Children's English Consonant Acquisition in the United States: A Review

Accuracy of Speech Sound Analysis: Comparison of an Automatic Artificial Intelligence Algorithm With Clinician Assessment

PURPOSE

Automatic speech analysis (ASA) and automatic speech recognition systems are increasingly being used in the treatment of speech sound disorders (SSDs). When utilized as a home practice tool or in the absence of the clinician, the ASA system has the potential to facilitate treatment gains. However, the feedback accuracy of such systems varies, a factor that may impact these gains. The current research analyzes the feedback accuracy of a novel ASA algorithm (Amplio Learning Technologies), in comparison to clinician judgments.

METHOD

A total of 3,584 consonant stimuli, produced by 395 American English-speaking children and adolescents with SSDs (age range: 4-18 years), were analyzed with respect to automatic classification of the ASA algorithm, clinician-ASA agreement, and interclinician agreement. Further analysis of results as related to phoneme acquisition categories (early-, middle-, and late-acquired phonemes) was conducted.

RESULTS

Agreement between clinicians and ASA classification for sounds produced accurately was above 80% for all phonemes, with some variation based on phoneme acquisition category (early, middle, late). This variation was also noted for ASA classification into "acceptable," "unacceptable," and "unknown" (which means no determination of phoneme accuracy) categories, as well as interclinician agreement. Clinician-ASA agreement was reduced for misarticulated sounds.

CONCLUSIONS

The initial findings of Amplio's novel algorithm are promising for its potential use within the context of home practice, as it demonstrates high feedback accuracy for correctly produced sounds. Furthermore, complexity of sound influences consistency of perception, both by clinicians and by automated platforms, indicating variable performance of the ASA algorithm across phonemes. Taken together, the ASA algorithm may be effective in facilitating speech sound practice for children with SSDs, even in the absence of the clinician.

Web-based pronunciation training and learning consonant clusters among EFL learners

Arab learners of English often face challenges when it comes to correctly pronouncing English consonant clusters. To address these difficulties, technology-driven methods can be employed to enhance the acquisition of proper English consonant cluster pronunciation. This research endeavor aimed to assess the impact of web-based pronunciation training on the articulation of consonant clusters. The research followed an experimental design, involving fifty-eight Saudi learners of English as a foreign language (EFL) who were enrolled at a public university in Saudi Arabia. These participants were randomly divided into two groups. The experimental group received a list of words containing consonant clusters to practice using YouGlish as a resource. Meanwhile, the control group was instructed to listen to the instructor's pronunciation and then practice producing the words with consonant clusters. The outcomes demonstrated a significant improvement in the production of words with consonant clusters among the experimental group, attributed to the utilization of web-based pronunciation training. These findings hold promise for the field of language learning, highlighting the effectiveness of web-based pronunciation training as a valuable tool for teaching second language pronunciation.

Narrative reconstruction in deaf and hearing children: A comparative study in the context of Arabic diglossia

This study explores the narrative skills of deaf and hearing children within the context of Arabic diglossia, a linguistic environment characterised by significant differences between spoken dialects and formal written language. Using Stein and Glenn's (1979) and Bruner's (1991) frameworks, the research analyses the narrative constructions of 13 hearing and 13 deaf children in Kuwait. The findings reveal that hearing children, benefiting from consistent exposure to spoken and formal Arabic, produced more coherent and detailed narratives compared to deaf children. Hearing participants also demonstrated greater vocabulary diversity. Age-related improvements in narrative skills were more pronounced among hearing children, while the impact of sign language exposure on narrative abilities was significant among deaf children. The study underscores the critical role of early language exposure and educational support in fostering narrative development, particularly in a diglossic context. These findings highlight the need for specialised educational strategies to support the unique narrative development needs of deaf children.

Factors affecting consonant production accuracy in children with cochlear implants: Expressive vocabulary and maternal education

BACKGROUND

Despite the ability of cochlear implants (CIs) to provide children with access to speech, there is considerable variability in spoken language outcomes. Research aimed at identifying factors influencing speech production accuracy is needed.

AIMS

To characterize the consonant production accuracy of children with cochlear implants (CWCI) and an age-matched group of children with typical hearing (CWTH) and to explore several factors that potentially affect the ability of both groups to accurately produce consonants.

METHODS & PROCEDURES

We administered the Bankson-Bernthal Test of Phonology (BBTOP) to a group of 25 CWCI (mean age = 4;9, SD = 1;6, range = 3;2-8;5) implanted prior to 30 months of age with a mean duration of implant usage of 3;6 and an age-matched group of 25 CWTH (mean age = 5;0, SD = 1;6, range = 3;1-8;6). The recorded results were transcribed, and the accuracy of the target consonants was determined. Expressive vocabulary size estimates were obtained from a language sample using the number of different words (NDW). A parent questionnaire provided information about maternal education, duration of CIs experience and other demographic characteristics of each child.

OUTCOMES & RESULTS

The CWCI group demonstrated some similarities to, and some differences from, their hearing peers. The CWCI demonstrated poorer consonant production accuracy overall and in various phonetic categories and word positions. However, both groups produced initial consonants more accurately than final consonants. Whilst CWCI had poorer production accuracy than CWTH for all phonetic categories (stops, nasals, fricatives, affricates, liquids and glides and consonant clusters), both groups exhibited similar error patterns across categories. For CWCI, the factors most related to consonant production accuracy when considered individually were expressive vocabulary size, followed by duration of CI experience, chronological age, maternal education and gender. The combination of maternal education and vocabulary size resulted in the best model of consonant production accuracy for this group. For the CWTH, chronological age followed by vocabulary size were most related to consonant production accuracy. No combination of factors yielded an improved model for the CWTH.

CONCLUSIONS & IMPLICATIONS

Whilst group differences in production accuracy between the CWCI and CWTH were found, the pattern of errors was similar for the two groups of children, suggesting that the children are at earlier stages of overall consonant production development. Although duration of CI experience was a significant covariate in a single-variable model of consonant production accuracy for CWCI, the best multivariate model of consonant production accuracy for these children was based on the combination of expressive vocabulary size and maternal education.

WHAT THIS PAPER ADDS

What is already known on the subject Research has shown that a range of factors is associated with consonant production accuracy by CWCIs, including factors such as the age at implant, duration of implant use, gender, other language skills and maternal education. Despite numerous studies that have examined speech sound production in these children, most have explored a limited number of factors that might explain the variability in scores obtained. Research that examines the potential role of a range of child-related and environmental factors in the same children is needed to determine the predictive role of these factors in speech production outcomes. What this paper adds to the existing knowledge Whilst the consonant production accuracy was lower for the CWCIs than for their typically hearing peers, there were some similarities suggesting that these children are experiencing similar, but delayed, acquisition of consonant production skills to that of their hearing peers. Whilst several factors are predictive of consonant production accuracy in children with implants, vocabulary diversity and maternal education, an indirect measure of socio-economic status, were the best combined predictors of consonant production accuracy. What are the potential or actual clinical implications of this work? Understanding the factors that shape individual differences in CWCI speech production is important for effective clinical decision-making and intervention planning. The present findings point to two potentially important factors related to speech sound production beyond the duration of robust hearing in CWCI, namely, a lexical diversity and maternal education. This suggests that intervention is likely most efficient that addresses both vocabulary development and speech sound development together. The current findings further suggest the importance of parental involvement and commitment to spoken language development and the importance of receiving early and consistent intervention aimed both at skill development and parental efficacy.

Book-Sharing for Toddlers with Clefts (BOOST): Protocol for a randomized controlled trial of a remote intervention to promote language development in children with cleft palate

BACKGROUND

Children with cleft palate, with or without cleft lip (CP±L), exhibit language delays on average compared to children without clefts. Interventions to address these disparities are scarce. In this multi-center study, Book Sharing for Toddlers with Clefts (BOOST), we will test a remote, parent-focused intervention to promote language development in children with CP±L.

OBJECTIVES

The study will test two primary hypotheses. First, toddlers randomized to BOOST will exhibit better language outcomes than children receiving standard-of-care (SOC). Second, we hypothesize that the BOOST program's effect on language outcomes is mediated by the frequency and quality of parent-child reading interactions.

METHODS

The study is a randomized-controlled trial comparing the BOOST group to a SOC comparison group. We will enroll N = 320 English and/or Spanish-speaking children ages 24-32 months with isolated CP±L (n = 160 per group). Both groups will receive children's books, and parents will record and upload videos of themselves reading the books with their children using a smartphone app developed for the study. Parents will also complete surveys asking whether they read to their children on five randomly selected days each week. In addition, the BOOST group will participate in 3 remote dialogic book-sharing intervention sessions via Zoom. We will code book-sharing videos to assess parents' target skill usage and children's expressive language. End-of-study assessments will include measures of child language outcomes (e.g., clinician-administered measures, parent reports, and naturalistic child language samples).

RESULTS

Enrollment began in April 2024 and will continue through approximately April 2028.

