Validation of the Intelligibility in Context Scale for Jamaican Creole-Speaking Preschoolers

Speech-Language Outcomes in the COVID-19 Milieu for Multilingual Jamaican Preschoolers and Considerations for Telepractice Assessments

PURPOSE

The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children's speech-language outcomes secondary to pandemic-related social restrictions.

METHOD

Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children's communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD (n = 226) Jamaican Creole-English-speaking preschoolers and those with fSSDs (n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica.

RESULTS

Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate.

CONCLUSIONS

Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children's speech-language outcomes in the context of acutely changing environmental circumstances.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25461505.

Measuring speech intelligibility with deaf and hard-of-hearing children: A systematic review

There is great variability in the ways in which the speech intelligibility of d/Deaf and hard-of-hearing (DHH) children who use spoken language as part, or all, of their communication system is measured. This systematic review examined the measures and methods that have been used when examining the speech intelligibility of children who are DHH and the characteristics of these measures and methods. A systematic database search was conducted of CENTRAL; CINAHL; Cochrane; ERIC; Joanna Briggs; Linguistics, Language and Behavior Abstracts; Medline; Scopus; and Web of Science databases, as well as supplemental searches. A total of 204 included studies reported the use of many different measures/methods which measured segmental aspects of speech, with the most common being Allen et al.'s (2001, The reliability of a rating scale for measuring speech intelligibility following pediatric cochlear implantation. Otology and Neurotology, 22(5), 631-633. https://doi.org/10.1097/00129492-200109000-00012) Speech Intelligibility Rating scale. Many studies included insufficient details to determine the measure that was used. Future research should utilize methods/measures with known psychometric validity, provide clear descriptions of the methods/measures used, and consider using more than one measure to account for limitations inherent in different methods of measuring the speech intelligibility of children who are DHH, and consider and discuss the rationale for the measure/method chosen.

Phonemic and pitch variability in bilingual preschoolers: A comparison of Jamaican Creole and English

PURPOSE

The purpose of this study was to investigate the cross-linguistic influences of Jamaican Creole (JC) and English on phonemic and vocal development in bilingual JC-English-speaking preschoolers.

METHOD

Sixteen typically developing children (12 females, M = 4 years; 4 months) completed the Diagnostic Evaluation of Articulation in Phonology Word Inconsistency Assessment subtest in JC and in English. Acoustic measures of voice onset time (VOT), VOT variability (VOT SD), mean fundamental frequency (fo), and fo variability (fo SD) were extracted from each target word. Prevoicing was noted. Mixed models and regression models were analysed to understand the patterns of acoustic measures in each language, and the relationship between phonemic and vocal variability, respectively.

RESULT

Analyses showed a significant effect of language on fo SD, wherein SD was greater in English than JC. JC spoken (percentage) was a significant positive predictor of VOT SD for voiced (short lag) productions. There was no relationship between phonemic and vocal variability measures.

CONCLUSION

Greater fo SD in English may be due to linguistic fo differences and speaking environment. Variability for voiced VOT is likely due to the continued maturation of vocal and articulatory control when children are developing adult-like productions, though longitudinal studies are needed.

Supporting Culturally Responsive Assessment Practices With Preschoolers: Guidance From Methods in the Jamaican Context

PURPOSE

There is a shortage of available methods to accurately inform the developmental status of children whose cultural and linguistic backgrounds vary from the mainstream. The purpose of this review article was to describe different approaches used to support the accurate characterization of speech, language, and functional communication in children speaking Jamaican Creole and English, an understudied paradigm in the speech pathology research.

METHOD

Approaches used across four previously published studies in the Jamaican Creole Language Project are described. Participants included 3- to 6-year-old Jamaican children (n = 98-262) and adults (n = 15-33). Studies I and II described validation efforts about children's functional communication using the Intelligibility in Context Scale (ICS; speech) and the Focus on the Outcomes of Communication Under Six (FOCUS; speech and language). Study III described efforts to accurately characterize difference and disorder in children's expressive grammar using adapted scoring, along with adult models to contextualize child responses. Last, Study IV applied acoustic duration (e.g., whole word) and an adapted scoring protocol to inform variation in speech sound productions in the Jamaican context where a post-Creole continuum exists.

RESULTS

Studies I and II offered promising psychometric evidence about the utility of the ICS and the FOCUS. Study III revealed strong sensitivity and specificity in classifying difference and disorder using adult models. Last, in Study IV, linguistically informed acoustic analyses and an adapted protocol captured variation in speech productions better than a standard approach.

CONCLUSIONS

Applying culturally responsive methods can enhance the accurate characterization of speech, language, and functional communication in Jamaican children. The innovative methods used offer a model approach that could be applied to other linguistic contexts where a mismatch exists between speech-language pathologists and their clientele.

PRESENTATION VIDEO

https://doi.org/10.23641/asha.23929461.

Intelligibility in Context Scale: Growth Curves for Typically Developing English-Speaking Children Between Ages 2;6 and 9;11

PURPOSE

The aim of this study was to quantify the clinical utility of the Intelligibility in Context Scale (ICS) English version by characterizing the growth patterns of the ICS composite scores and seven ICS individual item scores of typically developing American English-speaking children.

METHOD

Parents of 545 typically developing children aged 2;6-9;11 (years;months) completed the ICS. Using a proportional odds model, we regressed ICS composite scores on age and computed for model-estimated mean and lower quantile ICS composite scores. Logistic regression and proportional odds modeling were utilized to quantify the relationship of individual ICS items and age.

