Childhood speech disorders: reported prevalence, comorbidity and socioeconomic profile

Experiences establishing a new speech-language pathology training program in Ethiopia, a resource-limited setting: Lessons learned

PURPOSE

Ethiopia is the second most populous country in sub-Saharan Africa. While Ethiopia's health care system includes primary health centres, general, and specialised hospitals, allied health care like speech-language pathology was not available until 2003. This article was written with the aim of sharing the experience of establishing speech-language pathology as a profession and the first speech-language pathology training program in Ethiopia.

METHOD

In this paper, we retrospectively examine how the leadership of local stakeholders, a multidisciplinary team, and the development of a professional infrastructure led to the success of the program. The authorship group, who were involved in the program from inception to implementation, share their experiences.

RESULT

The speech-language pathology undergraduate program at Addis Ababa University graduated its first class in 2019. Plans to grow the training program at the graduate level are ongoing.

CONCLUSION

This novel program, grown from several international partnerships, is an example of how low- and middle-income countries can improve access to the service providers necessary to treat their populations.

Appointment Factors Contributing to Children with Speech Disorders Missing Speech and Language Pathology Appointments

This study explores missed pediatric speech and language pathology (SLP) appointments to identify barriers for patients with speech disorders. Data from 839 referrals at Boston Medical Center, including demographics, appointment details, COVID-19 lockdown, and number of items on patient problem lists, were analyzed using chi-square tests and logistic regression. The findings revealed that lockdown status, appointment timing, appointment type (in-person vs telemedicine), referral department (ear, nose, and throat [ENT] vs non-ENT), sex, race, primary language, birthplace, and primary care provider presence had no significant impact on attendance. However, the number of patient-listed problems, prior cancelations, and missed appointments were significant predictors of patients who did not keep appointments. In conclusion, this research emphasizes the patient's problem list and past appointment behavior as critical factors in predicting missed SLP appointments for pediatric speech disorder patients. These insights can guide targeted interventions to improve attendance and enhance SLP engagement.

Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study

BACKGROUND

Child disability has significant implications on their well-being and healthcare systems.

AIM

This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors.

METHODS

A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories.

RESULTS

The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1-1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2-30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5-6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3-5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1-12.1 & AOR = 3.7, 95% CI: 1.7-7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2-10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing.

CONCLUSION

The study found a high prevalence of disability among Egyptian children aged 1-6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.

Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study

Background

Child disability has significant implications on their well-being and healthcare systems. Aim: This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors.

Methods

A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories.

Results

The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1–1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2–30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5–6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3–5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1–12.1 & AOR = 3.7, 95% CI: 1.7–7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2–10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing.

Conclusion

The study found a high prevalence of disability among Egyptian children aged 1–6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.

Word-final complexity in speech sound intervention: two case studies

In speech sound intervention, consonant clusters promote generalisation (i.e. improvement in untreated sounds and words), ostensibly due to their relative complexity compared to other phonological targets. However, our understanding of clusters as intervention targets is largely restricted to those in word-initial position (e.g. [fl-], flip). The present study extends available work to consider the effects of word-final consonant cluster targets (e.g. [-ks]). Phonologically complex word-final clusters may be morphologically simple (e.g. mix) or morphologically complex (e.g. packs, inflected with third-person singular) - yet this cross-domain complexity remains an understudied phenomenon. Presently, two case studies provide an initial investigation of word-final cluster intervention targets for children with phonologically based speech sound disorders. Intervention targets for both Anna (3;7 [years;months]) and David (4;1) featured the phonologically complex word-final cluster [-ks], with Anna's target being morphologically simple and David's being morphologically complex. Intervention was provided in 45-minute, individual sessions three times per week for a maximum of 18 sessions. Both children demonstrated high target accuracy by intervention's end. Following intervention, both children demonstrated progress in intelligibility and ability to produce word-final consonant clusters; David further demonstrated generalisation across multiple measures. Results are interpreted with consideration of individual differences and existing research on complexity in phonological intervention. Overall, present findings motivate continued research, as manipulation of word-final complexity allows for emphasis on a context that is relevant for children with speech sound disorders, for peers with difficulties in morphology (including word-final grammatical morphemes) and for the substantial proportion of children demonstrating weaknesses in both domains.

The Association Between Atypical Speech Development and Adolescent Self-Harm

BACKGROUND

Adolescent self-harm is a major public health issue internationally. Various factors associated with adolescent self-harm have been identified, including being bullied and experiencing mental health problems. Stuttering and speech sound disorder are associated with both of these factors. It was hypothesized that both stuttering and speech sound disorder would be associated with self-harm. This is the first study to explore the relationship between communication disorders and adolescent self-harm.

METHOD

Secondary analysis of a large, longitudinal, prospective, community sample, the Avon Longitudinal Study of Parents and Children, was carried out. Clinicians identified children who stuttered or exhibited speech sound disorder at the age of 8 years. When the cohort members were 16 years old, they were asked to complete a questionnaire about self-harm. Multinomial logistic regression was used to examine the associations between stuttering and speech sound disorder and the self-harm outcomes, adjusting for other relevant factors.

RESULTS

Of 3,824 participants with data for both speech status and self-harm, 94 (2.5%; 95% confidence interval [CI; 2.0, 3.0]) stuttered at 8 years of age and 127 (3.3%; 95% CI [2.8, 3.9]) displayed speech sound disorder. Speech sound disorder at the age of 8 years was associated with self-harm with suicidal intent in both unadjusted and adjusted models. Differences between the adjusted and unadjusted models were small, suggesting that speech sound disorder is largely an independent risk factor for self-harm with suicidal intent. Stuttering at the age of 8 years was not associated with adolescent self-harm, and there was no association between speech sound disorder and self-harm without suicidal intent.

CONCLUSION

Compared with individuals without speech sound disorder, adolescents with speech sound disorder at the age of 8 years have twice the risk of reporting self-harm with suicidal intent, even when other important predictors are taken into account.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22573030.

Bioenvironmental Predictors of Childhood Reading and Speech Difficulties

PURPOSE

Reading and speech difficulties are common in childhood, yet it is not fully understood how much of their etiology is shared. This partly derives from methodological issues related to overlooking the potential co-occurrence between the two sets of difficulties. This study investigated the effects of five bioenvironmental predictors in a sample assessed for such co-occurrence.

METHOD

A combination of exploratory and confirmatory analyses was performed on longitudinal data from the National Child Development Study. Exploratory latent class analysis was performed on children's reading, speech, and language outcomes at ages 7 and 11 years. Membership in the obtained classes was modeled using a regression with sex and four early-life predictors: gestation period, socioeconomic status, maternal education, and the home reading environment.

