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Highman C, Overby M, Leitão S, Abbiati C, Velleman S. Update on Identification and Treatment of Infants and Toddlers With Suspected Childhood Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-21. [PMID: 37441847 DOI: 10.1044/2023_jslhr-22-00639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
PURPOSE The purpose of this tutorial is to (a) provide an updated review of the literature pertaining to proposed early features of childhood apraxia of speech (CAS), (b) discuss the findings of recent treatment studies of infants and toddlers with suspected CAS (sCAS), and (c) present evidence-based strategies and tools that can be used for the identification of and intervention for infants and toddlers with sCAS or at high risk for the disorder. METHOD Since Davis and Velleman's (2000) seminal work on assessment and intervention in infants and toddlers with sCAS, limited research has guided clinicians in the complex task of identifying and treating early speech motor difficulties prior to a definitive diagnosis of CAS. Following the structure of Davis and Velleman, we explore the proposed early characteristics of CAS with reference to contemporary research. Next, we describe the limited treatment studies that have investigated intervention for infants and toddlers at risk of or suspected of having CAS. Finally, we present practical suggestions for integrating this knowledge into clinical practice. CONCLUSIONS Many of the originally proposed correlates of CAS in infants and toddlers now have research supporting their presence. However, questions remain about the developmental trajectory of the disorder. Although limited in number and restricted by lack of experimental control, emerging treatment studies can help guide clinicians in providing appropriate intervention to infants and toddlers with sCAS who need not wait for a definitive diagnosis to initiate intervention.
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Affiliation(s)
- Chantelle Highman
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Megan Overby
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Suze Leitão
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Claudia Abbiati
- Department of Communication Sciences and Disorders, University of Vermont, Burlington
| | - Shelley Velleman
- Department of Communication Sciences and Disorders, University of Vermont, Burlington
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Persson A, Flynn T, Miniscalco C, Lohmander A. Impact of auditory variables on consonant production in babbling and early speech in children with moderate hearing loss - a longitudinal study. CLINICAL LINGUISTICS & PHONETICS 2022; 36:833-848. [PMID: 34324384 DOI: 10.1080/02699206.2021.1958260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/09/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
This longitudinal study aimed to investigate early consonant production and the impact of hearing aid (HA) use, and aided audibility in Swedish children with moderate hearing loss (CHL) who received amplification before 6 months of age. CHL (n = 11) and children with normal hearing (CNH) (n = 11) were followed-up at 10, 18, and 36 months of age. At 10 months of age, the CHL used significantly fewer oral stops (p < 0.01), dental/alveolar stops (p < 0.05) and had a significantly fewer number of different true consonants (p < 0.01). At 18 months, there were no significant differences between the groups regarding presence of oral stops, and dental/alveolar stops, but the significant difference in the number of different true consonants remained (p < 0.00). At 36 months of age, consonant proficiency did not differ between the groups. A higher number of hours of HA use was associated with the presence of consonant variables at 10 months. Aided audibility showed weak to moderate correlations with number of consonants produced and proficiency. This group of children presented with initial delays in their early consonant production but seemed to catch up as they aged. Consistency of HA use from initial fitting is an important factor that may decrease the possible delays in the development of early consonant production and proficiency in CHL by 36 months of age.
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Affiliation(s)
- Anna Persson
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Hearing Habilitation for Children and Youth, Karolinska University Hospital, Stockholm, Sweden
| | - Traci Flynn
- School of Humanities and Social Sciences, College of Human and Social Futures, University of Newcastle, Callaghan, Australia
| | - Carmela Miniscalco
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child Neuropsychiatry, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Huddinge, Sweden
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Persson A, Marklund U, Lohmander A, Flynn T. Expressive vocabulary development in children with moderate hearing loss - the impact of auditory variables and early consonant production. CLINICAL LINGUISTICS & PHONETICS 2022; 36:547-564. [PMID: 34231440 DOI: 10.1080/02699206.2021.1944321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
In this study, the early expressive vocabulary development was investigated in a group of children with moderate hearing loss (HL). Size and development of expressive vocabulary from 18 30 months were analyzed and compared to a group of children with normal hearing (NH). For the children with HL, the impact of auditory variables on number of words were examined. The relationship of early consonant production to number of words produced of both groups were examined and the phonological complexity of reported words was compared between the groups. The results showed that children with HL (n = 8) produced a similar number of words as the NH (n = 8) at 18 months, but fewer at 24 and 30 months. Hours of HA use showed significant correlations to number of words. The number of different true consonants at 18 months for the whole group showed a significant relationship to number of words produced at 24 months. No significant differences were found between children with HL and NH children regarding phonological complexity of reported words. The findings indicate that the children born with moderate HL who were fitted with hearing aids (HAs) before 6 months of age are at risk in their development of expressive vocabulary. Full-time use of HAs and monitoring of early consonant use should be encouraged in the early intervention of this target group.