RESULTS

ICS composite scores of typically developing children changed with age, but change was small and incremental, with scores compressed between 3 and 5 across the range of ages. An average child (i.e., on the 50th percentile) is expected to have an ICS composite score of 4 beginning at 3;0 and an ICS composite score of 5 by 6;6. On average, parents gave different intelligibility ratings based on communicative partners, and the rating differences between communicative partners decreased with age.

CONCLUSIONS

Given that ICS scores increase with age, the expected score for average children also increases. A child's age is a main factor for interpreting ICS scores.

Translation and validation of the Intelligibility in Context Scale into Sinhala for adolescents in Sri Lanka with cleft lip and palate

The Intelligibility in Context Scale (ICS) is a parent-report screening tool used to measure parents' perceptions of children's functional intelligibility. This tool has been translated into over 60 languages and found to have a good reliability and validity. The purpose of the current study was to translate the ICS into Sinhala (the ICS-SIN), the main language spoken by the Sinhalese people in Sri Lanka, and to validate it with both typically developing (TD) children and children with repaired cleft lip and/or palate (CLP). The translation process followed the forward-backward-forward method. A total of 88 parents of TD children and children with CLP aged 12-15 years old (TD n = 50, CLP n = 38) completed the ICS-SIN questionnaire. Parents of TD and CLP children reported their children's speech as most intelligible to parents and least intelligible to strangers. The ICS-SIN had high internal consistency for both groups (TD α = 0.87, p < 0.05, CLP α = 0.97, p < 0.05). The ICS-SIN total scores and item scores showed significant correlations, indicating a good construct validity. TD participant group's ICS-SIN average mean scores (M = 4.88, SD = 0.29) were significantly higher compared to the CLP ICS-SIN average mean scores (M = 4.64, SD = 0.67) and varied according to gender in both groups, suggesting good discriminant validity. The ICS-SIN has overall good psychometric properties. Therefore, this tool has the potential to be used as a valid parent-rating screening tool for clinical and research purposes in Sri Lanka.

Variability, accuracy, and cross-linguistic transfer in bilingual children speaking Jamaican Creole and English

Due to the lack of normative data about bilingual speech development and limited availability of diagnostic tools optimised for this population, bilingual children under consideration for speech-language services are at an elevated risk of misdiagnosis. In the absence of validated assessment tools, speech-language pathologists may use measures of accuracy and variability of speech production to diagnose suspected speech sound disorders in bilingual children. Research in general motor development suggests that variability and accuracy may trade off in the course of maturation, whereby movement variability spikes before the transition to a more mature stage of motor control. Such variability-accuracy tradeoffs have been described in monolingual speech development but are understudied in bilingual populations, where cross-linguistic transfer occurs. This study aimed to examine variability, accuracy, and cross-linguistic transfer in the speech of 20 bilingual children speaking Jamaican Creole and English. We hypothesised that children who showed higher accuracy in their productions would also exhibit more variable speech, indicating a variability-accuracy tradeoff. The Word Inconsistency Assessment from the Diagnostic Evaluation of Articulation and Phonology was administered to measure accuracy and variability in the English context, where misdiagnosis is likely to occur. Contrary to our hypothesis, we observed that individuals with higher accuracy tended to be less variable in their productions. Future research should examine longitudinal trajectories of accuracy and variability and consider a more culturally-appropriate definition of 'accuracy' in documenting bilingual speech sound development.

Construct validity of the focus on the outcomes of communication under six (FOCUS) total and profile scores for multilingual preschoolers: Considering functional speech skills

PURPOSE

To conduct an exploratory study to establish construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS) in the Jamaican context for FOCUS Total and Profile scores.

METHOD

Parents of a representative sample of 3-to-6-year-old Jamaican Creole (JC)-English-speaking simultaneous bilingual children completed the FOCUS in English, and the Intelligibility in Context Scale (ICS) in JC and in English. Children completed the Diagnostic Evaluation of Articulation and Phonology (DEAP) in both languages. Percent phonemes, consonants, and vowels correct were calculated using single word responses to DEAP items. Pearson correlations were completed to describe relationships between measurement scores.

RESULT

Convergent validity was found for FOCUS Total and ICS/JC scores. Convergent and divergent validity were found for specific FOCUS Profile scores and ICS/JC scores. Minimal evidence of convergent validity was found with FOCUS Total scores and transcription-based measures of speech production in JC and in English. Convergent and divergent validity were found between specific FOCUS Profile scores and some transcription-based measures of speech production in JC and in English.

CONCLUSION

This study provides evidence of construct validity for FOCUS Total and Profile scores. It also provides validity evidence for FOCUS scores in a multilingual context using a representative sample of children that serves to broaden the range of applicability of the FOCUS.

Characterizing Communicative Participation in Multilingual Jamaican Preschoolers

PURPOSE

This study characterized communicative participation and related aspects of functional communication for Jamaican Creole (JC)-English-speaking preschoolers with and without functionally defined speech sound disorders (fSSDs). This study included parent reports and direct assessment measures from an existing corpus of baseline data collected prior to the COVID-19 pandemic.

METHOD

The communicative participation of typically developing (TD; n = 226) bilingual JC-English-speaking preschoolers and those with fSSDs (n = 39) was documented using the Focus on the Outcomes of Communication Under Six (FOCUS). Functional speech intelligibility was recorded using the Intelligibility in Context Scale (ICS) in English and JC (ICS-JC). Objective measures of speech production were collected through direct child assessment in both languages and then transcribed and calculated for percent of consonants (PCC), vowels (PVC), and phonemes correct (PPC). Within-group relationships were explored using association testing, and differences between groups were explored through multivariate analyses.