RESULTS

The model yielded four latent classes that broadly reflected (1) average reading and speech, (2) excellent reading, (3) reading difficulties, and (4) speech difficulties. Early-life factors significantly predicted class membership. Male sex and preterm birth emerged as risk factors for both reading and speech difficulties. Protective effects against reading difficulties were identified for maternal education, and lower (but not higher) levels of socioeconomic status and the home reading environment.

CONCLUSIONS

Co-occurrence of reading and speech difficulties in the sample was low, and differential patterns of effect of the social environment were supported. Reading outcomes were under stronger malleable influence than speech outcomes.

Speech-language disorder severity, academic success, and socioemotional functioning among multilingual and English children in the United States: The National Survey of Children's Health

Research points to negative associations between educational success, socioemotional functioning, and the severity of symptoms in some speech-language disorders (SLDs). Nonetheless, the majority of studies examining SLDs in children have focused on monolinguals. More research is needed to determine whether the scant findings among multilinguals are robust. The present study used parent report data from the U.S. National Survey of Children's Health (2018 to 2020) to gain a better understanding of the impacts of SLD severity on indicators of academic success and socioemotional functioning among multilingual (n = 255) and English monolingual (n = 5,952) children with SLDs. Tests of between-group differences indicated that multilingual children evidenced more severe SLDs, had lower school engagement, and had lower reports of flourishing than English monolingual children with SLDs. Further, a greater proportion of multilingual children with SLDs missed more school days than English monolinguals. However, multilinguals were less likely to bully others or have been bullied than monolinguals. While the previous between-group differences were statistically significant, they were small (vs ≤ 0.08). Increased SLD severity predicted an increased number of repeated school grades, increased absenteeism, and decreased school engagement, when age and socioeconomic status were controlled. Increased SLD severity also predicted greater difficulty making and keeping friends and decreased flourishing. The effect of SLD severity on being bullied was statistically significant for the monolinguals but not multilinguals. There was a statistically significant interaction for SLD severity and sex for school engagement and difficulty making and keeping friends for monolinguals but not multilinguals. The interactions indicated that school engagement decreased more for females than for males while difficulties making and keeping friends increased more for males than females as one's SLD severity increased. While some findings were specific to monolinguals, tests of measurement invariance indicated that the same general pattern of relations among the variables were evident across the groups of multilinguals and monolinguals. These final findings can inform the interpretation of the results from both the current and future studies, while the overall findings can inform the development of intervention programs, thereby improving the long-term academic and socioemotional outcomes of children with SLDs.

Identifying developmental stuttering and associated comorbidities in electronic health records and creating a phenome risk classifier

PURPOSE

This study aimed to identify cases of developmental stuttering and associated comorbidities in de-identified electronic health records (EHRs) at Vanderbilt University Medical Center, and, in turn, build and test a stuttering prediction model.

METHODS

A multi-step process including a keyword search of medical notes, a text-mining algorithm, and manual review was employed to identify stuttering cases in the EHR. Confirmed cases were compared to matched controls in a phenotype code (phecode) enrichment analysis to reveal conditions associated with stuttering (i.e., comorbidities). These associated phenotypes were used as proxy variables to phenotypically predict stuttering in subjects within the EHR that were not otherwise identifiable using the multi-step identification process described above.

RESULTS

The multi-step process resulted in the manually reviewed identification of 1,143 stuttering cases in the EHR. Highly enriched phecodes included codes related to childhood onset fluency disorder, adult-onset fluency disorder, hearing loss, sleep disorders, atopy, a multitude of codes for infections, neurological deficits, and body weight. These phecodes were used as variables to create a phenome risk classifier (PheRC) prediction model to identify additional high likelihood stuttering cases. The PheRC prediction model resulted in a positive predictive value of 83 %.

CONCLUSIONS

This study demonstrates the feasibility of using EHRs in the study of stuttering and found phenotypic associations. The creation of the PheRC has the potential to enable future studies of stuttering using existing EHR data, including investigations into the genetic etiology.

Educational outcomes associated with persistent speech disorder

BACKGROUND

Children with persistent speech disorder (PSD) are at higher risk of difficulties with literacy, with some evidence suggesting an association with poorer educational attainment. However, studies to date have either used small clinical samples, which exclude children who have not been referred to clinical services, or relied on parent-teacher report of children's speech development. There is a need for an inclusive study to investigate the impact of PSD on educational outcomes using a population-based sample and robust measures of speech development.

AIM

Using a large prospective UK population-based study-the Avon Longitudinal Study of Parents and Children (ALSPAC)-this study investigated: (1) how children identified with PSD at age 8 years perform on educational attainment tests at ages 10-11 and 13-14 years in comparison with children without PSD; and (2) whether children identified with PSD at age 8 years are more likely to receive a label of special educational needs (SEN) in secondary school.

METHODS & PROCEDURES

We examined the data for 263 children with PSD and 6399 controls who had speech assessed at age 8 years in a research clinic. Educational attainment was measured using data from English school standard attainment tests. Data on SEN categorization were obtained between 11 and 13 years of age. Children with PSD and controls were compared using regression analyses adjusted for biological sex, maternal age, verbal, performance and full-scale IQ.

OUTCOMES & RESULTS

Children with PSD at age 8 years were more likely to achieve lower attainment scores at ages 10-11 years in English and mathematics and across all three subjects of English, mathematics and science at ages 13-14 years after controlling for biological sex and maternal education; score below target levels for English at both time points after controlling for verbal IQ, and at ages 13-14 years after controlling for performance IQ; and receive a label of SEN (typically for the category of cognition and learning needs or communication and interaction needs) in secondary school.

CONCLUSIONS & IMPLICATIONS

PSD identified at age 8 years is associated with poor educational attainment at ages 10-11 and 13-14 years in the core subjects of English, mathematics and science. Children with PSD at age 8 years are more likely to be identified with SEN at ages 11-13 years, particularly cognition and learning needs, and communication and interaction needs. We need to be aware of the potential for the long-term impact of PSD on educational attainment in providing appropriate and effective support throughout school. What this paper adds What is already known on the subject Speech-sound disorder is associated with reading and spelling difficulties, with some evidence to suggest that PSD is associated with a higher risk of literacy difficulties. Limited evidence also suggests that speech-sound disorder may be associated with poorer educational attainment. However, studies to date have used small clinical samples or parent-teacher report of speech development and there is a need to determine whether the association is observed in larger and more inclusive population-based samples. What this paper adds to existing knowledge This prospective, longitudinal study of a large community-based sample of English children has shown that PSD is associated with poorer educational attainment at the end of primary school and at ages 13-14 years. Children with PSD are also more likely to be identified as having SEN in secondary school, especially communication and interaction needs but also including cognition and learning needs. What are the potential or actual clinical implications of this work? Understanding the long-term implications of PSD on educational attainment highlights the importance of ongoing monitoring and support to enable children to reach their potential throughout primary and secondary school. The identification of children with a history of PSD during transition to secondary school will enable effective support to be put in place. The intervention for children with PSD should involve close collaboration between speech and language therapists and education professionals.

