, the samples from normal hearing children were dominated by words and phrases. At 24 mo of age, toddlers with normal hearing were more advanced than those with hearing loss on seven measures of the structural complexity of words. The children with normal hearing attempted more complex words and productions were more accurate than those of children with hearing loss. At 10 to 16 mo of age, the groups did not differ significantly on parent-report measures of receptive vocabulary. However, the hearing loss group was much slower to develop expressive vocabulary and demonstrated larger individual differences than the normal hearing group. Six children identified as atypical differed from all other children in vowel accuracy and complexity of word attempts. However, both atypical infants and typical infants with hearing loss were significantly less accurate than normal hearing infants in consonant and word production. Early measures of syllable production predicted unique variance in later speech production and vocabulary outcomes.

CONCLUSIONS

The transition from babble to words in infants with hearing loss appears to be delayed but parallel to that of infants with normal hearing. These delays appear to exert significant influences on expressive vocabulary development. Parents may appreciate knowing that some children with hearing loss may develop early vocabulary at a slower rate than children with normal hearing. Clinicians should monitor landmarks from babble onset through transitions to words. Indicators of atypical development were delayed and/or limited use of syllables with consonants, vowel errors and limited production of recognizable words.

Phonological processing and reading in children with speech sound disorders

PURPOSE

To examine the relationship between phonological processing skills prior to kindergarten entry and reading skills at the end of 1st grade, in children with speech sound disorders (SSD).

METHOD

The participants were 17 children with SSD and poor phonological processing skills (SSD-low PP), 16 children with SSD and good phonological processing skills (SSD-high PP), and 35 children with typical speech who were first assessed during their prekindergarten year using measures of phonological processing (i.e., speech perception, rime awareness, and onset awareness tests), speech production, receptive and expressive language, and phonological awareness skills. This assessment was repeated when the children were completing 1st grade. The Test of Word Reading Efficiency was also conducted at that time. First-grade sight word and nonword reading performance was compared across these groups.

RESULTS

At the end of 1st grade, the SSD-low PP group achieved significantly lower nonword decoding scores than the SSD-high PP and typical speech groups. The 2 SSD groups demonstrated similarly good receptive language skills and similarly poor articulation skills at that time, however. No between-group differences in sight word reading were observed. All but 1 child (in the SSD-low PP group) obtained reading scores that were within normal limits.

CONCLUSION

Weaknesses in phonological processing were stable for the SSD-low PP subgroup over a 2-year period.

Speech development patterns and phonological awareness in preschool children

To examine the association between speech production and early literacy skills, this study of 102 preschool children looked at phonological awareness in relation to whether children were delayed, typical, or advanced in their articulation of consonants. Using a developmental typology inspired by some of the literature on speech development (Kahn and Lewis, The Kahn-Lewis phonological analysis, 1986; Shriberg, Journal of Speech and Hearing Research 36(1):105-140, 1993a), we found that failure to master the early-8 consonants and a greater prevalence of certain types of production errors were associated with deficient phonological awareness. We also found that children who made no consonant errors had advanced phonological awareness relative to other children in the sample. In all cases, both productive speech patterns and speech errors were more closely linked with rhyme awareness than with phoneme awareness. The association between speech production and rhyme awareness may provide some new directions for the early preschool assessment of risk for reading problems.

Consonant and syllable structure patterns in childhood apraxia of speech: developmental change in three children

Changes in consonant and syllable-level error patterns of three children diagnosed with childhood apraxia of speech (CAS) were investigated in a 3-year longitudinal study. Spontaneous speech samples were analyzed to assess the accuracy of consonants and syllables. Consonant accuracy was low overall, with most frequent errors on middle- and late-developing sounds. Omissions and substitutions were the dominant error types. Analysis of syllables revealed higher frequencies of error on complex mono- and polysyllables. Multiple regression analyses revealed that consonant accuracy is predicted by syllable shape accuracy and polysyllable frequency. Improvement was noted over time, although irregular patterns of consonant and syllable-level errors persisted across the period studied. Findings suggest that consonant errors in CAS are related to syllable-level deficits, namely difficulty constructing syllabic frames for speech production targets.

LEARNING OUTCOMES

On the basis of this article, the reader will be able to (1) describe the deficits in consonant production demonstrated by the participants, (2) analyze the relationship between consonant production and syllable-level patterns of error and (3) consider the value of addressing syllable construction as a therapeutic goal.

[Severity of phonological disorders: perceptual judgment and percentage of correct consonants]

BACKGROUND

Phonological disorder.

AIM

To apply the percentage of correct consonant (PCC) index and to verify the correlation between this index and the one applied perceptually by judges.

METHOD

The PCC index of 50 phonological disordered subjects was calculated, after 60 judges heard the phonological tests for each subject and perceptually attributed the severity.

RESULTS

The PCC index varied from 40% to 98%, with the predominant classification of the population in the mild and mild-moderate levels.

CONCLUSION

A correlation between the perceptual judgment and the PCC indexes exists.

Error consistency and the evaluation of treatment outcomes

The consistency/variability of error substitution patterns may hold important implications for subgrouping children with speech disorders, as well as for relationships between learning and generalization patterns. There is a need to quantify and examine the range of consistency/variability within the speech disordered population as it relates to system-wide change. This investigation compared two groups of preschool children (N = 10 each) differing in the consistency/variability of errors on a variety of pre-treatment and treatment outcome measures. The Error Consistency Index (ECI), a measure of error variability across the entire phonological system, was used to identify groups at the extreme ends of the ECI distribution from a larger participant pool. Each participant was treated on three target singletons from among obstruents /s, z, f, integral, tintegral, k, g/ and liquids /l, r/ and change on these targets, as well as their generalization to untrained positions was assessed. Although there were significant differences between the variable and consistent groups on all pre-treatment measures, there were no significant group differences in target and generalization learning or in per cent consonants correct (PCC) change. These findings provide evidence to suggest that relationships observed between error variability for individual phonemes and learning of those targets may differ from those observed when consistency/variability is quantified for the entire system and change across a number of phonemes, and the system as a whole, is examined.

Characteristics of the sound systems of monolingual Vietnamese-speaking children with phonological impairment

There has been little or no research on Vietnamese phonological development, let alone on phonological disorders of Vietnamese-speaking children. The goal of this study is to evaluate the sound systems of monolingual Vietnamese-speaking children with phonological impairment. Independent and relational analyses of four children (ages 4;4 to 5;5) are presented in terms of error patterns, dialectal patterns, phonotactic constraints, and phonetic and phonemic inventories. The characteristics of these children's sound systems are compared to studies of phonological acquisition of other languages, in order to identify characteristics that may be universal versus those that may be language-specific in nature.