RESULTS

FOCUS scores and ICS and ICS-JC scores were found to be minimally to moderately related for Jamaican preschoolers in the TD group (r = .28-.34, p < .002) and strongly related in the fSSD group (r = .56-.60, p < .002). No relations were observed between the FOCUS scores and PCC/PVC/PPC in either language. There was a statistically significant difference between all FOCUS scores for Jamaican preschoolers in the TD and fSSD groups (p ≤ .002).

CONCLUSIONS

These findings provide additional evidence for using the FOCUS beyond documenting change in communicative participation to support clinical decision-making in planning and developing speech-language interventions. This study also documents an important characterization of JC-English-speaking children with and without fSSDs, offering data on children's abilities that can be used in future comparisons of communicative participation and speech functioning observed during the COVID-19 pandemic and beyond.

Characterizing Speech Sound Productions in Bilingual Speakers of Jamaican Creole and English: Application of Durational Acoustic Methods

PURPOSE

This study examined the speech acoustic characteristics of Jamaican Creole (JC) and English in bilingual preschoolers and adults using acoustic duration measures. The aims were to determine if, for JC and English, (a) child and adult acoustic duration characteristics differ, (b) differences occur in preschoolers' duration patterns based on the language spoken, and (c) relationships exist between the preschoolers' personal contextual factors (i.e., age, sex, and percentage of language [%language] exposure and use) and acoustic duration.

METHOD

Data for this cross-sectional study were collected in Kingston, Jamaica, and New York City, New York, United States, during 2013-2019. Participants included typically developing simultaneous bilingual preschoolers (n = 120, ages 3;4-5;11 [years;months]) and adults (n = 15, ages 19;0-54;4) from the same linguistic community. Audio recordings of single-word productions of JC and English were collected through elicited picture-based tasks and used for acoustic analysis. Durational features (voice onset time [VOT], vowel duration, whole-word duration, and the proportion of vowel to whole-word duration) were measured using Praat, a speech analysis software program.

RESULTS

JC-English-speaking children demonstrated developing speech motor control through differences in durational patterns compared with adults, including VOT for voiced plosives. Children's VOT, vowel duration, and whole-word duration were produced similarly across JC and English. The contextual factor %language use was predictive of vowel and whole-word duration in English.

CONCLUSIONS

The findings from this study contribute to a foundation of understanding typical bilingual speech characteristics and motor development as well as schema in JC-English speakers. In particular, minimal acoustic duration differences were observed across the post-Creole continuum, a feature that may be attributed to the JC-English bilingual environment.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21760469.

Linguistically Informed Acoustic and Perceptual Analysis of Bilingual Children's Speech Productions: An Exploratory Study in the Jamaican Context

PURPOSE

The aim of this study was to characterize speech acoustics in bilingual preschoolers who speak Jamaican Creole (JC) and English. We compared a standard approach with a culturally responsive approach for characterizing speech sound productions. Preschoolers' speech productions were compared to adult models from the same linguistic community as a means for providing confirmatory evidence of typical speech patterns specific to JC-English speakers.

METHOD

Two protocols were applied to the data collected using the Diagnostic Evaluation of Articulation and Phonology (DEAP) Articulation subtest: (a) the standardized DEAP protocol and (b) a culturally and linguistically adapted protocol reflective of the Jamaican post-Creole (English to Creole) continuum. The protocols were used to analyze responses from JC-English-speaking preschoolers (n = 119) and adults (n = 15). Responses were analyzed using acoustic (voice onset time, whole-word duration, and vowel duration) and perceptual (percentage of consonant correct-revised and response frequencies) measures.

RESULTS

The culturally responsive protocol captured variation in the frequency and acoustic differences produced in the post-Creole continuum, with higher amounts of "other" responses compared to "standard" target responses for both children and adults. Adults' whole-word durations were shorter and showed more consistent prevoicing during initial plosives compared to the children.

CONCLUSIONS

Applying culturally responsive methods, including knowledge of the variation produced in the post-Creole continuum and with adult models from the same linguistic community, improved the ecological validity of speech characterizations for JC-English preschoolers. Acoustic properties of speech should be investigated further as a means of describing bilingual development and distinguishing between difference and disorder.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20249382.

Fijian school students' Fiji English speech sound acquisition

Purpose: The aim of this study was to investigate Fijian students' acquisition of Fiji English speech sounds.Method: Participants were 72 multilingual students (5-10 years) living in Fiji who spoke the Fijian or Fiji Hindi dialects of Fiji English. The students' productions of single words from the Diagnostic Evaluation of Articulation and Phonology (DEAP) were analysed according to dialect using the Children's Independent and Relational Phonological Analysis (CHIRPA).Result: Most English consonants were acquired by 6;0. English consonants that were not in the inventories of Fijian or Fiji Hindi were the last acquired, while those that were common between English and the two languages were some of the earlier acquired consonants. Percentage of consonants correct (PCC) for Fiji English was significantly lower for Grade 1 students (M = 93.01, SD = 0.07) in comparison to Grade 4 students (M = 99.03, SD = 0.01). Plosive and nasal sounds were acquired by 90% of the students earlier than fricative, approximant and affricate sounds, though acquisition of some plosive and fricative sounds varied between Fiji English dialects. All word-initial consonant clusters were acquired by 90% of the students by 9;6, with r-clusters tending to be the latest acquired. The acquisition of word-final consonant clusters was highly variable as students often produced appropriate dialectal variants.Conclusion: Multilingual Fijian children may acquire English specific sounds later than their monolingual English-speaking peers. Consideration of the language environment and analysis of the speech sample with reference to the child's dominant English dialect is imperative for valid identification of speech sound disorder (SSD) in children who speak different dialects of English.