Development and measurement of psychometric properties of the Persian test of speech consistency in children with typical development

The current research pursues the study of developing the Persian test of speech consistency and investigating speech consistency in normally developing children in Iran. After developing the Persian test of speech consistency, the obtained speech samples of 317 participants (163 girls and 154 boys) were analyzed. This test of consistency includes 27 items. Experts' consensus over the characteristics of the Persian test of speech consistency was above 85%. Different age groups had statistically significant differences for the mean scores of the variable responses (p < .001), consistent correct (p < .001), and consistent incorrect responses (p = .007) in the Persian test of speech consistency. Also, there was a high value for the inter-rater reliability (ICC = .88, p < .001) as well as the moderate value for the test-retest reliability (ICC = .89, p < .001). The Persian test of speech consistency is regarded as a reliable and valid scale for measuring the speech consistency in Persian-speaking children. Future studies are proposed to investigate the speech consistency in Persian-speaking children with various kinds of speech sound disorders.

Association Between Emotional Disorders and Speech and Language Impairments: A National Population-Based Study

Anxiety and depression are common emotional problems in children and adolescents. This study used a long-term tracking large database to investigate whether the proportion of children who were diagnosed with speech and language impairments were later diagnosed with anxiety or depression were significantly greater than that of matched group of the same age and gender without speech and language impairments. More than 4300 eligible children with speech and language impairments and matched controls were identified and assessed for anxiety and depression. The risk of anxiety and depressive disorders in children with speech and language impairments were examined with Cox regression analyses and adjusting for covariables (gender, age, and comorbidities). The results showed that speech and language impairments were positively associated with anxiety disorders (adjusted hazard ratio [AHR] 2.87, 95% confidence interval [CI] 2.20-3.76) and depressive disorders (AHR 2.51, 95% CI 1.52-4.13). The number of boys with speech and language impairments was more than twofold that of girls, but boys did not different from girls in the risk of anxiety disorders (AHR 0.95, 95% CI 0.75-1.20) and depressive disorders (AHR 0.72, 95% CI 0.47-1.11). Infantile autism and intellectual disabilities were positively associated with anxiety (AHR 1.54, 95% CI 1.07-2.21; AHR 1.47, 95% CI 1.09-1.98), and the latter was positively associated with depression (AHR 1.83, 95% CI 1.06-3.17). In addition to speech and language impairments interventions, our findings supported the necessity of identification and interventions in anxiety and depressive disorders among children with speech and language impairments from elementary school until youth.

Risk factors for communication disorders and complaints of preschoolers in a School Health Program

ABSTRACT Purpose: to survey the prevalence of risk factors for communication disorders and complaints in preschoolers that participated in the School Health Program (SHP) and compare the findings with age and sex. Methods: the sample comprised 190 preschoolers reached by the SHP. The collection procedure involved the exploration of data in questionnaires previously filled out by their relatives. The risk factors and communication complaints were presented in the occurrence frequency. The evidence of associations between variables was verified with the Mann-Whitney and chi-square tests, and the 5% significance level was used for all comparisons. Results: baby bottle use was the most prevalent risk factor associated with age, being more frequent in younger children. The girls underwent more complications during pregnancy or birth and showed more nonnutritive sucking habits, whereas the boys had more hospital stays. Conclusion: regarding the investigated risk factors, the baby bottle use was the most reported one, followed by ear infections or other ear problems. Complaints related to speaking and hearing were seldom mentioned, although those related to speaking occurred more frequently.

Sexual Dimorphism Within Brain Regions Controlling Speech Production

Neural processing of speech production has been traditionally attributed to the left hemisphere. However, it remains unclear if there are structural bases for speech functional lateralization and if these may be partially explained by sexual dimorphism of cortical morphology. We used a combination of high-resolution MRI and speech-production functional MRI to examine cortical thickness of brain regions involved in speech control in healthy males and females. We identified greater cortical thickness of the left Heschl's gyrus in females compared to males. Additionally, rightward asymmetry of the supramarginal gyrus and leftward asymmetry of the precentral gyrus were found within both male and female groups. Sexual dimorphism of the Heschl's gyrus may underlie known differences in auditory processing for speech production between males and females, whereas findings of asymmetries within cortical areas involved in speech motor execution and planning may contribute to the hemispheric localization of functional activity and connectivity of these regions within the speech production network. Our findings highlight the importance of consideration of sex as a biological variable in studies on neural correlates of speech control.

Stuttering and Labor Market Outcomes in the United States

PURPOSE

The purpose of this study was to quantify relationships between stuttering and labor market outcomes, determine if outcomes differ by gender, and explain the earnings difference between people who stutter and people who do not stutter.

METHOD

Survey and interview data were obtained from the National Longitudinal Study of Adolescent to Adult Health. Of the 13,564 respondents who completed 4 waves of surveys over 14 years and answered questions about stuttering, 261 people indicated that they stutter. Regression analysis, propensity score matching, and Blinder-Oaxaca decomposition were used.

RESULTS

After controlling for numerous variables related to demographics and comorbidity, the deficit in earnings associated with stuttering exceeded $7,000. Differences in observable characteristics between people who stutter and people who do not stutter (e.g., education, occupation, self-perception, hours worked) accounted for most of the earnings gap for males but relatively little for females. Females who stutter were also 23% more likely to be underemployed than females who do not stutter.

CONCLUSIONS

Stuttering was associated with reduced earnings and other gender-specific disadvantages in the labor market. Preliminary evidence indicates that discrimination may have contributed to the earnings gap associated with stuttering, particularly for females.

Population Health in Pediatric Speech and Language Disorders: Available Data Sources and a Research Agenda for the Field

PURPOSE

The aim of the study was to provide an overview of population science as applied to speech and language disorders, illustrate data sources, and advance a research agenda on the epidemiology of these conditions.

METHOD

Computer-aided database searches were performed to identify key national surveys and other sources of data necessary to establish the incidence, prevalence, and course and outcome of speech and language disorders. This article also summarizes a research agenda that could enhance our understanding of the epidemiology of these disorders.

RESULTS

Although the data yielded estimates of prevalence and incidence for speech and language disorders, existing sources of data are inadequate to establish reliable rates of incidence, prevalence, and outcomes for speech and language disorders at the population level.

CONCLUSIONS

Greater support for inclusion of speech and language disorder-relevant questions is necessary in national health surveys to build the population science in the field.

Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys

Purpose

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population.

Method

We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation.

Results

Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%–56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%–22% experiencing food insecurity, compared to 11%–14% of their peers without any indications of speech-language difficulties).