Speech and language development in six infants adopted from China

Children adopted from China currently represent the largest group of newly internationally adopted children in the US. An exploratory investigation of the communicative development of six young females adopted at ages 9 to 17 months from China by US families was conducted. Children were followed longitudinally from approximately three months post-adoption to age three years. English language skills were assessed at approximately three-month intervals, detailed communicative analyses were conducted at six months post-adoption, and outcomes were measured at three years of age. Results indicated wide variability in rates of English language development. Phonological, social-communicative, and lexical bases of communication were intact for each child at six months post-adoption. At age three years, four of the children demonstrated speech and language skills within one standard deviation of standardized test norms, one child demonstrated skills above the normal range, and one child's skills were below the normal range. This study provides evidence of the resiliency of children's language learning abilities.

Syllables per word in typical and delayed speech acquisition

A number of authors have presented data on the word length (measured in syllables) in the spontaneous speech of children across the developmental period. These data suggest a developmental trend of increasing length with age. The current study sought to examine this possibility in more detail. Conversational speech data from 320 children with normal (or normalized) speech confirmed that the number of syllables per word in conversational speech increases significantly from age 3-8 years. Data from the conversational speech of 202 children with speech delay however showed no such trend. Reasons for the differences between the two groups are discussed.

Phonological deficits in French speaking children with SLI

BACKGROUND

This study investigated the phonological disorders of French-speaking children with specific language impairment (SLI) in production.

AIMS

The main goal was to confirm whether children with SLI have limitations in phonological ability as compared with normally developing children matched by mean length of utterance (MLU) and phonemic inventory size. A number of researchers have obtained findings pointing in this direction, but the conclusions have never been tested on French-speaking children. The second goal was to find out whether characteristic features of the French language are reflected in the nature of the children's phonological disorder.

METHODS & PROCEDURES

The spontaneous language of 16 children with SLI and 16 control children matched on MLU and phonemic inventory size (normal language development group) were analysed using different measures bearing on utterances, words, syllables and phonemes. In both SLI and NLD groups, the children were distributed into two different subgroups based on their MLU, with controlled phonemic inventory size.

OUTCOMES & RESULTS

The results supported a specific limitation in the phonological abilities of French children with SLI, as has already been demonstrated for English, Hebrew, Italian and Spanish-Catalan. However, two unexpected results were also obtained. First, a significant difference between children with SLI and control children could only be found for older children (MLU>3), not for younger children with MLU<3. This was true for all measures.

CONCLUSIONS

This finding highlights the importance of having a developmental perspective and needs to be confirmed through a longitudinal study. Second, deficits were much more significant at the phoneme level than at the syllable level. This may be explained by the fact that the pronunciation of syllables in French is very homogenous, making them easier to segment.

Correlates of phonological awareness in preschoolers with speech sound disorders

PURPOSE

The purpose of this study was to examine the relationships among variables that may contribute to poor phonological awareness (PA) skills in preschool-aged children with speech sound disorders (SSD).

METHOD

Ninety-five 4- and 5-year-old children with SSD were assessed during the spring of their prekindergarten year. Linear structural equation modeling was used to compare the fit of 2 models of the possible relationships among PA, speech perception, articulation, receptive vocabulary, and emergent literacy skills.

RESULTS

Half the children had significant difficulty with speech perception and PA despite demonstrating receptive language skills within or above the average range. The model that showed the best fit to the data indicated that speech perception is a pivotal variable that has a direct effect on PA and an indirect effect that is mediated by vocabulary skills. Articulation accuracy did not have a direct impact on PA. Emergent literacy skills were predicted by PA abilities.

CONCLUSIONS

Children with SSD are at greatest risk of delayed PA skills if they have poor speech perception abilities and/or relatively poor receptive vocabulary skills. Children with SSD should receive assessments of their speech perception, receptive vocabulary, PA, and emergent literacy skills.

Measuring severity of involvement in speech delay: segmental and whole-word measures

PURPOSE

This study examined whether any of a series of segmental and whole-word measures of articulatory competence captured more of the variance in impressionistic ratings of severity of involvement in speech delay. It also examined whether knowing the age of the child affected severity ratings.

METHOD

Ten very experienced speech-language pathologists rated severity of involvement from conversational speech samples obtained from 17 children with delayed speech. The ratings were then correlated with the candidate measures. The ratings by those who knew the ages of the children were also compared with the ratings by those who did not.

RESULTS

The severity ratings showed considerable variability. Ratings from 6 clinicians who largely agreed with each other (a "tin standard" group) were significantly associated with several of the candidate measures. Clinicians appeared to pay attention to number, type, and consistency of errors when rating severity. They also attended to both segmental and whole-word levels. Knowledge of the children's ages did not appear to affect the ratings.

CONCLUSIONS

The observed variability in the severity ratings raises significant questions about their usefulness. Objective measures such as some of those examined herein offer potential as more valid and reliable severity indexes.

Treating children with expressive phonological disorders: does phonological awareness therapy work in the clinic?

BACKGROUND

Recent research has shown that phonological awareness therapy can improve speech production in children with expressive phonological disorders. This approach may be appealing to clinicians as the therapy may also benefit the children's general phonological abilities and lead to gains in their literacy skills.

AIMS

To examine the effectiveness of phonological awareness therapy under conditions more similar to those prevailing in many speech and language therapy clinics. Children were treated in small groups and less intensive therapy was offered than in previous studies.

METHODS & PROCEDURES

Twenty children were randomly assigned to treated and untreated groups. A pre-/post-test design was used to monitor their progress in phonological awareness, literacy and speech production. Children were treated in groups of three. They received 12 hours of therapy.

OUTCOMES & RESULTS

Comparisons of the groups showed that the treated group made significantly greater gains in phonological awareness. However, differences between the groups in the measures of literacy and speech production were smaller and non-significant. Considerable variation was detected in the response of individual children to the therapy.

CONCLUSIONS

The results show the effectiveness of phonological awareness therapy in benefiting children's general phonological skills. However, the comparison of these and previous findings suggest that children may require more therapy than is often available if literacy and speech production are also to benefit. Further research is required to confirm the duration and intensity of therapy required. Until such information is available, clinicians might want to take a cautious approach and combine therapies that target phonological awareness with more traditional approaches, that target speech production more directly.

