Constructivist Strategies in Phonological Intervention

Phonological complexity in intervention for Spanish-speaking children with speech sound disorder

The efficiency of intervention for children with speech sound disorder may be influenced by linguistic complexity of the phonological intervention target. Complex targets, particularly, later-acquired, less-known consonants and consonant clusters, have been linked to greater post-intervention generalization to untargeted phonological structures. Yet there is little direct evidence to support target selection based on linguistic complexity for Spanish-speaking children with speech sound disorder. This intervention study utilizes an experimental single-case design to examine the efficacy of intervention in Spanish using different complex targets (i.e. /ɡɾ/, /bɾ/, and /l/). For each of the four Spanish-speaking children with speech sound disorder, sounds at 0% accuracy during baseline were monitored across the baseline period, during and post-intervention, and at one- and two-month follow-up visits. Over the course of intervention, only one participant achieved mastery of the targeted structure in practiced words. However, all participants demonstrated some amount of broad phonological generalization to untargeted consonants or clusters. Variable learning trajectories and broad phonological generalization are discussed as they relate to participant characteristics and linguistic complexity.

Treatment Targets for Co-Occurring Speech-Language Impairment: A Case Study

PURPOSE

The intersection of speech and language impairments is severely understudied. Despite repeatedly documented overlap and co-occurrence, treatment research for children with combined phonological and morphosyntactic deficits is limited. Especially little is known about optimal treatment targets for combined phonological-morphosyntactic intervention. We offer a clinically focused discussion of the existing literature pertaining to interventions for children with combined deficits and present a case study exploring the utility of a complex treatment target in word-final position for co-occurring speech and language impairment.

METHOD

Within a school setting, a kindergarten child (age 5;2) with co-occurring phonological disorder and developmental language disorder received treatment targeting a complex consonant cluster in word-final position inflected with third-person singular morphology.

RESULTS

For this child, training a complex consonant cluster in word-final position resulted in generalized learning to untreated consonants and clusters across word positions. However, morphological generalization was not demonstrated consistently across measures.

CONCLUSION

These preliminary findings suggest that training complex phonology in word-final position can result in generalized learning to untreated phonological targets. However, limited improvement in morphology and word-final phonology highlights the need for careful monitoring of cross-domain treatment outcomes and additional research to identify the characteristics of treatment approaches, techniques, and targets that induce cross-domain generalization learning in children with co-occurring speech-language impairment.

Application of a Motor Learning Treatment for Speech Sound Disorders in Small Groups

Speech sound treatment in the public schools is often conducted in small groups, but there are minimal data on the efficacy of group treatment. This study evaluated the efficacy of a motor learning-based treatment (Concurrent Treatment) provided to elementary-school students in small groups. Concurrent Treatment incorporates the randomized sequencing of various practice tasks (e.g., words, sentences, or storytelling) and can result in rapid speech sound acquisition during individual treatment settings. Twenty-eight 6- to 9-year-old children participated in a randomized pretest–posttest control group design. The experimental group received Concurrent Treatment, while the control group received treatment (if needed) after the study. Participants in the experimental group acquired their target speech sounds within 40 30-minute sessions in groups of up to four participants (effect size, d = 1.31).

Can children substitute for adult listeners in judging the intelligibility of the speech of children who are deaf or hard of hearing?

PURPOSE

Assessments of the intelligibility of speech produced by children who are deaf or hard of hearing (D/HH) provide unique insights into functional speaking ability, readiness for mainstream classroom placements, and intervention effectiveness. The development of sentence lists for a wide age range of children and the advent of handheld digital recording devices have overcome two barriers to routine use of this tool. Yet, difficulties in recruiting adequate numbers of adults to judge speech samples continue to make routine assessment impractical. In response to this barrier, it has been proposed that children who are 9 years or older might be adequate substitutes for adult listener-judges (Ertmer, 2011).

METHOD

To examine this possibility, 22 children from the 3rd, 4th, and 5th grades identified words from speech samples previously judged by adults.

RESULTS

Children in the 3rd and 4th grades identified fewer words than adults, whereas scores for 5th graders were not significantly different from those of the adults. All grade levels showed increasing scores across low, mid, and high levels of intelligibility.

CONCLUSIONS

Children who are functioning at a 5th grade level or higher can act as listener-judges in speech intelligibility assessments. Suggestions for implementing assessments and scoring child-listeners' written responses are discussed.

Rethinking assessment measures of phonological development and their application in bilingual acquisition

This article discusses the measurements for phonological and prosodic development put forward in Ingram [Ingram, D. (2002). The measurement of whole-word productions. Journal of Child Language, 29, 713-733.], while at the same time expanding the crucial measures, phonological mean length of utterance (PMLU) and proportion of whole-word proximity (PWP). The goal of the expansion is to accommodate a wider set of phenomena, specifically those related to bilingual acquisition of languages with different categories (e.g. closed syllables in German and open syllables in Spanish). Data from three monolingual Spanish children and from three bilingual German--Spanish children are presented as illustration of the modified measurements: expanded PMLU of features (ePMLU-F), expanded PMLU of syllables (ePMLU-S) and expanded PWP (ePWP). By means of measuring both features and prosodic positions, the expanded measurements do better justice to the various aspects of child phonology. Nonetheless, an important goal of this article is to stimulate discussion in order to bring our state-of-the-art closer to descriptive adequacy.