Parent rating of intelligibility: A discussion of the construct validity of the Intelligibility in Context Scale (ICS) and normative data of the Swedish version of the ICS

BACKGROUND

Intelligibility can be defined as the speakers' ability to convey a message to the listener and it is considered the key functional measure of speech. The Intelligibility in Context Scale (ICS) is a parent rating scale used to assess intelligibility in children.

AIMS

To describe normative and validation data on the ICS in Swedish and to investigate how these are related to age, gender and multilingualism.

METHODS & PROCEDURES

Two studies were included. Study 1 included ICS forms from 319 Swedish-speaking children (3:2-9:2 years:months). Study 2 included video recordings and ICS forms from 14 children with speech sound disorder (SSD) and two with typical speech. The video recordings were transcribed in the validation process, resulting in intelligibility reference scores to which ICS scores were correlated.

OUTCOMES & RESULTS

Study 1: The mean value of the ICS for the 319 children was 4.73. There were no differences in ICS score related to age or gender. The children in the multilingual group were significantly older than the monolingual group and had significantly lower ICS scores than the group of monolinguals. Study 2: There was a moderate correlation between the ICS score and the transcription-based intelligibility score, with the two children with typical speech excluded; however, this correlation was not significant.

CONCLUSIONS & IMPLICATIONS

We contribute mean scores and percentiles on the ICS for Swedish-speaking children. The finding that the ICS does not provide valid measures of intelligibility for the included children with SSD suggests that the instrument measures a different construct.

WHAT THIS PAPER ADDS

What is already known on the subject The ICS has been translated to numerous languages and validated against articulation measures in several previous studies. The validity of the Swedish version has been investigated against intelligibility based on transcription of single words. What this paper adds to existing knowledge The study provides normative values of the Swedish version of the ICS for children aged 3-9 years. This is the first study to use a gold standard measure of intelligibility in continuous speech to validate the ICS. The results show a somewhat dubious validity regarding ICS for the group of children with SSD included in the study. What are the potential or actual clinical implications of this work? The ICS's suitability as a measure of intelligibility is questionable; however, it might be of use for speech and language pathologists to give an overview of the parents' view of their child's ability to communicate, in order to make a decision on possible further assessment and intervention. The normative values of the Swedish version of the ICS could be of use in this decision process.

Inteligibilidad: diferentes perspectivas de su concepto y evaluación. Una revisión sistemática

Una adecuada inteligibilidad es un indicador del éxito en la comunicación. Su interferencia, a causa de cualquier patología, debe ser abordada en los objetivos primordiales de la terapia. No obstante, los métodos para su evaluación son poco conocidos. Objetivo: desarrollar una revisión sistemática que describa los métodos empleados en la medición de la inteligibilidad y discutir la conceptualización de este constructo. Metodología: se realiza una búsqueda en las bases de datos PubMed, ScieLo y Science Direct para identificar artículos publicados entre 1990 y 2018. Análisis y discusiones: Se seleccionan 50 investigaciones en inglés, español y portugués, que mostraron preferencia por medidas objetivas de evaluación, por sobre las medidas subjetivas de escala. La inteligibilidad se define mejor como un constructo dependiente de la señal acústica, a diferencia del concepto de comprensibilidad. Esta revisión ofrece información actualizada y organizada para optimizar procedimientos clínicos y científicos de medición de la inteligibilidad. 

Assessment of Intelligibility in Children with Velopharyngeal Insufficiency: The Relationship between Intelligibility in Context Scale and Experimental Measures

PURPOSE

The purpose of this study was to investigate the clinical application of the Intelligibility in Context Scale (ICS) instrument in children with velopharyngeal insufficiency (VPI). This study investigated the relationship between clinical speech outcomes and parental reports of speech intelligibility across various communicative partners.

METHODS

The ICS was completed by the parents of 20 English-speaking children aged 4-12 years diagnosed with VPI. The parents were asked to rate their children's speech intelligibility across communication partners using a 5-point scale. Clinical metrics obtained using standard clinical transcription on the Picture-Cued SNAP-R Test were: (1) percentage of consonants correct (PCC), (2) percentage of vowels correct (PVC), and (3) percentage of phonemes correct (PPC). Nasalance from nasometer data was included as an indirect measure of nasality. Intelligibility scores obtained from naive listener's transcriptions and speech-language pathologists' (SLP) ratings were compared with the ICS results.

RESULT

Greater PCC, PPC, PVC, and transcription-based intelligibility values were significantly associated with higher ICS values, respectively (r[20] = 0.84, 0.82, 0.51, and 0.70, respectively; p < 0.05 in all cases). There was a negative and significant correlation between ICS mean scores and SLP ratings of intelligibility (r = -0.74; p < 0.001). There was no significant correlation between ICS values and nasalance scores (r[20] = -0.28; p = 0.22).

CONCLUSION

The high correlations obtained between the ICS with PCC and PPC measures indicate that articulation accuracy has had a great impact on parents' decision-making regarding intelligibility in this population. Significant agreement among ICS scores with naive listener transcriptions and clinical ratings supports use of the ICS in practice.