A comparison of phonological skills of boys with fragile X syndrome and Down syndrome

In this study, the authors compared the phonological accuracy and patterns of sound change of boys with fragile X syndrome, boys with Down syndrome, and typically developing mental-age-matched boys. Participants were 50 boys with fragile X syndrome, ages 3 to 14 years; 32 boys with Down syndrome, ages 4 to 13 years; and 33 typically developing boys, ages 2 to 6 years, who were matched for nonverbal mental age to both the boys with fragile X syndrome and the boys with Down syndrome. All participants were administered a standardized articulation test, and their sound accuracy, phonological process, and proportion of whole-word proximity scores were analyzed. Although boys with fragile X syndrome were delayed in their speech development, they did not differ from the typically developing, mental-age-matched boys in the percentage of correct early-, middle-, and late-developing consonants; phonological processes; or whole-word proximity scores. Furthermore, boys with fragile X syndrome had fewer errors on early-, middle-, and late-developing consonants; fewer syllable structure processes; and higher whole-word proximity scores than did boys with Down syndrome. Boys with Down syndrome also were delayed in their speech development, yet their phonological inventories, occurrences of phonological processes, and proportion of whole-word proximity scores indicated greater delays in their phonological development than the younger, typically developing boys. These results suggest that males with fragile X syndrome display phonological characteristics in isolated words similar to younger, typically developing children, whereas males with Down syndrome show greater delays as well as some developmental differences compared with both the males with fragile X syndrome and typically developing males.

Assessment of Phonological Representations in Children With Speech Impairment

Purpose: This study explored the use of assessment tasks to examine underlying phonological representations in preschool children with speech impairment. The study also investigated the association between performance on phonological representation tasks and phonological awareness development.

Method: The performance of 9 children (aged 3;09 [years;months] to 5;03) with moderate or severe speech impairment and 17 children of the same age with typical speech development was investigated on a range of novel receptive-based assessment tasks designed to tap underlying phonological representations.

Results: Preschool children with speech impairment experienced more difficulty judging correct and incorrect speech productions of familiar multisyllable words and showed inferior performance in the ability to learn nonwords as compared to children without speech impairment. Performance on these tasks was moderately correlated with phonological awareness ability.

Clinical Implications: Factors such as the precision and accessibility of underlying phonological representations of spoken words may contribute to problems in phonological awareness and subsequent reading development for young children with speech impairment. Receptive-based assessments that examine underlying phonological representations provide clinically relevant information for children with speech impairment.

Análise da freqüência fundamental, jitter, shimmer e intensidade vocal em crianças com transtorno fonológico

O transtorno fonológico é uma alteração de manifestação primária de causa indefinida que torna a fala ininteligível. A análise de parâmetros vocais torna-se importante no processo do diagnóstico deste transtorno, pois distúrbios de voz poderiam interferir na produção dos sons da fala. OBJETIVO: O objetivo deste estudo foi verificar as características vocais relacionadas à intensidade e freqüência fundamental - F0 - e seus índices de perturbação - jitter e shimmer - em crianças com transtorno fonológico. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. MATERIAL E MÉTODO: Foram sujeitos 40 crianças distribuídas em dois grupos: 20 com transtorno fonológico e 20 sem alteração de fala e linguagem. Foram aplicadas provas de fonologia do Teste de Linguagem Infantil ABFW e de fala espontânea. Utilizou-se o Computer Speech Lab, para gravação e análise acústica das vogais /a/, /e/, /i/, por meio dos parâmetros vocais: freqüência fundamental, intensidade, jitter e shimmer. RESULTADOS: F0 - vogal /e/ é menor, em média, para o Grupo com Transtorno Fonológico (126Hz) e 237Hz no Grupo Controle. Para o shimmer e jitter não há evidência de que as médias do Grupo com Transtorno Fonológico sejam diferentes das do Grupo Controle (p= 0,191, p=0,865 respectivamente). Quanto à intensidade, há evidência de que a média diferencia os dois grupos (p= 0,002). CONCLUSÃO: A freqüência da vogal /e/ é menor no Grupo com Transtorno Fonológico. Existe diferença entre grupos para as médias da intensidade das vogais /a/, /e/ e /i/, sendo estas menores no Grupo com Transtorno Fonológico. Não foram encontradas diferenças entre grupos para as médias do jitter e do shimmer.

Analysis of fundamental frequency, jitter, shimmer and vocal intensity in children with phonological disorders

Phonological Disorder is a disturbance of primary manifestation of undefined causes that makes speech become unintelligible. The analysis of vocal parameters becomes important in the process of diagnosis of this disorder, since voice disorders could interfere in the production of speech sounds. Aim: The objective of this study was to verify vocal characteristics related to the intensity and fundamental frequency -F0- and their disturbance indexes - jitter and shimmer - in children with phonological disorders. Study design: clinical prospective with transversal cohort. Material and Method: There were 40 children, 20 of them with phonological disorders and 20 with no speech and language disturbances. Phonological exams with the ABFW infantile language test and spontaneous speech were applied. The Computer Speech Lab was used to record and perform acoustic analyses of the vowels /a/, /e/, /i/, through the vocal parameters: fundamental frequency, intensity, jitter and shimmer. Results: F0 - vowel /e/ was smaller, on average, in the Phonological Disorder Group and it was 126 Hz in the Control Group. To shimmer and jitter there was no evidence that the means of the Phonological Disorder Group were different from the ones of the Control Group (p= 0.191, p= 0.865, respectively). As for intensity, there was evidence that the average did not differ in the Phonological Disorder Group and the Control Group (p= 0.002). Conclusion: The frequency of the vowel /e/ was smaller in the Phonological Disorder Group. There was difference between the two groups regarding the means of intensity of vowels /a/, /e/ and /i/, smaller in the Phonological Disorder Group. No differences between the groups were found regarding the averages of jitter and shimmer.

A comparison of single words and conversational speech in phonological evaluation

PURPOSE

The purpose of the current study was to compare conversational speech samples with single-word samples that were partially tailored to the participants' individual phonological profiles, using aspects of nonlinear phonological frameworks as a basis for evaluation.

METHOD

There were 20 participants in the study, ranging in age from 3;0 to 10;5 (years;months). The Computerized Articulation and Phonology Evaluation System (J. J. Masterson & B. Bernhardt, 2001) was used to elicit single-word productions.