Conclusions

We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

Asthma, hay fever, and food allergy are associated with caregiver-reported speech disorders in US children

BACKGROUND

Children with asthma, hay fever, and food allergy may have several factors that increase their risk of speech disorder, including allergic inflammation, ADD/ADHD, and sleep disturbance. However, few studies have examined a relationship between asthma, allergic disease, and speech disorder. We sought to determine whether asthma, hay fever, and food allergy are associated with speech disorder in children and whether disease severity, sleep disturbance, or ADD/ADHD modified such associations.

METHODS

We analyzed cross-sectional data on 337,285 children aged 2-17 years from 19 US population-based studies, including the 1997-2013 National Health Interview Survey and the 2003/4 and 2007/8 National Survey of Children's Health.

RESULTS

In multivariate models, controlling for age, demographic factors, healthcare utilization, and history of eczema, lifetime history of asthma (odds ratio [95% confidence interval]: 1.18 [1.04-1.34], p = 0.01), and one-year history of hay fever (1.44 [1.28-1.62], p < 0.0001) and food allergy (1.35 [1.13-1.62], p = 0.001) were associated with increased odds of speech disorder. Children with current (1.37 [1.15-1.59] p = 0.0003) but not past (p = 0.06) asthma had increased risk of speech disorder. In one study that assessed caregiver-reported asthma severity, mild (1.58 [1.20-2.08], p = 0.001) and moderate (2.99 [1.54-3.41], p < 0.0001) asthma were associated with increased odds of speech disorder; however, severe asthma was associated with the highest odds of speech disorder (5.70 [2.36-13.78], p = 0.0001).

CONCLUSION

Childhood asthma, hay fever, and food allergy are associated with increased risk of speech disorder. Future prospective studies are needed to characterize the associations.

Prevalence and Predictors of Persistent Speech Sound Disorder at Eight Years Old: Findings From a Population Cohort Study

PURPOSE

The purpose of this study was to determine prevalence and predictors of persistent speech sound disorder (SSD) in children aged 8 years after disregarding children presenting solely with common clinical distortions (i.e., residual errors).

METHOD

Data from the Avon Longitudinal Study of Parents and Children (Boyd et al., 2012) were used. Children were classified as having persistent SSD on the basis of percentage of consonants correct measures from connected speech samples. Multivariable logistic regression analyses were performed to identify predictors.

RESULTS

The estimated prevalence of persistent SSD was 3.6%. Children with persistent SSD were more likely to be boys and from families who were not homeowners. Early childhood predictors identified as important were weak sucking at 4 weeks, not often combining words at 24 months, limited use of word morphology at 38 months, and being unintelligible to strangers at age 38 months. School-age predictors identified as important were maternal report of difficulty pronouncing certain sounds and hearing impairment at age 7 years, tympanostomy tube insertion at any age up to 8 years, and a history of suspected coordination problems. The contribution of these findings to our understanding of risk factors for persistent SSD and the nature of the condition is considered.

CONCLUSION

Variables identified as predictive of persistent SSD suggest that factors across motor, cognitive, and linguistic processes may place a child at risk.

Teachers' screening estimations of speech-language impairments in primary school children in Nepal

BACKGROUND

The prevalence of speech-language impairments in children have been estimated for several languages, primarily in developed countries. However, prevalence data is lacking for developing countries, such as Nepal.

AIMS

(1) To obtain teacher estimates of incidence and overall prevalence of speech-language impairments and its subtypes as a function of gender, age and grade level; and (2) to validate the screening instrument on Nepalese children.

METHODOLOGY

The adapted teachers' screening instrument, namely adapted Teachers' Speech and Language Referral Checklist (a-TSLRC), was administered in 2776 (690 and 2086) primary school children aged 5;00-11;11 years (mean = 8;11 years). The screening was conducted at four different points in time, i.e. Incidences I and II, and each incidence consisted of a testing and a retesting phase. Prior to this, teachers were trained in forum meetings, and an information sheet containing an overview of speech-language impairments, and guidelines/criteria for marking the occurrence of speech-language impairments in the TSLRC were disseminated.

OUTCOMES & RESULTS

Overall prevalence of speech-language impairments in children was estimated as 8.11%. Specifically, overall speech problems were estimated as 4.68%, and language problems as 8.0%. Additionally, the prevalence by subtypes of speech-language impairments as categorized in the TSLRC were reported to be 2.95% for an articulation/phonological problems, 2.09% for stuttering, 3.42% for a voice problems, 4.97% for a receptive language problems and 7.74% for an expressive language problems. The internal consistency among items was sufficient and a good intra-rater reliability was obtained.

CONCLUSIONS & IMPLICATIONS

The study indicates that the overall results of speech-language impairments in children via the adapted in-Nepalese criterion-referenced instrument are supported by international studies. In addition, justifiable reliability and validity was obtained. Therefore, based on these overall evidence, this instrument can be useful for the screening of speech-language impairments in primary school children in Nepal.

Eczema Is Associated with Childhood Speech Disorder: A Retrospective Analysis from the National Survey of Children's Health and the National Health Interview Survey

OBJECTIVE

To determine if eczema is associated with an increased risk of a speech disorder.

STUDY DESIGN

We analyzed data on 354,416 children and adolescents from 19 US population-based cohorts: the 2003-2004 and 2007-2008 National Survey of Children's Health and 1997-2013 National Health Interview Survey, each prospective, questionnaire-based cohorts.

RESULTS

In multivariate survey logistic regression models adjusting for sociodemographics and comorbid allergic disease, eczema was significantly associated with higher odds of speech disorder in 12 of 19 cohorts (P < .05). The pooled prevalence of speech disorder in children with eczema was 4.7% (95% CI 4.5%-5.0%) compared with 2.2% (95% CI 2.2%-2.3%) in children without eczema. In pooled multivariate analysis, eczema was associated with increased odds of speech disorder (aOR [95% CI] 1.81 [1.57-2.05], P < .001). In a single study assessing eczema severity, mild (1.36 [1.02-1.81], P = .03) and severe eczema (3.56 [1.70-7.48], P < .001) were associated with higher odds of speech disorder. History of eczema was associated with moderate (2.35 [1.34-4.10], P = .003) and severe (2.28 [1.11-4.72], P = .03) speech disorder. Finally, significant interactions were found, such that children with both eczema and attention deficit disorder with or without hyperactivity or sleep disturbance had vastly increased risk of speech disorders than either by itself.

CONCLUSIONS

Pediatric eczema may be associated with increased risk of speech disorder. Further, prospective studies are needed to characterize the exact nature of this association.