The Cultural and Diagnostic Appropriateness of Standardized Assessments for Dual Language Learners: A Focus on Jamaican Preschoolers

Purpose The aim of this study was to investigate the appropriateness of standardized assessments of expressive grammar and vocabulary in a sample of preschool-age dual language learners (DLLs) who use Jamaican Creole (JC) and English. Adult models from the same linguistic community as these children were used to inform culturally and linguistically appropriate interpretation of children's responses to a standardized assessment. Method JC-English-speaking preschoolers (n = 176) and adults (n = 33) completed the Word Structure and Expressive Vocabulary subtests of the Clinical Evaluation of Language Fundamentals Preschool-Second Edition. Adults' responses were used to develop an adapted scoring procedure that considered the influence of JC linguistic features on responses. DLLs' responses scored using the standard English and adapted JC procedures were compared. Results JC-English DLLs and adults used similar linguistic structures in response to subtest questions. DLLs' scores differed significantly from the standardized sample on both subtests. Preschoolers received higher raw and corresponding standard scores with adapted scoring compared to standard scoring. Adapted scoring that made use of adult models yielded high classification accuracy at a rate of 93.8% for Word Structure and 92.1% for Expressive Vocabulary. Conclusions Adapting standardized assessment scoring procedures using adult models may offer an ecologically valid approach to working with DLL preschoolers that can support a more accurate assessment of language functioning. These findings suggest that the use of standardized assessments for bilingual JC-English speakers requires a culturally responsive approach. Supplemental Material https://doi.org/10.23641/asha.14403026.

Intelligibility in 3-Year-Olds With Cleft Lip and/or Palate Using the Intelligibility in Context Scale: Findings from the Cleft Collective Cohort Study

Objective:

To provide comparison data on the Intelligibility in Context Scale (ICS) for a sample of 3-year-old English-speaking children born with any cleft type.

Design:

Questionnaire data from the Cleft Collective Cohort Study were used. Descriptive and inferential statistics were carried out to determine difference according to children’s cleft type and syndromic status.

Participants:

A total of 412 children born with cleft lip and/or palate whose mothers had completed the ICS when their child was 3 years old.

Main Outcome Measure(s):

Mothers’ rating of their children’s intelligibility using the ICS.

Results:

The average ICS score for the total sample was 3.75 ( sometimes-usually intelligible; standard deviation [SD] = 0.76, 95% CIs = 3.68-3.83) of a possible score of 5 ( always intelligible). Children’s speech was reported to be most intelligible to their mothers (mean = 4.33, SD = 0.61, 95% CIs = 4.27-4.39) and least intelligible to strangers (mean = 3.36, SD = 1.00, 95% CIs = 3.26-3.45). There was strong evidence ( P < .001) for a difference in intelligibility between children with cleft lip only (n = 104, mean = 4.13, SD = 0.62, 95% CIs = 4.01-4.25) and children with any form of cleft palate (n = 308, mean = 3.63, SD = 0.76, 95% CIs = 3.52-3.71). Children born with cleft palate with or without cleft lip and an identified syndrome were rated as less intelligible (n = 63, mean = 3.28, SD = 0.85, 95% CIs = 3.06-3.49) compared to children who did not have a syndrome (n = 245, mean = 3.72, SD = 0.71, 95% CIs = 3.63-3.81).

Conclusions:

These results provide preliminary comparative data for clinical services using the outcome measures recommended by the International Consortium for Health Outcomes Measurement.

Intelligibility in Context Scale: Sensitivity and specificity in the Jamaican context

The present study investigated the sensitivity and specificity of the English Intelligibility in Context Scale (ICS) and the ICS-Jamaican Creole (ICS-JC) translation with bilingual preschool-aged Jamaican children. Participants in this study were 262 English-Jamaican Creole simultaneous bilingual children (aged 3;3 to 6;3, M = 4;11, SD = 7.8). The ICS and ICS-JC were administered to parents in auditory form, rather than written form. Although recent evidence has demonstrated the validity and reliability of the ICS as an assessment tool in various languages, further data are needed to determine diagnostic accuracy of the ICS and ICS-JC in Jamaican children. The sensitivity and specificity of both tools were high in this cohort of children, indicating that in the Jamaican context, these versions of the ICS could be used as screening tools to identify children who require further assessment of speech sound disorders. A cut-off score of 4.12 was used for both tools to achieve high sensitivity (0.84) and specificity (0.70) values for the ICS, as well as high sensitivity (0.84) and specificity (0.71) for the ICS-JC. The results of this study also demonstrate that administration of the auditory ICS is a valid way of collecting parent reports about children's speech intelligibility, which has implications for use of the ICS in languages with no written form or with parents who have a low level of literacy in the languages they use. This investigation is relevant not only to this underserved population but broadens knowledge of research-based tools for working with bilingual children.