RESULTS

Both group and individual comparisons indicated very few differences in accuracy or treatment ramifications. The time required to elicit and transcribe the conversational samples was typically 3 times greater than the time required for the single-word task. The single-word task elicited more of the English-language targets.

CONCLUSIONS

The results of this study suggest that a single-word task tailored to some extent to the client's phonological system gives sufficient and representative information for phonological evaluation. A brief conversational sample remains useful for examining prosody, intelligibility, and other aspects of language, and as a check on the representativeness of the single-word sample.

Phonological Skills in Predominantly English-Speaking, Predominantly Spanish-Speaking, and Spanish-English Bilingual Children

Purpose: There is a paucity of information detailing the phonological skills of Spanish-English bilingual children and comparing that information to information concerning the phonological skills of predominantly English-speaking (PE) and predominantly Spanish-speaking (PS) children. The purpose of this study was to examine the relationship between amount of output (i.e., percentage of time each language was spoken) in each language and phonological skills in Spanish-English bilingual children and PE and PS children.

Method: Fifteen typically developing children, ranging in age from 5;0 (years;months) to 5;5 (mean=5;2), participated in the study. The participants consisted of 5 PE speakers, 5 PS speakers, and 5 bilingual (Spanish-English) speakers. A single-word assessment was used to gather information on phonological skills (consonant accuracy, type and frequency of substitutions, frequency of occurrence of phonological patterns [e.g., cluster reduction], accuracy of syllable types [e.g., CV, CVC, CCV, etc.]), and type and rate of cross-linguistic effects.

Results: The results indicated that there was no significant correlation between amount of output in each language and phonological skills either in the Spanish skills of PS children and Spanish-English bilingual speakers or in the English skills of PE children and Spanish-English bilingual speakers. In addition, there was no significant difference in segmental accuracy, syllabic accuracy, or percentage of occurrence of phonological patterns between either the Spanish skills of PS children and Spanish-English bilingual speakers or the English skills of PE children and Spanish-English bilingual speakers. Finally, the children showed a limited number of cross-linguistic effects.

Clinical Implications: Results from this study indicate no link between parent estimates of language output and phonological skill and demonstrate that Spanish-English bilingual children will have commensurate, although not identical, phonological skills as compared to age-matched PS and PE children.

Analysis of distortions in children with and without phonological disorders

PURPOSE

To verify using 4 different tests the incidence of distortions in children with and without phonological disorders.

METHOD

Forty children between 4 and 10.2 years of age, divided into 2 groups: 20 with normal development and 20 with phonological disorders. All children underwent the phonology tests of the Child Language Assessment ABFW and 2 spontaneous speaking tests to assess for phonologic alterations. After recording, the data were printed, analyzed, and classified according to the distortions. Nonparametric (Mann-Whitney) statistical analysis was performed with the significance level being set at P <.05.

RESULTS

The phonological disorder group had significantly more occurrences of distortions in all tests compared to the control group (naming, P = .04; imitation P <.001; spontaneous speaking 1, P = .01; and spontaneous speaking 2, P = .002. The Pearson correlation coefficients of the distortion occurrences among the 4 tests were high.

CONCLUSION

The phonological disorder group presented a greater number of distortions in all tests. The most frequent ones were /s, z, 3/ and the variability found within the phonological disorder group was very high. The children in this group had unstable phonological systems and so presented a high number of different distortions. Regarding the evaluation of the phonologic system, all the tests were good evaluation methods since the correlations between them were high.

Effect of phonemic perception training on the speech production and phonological awareness skills of children with expressive phonological delay

Children with expressive phonological delays often possess poor underlying perceptual knowledge of the sound system and show delayed development of segmental organization of that system. The purpose of this study was to investigate the benefits of a perceptual approach to the treatment of expressive phonological delay. Thirty-four preschoolers with moderate or severe expressive phonological delays received 16 treatment sessions in addition to their regular speech-language therapy. The experimental group received training in phonemic perception, letter recognition, letter-sound association, and onset-rime matching. The control group listened to computerized books. The experimental group showed greater improvements in phonemic perception and articulatory accuracy but not in phonological awareness in comparison with the control group.

Language and phonological skills in children at high risk of reading difficulties

BACKGROUND

Dyslexia is now generally acknowledged to involve difficulties in phonological processing. However, the links between reading difficulties and speech difficulties remain unclear.

METHOD

In the present study, 17 children with speech difficulties between the ages of four and six were compared to children with a family history of dyslexia and normally developing controls on phonological processing, phonological learning, phonological awareness and literacy tasks.

RESULTS

The two groups of children at risk of reading difficulties showed very similar patterns of impairment, with average vocabulary but poor input and output speech processing, phonological learning, phonological awareness and reading development.

CONCLUSIONS

It is concluded that the antecedents of reading difficulty are similar in these two groups of children, with both groups showing deficits in the development of phonological representations.

An objective and time-efficient method for determining severity of childhood speech delay

To address the need for an efficient and valid approach to determining the severity of a child's speech delay, this study compared 2 types of sampling procedures to derive a measure of percentage of consonants correct (PCC; L. D. Shriberg and J. Kwiatkowski, 1982). PCC scores of twenty-one 4- to 6-year-old children with speech delay derived from both an imitative sentence task and a conversational task were compared. Scores did not differ significantly and corresponded favorably with a reference criterion (S. M. Benner, 1992) for determining clinical equivalence. The imitative approach required considerably less time to complete. Thus, the sentence imitation procedure offers a valid and efficient alternative to conversational sampling. However, clinicians should consider individual child characteristics when choosing an imitative approach.

Spontaneous and Imitated Productions in Spanish-Speaking Children With Phonological Disorders

Purpose: Research examining the relationship between spontaneous and imitated productions for phonological analysis has indicated that the inclusion of imitated productions may overestimate children’s phonological abilities. Previous research in this area has included only English-speaking children. The purpose of this study was to determine what, if any, differences there were in the spontaneous and imitated productions of Spanish-speaking children with phonological disorders.

Method: Twelve Spanish-speaking children with phonological disorders (5 boys and 7 girls), ranging in age from 3;1 (years;months) to 4;9 ( M =3;11), participated in the study. Their spontaneous and imitated productions, based on a sample of single words, were analyzed to determine which elicitation task yielded the more adult-like production. Differences in consonant accuracy between the two tasks were analyzed, as was the shift in error type from spontaneous to imitated productions.

