Evaluation of Parent- and Speech-Language Pathologist-Delivered Multiple Oppositions Intervention for Children With Phonological Impairment: A Multiple-Baseline Design Study

Shared characteristics of intervention techniques for oral vocabulary and speech comprehensibility in preschool children with co-occurring features of developmental language disorder and speech sound disorder: a systematic review with narrative synthesis

OBJECTIVES

To descriptively compare and contrast intervention techniques for preschool children with features of developmental language disorder (outcome: oral vocabulary) and speech sound disorder (outcome: speech comprehensibility) and analyse them in relation to effectiveness and theory.

DESIGN

This is a systematic review with narrative synthesis. The process was supported by an expert steering group consisting of relevant professionals and people with lived experience.

DATA SOURCES

Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, ERIC, and Communication Source from January 2012 were searched. Relevant studies were obtained from an initial published review (up to January 2012).

ELIGIBILITY CRITERIA

Interventions for preschool children (80% aged 2:0-5:11 years) with idiopathic speech or language needs; outcomes relating to either oral vocabulary or speech comprehensibility.

DATA EXTRACTION AND SYNTHESIS

Searches were conducted on 27 January 2023. Two independent researchers screened at abstract and full-text levels. Data regarding intervention content (eg, techniques) and format/delivery (eg, dosage, location) were extracted. Data were synthesised narratively according to the methods of Campbell et al.

RESULTS

24 studies were included: 18 for oral vocabulary and 6 for speech comprehensibility. There were 11 randomised controlled trials, 2 cohort studies and 11 case series. Similarities included a focus on input-related techniques and similar therapy activities. Speech studies were more likely to be professional-led and clinic-led, rather than at home and through a parent. Analysis was restricted by heterogeneity in study design and terminology, as well as gaps within intervention reporting. Information deemed important to the expert steering group was missing.

CONCLUSIONS

Similarities and differences between intervention techniques for oral vocabulary and speech comprehensibility have been identified and synthesised. However, analysis of effectiveness was limited due to issues with study design and heterogeneity within studies. This has implications for the progression of the evidence base within the field.

PROSPERO REGISTRATION NUMBER

CRD42022373931.

Multiple oppositions intervention: effective phonological treatment of two children with cleft lip and palate and severe speech sound disorder

The purpose of this study was to investigate if multiple oppositions intervention (MOI) generated widespread change in the phonological systems of two children with cleft lip and palate (CLP) and severe speech sound disorders (SSD). We treated two children (ages 5;4 and 5;6) with CLP and severe SSD using MOI for 24 and 29 sessions. We measured the percentage consonants correct (PCC) for target consonants and untreated consonants in non-treatment single words, as well as PCC for connected speech. Data points were collected in the baseline, intervention, and maintenance phase with post-tests conducted immediately after intervention and at 1, 3, 6 and 12 months. Two speech and language therapists (SLTs) unfamiliar with the children performed phonetic transcriptions, and we calculated intra- and inter-rater agreement. We graphed the data, and used permutation tests to analyse the probability that the observed increases in PCC were due to random chance. Both children experienced considerable improvements in PCC across all measures at the first post-test, supporting the impact of MOI on their entire phonological system. The PCC continued to increase during the maintenance phase. By the final post-test, the PCC in connected speech exceeded 90% for both children, reducing their SSD classification to mild. Our findings support that a phonological, contrastive intervention approach targeting multiple consonants simultaneously can create system-wide phonological change for children with CLP and severe SSD. Further research with more participants is needed to strengthen these findings.

Dimensionality of Speech-Language Pathologists' Child-Directed Talk During School-Based Therapy With Primary-Grade Students

PURPOSE

The purpose of this study was to examine the measurement structure of the linguistic features of speech-language pathologists' (SLPs) talk during business-as-usual therapy sessions in the public schools and to test the longitudinal stability of a theorized dimensional structure consisting of quantity, grammatical complexity, and lexical complexity.

METHOD

Seventy-five SLPs' talk during therapy sessions with primary-grade students was automatically transcribed and coded for linguistic features from a corpus of 579 videotaped therapy session videos collected at the beginning, middle, and end of one school year with an approximately 12-week interval. We explored video characteristics and conducted descriptive statistics on eight linguistic indices of SLP talk to examine the variability in SLP talk between therapy sessions. Confirmatory factor analyses were used to explore the dimensional structure of SLP talk at each time point separately for the theorized three dimensions, and we conducted longitudinal measurement invariance analyses to test the stability of the three-factor structural model across the academic year.

RESULTS

There were considerable variabilities among SLPs in the characteristics of SLP talk during therapy sessions. The proposed three-factor structure of SLP talk consisting of quantity, grammatical complexity, and lexical complexity had good model fit at all three time points. The linguistic measurement properties representing the three factors were invariant over time.