Gender and geographic differences in the prevalence of reportable childhood speech and language disability in Taiwan

Speech and language disability (SLD) is not uncommon in children. However, data at the national level are limited, and geographic differences are seldom evaluated. Starting from 1980, the local governments in Taiwan has begun to certify disabled residents for providing various services and report cases to the central government according to the law, and the central government maintains a registry of reported cases, which provides a unique opportunity for studying SLD at the national level. Using the registry data from 2004 to 2010, we calculated the prevalence of SLD by age, gender, and geographic area and assessed the changes over time. Because the government discourages the certification under 3 years of age, we excluded cases under 3 years old from the analyses. We found that from 2004 to 2010 the registered cases between 3 and 17 years old increased from 1418 to 1637 per year, and the prevalence generally increased every year in all age groups except in 12-14 years of age. In each year there were more boy cases than girl cases, and the prevalence rate ratio increased from 1.50 to 1.83 (p < 0.05 in all years), with an increasing trend over time (p < 0.01). A higher prevalence was observed in the rural areas over the years, and the prevalence rate ratio increased from 1.35 to 1.71 (p < 0.05 in all years), with an increasing trend over time (p < 0.01). Further studies identifying the risk factors contributed to the increases might help the prevention of SLD in the future.

“He'll Grow out of it Soon—Won't He?”—The Characteristics of Older Children's Speech When They Do—and Don't—Grow out of it

Speech sound disorder is a common reason for referral to speech and language therapy services in the early years. While for some children, their difficulties are transitory and they either respond to intervention or their difficulties resolve, for others, their speech sound difficulties evolve into persistent speech disorder (PSD). The purpose of this article is to provide information on the features of PSD and how to assess children with PSD in order to identify the full range and limits of their speech sound system. Reference is made to ALSPAC, a large longitudinal population study, regarding prevalence, possible subtypes, and risk factors for PSD.

Prevalence of stuttering in primary school children in Cairo-Egypt

PURPOSE

To determine the prevalence of stuttering among primary school children in Cairo.

METHOD

A cross-sectional design was employed. Using a multi-stage random sample from 10 schools in Cairo, a total of 8765 primary school students were enrolled in the study. The teacher referring method was initially used to detect stuttering students, which was then confirmed by a Speech Language Pathologist (SLP) using Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria. Personal data were collected for all students and separate questionnaires were administered to the parents of each stuttering child, inquiring about consanguinity, family history, presence of other disorders and family attitudes towards the child.

RESULT

Prevalence of stuttering among primary school children in Cairo was 1.03%. The prevalence of stuttering showed a declining trend in the older age group. Stuttering was 7-fold more prevalent among left-handed students. Males had a higher prevalence of stuttering, but didn't reach statistical significance. Anxiety was expressed in 25% of the families of affected children. Positive family history was found in 28% of cases, mainly among first-degree relatives.

CONCLUSION

The current study showed a prevalence of stuttering comparable to other areas of the world with some evidence of hereditary background, although lower than that reported by other studies.

Healthcare costs associated with language difficulties up to 9 years of age: Australian population-based study

PURPOSE

This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children.

METHOD

Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme.

RESULT

It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $AU206, 95% CI = $90, $321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $AU1.2-$AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties.

CONCLUSION

Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

Cognitive development in children with language impairment, and correlation between language and intelligence development in kindergarten children with developmental delay

We performed a retrospective review of 65 children with developmental delay. The male-to-female ratio was 2.25 : 1, and the mean age was 5.8 years; performance IQ was 94.8, verbal IQ was 83, and full-scale IQ was 87.4. Twenty-three (35%) children had normal language development, 13 (20%) had below average language development, and 29 (45%) had developmental language disorder. Performance IQ was significantly better than verbal IQ in all children (P < .001), and there was no difference within the 3 language groups. The performance IQ (P = .007) of children with developmental language disorder and specific language impairment was significantly lower than that of children with normal language development. Performance IQ was found to be correlated with language score (r = .309, P = .012). The children with language impairment were associated with lower IQ scores. The discrepancy between performance IQ and verbal IQ persisted in children with developmental delay, not only in children with language disorder.

Referred speech-language and hearing complaints in the western region of São Paulo, Brazil

OBJECTIVE

The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints.

METHOD

This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions.

RESULTS

Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment.

CONCLUSIONS

The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders.

The impact of adolescent stuttering and other speech problems on psychological well-being in adulthood: evidence from a birth cohort study

BACKGROUND

Developmental stuttering is associated with increased risk of psychological distress and mental health difficulties. Less is known about the impact of other developmental speech problems on psychological outcomes, or the impact of stuttering and speech problems once other predictors have been adjusted for.

AIMS

To determine the impact of parent-reported adolescent stuttering and other speech difficulties on psychological distress and associated symptoms as measured by the Rutter Malaise Inventory.

METHOD & PROCEDURES

A British birth cohort dataset provided information about 217 cohort members who stuttered and 301 cohort members who had other kinds of speech problem at age 16 according to parental report, and 15,694 cohort members who had experienced neither stuttering nor other speech difficulties. The main analyses concerned associations between adolescent stuttering or speech difficulty and score on the Rutter Malaise Inventory at age 42. Other factors that had previously been shown to be associated with score on the Malaise Inventory were also included in the analyses.

OUTCOMES & RESULTS

In the adjusted analyses that controlled for other predictors, cohort members who were reported to stutter had higher malaise scores than controls overall, indicating a higher level of psychological distress, but they were not at significantly more likely to have malaise scores in the range indicating a risk of serious mental health difficulties. Cohort members who were reported to have other speech difficulties during adolescence had malaise scores that overall did not differ significantly from those of controls in the adjusted analyses, but they were at significantly greater risk of serious mental health difficulties.

CONCLUSIONS & IMPLICATIONS

These findings support those of other studies that indicate an association between stuttering and psychological distress. This study is the first to have shown that adolescents who experience speech difficulties other than stuttering are more likely than controls to be at risk of poorer mental health in adulthood. The results suggest a need for therapeutic provision to address psychosocial issues for both stuttering and other developmental speech disorders in adulthood, as well as further research into the consequences in adulthood of stuttering and other developmental speech disorders.

Description of multilingual participants who stutter

PURPOSE

The purpose of this review was to examine the descriptions of multilingual participants provided in stuttering literature to determine how frequently and consistently relevant factors of language profile are reported.

METHOD

We conducted a systematic search of published studies that included multilingual participants who stutter and reviewed the level of detail provided regarding language history, function, proficiency, stability, mode, accent, covert speech, and affective factors.

RESULTS

Twenty-three studies qualified to be included in the systematic review, consisting of 342 different multilingual stuttering participants. Of these 23 studies, the most frequently reported information included language proficiency (70%), history (56%), and function (43%). The specificity of the information used to define these factors was inconsistent. Affect was mentioned in 22% of studies, and language stability, mode, and accent information was included in less than 10% of the studies.