Preschool speech intelligibility and vocabulary skills predict long-term speech and language outcomes following cochlear implantation in early childhood

Speech and language measures during grade school predict adolescent speech-language outcomes in children who receive cochlear implants (CIs), but no research has examined whether speech and language functioning at even younger ages is predictive of long-term outcomes in this population. The purpose of this study was to examine whether early preschool measures of speech and language performance predict speech-language functioning in long-term users of CIs. Early measures of speech intelligibility and receptive vocabulary (obtained during preschool ages of 3-6 years) in a sample of 35 prelingually deaf, early-implanted children predicted speech perception, language, and verbal working memory skills up to 18 years later. Age of onset of deafness and age at implantation added additional variance to preschool speech intelligibility in predicting some long-term outcome scores, but the relationship between preschool speech-language skills and later speech-language outcomes was not significantly attenuated by the addition of these hearing history variables. These findings suggest that speech and language development during the preschool years is predictive of long-term speech and language functioning in early-implanted, prelingually deaf children. As a result, measures of speech-language functioning at preschool ages can be used to identify and adjust interventions for very young CI users who may be at long-term risk for suboptimal speech and language outcomes.

Relationships between speech intelligibility and word articulation scores in children with hearing loss

PURPOSE

This investigation sought to determine whether scores from a commonly used word-based articulation test are closely associated with speech intelligibility in children with hearing loss. If the scores are closely related, articulation testing results might be used to estimate intelligibility. If not, the importance of direct assessment of intelligibility is reinforced.

METHOD

Forty-four children with hearing losses produced words from the Goldman Fristoe Test of Articulation-Second Edition (Goldman & Fristoe, 2000) and sets of 10 short sentences. Correlation analyses were conducted between scores for 7 word-based predictor variables and percent-intelligible scores derived from listener judgments of stimulus sentences.

RESULTS

Six of 7 predictor variables were significantly correlated with percent-intelligible scores. However, regression analysis revealed that no single predictor variable or multivariable model accounted for more than 25% of the variability in intelligibility scores.

CONCLUSIONS

The findings confirm the importance of assessing connected speech intelligibility directly.

Assessing speech intelligibility in children with hearing loss: toward revitalizing a valuable clinical tool

BACKGROUND

Newborn hearing screening, early intervention programs, and advancements in cochlear implant and hearing aid technology have greatly increased opportunities for children with hearing loss to become intelligible talkers. Optimizing speech intelligibility requires that progress be monitored closely. Although direct assessment of intelligibility has been a cumbersome undertaking, advancements in digital recording technology and expanded strategies for recruiting listener-judges can make this tool much more practical in contemporary school and clinical settings.

PURPOSE

The main purposes of this tutorial are to present a rationale for assessing children's connected speech intelligibility, review important uses for intelligibility scores, and describe time-efficient ways to estimate how well children's connected speech can be understood. This information is offered to encourage routine assessment of connected speech intelligibility in preschool and school-age children with hearing loss.

Triangulating speech sound generalization

Generalization refers to the extension of learned behaviours to novel conditions, and it is one of the criteria by which the effectiveness and efficiency of a remediation programme may be judged. This article extracts principles of generalization from the treatment literature, and provides examples of how this information may be used to help guide treatment decisions. Included is a discussion of client, clinician, and treatment variables that may contribute to the generalization process.

Technological Innovations and Intervention Practices for Children With Cochlear Implants

This clinical forum has addressed many of the challenges associated with serving children who have cochlear implants. These include determining who may be a candidate for implantation; optimizing parent-child interactions for oral communication; developing comprehensive preschool programs; assessing and maximizing opportunities to communicate and learn in regular classrooms; making choices in communication modalities; providing effective intervention; and serving as a liaison for parents, school personnel, and medical professionals. In response to these challenges, the forum has provided the technical information needed to understand how a cochlear implant works, important research findings regarding choices in communication modalities, and ideas for assessing and serving children with implants. This information can provide speech, language, and hearing professionals with a base for developing their skills in the role of "local experts" for children who have cochlear implants. Filling this role also requires continuing education to keep up with innovations in technology and advancements in clinical practice. It is hoped that this forum has provided an impetus for further learning in a rapidly emerging and fascinating area of our profession.

Practice Makes Perfect

In this article, the possibility is raised that some children may implicitly view the therapy situation as one in which new sounds and language forms are learned and practiced. In contrast, the primary purpose of talking outside of therapy is meaningful communication. Inherent in this view of therapy and non-therapy is the incompatibility or inconsistency between practicing speech and communicating effectively. What led me to recognize this inconsistency and consider its potential clinical implications was the way in which my daughter Franne dealt with her phonological disorder.

What Are Executive Functions and Self-Regulation and What Do They Have to Do With Language-Learning Disorders?

In this article, executive functions and selfregulation are defined and the reciprocal influence of these factors on the performance of students with language-learning disorders (LLD) is explored. A case study demonstrates the integration of executive functions, self-regulation, and language processes within speech and language assessment and intervention. Clinicians are urged to consider the interactive effects of executive function, self-regulatory, and language processes when addressing the needs of students with LLD.