CONCLUSION

The BOOST study will address a critical gap in the literature on interventions to improve language in children with CP±L. The results will inform the care for toddlers with oral clefts and have potential applications for other populations.

The impact of enhanced Milieu teaching with phonological emphasis (EMT + PE) on the speech and language outcomes for toddlers with cleft palate in Brazil and the United States of America

PURPOSE

The purpose of this study was to compare the speech and language outcomes of children with cleft palate with or without cleft lip (CP+/-L) in the USA to children with CP+/-L in Brazil who underwent intervention with enhanced Milieu teaching with phonological emphasis (EMT + PE), as there are few cross-country intervention comparisons for children with CP+/-L.

METHOD

This is a retrospective analysis of 29 participants from the USA and 24 participants from Brazil who were matched on age. The US participants were between the ages of 13-35 months (M = 23.76), spoke Standard American English in the home, and were recruited from East Tennessee State University and Vanderbilt University. The Brazilian participants were between the ages of 20-34 months (M = 25.04), spoke Brazilian Portuguese in the home, and were recruited from the Hospital de Reabilitação de Anomalias Craniofaciais-Universidade de São Paulo. All treatment participants received EMT + PE from trained speech-language pathologists in hospital-university clinics.

RESULT

The treatment groups demonstrated greater gains than comparison groups in percent consonants correct, number of different words, and expressive/receptive vocabulary. There was no main effect nor interaction by country.

CONCLUSION

The application of EMT + PE in a second culture and language is a viable early intervention option for participants with CP+/-L.

Speech and Resonance Disorders in Children With Cleft Palate: Diagnostic Evaluation and Current Speech Therapy Modalities

This article will provide an overview of how speech and resonance can be impacted in children with cleft palate. The authors will outline evidence-based assessment and treatment approaches commonly used for children with cleft palate and provide information on current initiatives to provide speech therapy. The methods discussed will be the use of telehealth to provide access to speech therapy for patients in areas without speech-language pathologists and the use of speech therapy camps to offer intensive, limited-duration speech therapy for groups of children due to the lack of trained providers in certain geographical regions.

Working Toward Recommended Terminology in the Canadian Preschool Speech-Language Pathology Context

PURPOSE

This quality improvement project aimed to address the inconsistent use of clinical labels across a preschool speech and language program in Ontario, Canada. The study investigated whether a multicomponent knowledge translation (KT) intervention could increase speech-language pathologists' (SLPs') knowledge about the recommended clinical labels, motivate their intentions to use the labels, and facilitate practice change during a 3-month pilot period.

METHOD

The diffusion of innovations theory was utilized to identify and address known and suspected barriers and facilitators that could influence the adoption of consistent terminology. The intervention was evaluated using a pre-experimental study design (with pre, post, and follow-up testing) and included two phases: Phase 1 involved the pretraining survey, KT intervention, and posttraining survey, and Phase 2 included an exit survey after a 3-month pilot period.

RESULTS

Five hundred twenty-nine SLPs in Phase 1 and 387 SLPs in Phase 2 participated. Following the web-based intervention, SLPs demonstrated improved knowledge about the recommended labels with most indicating intentions to communicate the labels going forward. SLPs also reported increased comfort using labels and positive views on their importance and value. After the 3-month pilot period, SLPs' reported use of most recommended labels decreased, as did ratings of comfort, value, and importance. However, most SLPs reported intentions to use the labels going forward.

CONCLUSIONS

Despite having intentions to adopt the recommended labels, the lack of implementation by SLPs suggests the presence of additional barriers impacting their use of the recommended clinical labels in practice. Future work should investigate clinician-identified barriers to inform future implementation efforts.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25254940.

Special Education Assessment: Practices That Support Eligibility and Intervention

PURPOSE

Federal special education requirements specify that information districts must gather and review during the process of finding a student eligible for special education and developing a student's Individualized Education Program (IEP). The purpose of this tutorial is to describe the federal requirements related to evaluation and assessment and to apply best practices in assessment to those expectations, thereby enhancing teams' ability to identify students' strengths and needs, determine eligibility for services, and create high-quality IEPs.

METHOD

This tutorial includes a detailed review of the Individuals with Disabilities Education Act (IDEA) statute and regulations and the U.S. Department of Education guidance related to evaluation, assessment, and IEP development. The tutorial also reflects on an analysis of existing data regarding the identification of students with speech-language impairment in one state and a narrative review of the current literature related to assessment and its role in intervention planning.

RESULTS

The results indicate that the IDEA requires rigorous evaluation and assessment practices to determine eligibility (evaluation) and identify students' unique strengths and needs for intervention (assessment). By adhering to these requirements and employing evidence-based assessment practices, speech-language pathologists (SLPs) can be assured that they are gathering accurate and useful information. This information is fundamental to developing an IEP that will support students' acquisition of the knowledge and skills needed to progress in the general curriculum.

CONCLUSIONS

This tutorial reviews federal requirements related to assessment and links these with best practices in assessment, to facilitate compliance with federal evaluation requirements and IEP development in a manner that meets the needs of all students. SLPs can rely on the IDEA for guidance in completing their special education evaluations and assessments, using this as a framework for employing evidence-based assessment practices.

Factors affecting judgment accuracy when scoring children's responses to non-word repetition stimuli in real time

BACKGROUND

Non-word repetition (NWR) tests are an important way speech and language therapists (SaLTs) assess language development. NWR tests are often scored whilst participants make their responses (i.e., in real time) in clinical and research reports (documented here via a secondary analysis of a published systematic review).

AIMS

The main aim was to determine the extent to which real-time coding of NWR stimuli at the whole-item level (as correct/incorrect) was predicted by models that had varying levels of detail provided from phonemic transcriptions using several linear mixed method (LMM) models.

METHODS & PROCEDURES

Live scores and recordings of responses on the universal non-word repetition (UNWR) test were available for 146 children aged between 3 and 6 years where the sample included all children starting in five UK schools in one year or two consecutive years. Transcriptions were made of responses to two-syllable NWR stimuli for all children and these were checked for reliability within and between transcribers. Signal detection analysis showed that consonants were missed when judgments were made live. Statistical comparisons of the discrepancies between target stimuli and transcriptions of children's responses were then made and these were regressed against live score accuracy. Six LMM models (three normalized: 1a, 2a, 3a; and three non-normalized: 1b, 2b, 3b) were examined to identify which model(s) best captured the data variance. Errors on consonants for live scores were determined by comparison with the transcriptions in the following ways (the dependent variables for each pair of models): (1) consonants alone; (2) substitutions, deletions and insertions of consonants identified after automatic alignment of live and transcribed materials; and (3) as with (2) but where substitutions were coded further as place, manner and voicing errors.

OUTCOMES & RESULTS

The normalized model that coded consonants in non-words as 'incorrect' at the level of substitutions, deletions and insertions (2b) provided the best fit to the real-time coding responses in terms of marginal R2, Akaike's information criterion (AIC) and Bayesian information criterion (BIC) statistics.

CONCLUSIONS & IMPLICATIONS

Errors that occur on consonants when non-word stimuli are scored in real time are characterized solely by the substitution, deletion and insertion measure. It is important to know that such errors arise when real-time judgments are made because NWR tasks are used to assess and diagnose several cognitive-linguistic impairments. One broader implication of the results is that future work could automate the analysis procedures to provide the required information objectively and quickly without having to transcribe data.

WHAT THIS PAPER ADDS

What is already known on this subject Children and patients with a wide range of cognitive and language difficulties are less accurate relative to controls when they attempt to repeat non-words. Responses to non-words are often scored as correct or incorrect at the time the test is conducted. Limited assessments of this scoring procedure have been conducted to date. What this study adds to the existing knowledge Live NWR scores made by 146 children were available and the accuracy of these judgements was assessed here against ones based on phonemic transcriptions. Signal detection analyses showed that live scoring missed consonant errors in children's responses. Further analyses, using linear mixed effect models, showed that live judgments led to consonant substitution, deletion and insertion errors. What are the practical and clinical implications of this work? Improved and practicable NWR scoring procedures are required to provide SaLTs with better indications about children's language development (typical and atypical) and for clinical assessments of older people. The procedures currently used miss substitutions, deletions and insertions. Hence, procedures are required that provide the information currently only available when materials are transcribed manually. The possibility of training automatic speech recognizers to provide this level of detail is raised.

Perceptual measurement of articulatory goodness in young children: Relationships with age, speech sound acquisition, and intelligibility

Speech language pathologists regularly use perceptual methods in clinical practice to assess children's speech. In this study, we examined relationships between measures of speech intelligibility, clinical articulation test results, age, and perceptual ratings of articulatory goodness for children. We also examined the extent to which established measures of intelligibility and clinical articulation test results predicted articulatory goodness ratings, and whether goodness ratings were influenced by intelligibility. A sample of 164 (30-47 months) typically developing children provided speech samples and completed a standardised articulation test. Single word intelligibility scores and ratings of articulatory goodness were gathered from 328 naïve listeners; scores on a standardised articulation test were obtained from each child. Bivariate Pearson correlation, linear regression, and linear mixed effects modelling were used for analysis. Results showed that articulatory goodness ratings had the highest correlation with intelligibility, followed by age, followed by articulation score. Age and clinical articulation scores were both significant predictors of goodness ratings, but articulation scores made only a small contribution to prediction. Articulatory goodness ratings were substantially lower for unintelligible words compared to intelligible words, but articulatory goodness scores increased with age at the same rate for unintelligible and intelligible words. Perceptual ratings of articulatory goodness are sensitive to developmental changes in speech production (regardless of intelligibility) and yield a different kind of information than clinical articulation scores from standardised measures.