CONCLUSIONS

Results demonstrate that description of multilingual stuttering participants is inadequate and inconsistent. A recommended framework is provided for future studies to facilitate cross-study comparisons and enhance our ability to interpret the manifestation of stuttering in multilingual participants.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) summarize the current validity of cross-study comparisons in available research of multilingual participants who stutter; (b) describe the range of language factors to be included when providing descriptions of multilingual participants who stutter; (c) discuss the importance of consistency when describing language profiles of multilingual research participants.

Epidemiology of stuttering: 21st century advances

Epidemiological advances in stuttering during the current century are reviewed within the perspectives of past knowledge. The review is organized in six sections: (a) onset, (b) incidence, (c) prevalence, (d) developmental paths, (e) genetics and (f) subtypes. It is concluded that: (1) most of the risk for stuttering onset is over by age 5, earlier than has been previously thought, with a male-to-female ratio near onset smaller than what has been thought, (2) there are indications that the lifespan incidence in the general population may be higher than the 5% commonly cited in past work, (3) the average prevalence over the lifespan may be lower than the commonly held 1%, (4) the effects of race, ethnicity, culture, bilingualism, and socioeconomic status on the incidence/prevalence of stuttering remain uncertain, (5) longitudinal, as well as incidence and prevalence studies support high levels of natural recovery from stuttering, (6) advances in biological genetic research have brought within reach the identification of candidate genes that contribute to stuttering in the population at large, (7) subtype-differentiation has attracted growing interest, with most of the accumulated evidence supporting a distinction between persistent and recovered subtypes.

EDUCATIONAL OBJECTIVES

Readers will be exposed to a summary presentation of the most recent data concerning basic epidemiological factors in stuttering. Most of these factors also pertain to children's risks for experiencing stuttering onset, as well as risks for persistency. The article also aims to increase awareness of the implications of the information to research, and professional preparation that meets the epidemiology of the disorder.

Speech characteristics of 8-year-old children: findings from a prospective population study

Speech disorder that continues into middle childhood is rarely studied compared with speech disorder in the early years. Speech production in single words, connected speech and nonword repetition was assessed for 7390 eight-year-old children within the Avon Longitudinal Study of Parents and Children (ALSPAC). The majority (n=6399) had typical speech and 50 of these children served as controls. The remainder were categorised as using common clinical distortions only (CCD, n=582) or speech difficulties (SDiff, n=409). The samples from the CCD children were not analysed further. Speech samples from the SDiff and the control children were transcribed and analysed in terms of percentage consonants correct, error type and syllable structure. Findings were compared with those from children in the Shriberg et al. (1997) lifespan database (n=25). The 8-year-old children from ALSPAC in the SDiff and control groups achieved similar speech accuracy scores to the 8-year-old children in the lifespan database. The SDiff group had consistently lower scores than the ALSPAC control group, with the following measures most clearly differentiating the groups: single word task (percentage of substitutions and distortions), connected speech task (percentage of vowels correct (PVC), percentage of omission of singletons and entire clusters, and stress pattern matches), nonword repetition task (PVC, percentage of entire clusters omitted, percentage of distortions, and percentage of stress pattern matches). Connected speech and nonword samples provide useful supplementary data for identifying older children with atypical speech.

LEARNING OUTCOMES

The reader will recognize the methods used to identify speech characteristics in a large scale population study. They will describe how measures of speech accuracy in connected speech compare with the Shriberg et al. (1997) lifespan database. The reader will also recall information on how typically and atypically developing children differ on a range of measures across different types of speech sample.

Prevention of communication disorders--screening pre-school and school-age children for problems with hearing, vision and speech: European Consensus Statement

Background

Communication is an integral part of human behaviour. Communication disorders are associated mainly with impairment in hearing, vision, and/or speech, which influences the ability to receive, comprehend, produce, and express verbal, nonverbal, and graphic information. When unrecognized and unmanaged, these very often “invisible” conditions can have a significant detrimental effect on a child’s development, affecting educational, social, and psychological progress.

Material/Methods

A panel of experts discussed the screening of pre-school and school-age children for problems with hearing, vision, and speech during the 10^th Congress of the European Federation of Audiology Societies (EFAS), held in Warsaw, Poland, on 22 June, 2011.

Results

The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children was the result of the scientific discussions. It was endorsed by experts in audiology, otolaryngology, phoniatry, ophthalmology, and speech language pathology from throughout Europe^*. Key elements of the consensus, as described herein, are: 1) defining the role of screening programmes in the identification and treatment of communication disorders; 2) identifying the target population; 3) promoting general awareness about the consequences of communication disorders; 4) recognizing the need for a quality control system in screening programmes; 5) encouraging cooperation among European countries to provide a high level of public health services for the prevention, identification, and treatment of communication disorders.

Conclusions

The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children will encourage the appropriate authorities of the various countries involved to initiate screening for communication disorders in pre-school and school-age children.

Overlap in Speech-Language and Reading Services for Kindergartners and First Graders

Purpose

Speech-language pathologists (SLPs) and reading professionals provide educational services to children who are at risk for reading difficulties, although these professions do not necessarily coordinate efforts. To date, there is limited evidence regarding the proportion of children who receive services from both professionals. The current study reports the prevalence and overlap of speech-language and reading services provided to kindergartners and first graders in Virginia.

Method

This study analyzed a population-level database of reading screening scores from 74,730 kindergartners and 75,088 first graders. Information regarding the speech-language services received by these children was obtained. Prevalence rates of speech-language impairment, reading risk, and comorbidity were calculated. The distribution of children receiving speech-language services across categories of reading competence was examined.

Results

Findings indicated that ∼6% of the children received speech-language services and 11.1% of the kindergartners and 13.7% of the first graders received reading services. One-quarter of the children receiving speech-language services also received reading services. Furthermore, children receiving speech-language services received reading services at twice the rate of children who were not receiving speech-language services in both kindergarten (23.1% vs. 9.1%) and first grade (25.2% vs. 11.3%).

Clinical Implications

This study provides empirical support for improving coordination between SLPs and reading professionals.

Internet-based developmental screening: a digital divide between English- and Spanish-speaking parents

BACKGROUND

Internet-based developmental screening is being implemented in pediatric practices across the United States. Little is known about the application of this technology in poor urban populations.

OBJECTIVE

We describe here the results of focus groups, surveys, and in-depth interviews during home visits with families served by an urban safety-net organization to address the question of whether it is possible to use Internet or e-mail communication for medical previsit engagement in a population that is majority Hispanic, of low socioeconomic status, and has many non-English-speaking families.

METHODS

This study included families in 4 clinics within a safety-net health care system. The study design included the use of (1) parental surveys (n = 200) of a convenience sample of parents whose children received primary care in the clinics, (2) focus groups (n = 7 groups) with parents, and (3) in-depth interviews during home visits with 4 families. We used χ(2) and multivariate analyses to compare Internet access in English- and Spanish-speaking families. Standard qualitative methods were used to code focus-group texts and identify convergent themes.