The Narrative Competence of Bilingual Jamaican Creole- and English-Speaking Preschoolers

Purpose The purpose of this study is to characterize narrative competence of typically developing bilingual children using Jamaican Creole (JC) and English. Method Story comprehension and fictional storytelling tasks in JC and English were completed by 104 bilingual preschoolers aged 4-6 years. Story comprehension was analyzed using inferential story comprehension questions representing Blank's Question Hierarchy. Fictional storytelling was analyzed using the Monitoring Indicators of Scholarly Language framework for narrative macrostructure and microstructure. Results Story comprehension was significantly correlated within each language, but only questions from Level 4 of Blank's Question Hierarchy showed significant correlations between languages. Fictional storytelling was significantly better in English than in JC for macrostructure (total score, internal response, plan, consequence) and microstructure (total score, adverbs, elaborated noun phrases). Story complexity in JC and English was significantly correlated. In terms of developmental effects, children's macrostructure and story complexity appear to be better at 4 years than 5 years, with English outperforming JC. Furthermore, age correlated with story comprehension in JC. Conclusion Comparison of narrative competence in bilingual children provides much needed insights into language development, with examination of JC and English bilinguals representing an understudied bilingual context.

Variability across repeated productions in bilingual children speaking Jamaican Creole and English

PURPOSE

Previous work suggests that variability across repeated productions of the same word may be useful in diagnosing speech sound disorder (SSD) in bilingual children. However, there is debate over what level of variability in transcribed productions should be considered typical even in monolingual speech development. High variability in the input represents a factor that could promote increased production variability in bilinguals. For this reason, the current study examines transcription-based token-to-token variability in bilingual children speaking Jamaican Creole (JC) and English.

METHOD

Twenty-five bilingual children aged 3;4-5;1 and twenty-five monolingual children aged 2;9-4;1 from a previous study were recorded producing eleven items in three repetitions.

RESULT

Contrary to our hypothesis, bilingual children showed similar rates of token-to-token variability compared to the monolingual children. In a separate analysis of bilingual data across languages, bilingual children were more variable in JC compared to English productions.

CONCLUSION

The difference between language contexts suggests that creole languages, which exist on a usage continuum, may be associated with increased variability in production. Our findings suggest that token-to-token production variability may be of similar clinical utility for bilingual and monolingual populations.

Normative data and construct validity of a cross-linguistic functional speech outcome, the Intelligibility in Context Scale: Italian (ICS-I)

OBJECTIVES

The Intelligibility in Context Scale (ICS) is a parent-report scale, world-wide translated and widely validated, by which parents can rate their child's functional speech intelligibility according to seven different communicative partners. The study aimed to report and discuss the normative data of the Italian version of ICS (ICS-I) in Italian-speaking preschool children, and to investigate whether the age influences the ICS-I scores (construct validity). Socio-economic status (SES) of the family were investigated and compared to parents' ratings on child's speech intelligibility.

METHODS

A cross-sectional observational study was conducted. Italian-speaking children aged 3-6 years (n = 355; mean age = 56.06 months; SD = 9.8 months), without major developmental impairment, were recruited in kindergartens throughout a convenience sampling. Parents completed a self-report form on their family SES (educational level and employment status of fathers and mothers). Children were independently rated by their mothers (ICS-I_m) and fathers (ICS-I_f).

RESULTS

Results show that ICS normative data for the Italian preschool population (ICS-I_m = 4.52; SD = 0.46; ICS-I_f = 4.47; SD = 0.49) are consistent with previous evidence found in other languages, suggesting that ICS could be a potential cross-linguistic tool to assess functional intelligibility. A statistically significant (p < 0.001) improvement in ICS-I score was found with increase of age (construct validity). No evidence of association (p > 0.05) with ICS-I was found for SES family.

CONCLUSION

The study provides normative data of the functional intelligibility assessed by a subjective parental scale. As for other previous international studies, ICS-I normative data suggest that a preschool child without major impairment shows a high degree of speech intelligibility, even if minimal differences of intelligibility are reported for different communicative partners. The current findings support clinicians and researchers in implementing ICS-I in typical and also in atypical population with different SES background and promoting its application as a potential outcome measure in children with Speech Sound Disorders.

Revisiting the Cutoff Criteria of Intelligibility in Context Scale–Traditional Chinese

Background

This study evaluated the validity of the Intelligibility in Context Scale–Traditional Chinese (ICS-TC) and explored its potential as a screening tool for speech sound disorder (SSD) in Cantonese-speaking children in Hong Kong.

Method

The parents of 789 Cantonese-speaking children aged between 2;4 (years;months) and 6;9 completed the ICS-TC. Children were categorized into 2 groups: (a) an SSD group whose initial consonant scores in a standardized assessment were equal to or lower than −1.33 SD and (b) a non-SSD group whose scores were higher than −1.33 SD . The screening accuracy of ICS-TC using a previously proposed cutoff was appraised. A cutoff score for each age group was determined when the effect of age on the ICS-TC mean scores was significant and the corresponding screening accuracy was appraised.

Results

When the previously proposed cutoff was applied to the whole sample, sensitivity and specificity were unsatisfactory. Given the significant age effect, new cutoff scores for each age group were estimated. The new cutoff scores only led to remarkably improved screening accuracy for Age Group 4 (4;0–4;5) but little to no improvement for other age groups.

Conclusions

There is limited clinical use of ICS-TC as a screening tool with a single cutoff score for children at different ages. Its clinical utility might be limited to children of about 4 years of age, where ICS-TC scores demonstrated the best differentiation between children with and without speech concerns. Future studies could refine the screening criteria to further minimize the number of false positives.