Corpus of Mandarin Child Language: a preliminary study on the acquisition of semantic content categories in Mandarin-speaking preschoolers

In studying language acquisition in children, sizable research studies have been focusing on the investigation of form and lexical semantics. This study aims to establish a child language database annotated both syntactically with part of speech and semantically with semantic content category to supplement the study of child language acquisition in the semantic domain beyond lexical level. The Corpus of Mandarin Child Language (CMCL) that documented the production of different semantic content categories by Mandarin-speaking children was established. Naturalistic language samples of 82 native Mandarin-speaking children aged 25-60 months, divided into three age groups, were obtained. The corresponding semantic content categories coded in each utterance were tagged according to previous studies, in addition to the annotations of part of speech. MLU and lexical diversity were examined and the usage and acquisition of different semantic content categories were also analyzed. The results regarding syntactic complexity and lexical diversity replicated the typical language acquisition pattern from previous studies, which supported the validity of the data obtained in the CMCL. To investigate the trajectory of acquisition of various semantic content categories by age, a 90% acquisition criterion was used. Our findings regarding the acquisition order of semantic content category were basically in line with previous studies in general, with some minor differences. This acquisition order observed is largely explained by the cognitive and syntactic complexity associated with the semantic content category, with additional influence from language specific properties and cultural specific factors of Mandarin. In addition, with the tags in both part-of-speech and semantic content category, the CMCL potentially provides a platform for examining the form-content interface in early child language acquisition, which also implies significantly on the theoretical and clinical ground.

The maluma/takete effect is late: No longitudinal evidence for shape sound symbolism in the first year

The maluma/takete effect refers to an association between certain language sounds (e.g., /m/ and /o/) and round shapes, and other language sounds (e.g., /t/ and /i/) and spiky shapes. This is an example of sound symbolism and stands in opposition to arbitrariness of language. It is still unknown when sensitivity to sound symbolism emerges. In the present series of studies, we first confirmed that the classic maluma/takete effect would be observed in adults using our novel 3-D object stimuli (Experiments 1a and 1b). We then conducted the first longitudinal test of the maluma/takete effect, testing infants at 4-, 8- and 12-months of age (Experiment 2). Sensitivity to sound symbolism was measured with a looking time preference task, in which infants were shown images of a round and a spiky 3-D object while hearing either a round- or spiky-sounding nonword. We did not detect a significant difference in looking time based on nonword type. We also collected a series of individual difference measures including measures of vocabulary, movement ability and babbling. Analyses of these measures revealed that 12-month olds who babbled more showed a greater sensitivity to sound symbolism. Finally, in Experiment 3, we had parents take home round or spiky 3-D printed objects, to present to 7- to 8-month-old infants paired with either congruent or incongruent nonwords. This language experience had no effect on subsequent measures of sound symbolism sensitivity. Taken together these studies demonstrate that sound symbolism is elusive in the first year, and shed light on the mechanisms that may contribute to its eventual emergence.

Strategies for Teaching Verbs to Children with and without Language Impairment

The aim of this feasibility study was to extend the current evidence base on intransitive verb learning by evaluating and comparing three strategies (syntactic cues, semantic cues, combined cues) for teaching novel verbs to expand the vocabularies of children with and without language impairment. Twenty-three children with typical development, seven children with developmental language disorder, and eight children with Down syndrome participated in Studies 1, 2, and 3, respectively. They were taught novel, intransitive verbs using syntactic, semantic, and combined cues and then asked to receptively identify and expressively label the novel verbs. Across all conditions, participants learned novel verbs receptively with large effect sizes and participants with typical development and Down syndrome also learned the verbs expressively with large effect sizes. There were no significant differences between conditions. This study extends word-learning research by evaluating not only receptive but also expressive intransitive verb learning to expand one's vocabulary. The results provide positive evidence for three effective strategies for teaching intransitive verbs to children with and without language impairment.

Articulatory and segmental performance in children with and without speech disorder: A multiple case pilot study

This multiple case pilot study explored how nonword imitation influences articulatory and segmental performance in children with and without speech disorder. Eight children, ages 4- to 8-years-old, participated, including two children with childhood apraxia of speech (CAS), four children with phonological disorder (PD), and two children with typical development (TD). Tokens included two complexity types and were presented in random order. Minimal feedback was provided and nonwords were never associated with a referent. Kinematic and transcription data were analysed to examine articulatory variability, segmental accuracy, and segmental variability in session 1 and session 5. Descriptive statistics, percent change, effect sizes, and Pearson correlations are reported. In session 1, the two participants with CAS showed high articulatory variability, low segmental accuracy, and high segmental variability compared to the participants with PD and TD. By session 5, both participants with CAS, two with PD, and one with TD showed increased articulatory variability in the lowest complexity nonword. Segmental accuracy remained low and variability remained high for the two participants with CAS in session 5, whereas several participants with PD and TD showed improved segmental performance. Articulatory and segmental variability were not significantly correlated. The results of this study suggest that motor practice with minimal feedback and no assignment of a lexical referent can instantiate positive changes to segmental performance for children without apraxia. Positive changes to segmental performance are not necessarily related to increased articulatory control; these two processing levels can show distinct and disparate learning trajectories.

School-Based Speech-Language Pathologists' Engagement With Evidence-Based Practice: An Update With Implications for Implementation Research

PURPOSE

We replicated a prior survey study (Hoffman et al., 2013) to document current evidence-based practice (EBP) patterns as reported by school-based speech-language pathologists (SLPs) during the 2021-2022 school year.

METHOD

Via an online survey, SLPs reported their training experiences and needs, workplace resources, and frequency of engagement in EBP activities.

RESULTS

A total of 889 SLPs in 50 states participated in the survey. Results revealed that 19% of seasoned SLPs (with more than 10 years since last degree) had no formal training in EBP, 22% of SLPs worked in school districts with official EBP procedural guidelines, and 36% had scheduled time in their work week to support EBP activities. Early career (EC) professionals were more likely than seasoned career (SC) professionals to pose and research one or more EBP questions per year and to read journal articles about assessment and treatment. The gap in article use by experience groups was larger than a decade ago. Like prior survey results, the majority of SLPs read zero to four American Speech-Language-Hearing Association (ASHA) journal articles on assessment or intervention per year, with similar results for reading non-ASHA journal articles.

CONCLUSIONS

Although the past decade has fostered some positive increases in the use of EBP resources and engagement in EBP activities, there continues to be a need for additional training and support for school-based SLPs to fully implement EBP. Training and implementation support should account for differences in training preferences and workplace resources and address differentiation of reported practices by EC versus SC professionals. Further implications for implementation science in schools are provided.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23152817.

Subtract Before You Add: Toward the Development of a De-Implementation Approach in School-Based Speech Sound Therapy

PURPOSE

It is often difficult for school-based speech-language pathologists (SLPs) to prioritize implementing new practices for children with speech sound disorders (SSDs), given burgeoning caseloads and the myriad of other workload tasks. We propose that de-implementation science is equally as important as implementation science. De-implementation science is the recognition and identification of areas that are of "low-value and wasteful." Critically, the idea of de-implementation suggests that we first remove something from a clinician's workload before requesting that they learn and implement something new.

METHOD

Situated within the Sustainability in Healthcare by Allocating Resources Effectively (SHARE) framework, we review de-implementation science and current speech sound therapy literature to understand the mechanisms behind continuous use of practices that are no longer supported by science or legislation. We use vignettes to highlight real-life examples that clinicians may be facing in school-based settings and to provide hypothetical solutions, resources, and/or next steps to these common challenges.

RESULTS

By focusing on Phase 1 of the SHARE framework, we identified four primary practices that can be de-implemented to make space for new evidence-based techniques and approaches. These four practices were determined based on an in-depth review of SLP-based survey research: (a) overreliance on speech sound norms for eligibility determinations, (b) the omission of phonological processing skills within evaluations, (c) homogeneity of service delivery factors, and (d) the use of only one treatment approach for all children with SSDs.

CONCLUSIONS

De-implementation will take work and may lead to some difficult discussions. Implementing a framework, such as SHARE, can guide SLPs toward a reduction in workloads and improved outcomes for children with SSDs.

Long-Term Outcomes for Individuals With Childhood Apraxia of Speech

PURPOSE

The study's primary aims were to describe the long-term speech outcomes for adolescents and young adults with a history of childhood apraxia of speech (CAS) and to examine the association of persistent speech sound errors with measures of literacy skills, phonological processing, motor speech production, and parent report of early motor difficulty.