RESULTS

In multivariate analysis, independent factors associated with computer use were English versus Spanish language (odds ratio: 3.2 [95% confidence interval: 1.4-6.9]) and education through at least high school (odds ratio: 4.7 [95% confidence interval: 2.3-9.7]). In focus groups, the concept of parental previsit work, such as developmental screening tests, was viewed favorably by all groups. However, many parents expressed reservations about doing this work by using the Internet or e-mail and stated a preference for either paper or telephone options. Many Spanish-speaking families discussed lack of access to computers and printers.

CONCLUSIONS

In this economically disadvantaged population, language and maternal education were associated with access to the Internet. Given the potential power of previsit work to tailor well-child visits to the needs of individual families, alternative strategies to using the Internet should be explored for populations without reliable Internet access.

Epidemiology of speech and language impairment in a nationally representative sample of 4- to 5-year-old children

PURPOSE

To draw on multiple sources of information to determine prevalence of speech and language impairment in young Australian children.

METHOD

Information about 4,983 children (ages 4-5 years) from Growing Up in Australia: The Longitudinal Study of Australian Children (Australian Institute of Family Studies, 2007) was obtained via parent interviews and questionnaires, teacher questionnaires, and direct assessment. Data were statistically weighted to the Australian population of 253,202 children in the target age group.

RESULTS

Parent-reported prevalence: 25.2% had concerns about how their child talked and made speech sounds (11.8% "concerned"; 13.4% "a little concerned"), and 9.5% had concerns about how their child understood language (4.4% "concerned"; 5.1% "a little concerned"). Parents who reported concerns identified "speech not clear to others" as the most frequent area of difficulty (12.0%). Teacher-reported prevalence: 22.3% of children were considered to be less competent than others in their expressive language ability (6.7% "much less competent"; 15.6% "less competent"); 16.9% were considered to be less competent than others in their receptive language ability (4.0% "much less competent"; 12.9% "less competent"). The match between parent and teacher identification was higher for expressive speech and language concern than for receptive language. Direct assessment: 13.0% of children were 1-2 SDs below the mean on the Adapted Peabody Picture Vocabulary Test-III (S. Rothman, 2003), and a further 1.7% were > 2 SDs below the mean. Parent and teacher reports were significantly correlated with scores obtained via direct assessment. Period prevalence: Parents and teachers reported that 14.5% of children had accessed speech-language pathologist (SLP) services. 2.2% indicated that they needed but could not access an SLP.

CONCLUSION

Multiple indicators of speech and language impairment in diverse contexts confirmed the high prevalence of this condition in early childhood and a concomitant need for SLP services.

Comorbidity of motor and language impairments in preschool children of Taiwan

Comorbidity of motor and speech/language impairments was investigated in 363 preschool children between the ages of 5 and 6 years (boys: 205, age 6.04+/-0.48 years; girls: 158, age 5.98+/-0.53 years). The children were sampled from two municipals of Taiwan, and were determined to present no apparent neurological, musculoskeletal, cardiopulmonary system impairment or mental insufficiency. They were administered with three speech/language tests and a motor test (Movement Assessment Battery for Children, or M-ABC). The results showed a significant correlation between the total score of the motor test and the total score of each of the speech and language tests. Regression analysis that controlled for IQ (C-TONI) further showed that manual dexterity, but not ball skills or balance, of M-ABC was predictive of all scores on the speech and language tests. To determine a deficit on a test, a score at or below the 10th percentile of the norm or a score at or below 1.25SD from the group mean was established as the cutoff. For the speech/language impairment, a deficit on at least two out of the three tests also applied. Following these criteria, 22 children (6.1%) were identified to have Developmental Speech and Language Disorder (DSLD), and 45 (12.4%) to have Developmental Coordination Disorder (DCD). Comorbid DSLD and DCD were found in six children (1.65%). Chi-square analysis revealed a significant correlation between DSLD and DCD (p<.03). The odds of DSLD was higher (by about three-fold) among the children with DCD than among the children without (0.15 vs. 0.05). Comorbid motor and speech/language impairments in preschool children appear to be a significant clinical condition that requires the attention of the therapeutic community. Manual dexterity, in particular, seems to be an important clue for understanding the shared mechanism of motor and speech/language impairments.

Teacher identification of speech and language impairment in kindergarten students using the Kindergarten Development Check

The purpose of this paper was to profile the extent and accuracy of teacher identification of speech and language impairment within a kindergarten student population in Tasmania, Australia, using the Kindergarten Development Check (KDC). A total of 286 kindergarten students (aged 4-5 years and in their first year of formal schooling) were screened by teachers with the KDC on two separate occasions over their kindergarten year. In the following academic year, each of the same 286 students were assessed by a speech-language pathologist, and diagnosed with either typically developing or impaired speech and/or language skills. Review of KDC data determined the number of students identified by teachers with speech and language impairment at each occasion during their kindergarten year. Comparison of data from the later KDC administration and speech-language pathology assessment then determined the correspondence between identification of speech and language impairment by teachers and speech-language pathologists. Upon initial administration of the KDC, 51 (17.8%) students were identified by teachers with language impairment and 47 (16.4%) students with speech impairment. Following the second administration of the KDC 3 months later, 20 (7.0%) students continued to be identified with language impairment, and 39 (13.6%) with speech impairment. Comparison of speech-language pathology testing results and KDC data from the second administration found the overall validity of teacher identification was 86.4% and 71% for speech and language impairment respectively. Specificity rates were high, with 93% and 97% of students with typically developing speech and language skills respectively, correctly classified on the KDC. However, the sensitivity was only 50% for speech impairment and 15% for language impairment, indicating that 50% of students presenting with speech impairment and 85% of students with language impairment in their subsequent academic year were not recorded by teachers as having such a difficulty on the later KDC administration during their kindergarten year. The KDC appears to be ineffective in supporting kindergarten teachers to identify students with ongoing speech and to a greater extent, language impairment. Measures to improve the sensitivity of the KDC in particular need to be considered by speech-language pathologists and educational professionals in Tasmania.

Prevalence of speech and/or language impairment in preparatory students in northern Tasmania

The purpose of this paper is to report the prevalence of speech and/or language impairment in a sample of preparatory students in northern Tasmania, Australia. A total of 308 preparatory students attending 30 public schools in northern Tasmania were administered assessments by a speech-language pathologist, and subsequently diagnosed with either typical or impaired speech and/or language skills. Overall, 41.2% of assessed preparatory students were identified as having either speech and/or language impairment. Specifically, 8.7% of students were found to have isolated speech impairment, 18.2% were diagnosed with isolated language impairment, and 14.3% were identified as having comorbid speech and language impairment. Compared to prior Australian and international research, the present data reflect one of the highest prevalence estimates for speech and/or language impairment reported to date. Given the relative paucity of Australian prevalence data, further epidemiological research specifically of Australian children is needed to validate the current findings.