CONCLUSIONS

Results provided robust evidence of between-SLP variability in their child-directed talk, established a three-dimensional structure of the linguistic features in SLP talk, and identified that the linguistic features in SLP talk stably measured the same constructs across one school year, based on measurement invariance. The dimensions of SLP talk during therapy with students may represent important, malleable features of therapy that influence child language gains.

Shared characteristics of intervention techniques for oral vocabulary and speech comprehensibility in preschool children with co-occurring features of developmental language disorder and a phonological speech sound disorder: protocol for a systematic review with narrative synthesis

INTRODUCTION

Evidence suggests that over one-third of young children with developmental language disorder (DLD) or speech sound disorder (SSD) have co-occurring features of both. A co-occurring DLD and SSD profile is associated with negative long-term outcomes relating to communication, literacy and emotional well-being. However, the best treatment approach for young children with this profile is not understood. The aim of the proposed review is to identify intervention techniques for both DLD and SSD, along with their shared characteristics. The findings will then be analysed in the context of relevant theory. This will inform the content for a new or adapted intervention for these children.

METHODS AND ANALYSIS

This search will build on a previous systematic review by Roulstone et al (2015) but with a specific focus on oral vocabulary (DLD outcome) and speech comprehensibility (SSD outcome). These outcomes were identified by parents and speech and language therapists within the prestudy stakeholder engagement work. The following databases will be searched for articles from January 2012 onwards: Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, Communication Source and ERIC. Two reviewers will independently perform the title/abstract screening and the full-text screening with the exclusion criteria document being revised in an iterative process. Articles written in languages other than English will be excluded. Data will be extracted regarding key participant and intervention criteria, including technique dosage and delivery details. This information will then be pooled into a structured narrative synthesis.

ETHICS AND DISSEMINATION

Ethical approval is not needed for a systematic review protocol. Dissemination of findings will be through peer-reviewed publications, social media, and project steering group networks.

PROSPERO REGISTRATION NUMBER

CRD4202237393.

Creencias y actitud hacia la Práctica Basada en la Evidencia de fonoaudiólogos latinoamericanos dedicados exclusivamente a la práctica clínica y educativa

La Práctica Clínica Basada en la Evidencia (PBE) sugiere al fonoaudiólogo/a la incorporación de acciones orientadas a dar respuesta a las necesidades de los usuarios en contextos específicos. Dichas acciones incluyen planteamiento de interrogantes, revisión crítica de evidencia disponible y toma de decisiones integrando la experiencia clínica, la evidencia y las preferencias del usuario. Si bien este paradigma se ha posicionado en la disciplina en la última década, resulta compleja su implementación para los profesionales que se encuentran completamente dedicados a la práctica clínica y/o educativa. El objetivo de este estudio es analizar las creencias y actitud hacia la PBE de fonoaudiólogos/as dedicados a labores clínicas y/o educativas a tiempo completo en diferentes países de Latinoamérica. Se trata de un estudio cualitativo, fenomenológico. Se realizaron entrevistas semiestructuradas a fonoaudiólogos/as residentes en Argentina, Paraguay, Chile, Perú, Colombia, Uruguay y Costa Rica. Para los análisis de resultados se contó con entrevistas a 9 profesionales. La mayoría de los encuestados considera que la PBE se limita a las publicaciones científicas y que se dificulta la implementación en su contexto laboral, principalmente por la falta de tiempo asociada a la revisión de literatura científica actualizada. Como conclusión cabe indicarse que existe una creencia errada en términos conceptuales sobre el significado de la PBE, generando actitudes ambiguas hacia dicho paradigma. En Latinoamérica se hace necesaria la reflexión respecto a la formación de fonoaudiólogos/as para que desde el pregrado puedan manejar mayores recursos para la toma de decisiones en la evaluación e intervención; y así disminuir la brecha entre los investigadores y quienes se dedican eminentemente a la práctica clínica.

Cultural Adaptation of Parent-Implemented Early Communication Interventions: A Scoping Review

PURPOSE

Parent-implemented early communication interventions are commonly delivered to culturally and linguistically diverse families. Although there is evidence from fields such as public health or psychology, there is little guidance regarding what elements to culturally adapt for parent-implemented speech-language pathology interventions. This scoping review addresses this gap by identifying parent-implemented early communication interventions that have been culturally adapted and describing which intervention components were adapted. Definitions of culture, use of adaptation frameworks, and adaptation guidelines, policies, and recommendations are also reported.

METHOD

The databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PsycINFO, and Embase via OVID were searched. Supplementary search methods, including hand-searching of references and a gray literature search, were also conducted. Covidence software was used to deduplicate, collate, and review articles. Population, intervention, study, and cultural adaptation data were extracted and synthesized using the Ecological Validity Framework.