METHOD

Data from a large longitudinal 25-year study were used to explore outcomes for 32 individuals with a history of CAS, ages 12;6 (years;months) to 25 years (M = 17.4, SD = 4.7). Persistent and nonpersistent groups were compared on decoding, phonological processing, multisyllabic word repetition, diadochokinetic rate, and parent report of motor involvement. Parametric (Welch's t tests) and nonparametric tests (Wilcoxon and Fisher exact tests) were used to identify differences between the groups' distributions. Developmental trajectories of speech production were plotted.

RESULTS

Outcomes for individuals with CAS are highly variable, with some demonstrating speech sound errors into adolescence and young adulthood. Speech sound errors were primarily on later developing sounds. Persistence was significantly associated with early motor difficulties. Difficulties with multisyllabic words, phonological processing, and literacy were often present regardless of persistence or nonpersistence of speech errors.

CONCLUSIONS

Children with CAS are at risk for persistent speech sound errors into adulthood. For children showing limited progress with more traditional speech therapy, alternative interventions should be explored. Individuals with persistent speech sound errors are more likely to have a history of early motor deficits. Regardless of persistence, participants with CAS demonstrated ongoing weaknesses in literacy, phonological processing skills, and complex speech production tasks.

Neural Changes in Children With Residual Speech Sound Disorder After Ultrasound Biofeedback Speech Therapy

PURPOSE

Children with residual speech sound disorders (RSSD) have shown differences in neural function for speech production, as compared to their typical peers; however, information about how these differences may change over time and relative to speech therapy is needed. To address this gap, we used functional magnetic resonance imaging (fMRI) to examine functional activation and connectivity on adaptations of the syllable repetition task (SRT-Early Sounds and SRT-Late Sounds) in children with RSSD before and after a speech therapy program.

METHOD

Sixteen children with RSSD completed an fMRI experiment before (Time 1) and after (Time 2) a speech therapy program with ultrasound visual feedback for /ɹ/ misarticulation. Progress in therapy was measured via perceptual ratings of productions of untreated /ɹ/ word probes. To control for practice effects and developmental change in patterns of activation and connectivity, 17 children with typical speech development (TD) completed the fMRI at Time 1 and Time 2. Functional activation was analyzed using a region-of-interest approach and functional connectivity was analyzed using a seed-to-voxel approach.

RESULTS

Children with RSSD showed a range of responses to therapy. After correcting for multiple comparisons, we did not observe any statistically significant cross-sectional differences or longitudinal changes in functional activation. A negative relationship between therapy effect size and functional activation in the left visual association cortex was on the SRT-Late Sounds after therapy, but it did not survive correction for multiple comparisons. Significant longitudinal changes in functional connectivity were observed for the RSSD group on SRT-Early Sounds and SRT-Late Sounds, as well as for the TD group on the SRT-Early Sounds. RSSD and TD groups showed connectivity differences near the left insula on the SRT-Late Sounds at Time 2.

CONCLUSION

RSSD and treatment with ultrasound visual feedback may thus be associated with neural differences in speech motor and visual association processes recruited for speech production.

The impact of age on the treatment of late-acquired sounds in children with speech sound disorders

The question of 'when' to treat speech sounds is often posed in the context of normative data. The new normative data suggest that speech sounds such as /ɹ/ and /l/ are acquired earlier than previously thought. The present study compared the treatment of late-acquired sounds between two age groups of English-speaking children: Young children (4-5) and Old children (7-8). Eight monolingual children with speech sound disorder (SSD) participated in the study. Each child received a criterion-based, standardised, two-phase therapy protocol. Treatment efficacy was measured by examining children's accuracy on real world speech probes. Treatment efficiency was measured by calculating the number of sessions required to meet the exit criterion and the mean session duration. For treatment efficacy, young children learned treated sounds as effectively as oldchildren did. For treatment efficiency, both groups required a comparable number of sessions, but young children required longer sessions than old children. The results suggest that delaying treatment of individual speech sounds is unnecessary and that a range of sounds should be considered as potential treatment targets.

Assessing the language of 2 year-olds: From theory to practice

Early screening for language problems is a priority given the importance of language for success in school and interpersonal relationships. The paucity of reliable behavioral instruments for this age group prompted the development of a new touchscreen language screener for 2-year-olds that relies on language comprehension. Developmental literature guided selection of age-appropriate markers of language disorder risk that are culturally and dialectally neutral and could be reliably assessed. Items extend beyond products of linguistic knowledge (vocabulary and syntax) and tap the process by which children learn language, also known as fast mapping. After piloting an extensive set of items (139), two phases of testing with over 500 children aged 2; 0-2; 11 were conducted to choose the final 40-item set. Rasch analysis was used to select the best fitting and least redundant items. Norms were created based on 270 children. Sufficient test-retest reliability, Cronbach's alpha, and convergent validity with the MB-CDI and PPVT are reported. This quick behavioral measure of language capabilities could support research studies and facilitate the early detection of language problems.

Naive Listener Ratings of Speech Intelligibility Over the Course of Motor-Based Intervention in Children With Childhood Apraxia of Speech

PURPOSE

The aim of this study was to describe changes in speech intelligibility and interrater and intrarater reliability of naive listeners' ratings of words produced by young children diagnosed with childhood apraxia of speech (CAS) over a period of motor-based intervention (dynamic temporal and tactile cueing [DTTC]).

METHOD

A total of 120 naive listeners (i.e., listeners without experience listening to children with speech and/or language impairments; age range: 18-45 years) orthographically transcribed single-word productions by five children (age range: 2;6-3;11 [years;months]) across three time points over an intervention period (baseline, post-treatment, maintenance). Changes in intelligibility and interrater and intrarater reliability were examined within and across time points.

RESULTS

Speech intelligibility significantly increased in children with CAS over the course of treatment, and these gains were also maintained at 6 weeks posttreatment. There was poor-to-fair consistency between listeners (interrater reliability) and excellent consistency within listeners (intrarater reliability) in ratings of speech intelligibility within and across time points.

CONCLUSIONS

Motor-based intervention increases speech intelligibility following a period of DTTC treatment. Variability among naive listeners of speech intelligibility was also present, with intrarater reliability (within listeners) yielding greater consistency than interrater reliability (between listeners). The implications for including naive listeners as raters of speech intelligibility for research and clinical purposes are discussed.

Tongue Shape Complexity in Children With and Without Speech Sound Disorders

PURPOSE

This study investigates the hypothesis that younger speakers and speakers with more severe speech sound disorders are more likely to use simpler (undifferentiated) tongue gestures due to difficulties with, or immaturity of, lingual motor control.

METHOD

The hypothesis is tested using cross-sectional secondary data analysis of synchronous audio and high-speed ultrasound recordings from children with idiopathic speech sound disorders (n = 30, aged 5;0-12;11 [years;months]) and typically developing children (n = 29, aged 5;8-12;10), producing /a/, /t/, /ɹ/, /l/, /s/, and /ʃ/ in an intervocalic /aCa/ environment. Tongue shape complexity is measured using NINFL (Number of INFLections) and modified curvature index (MCI) from splines fitted to ultrasound images at the point of maximal lingual gesture. Age, perceived accuracy, and consonant are used as predictors.

RESULTS

The results suggest that as age increases, children with speech sound disorders have lower MCI compared to typically developing children. Increase in age also led to decrease of MCI for the typically developing group. In the group of children with speech sound disorders, perceptually incorrect /ɹ/ productions have lower MCI than correct productions, relative to /a/.

CONCLUSIONS

There is some evidence of systematic tongue shape complexity differences between typically developing children and children with speech sound disorders when accounting for increase in age. Among children with speech sound disorders, increase in age and perceptually incorrect consonant realizations are associated with decreasing tongue shape complexity.

Multilingual Speech Acquisition by Vietnamese-English-Speaking Children and Adult Family Members

PURPOSE

This article presents a large-scale example of culturally responsive assessment and analysis of multilingual Vietnamese-English-speaking children and their family members using the VietSpeech Protocol involving (a) examining all spoken languages, (b) comparing ambient phonology produced by family members, (c) including dialectal variants in the definition of accuracy, and (d) clustering participants with similar language experience.

METHOD

The VietSpeech participants (N = 154) comprised 69 children (2;0-8;10 [years;months]) and 85 adult family members with Vietnamese heritage living in Australia. Speech was sampled using the Vietnamese Speech Assessment (Vietnamese) and the Diagnostic Evaluation of Articulation and Phonology (English).