Communication disorders: prevalence and comorbid intellectual disability, autism, and emotional/behavioral disorders

PURPOSE

To determine a population-based estimate of communication disorders (CDs) in children; the co-occurrence of intellectual disability (ID), autism, and emotional/behavioral disorders; and the impact of these conditions on the prevalence of CDs.

METHOD

Surveillance targeted 8-year-olds born in 1994 residing in 2002 in the 3 most populous counties in Utah (n = 26,315). A multiple-source record review was conducted at all major health and educational facilities.

RESULTS

A total of 1,667 children met the criteria of CD. The prevalence of CD was estimated to be 63.4 per 1,000 8-year-olds (95% confidence interval = 60.4-66.2). The ratio of boys to girls was 1.8:1. Four percent of the CD cases were identified with an ID and 3.7% with autism spectrum disorders (ASD). Adjusting the CD prevalence to exclude ASD and/or ID cases significantly affected the CD prevalence rate. Other frequently co-occurring emotional/behavioral disorders with CD were attention deficit/hyperactivity disorder, anxiety, and conduct disorder.

CONCLUSIONS

Findings affirm that CDs and co-occurring mental health conditions are a major educational and public health concern.

Subjective burden in mothers of speech-impaired children

OBJECTIVE

Evaluation of perceived subjective burden in mothers of speech-impaired children against the presence or absence of an emotional disorder.

METHODS

89 mothers (age 33.3 +/- 5.5 years, range: 19.6-43.8 years) of 89 preschool children (23 girls, 66 boys, age: 3.9 +/- 1.5 years, range: 1.6- 7.1 years) with specific speech impairment were investigated. German versions of the Hospital Anxiety and Depression Scale (HADS) and the Burden Scale for Family Caregivers (BSFC) were applied.

RESULTS

11% of the mothers met criteria for a depressive disorder (normal controls: 2.5%; p = 0.008). Twenty-eight percent of the mothers met criteria for anxiety disorders (normal controls: 9.6%; p = 0.000). The HADS depression subscore and the BSFC correlate with r = 0.75. The HADS anxiety subscore and the BSFC correlate with r = 0.59.

CONCLUSIONS

Results suggest the need for routine clinical assessment of mothers' well-being when their children are affected by speech impairment.

Motor profile of children with developmental speech and language disorders

OBJECTIVES

The purpose of this study was to investigate the motor profile of 125 children with developmental speech and language disorders and to test for differences, if any, in motor profile among subgroups of children with developmental speech and language disorders.

METHODS

The participants were 125 children with developmental speech and language disorders aged 6 to 9 years from 2 special schools for children with communication problems in the northern Netherlands. They were tested with the Movement Assessment Battery for Children. The children were classified by the schools' speech and language therapists into 3 subgroups on the basis of language tests, oral motor tests, and clinical examinations: children with speech disorders (n = 14), language disorders (n = 46), or both (n = 65).

RESULTS

Compared with the norms of the Movement Assessment Battery for Children, children with developmental speech and language disorders performed significantly less well. Results showed that 51% of the children with developmental speech and language disorders had borderline or definite motor problems. Children with language disorders had significantly lower scores (ie, better performance) on the ball-skills subtest and the total test than children with speech disorders and children with both speech and language disorders. Furthermore, children with language disorders had significantly better performance on the balance subtest than children with both speech and language disorders.

CONCLUSIONS

The findings of this study support the idea that developmental speech and language disorders are frequently associated with motor problems and that the kind of developmental speech and language disorders affects motor performance differently. Speech and language disorders seem to have more impact on motor performance than only language disorders, and it seems that when speech production is affected, motor problems are more pronounced. The findings support the need to give early and more attention to the motor skills of children with developmental speech and language disorders in the educational and home setting, with special attention to children whose speech is affected.

The Prevalence of Stuttering, Voice, and Speech-Sound Disorders in Primary School Students in Australia

Purpose

The aims of this study were threefold: to report teachers' estimates of the prevalence of speech disorders (specifically, stuttering, voice, and speech-sound disorders); to consider correspondence between the prevalence of speech disorders and gender, grade level, and socioeconomic status; and to describe the level of support provided to schoolchildren with speech disorders.

Method

Students with speech disorders were identified from 10,425 students in Australia using a 4-stage process: training in the data collection process, teacher identification, confirmation by a speech-language pathologist, and consultation with district special needs advisors.

Results

The prevalence of students with speech disorders was estimated; specifically, 0.33% of students were identified as stuttering, 0.12% as having a voice disorder, and 1.06% as having a speech-sound disorder. There was a higher prevalence of speech disorders in males than in females. As grade level increased, the prevalence of speech disorders decreased. There was no significant difference in the pattern of prevalence across the three speech disorders and four socioeconomic groups; however, students who were identified with a speech disorder were more likely to be in the higher socioeconomic groups. Finally, there was a difference between the perceived and actual level of support that was provided to these students.

Conclusion

These prevalence figures are lower than those using initial identification by speech-language pathologists and similar to those using parent report.

Demographics of Preschoolers Who Require AAC

Purpose

The purpose of the investigation was to gather demographic information pertaining to preschoolers who require augmentative and alternative communication (AAC).

Method

To obtain this information, a survey was developed and then distributed to preschool speech-language pathologists (SLPs) in Pennsylvania.

Results

Results indicated that approximately 12% of preschoolers receiving special education services required AAC. These children came from diverse ethnic and racial backgrounds, had a wide variety of disabilities, used a range of AAC systems, and required services from a wide range of educational professionals.

Implications

The findings indicate the pressing need for all preschool SLPs to be prepared to provide services for children who require AAC.

[Subjective aspects in mothers of speech impaired children]

OBJECTIVE

The purpose of this study was to evaluate the subjective burden in mothers of speech impaired children against the presence or absence of emotional disorders such as anxiety and depression.

METHODS

A total of 89 mothers (age 33.3+/-5.5 years, range: 19.6-43.8 years) of 89 speech impaired preschool children (23 girls, 66 boys, age: 3.9+/-1.5 years, range: 1.6-7.1 years) were examined. Screening for a depressive or anxiety disorder was performed using the German version of the Hospital Anxiety and Depression Scale HADS-D. The "Short Questionnaire on Current Burden" (Kurzfragebogen zur Aktuellen Belastung, KAB) was used to measure the level of perceived subjective burden at the time of the investigation.

RESULTS

A higher score in the KAB test occurred significantly more often in mothers with a positive HADS depression/anxiety subscale result than in those with a negative one.

CONCLUSIONS

There is a need for specific assessment of wellbeing in mothers of speech impaired children. In clinical practice, one may restrict oneself to the use of a screening test for anxiety and depression.