Validation of the Intelligibility in Context Scale for Korean-speaking pre-school children

Purpose: The Intelligibility in Context Scale (ICS) is a parent-reported screening tool focussed on parents' perception of their child's speech intelligibility. The purposes of this study were to evaluate the psychometric properties of the Korean version of the ICS (ICS-K) and to investigate whether the ICS-K is a useful tool for distinguishing between Korean-speaking children with typical development (TD) and those with speech sound disorder (SSD). Method: A total of 178 Korean-speaking pre-school children (145 children with TD and 33 children with SSD) participated in this study. Speech skills were assessed using the Assessment of Phonology and Articulation for Children. The parents of the children completed the ICS-K. Result: The ICS-K showed high internal consistency and test-retest reliability. Criterion validity was established through a significant correlation between the ICS-K and the percentage of consonants correct. Construct validity was also established through significant correlations between the ICS-K mean scores and the item scores. A discriminant analysis revealed that the ICS-K had high sensitivity (90.9%) and adequate specificity (77.9%) in classifying children into either the TD or the SSD group. Conclusion: The psychometric properties of the ICS-K support its clinical value in measuring functional speech intelligibility in Korean-speaking children with SSD.

Measuring intelligibility in signed languages

Intelligibility of spoken languages is a widely discussed construct; however, intelligibility, as it pertains to signed languages, has rarely been considered. This study provides an initial investigation of the construct of intelligibility in American Sign Language (ASL) and evaluates potential measures for self-report and expert ratings of sign intelligibility that examined the frequency of understanding, amount of understanding, and ease of understanding. Participants were 66 college students (42 Deaf, 24 hearing) who had self-rated ASL skills ranging from poor to excellent. Participants rated their own intelligibility in ASL and then provided a signed language sample through a picture description task. Language samples were reviewed by an expert rater and measures of intelligibility were completed. Results indicated that expert ratings of sign intelligibility across all measures were significantly and positively correlated. Understanding of the signer was predicted by the amount of understanding, frequency of understanding, and ASL production skills, while understanding the picture being described was predicted by ease of understanding and ASL grammar skills. Self- and expert ratings of sign intelligibility using the ASL version of the Intelligibility in Context Scale were not significantly different. Self-report of sign intelligibility for viewers of different familiarity using the ICS-ASL was found not to be feasible due to many participants not being in contact with ASL users in the relationships defined by the measure. In conclusion, this preliminary investigation suggests that sign intelligibility is a construct worthy of further investigation.

Bilingual Preschoolers' Spontaneous Productions: Considering Jamaican Creole and English

Purpose

The purpose of this study was to characterize grammatical production in Jamaican Creole (JC) and English using the Index of Productive Syntax (IPSyn; Scarborough, 1990 ) in a sample of typically developing bilingual Jamaicans.

Method

Spontaneous language samples were collected in JC and English from 62 preschoolers aged 4–6 years. Language samples were analyzed for IPSyn subdomains (Total Score, Noun Phrases, Verb Phrases, Questions/Negations, Sentence Structures), mean length of utterance in morphemes, and number of different words. Child and family demographic information were also collected along with nonverbal IQ performance.

Results

IPSyn Total Score in JC and English were significantly correlated, and significant correlations were found between IPSyn subdomains in each language for Noun Phrases, Verb Phrases, and Sentence Structures, but not Questions/Negations. Item analysis for the IPSyn items showed that only 7 of the 56 items did not perform similarly in both languages, with performance on only 2 of these being significantly different. IPSyn scores in both languages were correlated with mean length of utterance in morphemes and number of different words, but only IPSyn JC was correlated with nonverbal IQ and age.

Conclusion

The IPSyn shows promise as a mainstream tool useful in characterizing grammatical productions across languages in typically developing bilingual Jamaican preschoolers.

An Investigation of the Clinical Use of a Single-Word Procedure to Assess Intelligibility (Swedish Test of Intelligibility for Children) and an Evaluation of the Validity and Reliability of the Intelligibility in Context Scale

Purpose Intelligibility is a core concept of speech-language pathology, central both to the assessment of speech disorders and to intervention in such disorders. One purpose of this study was to investigate the reliability and usability of a single-word assessment procedure, the Swedish Test of Intelligibility for Children (STI-CH), in a clinical setting. Another purpose was to investigate the validity and reliability of an assessment method designed to assess functional intelligibility: the Intelligibility in Context Scale (ICS). Method Thirty children aged 4;1-10;1 years;months were recruited from speech-language pathology clinics in Western Sweden. Each child's treating speech-language pathologist served as listener in the STI-CH assessment while the ICS was completed by each child's parents. External listeners (2 last-year speech-language pathology students) were used to assess the validity of the speech-language pathology. Results The mean duration of the test procedure for the STI-CH was about 19 min, and 57% of the test sessions were reported as difficult. There was a weak but statistically significant correlation between the results from the STI-CH and the ICS ( r = .40, p < .05), and both methods showed high reliability in terms of interlistener reliability (intraclass correlation exceeding .97) and internal consistency, respectively. Conclusions The STI-CH had high reliability and was time efficient but had some procedural problems. The ICS had moderate validity but high reliability. The STI-CH is promising for clinical use but needs to be developed further. The validity of the ICS can be discussed and needs to be further investigated.