RESULTS

Children's Vietnamese consonant accuracy was significantly higher when dialectal variants were accepted (percentage of consonants correct-dialect [PCC-D]: M = 87.76, SD = 8.18), compared to when only Standard Vietnamese was accepted as the correct production (percentage of consonants correct-standard [PCC-S]: M = 70.34, SD = 8.78), Cohen's d = 3.55 (large effect). Vietnamese voiced plosives, nasals, semivowels, vowels, and tones were more often correct than voiceless plosives and fricatives. Children's Standard Australian English consonant accuracy (PCC-S) was 82.51 (SD = 15.57). English plosives, nasals, glides, and vowels were more often correct than fricatives and affricates. Vietnamese word-initial consonants had lower accuracy than word-final consonants, whereas English consonant accuracy was rarely influenced by word position. Consonant accuracy and intelligibility were highest for children with high proficiency in both Vietnamese and English. Children's consonant productions were most similar to their mothers' than other adults or siblings' productions. Adults' Vietnamese consonants, vowels, and tones were more likely to match Vietnamese targets than their children's productions.

CONCLUSIONS

Children's speech acquisition was influenced by cross-linguistic, dialectal, maturational, language experience, and environmental (ambient phonology) factors. Adults' pronunciation was influenced by dialectal and cross-linguistic factors. This study highlights the importance of including all spoken languages, adult family members, dialectal variants, and language proficiency to inform differential diagnosis of speech sound disorders and identify clinical markers in multilingual populations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23290055.

Interpretation of Misarticulated Words by Children With and Without Speech Sound Disorders

PURPOSE

Children with speech sound disorders (SSDs) often struggle with forming early representations for phonemes and words, which could impact their speech production as well as their lexical access. This difficulty may limit their ability to accurately identify nonexemplar productions of words, such as developmental misarticulations produced by peers. The purpose of this study was to examine word interpretation of misarticulated words by children with SSD.

METHOD

Seventeen monolingual English-speaking preschoolers were assessed for language, phonological processing, and articulation skills. Participants heard three types of words: accurate productions (e.g., "leaf"), common misarticulated productions (e.g., "weaf"), uncommon misarticulated productions (e.g., "yeaf"), and unrelated nonwords (e.g., "gim"). Children were presented with these words aurally and asked to select the picture that matched what they heard-either a real object or a blank square.

RESULTS

The proportion of real object picture selections was calculated for each word type and compared within subjects. The findings indicate that children with SSD reliably associated common misarticulated words with pictured objects more frequently than they did in the uncommon misarticulation condition. These results were compared between subjects to typically developing (TD) peers' responses using a one-way analysis of variance. The results indicate that children with SSD identified common substitutions as real object pictures more often than TD peers.

CONCLUSION

The results of this study suggest that children with SSD are sensitive to the commonness of misarticulations; however, they accept common substitutions as real object pictures significantly more often than TD peers.

Effect of Speaker Age on Listener Perceptions of Word-Final /l/

PURPOSE

This study investigated an effect of speaker age on listeners' perception of word-final /l/ produced by child and adult speakers of Southern White Vernacular English, a dialect that shows higher rates of word-final /l/ vocalization than other dialects of English.

METHOD

Stimuli included children and adults' word-final /l/ embedded in monosyllabic words in two vowel contexts (/i, ɪ/ and /ɔ, ɑ/). A total of 25 monolingual adult listeners listened to each word and were asked to judge the /l/-likeness using a visual analog scale. Average listener ratings and three acoustic measures (F2 transition rate [F2 TR] and F2-F1 [Hz] values at 20% and 80% time points along the vowel-/l/ duration) were analyzed.

RESULTS

Adult productions were rated more as correct /l/ than those of children in both vowel contexts, despite the similarity in their F2 TR and F2-F1 values at the 80% time point. Correlation between the acoustic measures and the average listener ratings were weak for all three measures for adults' productions. For children's productions, while the correlation with F2 TR values were weak, moderate significant correlations were found for F2-F1 values at the 20% and 80% time points. In terms of vowel context, word-final /l/ in the high front vowel context was rated more as /l/ than those in low back vowel context.

CONCLUSIONS

Findings suggest that listeners are more likely to accept word-final /l/ as being correct when produced by adult speakers, regardless of their acoustic characteristics, but more likely to perceive an error when produced by a child and attend more to acoustic information for their perceptual judgment. This highlights the importance of considering children's dialectal background when judging word-final /l/, which is more likely to be vocalized in certain dialects and certain vowel contexts, and thus can be misjudged without such consideration.

Comparing metrics for quantification of children's tongue shape complexity using ultrasound imaging

Speech sound disorders can pose a challenge to communication in children that may persist into adulthood. As some speech sounds are known to require differential control of anterior versus posterior regions of the tongue body, valid measurement of the degree of differentiation of a given tongue shape has the potential to shed light on development of motor skill in typical and disordered speakers. The current study sought to compare the success of multiple techniques in quantifying tongue shape complexity as an index of degree of lingual differentiation in child and adult speakers. Using a pre-existing data set of ultrasound images of tongue shapes from adult speakers producing a variety of phonemes, we compared the extent to which three metrics of tongue shape complexity differed across phonemes/phoneme classes that were expected to differ in articulatory complexity. We then repeated this process with ultrasound tongue shapes produced by a sample of young children. The results of these comparisons suggested that a modified curvature index and a metric representing the number of inflection points best reflected small changes in tongue shapes across individuals differing in vocal tract size. Ultimately, these metrics have the potential to reveal delays in motor skill in young children, which could inform assessment procedures and treatment decisions for children with speech delays and disorders.

Characterizing sensorimotor profiles in children with residual speech sound disorder: a pilot study

PURPOSE

Children with speech errors who have reduced motor skill may be more likely to develop residual errors associated with lifelong challenges. Drawing on models of speech production that highlight the role of somatosensory acuity in updating motor plans, this pilot study explored the relationship between motor skill and speech accuracy, and between somatosensory acuity and motor skill in children. Understanding the connections among sensorimotor measures and speech outcomes may offer insight into how somatosensation and motor skill cooperate during speech production, which could inform treatment decisions for this population.

METHOD

Twenty-five children (ages 9-14) produced syllables in an /ɹ/ stimulability task before and after an ultrasound biofeedback treatment program targeting rhotics. We first tested whether motor skill (as measured by two ultrasound-based metrics of tongue shape complexity) predicted acoustically measured accuracy (the normalized difference between the second and third formant frequencies). We then tested whether somatosensory acuity (as measured by an oral stereognosis task) predicted motor skill, while controlling for auditory acuity.

RESULTS

One measure of tongue shape complexity was a significant predictor of accuracy, such that higher tongue shape complexity was associated with lower accuracy at pre-treatment but higher accuracy at post-treatment. Based on the same measure, children with better somatosensory acuity produced /ɹ/ tongue shapes that were more complex, but this relationship was only present at post-treatment.

CONCLUSION

The predicted relationships among somatosensory acuity, motor skill, and acoustically measured /ɹ/ production accuracy were observed after treatment, but unexpectedly did not hold before treatment. The surprising finding that greater tongue shape complexity was associated with lower accuracy at pre-treatment highlights the importance of evaluating tongue shape patterns (e.g., using ultrasound) prior to treatment, and has the potential to suggest that children with high tongue shape complexity at pre-treatment may be good candidates for ultrasound-based treatment.

Longitudinal change in speech classification between 4 and 10 years in children with cerebral palsy

AIM

To examine speech impairment severity classification over time in a longitudinal cohort of children with cerebral palsy (CP).

METHOD

A total of 101 children (58 males, 43 females) between the ages of 4 and 10 years with CP participated in this longitudinal study. Speech severity was rated using the Viking Speech Scale (VSS), a four-level classification rating scale, at 4, 6, 8, and 10 years (age 4 years: mean = 52 months [3 SD]; age 6 years: mean = 75 months [2 SD]; age 8 years: mean = 100 months [4 SD]; age 10 years: mean = 125 months [5 SD]). We used Bayesian mixed-effects ordinal logistic regression to model (1) the extent to which speech severity changed over time and (2) patterns of change across age groups and classification rating group levels.

RESULTS

VSS ratings decreased (speech severity became less severe) between 4 and 10 years of age. Children who were first classified in VSS levels I, II, or III at age 4 years had a high probability of staying at, or improving to, VSS level I by 10 years. Children who were first classified in VSS level IV at 4 years had a high probability of remaining in VSS level IV at 10 years.

INTERPRETATION

Early speech performance is highly predictive of later childhood speech abilities. Children with any level of speech impairment at age 4 years should be receiving speech therapy. Those with more severe speech impairments should be introduced to augmentative and alternative communication as soon as possible.

WHAT THIS PAPER ADDS

Children with early Viking Speech Scale (VSS) ratings below level IV have a good prognosis for speech improvement. Children with early VSS level IV ratings are likely to remain at VSS level IV over time. Children did not show worsening of VSS level between the ages of 4 and 10 years.