Results: The results indicated that spontaneous and imitated productions were identical in 62% of the cases, an imitated production was more adult-like than a spontaneous one in 25% of the cases, and a spontaneous form was more adult-like than an imitated one in approximately 13% of the cases. Consonant accuracy for some children also varied as a function of elicitation task.

Clinical Implications: For additional diagnostic and prognostic value, speech-language pathologists can incorporate imitated responses in their analyses.

Phonological awareness and phonemic perception in 4-year-old children with delayed expressive phonology skills

The purpose of this study was to compare the phonological awareness abilities of 2 groups of 4-year-old children: one with normally developing speech and language skills and the other with moderately or severely delayed expressive phonological skills but age-appropriate receptive vocabulary skills. Each group received tests of articulation, receptive vocabulary, phonemic perception, early literacy, and phonological awareness skills. The groups were matched for receptive language skills, age, socioeconomic status, and emergent literacy knowledge. The children with expressive phonological delays demonstrated significantly poorer phonemic perception and phonological awareness skills than their normally developing peers. The results suggest that preschool children with delayed expressive phonological abilities should be screened for their phonological awareness skills even when their language skills are otherwise normally developing.

Outcomes of different speech and language goal attack strategies

The purpose of this study was to assess phonological and morphosyntactic change in children with co-occurring speech and language impairments using different goal attack strategies. Participants included 47 preschoolers, ages 3;0 (years;months) to 5;11, with impairments in both speech and language: 40 children in the experimental group and 7 in a no-treatment control group. Children in the experimental group were assigned at random to each of 4 different goal attack strategies: (a) in the phonology first condition, children received a 12-week block of phonological intervention followed by 12 weeks of work on morphosyntax; (b) the morphosyntax first condition was the same as phonology first, with the order of interventions reversed; (c) the alternating condition involved intervention on phonology and morphosyntax goals that alternated domains weekly; and (d) the simultaneous condition addressed phonological and morphosyntactic goals each session. Data were collected pretreatment, after the first intervention block, and posttreatment (after 24 weeks). For the control group, data were collected at the beginning and end of a period equivalent to 1 intervention block. Change in a finite morpheme composite and target generalization phoneme composite was assessed. Results showed that morphosyntactic change was greatest for children receiving the alternating strategy after 24 weeks of intervention. No single goal attack strategy was superior in facilitating gains in phonological performance. These results provide preliminary evidence that alternating phonological and morphosyntactic goals may be preferable when children have co-occurring deficits in these domains; further research regarding cross-domain intervention outcomes is necessary.

Children's consonant inventories after extended cochlear implant use

Qualitative descriptions of the consonant inventories of 12 children who have used cochlear implants for at least 5 years are provided, together with description of sound correspondences between children's systems and the ambient language (English). Productions of English words were elicited in a picture-naming task, and a consonant inventory for each child was determined. Results showed that the consonant inventories of children who use cochlear implants are not simply subsets of the inventory of the ambient language, but rather unique sets of segments that may include consonants not in the ambient inventory. Comparison of the inventories of oral communication users and total communication users revealed qualitative differences between the 2 groups, based on the presence or absence of both English and non-English sound segments. Inventories of oral communication users tended to contain more English segments (e.g., alveolar fricatives, velar stops, velar nasals) than did the inventories of total communication users. Conversely, specific non-English segments, such as uvular stops, tended to occur in the inventories of total communication users more than in inventories of oral communication users. Therefore, a complete understanding of the phonological systems of children who use cochlear implants depends on full accounts of their segment inventories. Such understanding may affect decisions regarding habilitation procedures, insofar as successful acquisition of a linguistic system involves not only the inclusion of all ambient sound segments, but also the exclusion of all nonambient ones.

Predictors of phonological change following intervention

To date, predictor variables strongly associated with phonological change as a result of intervention have not been identified. The purpose of this study was to determine the best predictor or combination of predictors of change in percentage of consonants correct (PCC; L. D. Shriberg and J. Kwiatkowski, 1982) as a result of speech-language intervention for a group of 20 participants and to replicate this procedure with a second group of 20. Participants were preschool children, ages 3;0 (years;months) to 5;11, with impairments in phonology and morphosyntax who received intervention focused on both phonology and morphosyntax in different goal attack configurations. The relationship of predictor variables chronological age, inventory size, error consistency, and expressive language to the criterion variable, change in PCC, was investigated. In both the initial study and the replication, the mean change in PCC following a 24-week intervention period was 13.1%. In the initial study, error consistency and a finite morpheme composite (FMC; L. M. Bedore and L. B. Leonard, 1998) accounted for 52% of the variance for the criterion variable. Error consistency at the first step in the regression accounted for 31.6% of the variance. In the replication, error consistency was the only variable related to PCC change, again accounting for 31% of the variance. Further research examining overall error consistency is warranted.

Assessment of specific language impairment in Swedish

The results from pre-testings of 42 children selected for a cross-linguistic study are discussed to establish the usefulness of the assessment instruments used and whether the children selected are similar to children with specific language impairment (SLI) from other countries. The results from assessments of grammatical production, language comprehension and phonology clearly distinguished children with SLI from age-matched controls, while they differed from language matched controls only on phonological measures. As a group the children with SLI were about 2 years delayed on grammatical production measures and about 1 year on language comprehension. The assessment instruments used thus seem capable of distinguishing children with SLI. The Swedish children selected exhibit the same range of problems as children with SLI selected in other countries.

A Prospective Longitudinal Study of Phonological Development in Late Talkers

Purpose: This study involved prospective longitudinal data on 5 late talkers to provide information about the course of phonological development in order to identify possible predictors of delayed versus deviant development.

Method: Five children (3 boys, 2 girls) were identified as late talkers and divided into a younger group and an older group. Each child was followed monthly for 10 to 12 months (22–33 months for the younger group and 30–42 months for the older group). Two types of monthly language samples (free play and elicited) were obtained to describe the individual courses of phonological development for each child. Independent and relational analyses were completed at each age to describe word-initial and word-final phonetic inventories, syllable structure, syllable diversity, percentage of consonants correct (PCC), sound variability, and error patterns.

Results: The results indicated that 3 of the children resolved their late onset of speech by 33 to 35 months of age. In addition to quantitative factors, (e.g., limited phonetic inventory, lower PCC, and more sound errors), qualitative variables (e.g., atypical error patterns, greater sound variability, and slower rate of resolution) also were identified as potential markers of long-term phonological delay.