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Affiliation(s)
- Anna Persson
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Hearing Habilitation for Children and Youth, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Marklund
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication, Linköping University, Sweden
- Department of Neurology, Speech-Language Pathology Clinic, Danderyd Hospital, Stockholm, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology Speech and Language Pathology, Karolinska University Hospital, Huddinge, Sweden
| | - Traci Flynn
- School of Humanities and Social Sciences, College of Human and Social Futures, University of Newcastle, Newcastle, Australia
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Bartl-Pokorny KD, Pokorny FB, Garrido D, Schuller BW, Zhang D, Marschik PB. Vocalisation Repertoire at the End of the First Year of Life: An Exploratory Comparison of Rett Syndrome and Typical Development. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2022; 34:1053-1069. [PMID: 36345311 PMCID: PMC9633508 DOI: 10.1007/s10882-022-09837-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 05/27/2023]
Abstract
Rett syndrome (RTT) is a rare, late detected developmental disorder associated with severe deficits in the speech-language domain. Despite a few reports about atypicalities in the speech-language development of infants and toddlers with RTT, a detailed analysis of the pre-linguistic vocalisation repertoire of infants with RTT is yet missing. Based on home video recordings, we analysed the vocalisations between 9 and 11 months of age of three female infants with typical RTT and compared them to three age-matched typically developing (TD) female controls. The video material of the infants had a total duration of 424 min with 1655 infant vocalisations. For each month, we (1) calculated the infants' canonical babbling ratios with CBRUTTER, i.e., the ratio of number of utterances containing canonical syllables to total number of utterances, and (2) classified their pre-linguistic vocalisations in three non-canonical and four canonical vocalisation subtypes. All infants achieved the milestone of canonical babbling at 9 months of age according to their canonical babbling ratios, i.e. CBRUTTER ≥ 0.15. We revealed overall lower CBRsUTTER and a lower proportion of canonical pre-linguistic vocalisations consisting of well-formed sounds that could serve as parts of target-language words for the RTT group compared to the TD group. Further studies with more data from individuals with RTT are needed to study the atypicalities in the pre-linguistic vocalisation repertoire which may portend the later deficits in spoken language that are characteristic features of RTT.
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Affiliation(s)
- Katrin D. Bartl-Pokorny
- iDN – interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Florian B. Pokorny
- iDN – interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Dunia Garrido
- Mind, Brain, and Behaviour Research Centre, University of Granada, Granada, Spain
| | - Björn W. Schuller
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
- GLAM – Group on Language, Audio, & Music, Department of Computing, Imperial College London, London, UK
| | - Dajie Zhang
- iDN – interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- Child and Adolescent Psychiatry and Psychotherapy, Systemic Ethology and Developmental Science, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
| | - Peter B. Marschik
- iDN – interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- Child and Adolescent Psychiatry and Psychotherapy, Systemic Ethology and Developmental Science, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Nyman A, Strömbergsson S, Lohmander A. Canonical babbling ratio - Concurrent and predictive evaluation of the 0.15 criterion. JOURNAL OF COMMUNICATION DISORDERS 2021; 94:106164. [PMID: 34773732 DOI: 10.1016/j.jcomdis.2021.106164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Canonical babbling ratio (CBR) is a commonly used measure to quantify canonical babbling (CB), and 0.15 is the commonly accepted criterion for the canonical babbling stage. However, this has not been thoroughly investigated. The aim of this study was to evaluate the validity of this criterion using concurrent and predictive comparisons. METHODS Longitudinal data from 50 children recruited in different clinical projects were used. At 10 months of age, CBR was calculated based on counted utterances from audio-video recorded parent-child interactions. The videos were also assessed by CB observation, where an observer made an overall judgement on whether the child was in the canonical babbling stage or not. For the concurrent evaluation, CBR was compared to CB observation as a reference test, using area under the curve (AUC). The criterion resulting in the best combination of sensitivity and specificity was identified using positive likelihood ratios. In the predictive comparisons CBR was analyzed as a predictor of speech/language difficulties at 30-36 months. Participants presenting with difficulties in consonant production and/or parent-reported vocabulary were considered to have speech/language difficulties. Sensitivity and specificity were compared for CBR using the 0.15 criterion and the new criterion identified in this study. RESULTS An AUC of 0.87 indicated that CBR is a valid measure of canonical babbling in 10-month-old children. The best combination of sensitivity and specificity was found at a criterion of 0.14 (sensitivity 0.96, specificity 0.70). In the predictive comparison, CBR with a 0.14 or 0.15 criterion revealed the same sensitivity (0.71) but 0.14 showed a slightly better specificity (0.52 versus 0.42). CONCLUSIONS CBR is a valid measure of CB (at 10 months). However, when using CBR to classify children's babbling as canonical or non-canonical, researchers need to carefully consider the implications of the chosen criterion.