Is children's speech development changing? Preliminary evidence from Australian English-speaking 3-year-olds

Purpose: Around 9% of children have difficulty acquiring intelligible speech despite typical sensory, neuro-motor and cognitive function. Speech-language pathologists (SLPs) rely on descriptions of children's speech errors to identify speech sound disorder (SSD) and determine intervention targets and goals. Existing normative data, however, need re-evaluation to reflect changes in populations and the language learning environment. This research evaluates whether developmental phonological patterns widely accepted as describing typical acquisition predict speech errors in a recent sample of pre-school children.Method: In 2015, 99 neurotypical children aged 3;0-3;8 years;months were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP). Their performance was compared to studies describing speech development by children of the same age for phone repertoire and phonological patterns.Result: There were differences for both measures. Phone repertoire differences were marginal, but changes in phonological pattern use were unexpected. Suppression of three developmental phonological patterns (stopping of fricatives, final consonant deletion and voicing contrasts) was delayed compared to previous norms. Atypical consonant cluster reduction, sometimes considered a marker for disorder, was observed in 10% of children.Conclusion: There were qualitative differences in the speech development of the 2015 cohort of children compared to previous developmental norms. Valid and current normative data are necessary for the accurate identification of children needing intervention. The differences we found reinforce the need for regular updating of assessment tools, as well as greater understanding of how children's language learning environments are changing and potentially influencing speech development.

The importance of deep speech phenotyping for neurodevelopmental and genetic disorders: a conceptual review

Background

Speech is the most common modality through which language is communicated, and delayed, disordered, or absent speech production is a hallmark of many neurodevelopmental and genetic disorders. Yet, speech is not often carefully phenotyped in neurodevelopmental disorders. In this paper, we argue that such deep phenotyping, defined as phenotyping that is specific to speech production and not conflated with language or cognitive ability, is vital if we are to understand how genetic variations affect the brain regions that are associated with spoken language.

Speech is distinct from language, though the two are related behaviorally and share neural substrates. We present a brief taxonomy of developmental speech production disorders, with particular emphasis on the motor speech disorders childhood apraxia of speech (a disorder of motor planning) and childhood dysarthria (a set of disorders of motor execution). We review the history of discoveries concerning the KE family, in whom a hereditary form of communication impairment was identified as childhood apraxia of speech and linked to dysfunction in the FOXP2 gene. The story demonstrates how instrumental deep phenotyping of speech production was in this seminal discovery in the genetics of speech and language. There is considerable overlap between the neural substrates associated with speech production and with FOXP2 expression, suggesting that further genes associated with speech dysfunction will also be expressed in similar brain regions. We then show how a biologically accurate computational model of speech production, in combination with detailed information about speech production in children with developmental disorders, can generate testable hypotheses about the nature, genetics, and neurology of speech disorders.

Conclusions

Though speech and language are distinct, specific types of developmental speech disorder are associated with far-reaching effects on verbal communication in children with neurodevelopmental disorders. Therefore, detailed speech phenotyping, in collaboration with experts on pediatric speech development and disorders, can lead us to a new generation of discoveries about how speech development is affected in genetic disorders.

Telepractice Treatment of Residual Rhotic Errors Using App-Based Biofeedback: A Pilot Study

PURPOSE

Although mobile apps are used extensively by speech-language pathologists, evidence for app-based treatments remains limited in quantity and quality. This study investigated the efficacy of app-based visual-acoustic biofeedback relative to nonbiofeedback treatment using a single-case randomization design. Because of COVID-19, all intervention was delivered via telepractice.

METHOD

Participants were four children aged 9-10 years with residual errors affecting American English /ɹ/. Using a randomization design, individual sessions were randomly assigned to feature practice with or without biofeedback, all delivered using the speech app Speech Therapist's App for /r/ Treatment. Progress was assessed using blinded listener ratings of word probes administered at baseline, posttreatment, and immediately before and after each treatment session.

RESULTS

All participants showed a clinically significant response to the overall treatment package, with effect sizes ranging from moderate to very large. One participant showed a significant advantage for biofeedback over nonbiofeedback treatment, although the order of treatment delivery poses a potential confound for interpretation in this case.

CONCLUSIONS

While larger scale studies are needed, these results suggest that app-based treatment for residual errors can be effective when delivered via telepractice. These results are compatible with previous findings in the motor learning literature regarding the importance of treatment dose and the timing of feedback conditions.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.18461576.

Implementing Speech Perception and Phonological Awareness Intervention for Children With Speech Sound Disorders

PURPOSE

Children with speech sound disorders have more difficulties producing speech sounds accurately than same-age peers. In addition, they often have difficulties with speech perception, and weaker phonological awareness skills than their peers and are at risk for negative long-term academic and socio-emotional outcomes. In this tutorial, we describe ways in which clinicians can target speech perception and/or phonological awareness within the context of speech production practice.

METHOD

First, we briefly describe the speech perception and phonological awareness skills of children with speech sound disorders and summarize previous intervention studies that targeted speech production and speech perception and/or phonological awareness skills. Next, we demonstrate how clinicians may incorporate speech perception and phonological awareness intervention in speech therapy through example instructional objectives and activities and include a case study.

CONCLUSION

Incorporating speech perception and phonological awareness into speech production intervention may improve speech and literacy outcomes for children with speech sound disorders.

Perception of Children's Productions of /l/: Acoustic Correlates and Effects of Listener Experience

INTRODUCTION

The aim of the current study was to examine the effect of listeners' experience with child speech and phonetic training on perceptual judgment of children's word-initial /l/ productions. The acoustic correlates of acceptable and misarticulated productions of /l/ and their relation to listeners' experience with child speech were explored.

METHODS

Three listener groups listened to children's word-initial /l/ productions embedded in monosyllabic words and judged the "/l/-likeness" of the productions using a Visual Analog Scale (VAS). Three listener groups included (a) speech-language pathologists with at least 10 years of experience (SLP group), (b) graduate students in speech-language pathology (GS group), and (c) naïve listeners with no clinical phonetics experience (NL group). Acoustic correlates (both static and dynamic measures) of listeners' perception of /l/ sounds were also investigated.

RESULTS

While mean VAS ratings did not differ significantly by listener group, the SLP group used a wider range of the VAS than the GS and NL groups. Correlational analysis between the static measure (F2-F1 values) and mean listener ratings showed that listeners tend to perceive sounds with the highest F2-F1 values more as /j/ than /l/, while those with the lowest F2-F1 value were perceived more as /w/ than /l/, especially for sounds that are in between phonemic categories. Listener ratings were not highly correlated with dynamic measures.

CONCLUSION

These results suggest that experienced listeners use the VAS more continuously than less experienced listeners to indicate perception of subphonemic features of children's productions of /l/, and that their ratings correlate with acoustic measures. Furthermore, listeners with experience with child speech and phonetic training are more sensitive to subphonemic features of children's productions of /l/, especially for misarticulated productions. This supports the clinical use of VAS for perceptual judgments of children's /l/ productions.

Using the Experience Sampling Method to Examine the Details of Dosage in School-Based Speech Sound Therapy

PURPOSE

The purpose of this project was to collect practice-based evidence regarding dosage in speech sound therapy sessions in school-based settings. Dosage is the number of trials within a therapy session for any one particular child. School-based speech-language pathologists (SLPs) face a variety of obstacles to service delivery, often making the implementation of evidence-based practices difficult. To that end, we were interested in exploring how therapy parameters, such as group size and session frequency were associated with dosage.

METHOD

Using the experience sampling method, we queried school-based SLPs (n = 90) across the United States. SLPs participated via a phone application, which randomly alerted them to participate 3 times per day for 5 days. SLPs also completed a demographic questionnaire that included information regarding caseload size and job satisfaction.

RESULTS

We report results from 670 therapy sessions. Results revealed that the therapy parameter of group size was negatively related to dosage. The SLP parameter of caseload size was positively related to dosage, but this was a small association. The child parameter of comorbidity was negatively related to dosage.

CONCLUSIONS

Our results support that as group size increases, children receive smaller doses of speech sound practice. Similarly, children who have a reported comorbidity received smaller doses compared to children who have an isolated speech sound disorder. We discuss implications for school-based practitioners and researchers.

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.

Prelinguistic Consonant Production and the Influence of Mouthing Before and After Cochlear Implantation

OBJECTIVES

The goal of the study was to investigate prelinguistic consonant production and the influence of vocalizations that co-occurred with object mouthing on consonant production in infants with profound sensorineural hearing loss before and after cochlear implantation to advance knowledge of early speech development in infants with profound hearing loss.

DESIGN

Participants were 43 infants, 16 infants with profound sensorineural hearing loss and 27 hearing infants. In the mixed longitudinal and cross-sectional design, infants with profound hearing loss and age-matched hearing infants participated before cochlear implantation, at an average age of 9.9 mo, and/or after cochlear implantation, at an average age of 17.8 mo. Mean age at cochlear implantation for infants with profound hearing loss was 12.4 mo; mean duration of cochlear implant use at time of testing was 4.2 mo.

RESULTS

Before and after cochlear implantation, infants with profound hearing loss produced significantly fewer supraglottal consonants per consonant-vowel vocalization than hearing peers and had smaller overall consonant inventories. Before, but not after cochlear implantation, infants with profound hearing loss produced proportionally more vocalizations, supraglottal consonant-vowel vocalizations, and different supraglottal consonants in vocalizations during mouthing than did hearing infants.