RESULTS

Twenty-one articles were included from the database and supplementary searches. No studies defined culture, and only three used cultural adaptation models or frameworks to guide adaptation. Studies varied greatly in what they adapted; language adaptations, such as translation, were conducted most frequently, and intervention goals were rarely adapted. Only three studies obtained parent feedback to inform cultural adaptation for future recommendations.

CONCLUSIONS

More clarity in the reporting of cultural adaptation for communication interventions is required. Cultural adaptation frameworks are useful tools to guide adaptation but can be difficult to operationalize. Additional research in this area is necessary to help clinicians provide culturally responsive, parent-implemented communication interventions.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20416107.

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.

Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project

Speech sound disorder (SSD) affects up to 25% of UK children and may impact on: effective communication; the development of relationships; school progression and overall well-being. The evidence base shows that intervention for children with SSD is more effective and efficient when provided intensively in relation to the number of target sounds elicited in sessions (dose) and number of sessions per week (frequency). Southern Health and Social Care (HSC) Trust's baseline intensity of speech and language therapy (SLT) intervention was similar to that often found in current practice across the UK,where ~30 target sounds were elicited (dose) in once weekly sessions (frequency) over a 6-week block, followed by a break from therapy. This quality improvement (QI) project aimed to increase intensity of intervention for children with severe SSD within Southern HSC Trust's community SLT service to improve outcomes for children and their parents. QI methods supported accurate identification of ten 4-5 year olds with severe SSD and increased the intensity of their intervention over a 12-week period by measuring a range of data and speech outcomes. Findings showed a sustainable increase of dose (number of targets elicited per session) to levels recommended in the research (≥70). However, it was difficult to sustain increased frequency of appointments (to twice weekly) because of contextual factors such as sickness, etc. Accommodating this, measuring days between appointments captured an overall increase in the number of appointments attended across time. Child speech outcomes improved for direct speech measures and parent ratings of intelligibility. The intensive model of intervention has been implemented for children identified with severe SSD across Southern HSC Trust's community service with ongoing audit and development, and findings have been disseminated.

Minimal, Maximal, or Multiple: Which Contrastive Intervention Approach to Use With Children With Speech Sound Disorders?

PURPOSE

This tutorial contrasts a familiar and frequently used speech sound disorder (SSD) intervention approach, conventional minimal pair, with newer but less familiar and less frequently used variants that may be more effective: (a) maximal opposition and (b) multiple oppositions.

METHOD

This tutorial provides a general description of each contrastive approach, focusing on the evidence base and a small number of critical elements that define the approach and make it unique from all other approaches. Hypothetical cases are used to illustrate how the approaches can be tailored to child needs and speech-language pathologist (SLP) expertise. Supplemental materials enhance the reader's skill in using these approaches in their practice with a minimal initial investment.

RESULTS

The reader will be able to identify which children with SSD are appropriate for conventional minimal pair, maximal opposition, or multiple oppositions approaches and will be able to plan intervention (i.e., select target sounds and contrasting words or nonwords, develop intervention activities, write goals, and determine intervention intensity) for each of these approaches.

CONCLUSIONS

This tutorial highlights that using the conventional minimal pair approach should be restricted to children with a small number of errors (i.e., older children or children with mild SSD). There is an opportunity for SLPs to use newer, more efficacious approaches with younger children and children with more severe SSDs. The maximal opposition approach is well suited to children with multiple errors across multiple sound classes. The multiple oppositions approach specifically targets global phoneme collapses that impact intelligibility.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19178783.

Moving Beyond Single Word Acquisition of Speech Sounds to Connected Speech Development With Dynamic Assessment

PURPOSE

The aim of this study was to document speech sound development across early childhood from a dynamic assessment (DA) perspective that captures a breadth of linguistic environments using the Glaspey Dynamic Assessment of Phonology (Glaspey, 2019), as well as to provide normative data for speech-language pathologists to compare speech skills when making clinical decisions and provide historical context. Targets of English were evaluated via DA for the (a) age of acquisition in single words; (b) continued development through connected speech; (c) early, mid, and late sequence; and (d) differences between single word and connected speech productions.

METHOD

Data were extracted from the reported results of the norming study for the Glaspey Dynamic Assessment of Phonology, which included a representative sample of 880 children ages 3 years to 10;11 (years;months). Comparisons were made with 49 items including multisyllabic words, clusters, and phonemes of English across word positions.

RESULTS

Assessment with DA showed that acquisition in single words is nearly complete by age 6 years with a 90% mastery level, and the sequence suggests an Early-13, Mid-16, and Late-14 for items by word position. In connected speech, a wider range of progression is evident from the emergence of sound production at 50%, 75%, and 90% mastery levels with observed changes between ages 3 and 10 years.

CONCLUSIONS

Given a DA approach across connected linguistic environments, children continue to progress in their development of speech sounds from early childhood well into their school-age years and for some sounds beyond the age of 10 years. DA challenges the language system to better reflect children's developmental progression.