Clinical Implications: This study provides information to clinicians so they can identify those children who are less likely to resolve their late onset of phonological development without direct intervention. Procedures are described for assessing early linguistic behaviors that incorporate independent and relational analyses on more extensive speech samples (elicited and free play). From these analyses, clinicians can examine quantitative and qualitative variables to differentiate phonological delay from deviance.

Phonological profiles of 2-year-olds with delayed language development: predicting clinical outcomes at age 3

Twenty-eight 2-year-olds were screened for language development using the Language Development Survey (LDS; L. Rescorla, 1989) and underwent a clinical evaluation within a month following LDS administration. Six measures of phonological development were derived from 20-min language samples of parent-child play interactions, including number of different consonants, number of different consonants in the initial and final positions, number of different consonant clusters in the initial and final position, and percentage of closed syllables shapes. Comparisons were made among 3 groups: (a) those who screened positive on the LDS (LDS+) who were within normal limits on follow-up, (b) those who were identified as language delayed (LD), and (c) children who were language normal (LN). Results revealed that children who were LDS+ and LD had comparable phonetic profiles. The LD group had significantly lower scores on all phonetic measures tested, as compared to the LN group. Clinical recommendations were available on a subset of 13 children who were reassessed at age 3. Children who received "monitor" or "treatment" recommendations at age 3 had significantly lower z scores on measures of phonetic development recorded at 2 years of age than toddlers who received a recommendation of "no concerns" at 3 years. Our preliminary findings indicated that the more delayed the 2-year-old child was in phonological development, the more at risk the child was for continuing delays at age 3.

A prospective cross-sectional study of speech in patients with the 22q11 deletion syndrome

The purpose of this study was to investigate a consecutive series of 65 participants between 3 and 33 years of age (median age of 9 years and 4 months) with a confirmed 22q11.2 deletion, in order to ascertain the frequency and severity of articulation difficulties, velopharyngeal impairment (VPI), and the level of intelligibility. The majority had velopharyngeal impairment; over half of them to such a degree that surgery had been performed or was considered necessary. A high level of correct place and manner of consonants was only found in children with the 22q11 deletion syndrome from age 6. The most misarticulated consonants were stops and fricatives. Glottal articulation assessed in words and sentences was less frequent than expected according to earlier studies. A high prevalence of reduced intelligibility at different ages indicates an obvious communication limitation in younger children, and for some individuals even as teenagers and adults.

EDUCATIONAL OBJECTIVES

As a result of this activity, the participant will have knowledge about the frequency and severity of: (1) articulation difficulties; (2) velopharyngeal impairment; and (3) the level of intelligibility in patients with a 22q11.2 deletion.

Designing and Implementing an Early Literacy Screening Protocol

The American Speech-Language-Hearing Association (2001) recently asserted that speech-language pathologists can and should play an important role in promoting literacy for young children with communicative impairments. Early literacy screening provides a valuable tool for speech-language pathologists to use for the timely detection of difficulties in literacy achievement. In addition, results of early literacy screening can be used to guide intervention and instruction. This article provides a rationale for incorporating early literacy screening into service delivery. It also makes recommendations for determining which children and what areas of literacy should be targeted in screening activities. Suggestions for interpreting findings are also provided, as are strategies for using screening to guide early literacy intervention.

Lexical organization and phonological change in treatment

Word frequency and neighborhood density are properties of lexical organization that differentially influence spoken-word recognition. This study examined whether these same properties also affect spoken-word production, particularly as related to children with functional phonological delays. The hypothesis was that differential generalization would be associated with a word's frequency and its neighborhood density when manipulated as input in phonological treatment. Using a multiple baseline across subjects design, 8 children (aged 3;10 to 5;4) were randomly enrolled in 1 of 4 experimental conditions targeting errored sounds in high-frequency, low-frequency, high-density, or low-density words. Dependent measures were generalization of treated sounds and untreated sounds within and across manner classes as measured during and following treatment. Results supported a hierarchy of phonological generalization by experimental condition. The clinical implications lie in planning for generalization through the input presented in treatment. Theoretically, the results demonstrate that lexical organization of words in the mental lexicon interacts with phonological structure in learning.

Evaluating rate, accuracy, and fluency of young children's diadochokinetic productions: a preliminary investigation

Diadochokinetic (DDK) rates are commonly assessed in children with speech-language disorders, even though the implications of fast or slow DDK rates are not clear. This study explored the possibility that the accuracy and fluency of DDK productions may provide a meaningful supplement to traditional measures of DDK rate. Participants were 15 boys, age 3-7, with normal speech-language development, who were asked to produce "puh-tuh-kuh" or "pattycake" in a standard DDK task. Analyses revealed that normally developing children produce frequent articulation errors but few disfluencies during DDK tasks. Errors and disfluencies did not affect DDK rate, suggesting that the rate of DDKs may be a relatively insensitive measure of children's speaking abilities. Although an expected correlation was found between age and overall DDK rate, no correlations were found between age and the frequency of articulation errors or speech disfluencies. Findings suggest that measures of DDK accuracy and fluency may provide information about children's speech development that is independent of age and may be more closely related to oral motor development than rate. Overall, results underscore concerns with the interpretation of DDK rate and highlight ways that rate measures might be supplemented with measurement of accuracy and fluency in the evaluation of children's speaking abilities.

EDUCATIONAL OBJECTIVES

The reader will learn about a technique that may facilitate the evaluation of young children's oral DDK abilities. The reader will learn about the frequency and type of errors children produce on DDKs and how this information can be used in the assessment of children's oral motor abilities.

Efficacy and Cross-Domain Effects of a Morphosyntax and a Phonology Intervention

Purpose: The purpose of this study was three-fold: (a) to determine the efficacy of a morphosyntax and a phonology intervention against a no-treatment control group, (b) to assess the effects of those interventions on the non-targeted domain, and (c) to evaluate sequence effects when children receive both interventions.

Method: Twenty preschoolers with impairments in both morphosyntax and phonology were assigned randomly to an intervention of two 12-week blocks beginning with either a block of phonology first ( n = 10) or a block of morphosyntax first ( n = 10). Data were collected at pretreatment, after the first intervention block, and posttreatment. For a control group of 7 children, data were collected at the beginning and end of a time period equivalent to one intervention block. Changes in a finite morpheme composite and target/generalization phoneme composite were assessed.

Results: In comparison to the control group, both interventions were effective at a statistically significant level in facilitating improvement in the target domain after 12 weeks. The morphosyntax intervention led to cross-domain change in phonology that was similar to that achieved by the phonology intervention. The morphosyntax first sequence also led to slightly better overall morphosyntactic performance.