CONCLUSIONS

The results document consonant production before cochlear implantation in a larger group of infants with profound hearing loss than previously examined. The results also extend evidence of early delays in consonant production to infants who received cochlear implants at 12 mo of age, and show that they likely miss the potential benefits of auditory-motor feedback in vocalization-mouthing combinations that occur before they have access to sound through cochlear implants.

Speech Development Between 30 and 119 Months in Typical Children II: Articulation Rate Growth Curves

Purpose We aimed to develop normative growth curves for articulation rate during sentence repetition for typically developing children. Our primary goal was the development of quantile/percentile growth curves so that typical variation in articulation rate with age could be estimated. We also estimated when children became adultlike in their articulation rate, and we examined the contributions of age and utterance length to articulation rate. Method This cross-sectional study involved collection of in-person speech samples from 570 typically developing children (297 girls; 273 boys) who passed speech, language, and hearing screening measures. Pauses greater than 150 ms in duration were removed from the samples, and articulation rate was measured in syllables per second (sps). Results Articulation rate reliably increased with age and utterance length. Rate in all key percentiles increased with age. The median rate (50th percentile) increased from 2.7 sps at 36 months to 3.3 sps at 96 months. The 5th percentile increased from 2.3 to 3.1 sps over the same age range. Using 3.2 sps as a benchmark for adultlike speech, we found the 25th, 50th, and 75th percentiles reached adultlike rates at 99, 75, and 53 months, respectively. Conclusions Articulation rate increases from early childhood into middle childhood, and it is generally adultlike by 10 years of age. Variability in articulation rate among typical children was substantial. Implications for prior research and for clinical usage are discussed.

Which Speech Sound Norms Are Used in U.S. Public Schools? A Retrospective Survey Analysis

Normative data concerning speech sound acquisition are widely and heavily used in the United States to determine eligibility for services. Normative studies differ in the age and geographic location of participants, which can limit applicability across the United States. In 2016, we queried school-based speech-language pathologists (SLPs) in the United States using a web-based survey to determine which speech sound norms are used. Nine regions from the U.S. census were represented. The Iowa-Nebraska norms were most commonly reported. However, many SLPs were unable to name the source of the data that they used. More than 60% of the sample indicated that they referred to one source of normative data. Results of a logistic regression indicated that region of the United States predicted if SLPs used one or multiple sources. Specifically, SLPs in the West North Central region of the United States (which includes Iowa and Nebraska) were more likely to use only one source of data, the Iowa-Nebraska norms. We recommend that speech sound norms are less heavily relied upon for eligibility decisions, particularly due to the substantial variations in culture and dialect throughout the various regions of the United States.

Factors that influence non-word repetition performance in children with and without persistent speech sound disorders

BACKGROUND

Nonword repetition (NWR) is a common phonological processing task that is reported to tap into many cognitive, perceptual, and motor processes. For this reason, NWR is often used in assessment batteries to aid in verifying the presence of a reading or language disorder.

AIMS

To examine the extent to which child- and item-level factors predict the probability of a correct response on a non-word repetition (NWR) task in a sample of children with persistent speech sound disorders (P-SSDs) compared with their typically developing peers.

METHODS & PROCEDURES

A total of 40 American-English-speaking children were tested on an NWR task for which the stimuli were manipulated for phonological neighbourhood density and list length. Additional measures of vocabulary and word reading were also administered.

OUTCOMES & RESULTS

Children who were typically developing were 1.82 times more likely than children with P-SSD to respond correctly. The item-level factor of phonological neighbourhood density influenced performance, but only for the P-SSD group, and only at certain list lengths. Vocabulary and word-reading ability also influenced NWR task performance.

CONCLUSIONS & IMPLICATIONS

Children with P-SSD present as a complex and heterogeneous group. Multiple factors contribute to their ability to perform phonological tasks such as NWR. As such, attention to the item-level factors in screenings and assessments is necessary to ensure that appropriate decisions are made regarding diagnosis and subsequent treatment.

WHAT THIS PAPER ADDS

What is already known on the subject? Good expressive vocabulary is important for children with speech sound disorders; it can aid in their performance on phonological processing tasks like NWR. Nonword repetition may be a helpful test/ subtest to add to assessment batteries when evaluating children with speech sound disorders. What this paper adds to existing knowledge? Vocabulary and word reading abilities must also be measured for children with SSDs, to observe the bigger picture of their linguistic abilities. What are the potential or actual clinical implications of this work? The relation between word reading and speech sound production influences performance on phonological processing tasks.

Speech Development Between 30 and 119 Months in Typical Children I: Intelligibility Growth Curves for Single-Word and Multiword Productions

Purpose We extended our earlier study on normative growth curves for intelligibility development in typical children from 30 to 119 months of age. We also determined quantile-specific age of steepest growth and growth rates. A key goal was to establish age-specific benchmarks for single-word and multiword intelligibility. Method This cross-sectional study involved collection of in-person speech samples from 538 typically developing children (282 girls and 256 boys) who passed speech, language, and hearing screening measures. One thousand seventy-six normal-hearing naïve adult listeners (280 men and 796 women) orthographically transcribed children's speech. Speech intelligibility was measured as the percentage of words transcribed correctly by naive adults, with single-word and multiword intelligibility outcomes modeled separately. Results The age range for 50% single-word intelligibility was 31-47 months (50th-5th percentiles), the age range for 75% single-word intelligibility was 49-87 months, and the age range for 90% intelligibility for single words was 83-120+ months. The same milestones were attained for multiword intelligibility at 34-46, 46-61, and 62-87 months, respectively. The age of steepest growth for the 50th percentile was 30-31 months for both single-word and multiword intelligibility and was later for children in lower percentiles. The maximum growth rate was 1.7 intelligibility percentage points per month for single words and 2.5 intelligibility percentage points per month for multiword intelligibility. Conclusions There was considerable variability in intelligibility development among typical children. For children in median and lower percentiles, intelligibility growth continues through 9 years. Children should be at least 50% intelligible by 48 months. Supplemental Material https://doi.org/10.23641/asha.16583426.

Phonological acquisition in 3- to 5-year-old Kurdish-Speaking children in Iran

BACKGROUND

given the lack of sufficient information and research about phonological acquisition in the Kurdish language, the aim of this study was to examine phonological acquisition in typically developing Kurdish-speaking children. Three analyses were performed: (1) the age of customary, acquisition and mastery production of Kurdish consonants; (2) phonological accuracy and the age of phonological pattern suppression; and (3) effect of age and sex on speech sound acquisition.

METHODS

this research assessed 120 monolingual Kurdish-speaking children aged 3;0 to 5;0 years. The participants were selected randomly from the health center of Bukan city, Iran. Acquisition of 29 Kurdish consonants was assessed using the Kurdish Speech Test.

FINDINGS

results found that Kurdish-speaking children had acquired all the vowels before 3;0 and all the consonants in the three positions of initial, medial and final up to 4;6 years old, with the exception of /ʤ/ in initial position, /ɣ/ in medial position and /ʒ/, /z/, /ɡ/, /ɣ/ in final position. Consonant production in initial position was more accurate than in medial and final positions. The accuracy of Kurdish vowels and consonants improves with increasing age as phonological patterns decrease. There was no significant sex difference within the age groups; however, overall, a statistically significant difference was noted for fricative production and for production of word final consonants in the older groups with females outperforming males.

CONCLUSIONS

the present study is the first investigation of speech sound acquisition in Kurdish-speaking children. Knowledge of typical speech sound acquisition provides a basis for speech-language pathologists working with Kurdish-speaking children to differentiate children with typical development from those with speech delays and speech sound disorders.

Does Early Phonetic Differentiation Predict Later Phonetic Development? Evidence From a Longitudinal Study of /ɹ/ Development in Preschool Children

Purpose We evaluated whether children whose inaccurate /ɹ/ productions showed evidence phonetic differentiation with /w/ at 3.5-4.5 years of age improved in /ɹ/ production over the next year more than children whose inaccurate productions did not show evidence of such differentiation. We also examined whether speech perception, inhibitory control, and vocabulary size predicted growth in /ɹ/. Method A set of typically developing, monolingual English-speaking preschool children (n = 136) produced tokens of /ɹ/- and /w/-initial words at two time points (TPs), at which they were 39-52 and 51-65 months old. Children's productions of /ɹ/ and /w/ were narrowly phonetically transcribed. Children's productions at the earlier time point were rated by naïve listeners using a visual analog scale measure of phoneme goodness; these ratings were used to assess the degree of phonetic differentiation between /ɹ/ and /w/. Results Accuracy for both phonemes varied considerably at both TPs. The growth in accuracy of /ɹ/ between the two TPs was not predicted by any individual-differences measures, nor by the degree of differentiation between /ɹ/ and /w/at the earlier time point. Conclusion Low vocabulary size, low inhibitory control, poor speech perception, and the absence of early phonetic differentiation are not necessarily limiting factors in predicting /ɹ/ growth in individual children in the age range we studied.