The UNICEF/Washington Group Child Functioning Module-Accuracy, Inter-Rater Reliability and Cut-Off Level for Disability Disaggregation of Fiji's Education Management Information System

This paper explores the validity (sensitivity and specificity) of different cut-off levels of the UNICEF/Washington Group Child Functioning Module (CFM) and the inter-rater reliability between teachers and parents as proxy respondents, for disaggregating Fiji's education management information system (EMIS) by disability. The method used was a cross-sectional diagnostic accuracy study comparing CFM items to standard clinical assessments for 472 primary school aged students in Fiji. Whilst previous domain-specific results showed "good" to "excellent" accuracy of the CFM domains seeing, hearing, walking and speaking, newer analysis shows only "fair" to "poor" accuracy of the cognitive domains (learning, remembering and focusing attention) and "fair" of the overall CFM (area under the Receiver Operating Characteristic curve: 0.763 parent responses, 0.786 teacher responses). Severe impairments are reported relatively evenly across CFM response categories "some difficulty", "a lot of difficulty" and "cannot do at all". Most moderate impairments are reported as "some difficulty". The CFM provides a core component of data required for disaggregating Fiji's EMIS by disability. However, choice of cut-off level and mixture of impairment severity reported across response categories are challenges. The CFM alone is not accurate enough to determine funding eligibility. For identifying children with disabilities, the CFM should be part of a broader data collection including learning and support needs data and undertaking eligibility verification visits.

Impact of communication partner familiarity and speech accuracy on parents' ratings of their child for the Intelligibility in Context Scale: Dutch

PURPOSE

The aim of this study was to examine the role of familiarity of a communication partner on Dutch parents' perception of their child's intelligibility, for children with typically-developing speech (TD) or speech sound disorder (SSD).

METHOD

Participants were 67 Dutch-speaking children (48-84 months), 48 with TD and 19 with SSD. Item scores on the parent-rated Intelligibility in Context Scale: Dutch (ICS-NL) were compared between groups and related to naive listeners' ratings of children's intelligibility (IR), and a measure of speech accuracy (i.e. percentage of consonants correct-adjusted, PCC-A).

RESULT

Statistical analysis yielded a significant Group by Familiarity interaction on the ICS-NL. Parents rated the intelligibility of their child with SSD as higher with more familiar communication partners than less familiar, more so than parents of children with TD. In the SSD group, IR was more strongly correlated with ICS-NL item scores for less familiar partners. PCC-A was only correlated with ICS-NL item 7 (strangers).

CONCLUSION

Parents perceive their children as more intelligible with people in close relationships, likely due to their higher familiarity with the child's speech. Children's relationships should be considered with respect to communicative participation. PCC-A may be a less reliable predictor of participation in family and community life.

Measurement accuracy: Enabling human rights for Fijian students with speech difficulties

PURPOSE

The Universal Declaration of Human Rights enshrines the rights to communication and education and measuring access to these rights for children with disabilities is fundamental. The UNICEF/Washington Group Child Functioning Module (CFM) is being promoted to measure progress against the Sustainable Development Goals for children with disabilities. This cross-sectional diagnostic accuracy study in Fiji compares parent and teacher CFM responses to the Intelligibility in Context Scale for 463 primary-aged students with and without speech difficulties.

METHOD

Receiver operating characteristic curves were constructed to analyse CFM accuracy and determine optimal cut-off points; inter-rater reliability between teachers and parents was calculated.

RESULT

Parent responses to the CFM speech questions achieved an area under the curve of 0.98, indicating "excellent" diagnostic accuracy. Teachers achieved 0.92 ("very good"). The Youden Index identified the optimal cut-off as "some difficulty".

CONCLUSION

The CFM appears effective when used by parents or teachers for distinguishing between children with and without speech difficulties. While identified as the optimal cut-off statistically, the "some difficulty" category identifies too many children without speech difficulties to be simplistically applied to funding eligibility. The CFM should be used as a screening tool, followed by further assessment to confirm eligibility.

The German Intelligibility in Context Scale (ICS-G): reliability and validity evidence

BACKGROUND

In 2012 the Intelligibility in Context Scale (ICS) was published as a parent-report screening assessment that considers parents' perceptions of their children's functional intelligibility with a range of communication partners that differ in levels of authority and familiarity in real-life situations. To date, the ICS has been translated into 60 languages (including German).

AIMS

To evaluate the psychometric properties of the German translation of the ICS ( = ICS-G), especially its reliability and validity, using four objective measures of speech sound disorder (SSD) severity: percentage of consonants correct (PCC); percentage of initial consonants correct (PICC); percentage of vowels correct (PVC); and percentage of phonemes correct (PPC).

METHODS & PROCEDURES

Children who were typically developing (TD) and children with SSD (n = 181; 90 males, 81 females; mean age = 4.18 years, SD = 0.79 years, range = 3;0-5;11 years) were recruited through 13 kindergartens and 15 speech-language pathologists (SLPs) in Germany. All children's parents completed the ICS-G. To obtain an insight into the severity of SSD (n = 30), children's speech skills were assessed with PLAKSS-II. For the analysis of test-retest reliability the ICS-G was re-administered with a subsample of parents (n = 36) after 1 week.

OUTCOMES & RESULTS

The ICS-G had high internal consistency (α = .95, p < .001) and high test-retest reliability (r = .998, p < .001). The ICS-G total scores and item scores for both samples showed significant correlations, indicating good construct validity. Analyses revealed low but significant correlations with external factors (e.g., age, social class). Criterion validity was established through significant correlations between the ICS-G and scores for PCC (r = .43), PICC (r = .43), PVC (r = .62) and PPC (r = .47). The discriminatory ability of the ICS-G was indicated by significantly higher mean scores for the TD group (mean = 4.49, SD = 0.47) than the SSD group (mean = 3.97, SD = 0.63).

CONCLUSIONS & IMPLICATIONS

The overall good psychometric properties of the ICS-G support its use by SLPs for clinical and research purposes with German-speaking children.