Clinical Implications: Clinically, results suggest targeting morphosyntax first, followed by phonology, if using a block intervention sequence for children with concomitant morphosyntactic and phonological impairments.

Consonant cluster development in two-year-olds: general trends and individual difference

A holistic view of phonological development can be attained only through exploration of the relationship between universal developmental sequences, to establish a general pattern of development and individual learning and to provide information regarding variability. This study examined consonant cluster production, looking specifically at the relationship between general trends and individual differences as children acquire these sounds. The spontaneous speech of 16 normally developing Anglo-Australian 2-year-olds was elicited monthly for 6 months, and the corpus of 96 samples was examined using independent and relational phonological analyses. Data demonstrated that 2-year-olds were able to produce a range of consonant clusters in word-initial and word-final position, but few of the younger participants could produce consonant clusters correctly. Only half of the participants showed an increase in the percent of consonant clusters produced correctly over the 6-month period; however, their developing phonological maturity was revealed in the increase in the range and diversity of their repertoire of consonant clusters and by their closer approximations to the adult target. Specific findings of the study were compared to 10 trends for children's acquisition of consonant clusters emerging from the literature over the last 70 years.

A Whole-Word Approach to Phonological Analysis and Intervention

This paper introduces a whole-word approach to phonological analysis and then demonstrates the use of the approach by conducting an analysis and outlining treatment recommendations for a child with a phonological disability. Rationale for using a whole-word approach and also for defining phonological typologies are presented using the view that children are word oriented and use different patterns to acquire their phonological systems. New measures for word complexity and target proximity are explained, and four components of a phonological analysis are outlined and subsequently demonstrated.

The effect of target-selection strategy on phonological learning

In this study, 48 children with moderate or severe delays in phonological ability received treatment for four phonemes, selected in accordance with either traditional or nontraditional target-selection criteria. Children who received treatment for phonemes that are early developing and associated with greater productive phonological knowledge showed greater progress toward acquisition of the target sounds than did children who received treatment for late-developing phonemes that were associated with little or no productive phonological knowledge. Between-group differences in generalization learning were not observed. Child enjoyment of therapy did not differ between groups, but parental satisfaction with treatment progress was greater for children in the traditional group than for children in the nontraditional group.

Risk for speech disorder associated with early recurrent otitis media with effusion: two retrospective studies

The goals of this two-part series on children with histories of early recurrent otitis media with effusion (OME) were to assess the risk for speech disorder with and without hearing loss and to develop a preliminary descriptive-explanatory model for the findings. Recently available speech analysis programs, lifespan reference data, and statistical techniques were implemented with three cohorts of children with OME and their controls originally assessed in the 1980s: 35 typically developing 3-year-old children followed since infancy in a university-affiliated pediatrics clinic, 50 typically developing children of Native American background followed since infancy in a tribal health clinic, and (in the second paper) 70 children followed prospectively from 2 months of age to 3 years of age and older. Dependent variables included information from a suite of 10 metrics of speech production (Shriberg, Austin, Lewis, McSweeny, & Wilson, 1997a, 1 997b). Constraints on available sociodemographic and hearing status information limit generalizations from the comparative findings for each database, particularly data from the two retrospective studies. The present paper reports findings from risk analysis of conversational speech data from the first two cohorts, each of which included retrospective study of children for whom data on hearing loss were not available. Early recurrent OME was not associated with increased risk for speech disorder in the pediatrics sample but was associated with approximately 4.6 (CI = 1.10-20.20) increased risk for subclinical or clinical speech disorder in the children of Native American background. Discussion underscores the appropriateness of multifactorial risk models for this subtype of child speech disorder.

Otitis media, fluctuant hearing loss, and speech-language outcomes: a preliminary structural equation model

The goals of this study were to estimate the risk for lowered speech-language outcomes associated with early recurrent otitis media with effusion (OME) with and without hearing loss and to develop a preliminary descriptive-explanatory model for the findings. Three statistical approaches were used to assess associations among OME, hearing loss, and speech-language outcomes. Participants were a subsample of 70 children followed prospectively in the Dallas Cooperative Project on Early Hearing and Language Development (Friel-Patti & Finitzo, 1990). Findings indicated that hearing levels at 12-18 months were significantly associated with speech delay and low language outcomes at 3 years of age. The risk for subclinical or clinical speech delay at 3 years of age was 2% for children with less than 20 dB average hearing levels at 12-18 months and 33% for children with greater than 20 dB average hearing levels at 12-18 months. A structural equation model (Jöreskog & Sörbom, 1993) indicated that the significant and substantial effects of hearing levels at 12-18 months on speech status at 3 years were significantly mediated by language status at 3 years. Discussion includes implications of these findings for alternative speech perception models linking early OME and hearing loss to later speech-language disorder.

Maternal education and measures of early speech and language

The present study was designed to determine whether 4 measures of children's spontaneous speech and language differed according to the educational level of the children's mothers. Spontaneous language samples from 240 three-year-old children were analyzed to determine mean length of utterance in morphemes (MLUm), number of different words (NDW), total number of words (TNW), and percentage of consonants correct (PCC). A norm-referenced, knowledge-dependent measure of language comprehension, the Peabody Picture Vocabulary Test-Revised (PPVT-R), was also included for purposes of comparison with the spontaneous measures. Three levels of maternal education were compared: less than high school graduate, high school graduate, and college graduate. Trend analyses showed statistically significant linear trends across educational levels for MLUm, NDW, TNW, and PPVT-R; the trend for PCC was not significant. The relationship of maternal education and other sociodemographic variables to measures of children's language should be examined before using such measures to identify children with language disorders.

Early childhood stuttering II: initial status of phonological abilities

Research on the relation between stuttering and phonological/articulation deficits has been reported in the literature over several decades. Yet virtually none of these investigations has taken into account that "children who stutter" includes a large number who spontaneously recover within a few months or years after onset. Thus, little attention has been given to differences between the phonological abilities of children whose stuttering persists and those who recover. This investigation compares these two groups soon after stuttering onset, before it was possible to classify them as members of either group, on a number of phonological characteristics, including mean percentage of error, relative levels of severity of phonological impairment, error on specific phonological patterns, progress in development of key patterns, and the children's strategies for coping with unmastered patterns. The results indicate that the children whose stuttering would be persistent had poorer mean scores on each of our measures than did the children who would recover from stuttering. Both groups, however, showed progression in phonological development that followed the expected order, and they used typical strategies when patterns had not yet been acquired. The persistent group was moving more slowly, however, so phonological development was more delayed than in the children who would recover from stuttering. Our findings support the assumption that most previous studies probably have compared children with persistent stuttering to normally fluent children, and that those who recovered early were not considered differentially.