Extending Ultrasound Tongue Shape Complexity Measures to Speech Development and Disorders

Purpose Generalizations can be made about the order in which speech sounds are added to a child's phonemic inventory and the ways that child speech deviates from adult targets in a given language. Developmental and disordered speech patterns are presumed to reflect differences in both phonological knowledge and skilled motor control, but the relative contribution of motor control remains unknown. The ability to differentially control anterior versus posterior regions of the tongue increases with age, and thus, complexity of tongue shapes is believed to reflect an individual's capacity for skilled motor control of speech structures. Method The current study explored the relationship between tongue complexity and phonemic development in children (ages 4-6 years) with and without speech sound disorder producing various phonemes. Using established metrics of tongue complexity derived from ultrasound images, we tested whether tongue complexity incrementally increased with age in typical development, whether tongue complexity differed between children with and without speech sound disorder, and whether tongue complexity differed based on perceptually rated accuracy (correct vs. incorrect) for late-developing phonemes in both diagnostic groups. Results Contrary to hypothesis, age was not significantly associated with tongue complexity in our typical child sample, with the exception of one association between age and complexity of /t/ for one measure. Phoneme was a significant predictor of tongue complexity, and typically developing children had more complex tongue shapes for /ɹ/ than children with speech sound disorder. Those /ɹ/ tokens that were rated as perceptually correct had higher tongue complexity than the incorrect tokens, independent of diagnostic classification. Conclusions Quantification of tongue complexity can provide a window into articulatory patterns characterizing children's speech development, including differences that are perceptually covert. With the increasing availability of ultrasound imaging, these measures could help identify individuals with a prominent motor component to their speech sound disorder and could help match those individuals with a corresponding motor-based treatment approach. Supplemental Material https://doi.org/10.23641/asha.14880039.

The Effect of Practice on Variability in Childhood Apraxia of Speech: A Multidimensional Analysis

Purpose Variability has been interpreted in differing ways according to context (e.g., development, speech impairment, and learning). A challenge arises when interpreting variability in the context of learning for children with speech impairment characterized by high movement variability, as in childhood apraxia of speech (CAS). The objective of this study is to investigate changes in variability in CAS with practice in comparison to patterns seen in children with non-CAS speech sound disorders (SSD) and typical development. Method Speech production variability was examined in 24 children (5-6 years of age) with CAS, non-CAS SSD, and typical development in production of nonwords of varied motoric complexity. Multidimensional analyses were performed using measures of token-to-token speech consistency (percent word consistency), acoustic variability (acoustic spatiotemporal index), and movement variability (lip aperture spatiotemporal index). Changes in variability were examined in each group of children by comparing the first half to the last half of nonword tokens in the same data collection session. The impact of token complexity on practice effects was also explored across groups of children. Results All children displayed increased speech consistency within this practice period (p = .01). Only children with CAS displayed increased movement variability following practice (p = .01). Differences in acoustic and kinematic variability were observed across complexity levels in all groups, though these did not interact with practice effects. Discussion These findings suggest that increased movement variability in children with CAS might be facilitating perceptual consistency. It is believed that this finding reflects an inefficient strategy adapted by children with CAS in the absence of motor-based cueing and feedback to guide speech performance with practice.

Icelandic Children's Acquisition of Consonants and Consonant Clusters

Purpose This study investigated Icelandic-speaking children's acquisition of singleton consonants and consonant clusters. Method Participants were 437 typically developing children aged 2;6-7;11 (years;months) acquiring Icelandic as their first language. Single-word speech samples of the 47 single consonants and 45 consonant clusters were collected using Málhljóðapróf ÞM (ÞM's Test of Speech Sound Disorders). Results Percentage of consonants correct for children aged 2;6-2;11 was 73.12 (SD = 13.33) and increased to 98.55 (SD = 3.24) for children aged 7;0-7;11. Overall, singleton consonants were more likely to be accurate than consonant clusters. The earliest consonants to be acquired were /m, n, p, t, j, h/ in word-initial position and /f, l/ within words. The last consonants to be acquired were /x, r, r̥, s, θ, n̥/, and consonant clusters in word-initial /sv-, stl-, str-, skr-, θr-/, within-word /-ðr-, -tl-/, and word-final /-kl̥, -xt/ contexts. Within-word phonemes were more often accurate than those in word-initial position, with word-final position the least accurate. Accuracy of production was significantly related to increasing age, but not sex. Conclusions This is the first comprehensive study of consonants and consonant cluster acquisition by typically developing Icelandic-speaking children. The findings align with trends for other Germanic languages; however, there are notable language-specific differences of clinical importance.

Service Delivery Schedule Effects on Speech Sound Production Outcomes

Purpose Children with speech sound disorders feature prominently on the caseloads of speech-language pathologists working in schools, with many receiving services once or twice weekly for 20-30 min. This study compared the outcomes of services provided twice weekly for 30 min to those provided 4 times weekly for 15 min to examine their effectiveness in remediating speech sound disorders in an elementary school setting. Method A total of 35 students were recruited from an existing public school caseload for participation. Participants were randomly assigned to receive school-based speech therapy services for either 30 min twice weekly or 15 min 4 times weekly. There were no differences between groups in age, gender, or the amount of time spent in general education. Growth was measured by the percentage of Individualized Education Program goals mastered and the percentage of sounds produced correctly in isolation. Results After one calendar year, there was a negligible difference between groups on both the percentage of Individualized Education Program goals mastered and the percentage of sounds produced correctly in isolation. On average, both scheduling configurations were effective in meeting students' needs. Conclusions The results of this study suggest that children with speech sound disorders receiving school-based speech therapy services can benefit from a variety of scheduling options. Awareness of such options is an invaluable resource to speech-language pathologists wanting to provide effective and efficient services. Future research should continue investigating service delivery models' effects in applied settings.

Evidence for [Coronal] Underspecification in Typical and Atypical Phonological Development

The Featurally Underspecified Lexicon (FUL) theory predicts that [coronal] is the language universal default place of articulation for phonemes. This assumption has been consistently supported with adult behavioral and event-related potential (ERP) data; however, this underspecification claim has not been tested in developmental populations. The purpose of this study was to determine whether children demonstrate [coronal] underspecification patterns similar to those of adults. Two English consonants differing in place of articulation, [labial] /b/ and [coronal] /d/, were presented to 24 children (ages 4-6 years) characterized by either a typically developing phonological system (TD) or a phonological disorder (PD). Two syllables, /bɑ/ and /dɑ/, were presented in an ERP oddball paradigm where both syllables served as the standard and deviant stimulus in opposite stimulus sets. Underspecification was examined with three analyses: traditional mean amplitude measurements, cluster-based permutation tests, and single-trial general linear model (GLM) analyses of single-subject data. Contrary to previous adult findings, children with PD demonstrated a large positive mismatch response (PMR) to /bɑ/ while the children with TD exhibited a negative mismatch response (MMN); significant group differences were not observed in the /dɑ/ responses. Moreover, the /bɑ/ deviant ERP response was significantly larger in the TD children than in the children with PD. At the single-subject level, more children demonstrated mismatch responses to /dɑ/ than to /bɑ/, though some children had a /bɑ/ mismatch response and no /dɑ/ mismatch response. While both groups of children demonstrated similar responses to the underspecified /dɑ/, their neural responses to the more specified /bɑ/ varied. These findings are interpreted within a proposed developmental model of phonological underspecification, wherein children with PD are functioning at a developmentally less mature stage of phonological acquisition than their same-aged TD peers. Thus, phonological underspecification is a phenomenon that likely develops over time with experience and exposure to language.

Characteristics of Functional Speech Sound Disorders in Korean Children

Purpose: A speech sound disorder (SSD) is defined as the presence of a problem with articulation and phonological processes in a child. This study analyzed the clinical characteristics of Korean patients with functional SSDs without any neuromuscular abnormalities. Methods: The medical records of patients aged 36 to 72 months old who were diagnosed with SSDs were retrospectively reviewed. SSD patients who scored less than 85 in the U-Tap test were divided into two groups according to their receptive language scores on the PRES/SELSI. Results: Sixty-seven percent of patients with language impairment (LI) who were diagnosed with an SSD initially visited the hospital for a delay in language development (n=18, 66.7%). Among children with only an SSD, 26.7% (n=8) of the patients recognized it as a language developmental problem. All SSD patients had substitution errors in the onset of initial syllables (SSD, SSD+LI: 100%; typical development [TD]: 37.5%). Of particular note, SSD children with LI had more omission errors (55.6%) than patients with SSD only (16.7%). SSD patients had higher error rates than TD children in all consonants except for the glottal element (P<0.01). The lower the U-Tap score of SSD patients, the lower their expressive language score (P<0.001). Conclusion: A high percentage of children with SSD initially visited the hospital for the treatment of language development delays. Articulation tests are essential for children who suffer from language delay. Furthermore, since incorrect articulation can lead to delays in expressive language development, early interventions should be considered.