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Affiliation(s)
- Anna Nyman
- Division of Speech and Language Pathology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Habilitation and Health, Region Stockholm, Stockholm, Sweden.
| | - Sofia Strömbergsson
- Division of Speech and Language Pathology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech-Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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Sahlén B, Ibertsson T, Asker-Árnason L, Brännström J, Hansson K. Best ear hearing level, time factors and language outcome in Swedish children with mild and moderate hearing loss with hearing aids. LOGOP PHONIATR VOCO 2021; 47:239-248. [PMID: 34287105 DOI: 10.1080/14015439.2021.1951347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The risk for language disorder is high in children with all levels of hearing loss (HL). Early identification and intervention should be as important for children with mild HL as for those with more severe HL. Despite new-born hearing screening, a recent survey of speech language therapist services in southern Sweden indicates that children with mild and moderate HL are severely neglected when it comes to language assessment and language intervention. In this study we explore associations between Best Ear Hearing Level (BEHL), time factors and language skills in Swedish children with HL with hearing aids (HA). METHOD Participants were 19 children with mild HL (BEHL 23-39) and 22 children with moderate HL (BEHL 40-70) aged 5-15 years. Information on age at diagnosis and at HA fitting were collected. The children performed a nonword repetition and a sentence comprehension task. RESULTS The time elapsed between diagnosis and fitting with HA was longer for the children with mild HL.Participants with mild HL received their HA significantly later than children with moderate HL. No association between BEHL and the two language measures was found, and language skills were not better in children with mild than moderate HL. 17% of participants performed below cut-off for language disorder on both language measures. CONCLUSION Given the risk for long-term academic and social consequences of even mild HL delayed HA intervention for children with HLleads to serious concerns by families, clinicians, and pedagogues.
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Affiliation(s)
- Birgitta Sahlén
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Tina Ibertsson
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Lena Asker-Árnason
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Jonas Brännström
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Kristina Hansson
- Department of Clinical Sciences, Lund, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
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Persson AE, Al-Khatib D, Flynn T. Hearing Aid Use, Auditory Development, and Auditory Functional Performance in Swedish Children With Moderate Hearing Loss During the First 3 Years. Am J Audiol 2020; 29:436-449. [PMID: 32693611 DOI: 10.1044/2020_aja-19-00092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose This study investigated longitudinal hearing aid (HA) use in a cohort of children with moderate hearing loss (CHL), fitted with amplification before the age of 6 months. Additionally, the relationship of HA use and aided audibility on outcomes of parental questionnaires of auditory skills was examined, and these outcomes were compared to a group of children with normal hearing (CNH). Method Nine CHL and 29 CNH and their parents participated in the study. Measures were collected at initial fitting, 10, 18, 24, 30, and 36 months of age. Parents reported hours of HA use and situations the HAs were used. Datalogging and speech intelligibility index were also collected. Auditory skills were measured through parental questionnaires. Results The mean hours of HA use/day for this cohort increased from 7.55 at the ages of 10 months to 10.15 at 36 months according to datalogging. Parental estimations of hours of HA use and in which situations varied between subjects. Correlations between HA use from datalogging and speech intelligibility index to measures of auditory skills were weak. CHL showed similar results to CNH on auditory development at the ages of 10, 18, and 24 months but presented with significantly lower scores on auditory functional performance in noise at 30 and 36 months of age. Conclusions Longitudinal monitoring of HA use from fitting of amplification with the combination of objective and subjective tools may have a positive impact on HA use in CHL. The lower scores on listening in noise compared to CNH call for further attention.
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Affiliation(s)
- Anna Elisabeth Persson
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Hearing Habilitation for Children and Youth, Karolinska University Hospital, Stockholm, Sweden
| | - Dareen Al-Khatib
- Department of Hearing Habilitation for Children and Youth, Karolinska University Hospital, Stockholm, Sweden
| | - Traci Flynn
- School of Humanities and Social Sciences, University of Newcastle, Callaghan, New South Wales, Australia
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