Probability estimates and paths to consonant normalization in children with speech delay

Probable ages of normalization were calculated for 24 children with speech delay, using Kaplan-Meier analysis and a threshold score of 85% on the Percent of Consonants Correct, Percent of Consonants Correct-Adjusted, and Percent of Consonants Correct-Revised metrics. Simple formulas are provided that permit calculation of the likelihood that individual children with speech delay will normalize by a given age. The sex of a child was found to have no significant influence on age of normalization. Analysis revealed two different paths to normalization. In Path A, errors of deletion, substitution, and omission declined as correct productions increased. In Path B, common clinical distortions increased as deletions and substitutions decreased. The ages of more and less rapid phonological gain correspond to and partially explain the findings of Shriberg, Gruber, and Kwiatkowski (1994), who studied more severely involved children. Children who follow Path B are those who retain residual errors in their speech.

Feature analysis of segmental errors in children with phonological disorders

There has been a longstanding controversy about the existence, nature, and differentiation of developmental apraxia of speech (DAS), leading to numerous investigations of characteristics that define this articulatory disorder. An analysis of substitutions relative to target sounds led Thoonen, Maassen, Gabreëls, and Schreuder (1994) to conclude that children with DAS show a pattern of feature retention in their error productions that contrasted with that of children with normal articulation. This pattern, in which place of articulation was retained in the substituted sound less frequently than manner of production or voicing, was considered by Thoonen et al. to be of diagnostic significance. The current research re-examines this claim by comparing the retention patterns obtained by Thoonen et al. for children suspected of having DAS to patterns for children suspected of having a phonological disorder. An examination of substitutions used by 20 children who were diagnosed with and treated for phonological disorders demonstrated the same pattern of feature retention that was described for children with DAS. The results of this study showed that voicing is maintained most frequently; manner of production is the next most retained feature; and place of articulation is the feature that is retained least often when a substitute is used for a sound that isn't produced correctly. In a second analysis, this pattern of feature retention was compared to children's phonological knowledge as indexed by percent correct underlying representation (PCUR). Contrary to the findings of Thoonen et al., however, the present work found an inverse relationship between retention of place and phonological knowledge. Children with greater phonological knowledge retained place less often than children with more limited phonetic inventories. These patterns of feature retention may be representative of specific development sequences that occur during phonological acquisition.

Guidelines for documentation of treatment efficacy for young children who stutter

The pressing need to document treatment efficacy for young children who stutter is discussed. Guidelines for such documentation are suggested and illustrated. Measures for verifying treatment effects in four realms are delineated: (a) conditions of documentation, (b) dependent variables to be measured, (c) establishment of treatment integrity, and (d) verification of the relationship between treatment and outcome. Illustrations of the application of the suggested guidelines are presented for 2 children.

Phonological skills of children with specific expressive language impairment (SLI-E): outcome at age 3

Naturalistic speech samples of 29 3-year-olds diagnosed with specific expressive language delay (SU-E) were compared to those produced by 19 age-matched normally developing peers in order to determine their improvement in phonological skills since age 2, when Rescorla and Ratner (1996) studied them. Specifically, the groups were compared with regard to vocalization rate, verbalizations, fully intelligible utterances, phonetic inventories, percentages of consonants correct (PCC), phonological processes, and mean length of utterance (MLU). Results revealed that there was no significant difference between the groups in their numbers of vocalizations (as there had been at age 2), although there continued to be differences in their phonetic inventories, PCC scores, and overall intelligibility. These findings suggest that at age 2 the children with SU-E were not only less phonologically skilled but less talkative, whereas by age 3 they were equally vocal. Analysis of the phonetic inventories of the children demonstrated that for most consonants, the SLI-E group followed the some pattern of development as the comparison children, but more of the normally developing group had productive control of each consonant, consistent with findings of Rescorla and Ratner. There continued to be differences in intelligibility as measured by rates of verbalization (those utterances with at least one intelligible word) and fully intelligible utterances. Using these measures, we found that approximately half the SU-E children had caught up with their normally developing peers in terms of articulation, whereas half of them continued to be significantly delayed. Finally, although some of the late-bloomer group had caught up to the comparison children in language skills, as measured by MLU, many had not, suggesting that there was a tendency for the children to catch up in some articulation skills before catching up in language abilities.

Treatment efficacy: functional phonological disorders in children

This report addresses the efficacy of treatment for functional phonological disorders in children. The definition of phonological disorders and their incidence and prevalence are first presented. The impact of this disorder on the lives of children and the role that speech-language pathologists play in treating this disorder are then discussed. Evidence of the positive outcome of phonological treatment is reviewed, with particular emphasis on treatment procedures that have been deemed effective, the specific effects of these treatments on improving intelligibility, and comparisons between treatments in facilitating improved sound production.

Temperament in late talkers

This study examines the temperamental characteristics of children who were identified at age two as being slow in expressive language development, and those of peers with normal language history. When the children were in first grade (approximately age six), parents and clinicians rated subjects' temperamental characteristics, using a standardized temperament assessment instrument. Subjects with a history of slow expressive language development were rated significantly lower on Approach/Withdrawal--indicating shyness, aloofness, or reduced outgoingness--than peers with normal language history. Approach/Withdrawal scores were significantly correlated with average sentence length in spontaneous speech, and this measure also predicted Approach/Withdrawal scores in regression analyses. The clinical and theoretical implications of these findings for early language delay are discussed.

The influence of sentence elicitation variables on children's speech production

This study investigated the potential influence of adult-modeled sentences on the speech production of 15 children with speech delays of unknown origin. Two comparison tokens of target words containing sounds with inconsistently realized phonemes were sampled in picture descriptions elicited with and without adult-modeled descriptive sentences. Ten listeners made forced-choice paired-comparisons to identify the children's relatively more advanced word productions. From 205 total comparisons, listeners identified 130 word pairs that included one token more advanced than the other. Significantly more of the children's advanced word productions occurred in sentences elicited with an adult model sentence. Discussion considers theoretical and clinical perspectives of an assumption that variables facilitating children's language production may benefit speech production.