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Fujiki RB, Lien KM, Munday J, Thibeault SL. Socioeconomic Deprivation Detrimentally Influences Language Outcomes in Toddlers With Cleft Palate. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3113-3132. [PMID: 39173117 PMCID: PMC11427525 DOI: 10.1044/2024_jslhr-24-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/16/2024] [Accepted: 06/27/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE The purpose of this study was to examine the influence of socioeconomic deprivation on language and developmental outcomes in toddlers with cleft palate with or without cleft lip (CP ± L). Other factors known to influence language outcomes were also considered, including home language history, history of hearing problems, syndromic diagnoses, and sex. METHOD A multicenter, cross-sectional study design was conducted. Data for 566 16-month-old toddlers with CP ± L were collected from 17 outpatient cleft palate clinics located throughout the United States. Outcome measures included the MacArthur-Bates Communicative Development Inventories, LENA Developmental Snapshot, age at first word as reported by the caregiver, and the Ages and Stages Questionnaires-Third Edition (ASQ-3). Multivariable linear or logistic regression was used to determine the influence of socioeconomic deprivation, as measured by the Area Deprivation Index, on language and developmental outcomes. RESULTS Greater socioeconomic deprivation significantly predicted poorer language outcomes in toddlers with CP ± L, including receptive vocabulary words (p = .02), expressive vocabulary words (p = .02), and late-developing gestures (p = .02). Additionally, toddlers from less affluent neighborhoods produced their first words significantly later than their counterparts living in more affluent areas (p < .01). Lower maternal education levels predicted significantly increased risk for problem solving delays (p < .01), and patients with subsidized insurance were at significantly increased risk for personal-social delays on the ASQ-3 (p < .01). CONCLUSIONS Children with CP ± L are susceptible to developmental delays associated with socioeconomic deprivation. These findings have implications for identifying a child's individual risk factors for developmental language disorders when conducting speech-language assessments. Future study should examine how inequities in care can be mitigated and addressed.
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Affiliation(s)
| | - Kari M. Lien
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - John Munday
- Department of Surgery, University of Wisconsin–Madison
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Gisselsson-Solen M, Gunasekera H, Hall A, Homoe P, Kong K, Sih T, Rupa V, Morris P. Panel 1: Epidemiology and global health, including child development, sequelae and complications. Int J Pediatr Otorhinolaryngol 2024; 178:111861. [PMID: 38340606 DOI: 10.1016/j.ijporl.2024.111861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To summarise the published research evidence on the epidemiology of otitis media, including the risk factors and sequelae associated with this condition. DATA SOURCES Medline (PubMed), Embase, and the Cochrane Library covering the period from 2019 to June 1st, 2023. REVIEW METHODS We conducted a broad search strategy using otitis [Medical Subject Heading] combined with text words to identify relevant articles on the prevalence, incidence, risk factors, complications, and sequelae for acute otitis media, otitis media with effusion, and chronic suppurative otitis media. At least one review author independently screened titles and abstracts of the retrieved records for each condition to determine whether the research study was eligible for inclusion. Any discrepancies were resolved by reviewing the full text followed by discussion with a second review author. Studies with more than 100 participants were prioritised. RESULTS Over 2,000 papers on otitis media (OM) have been published since 2019. Our review has highlighted around 100 of these publications. While the amount of otitis media research on the Medline database published each year has not increased, there has been an increase in epidemiological studies using routinely collected data and systematic review methodology. Most of the large incidence studies have addressed acute otitis media (AOM) in children. Several studies have described a decrease in incidence of AOM after the introduction of conjugate PCV vaccines. Similarly, a decrease was noted when rates of coronavirus disease of 2019 (COVID-19) were high and there were major public health efforts to reduce the spread of infection. There have been new studies on OM in adults and OM prevalence in a broader range of countries and population subgroups. CONCLUSION Overall, the rates of severe and/or suppurative OM appeared to be decreasing. However, there is substantial heterogeneity between populations. While better use of available data is informative, it can be difficult to predict rates of severe disease without accurate examination findings. Most memorably, the COVID-19 pandemic had an enormous impact on the research and clinical services for otitis media for most of the period under review. IMPLICATIONS FOR PRACTICE The use of routinely collected data for epidemiological studies will lead to greater variability in the definitions and diagnostic criteria used. The impact of new vaccines will continue to be important. Some of the lessons learned during the COVID-19 pandemic concerning behaviours that reduce spread of respiratory viruses can hopefully be used to decrease the burden of otitis media in the future. There are still many countries in the world where the burden of otitis media is not well described. In countries where otitis media has been studied over many years, new potential risk factors continue to be identified. In addition, a better understanding of the disease in specific subgroups has been achieved.
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Affiliation(s)
- Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden.
| | - Hasantha Gunasekera
- Children's Hospital Westmead Clinical School, University of Sydney, Australia
| | | | - Preben Homoe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zeeland University Hospital, Koege, Denmark
| | - Kelvin Kong
- School of Medicine and Public Health, Newcastle, Australia
| | - Tania Sih
- Medical School University of Sao Paolo, Brazil
| | | | - Peter Morris
- Menzies School of Health Research Charles Darwin University Darwin, Australia
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De Ryck M, Van Lierde K, Alighieri C, Hens G, Bettens K. A protocol for a randomized-controlled trial to investigate the effect of infant sign training on the speech-language development in young children born with cleft palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:2212-2221. [PMID: 37376898 DOI: 10.1111/1460-6984.12920] [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: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Children born with a cleft palate with or without cleft lip (CP ± L) are known to be at risk for speech-language disorders that impact educational and social-emotional growth. It is hypothesized that speech-language intervention delivered before the age of 3 years could decrease the impact of CP ± L on speech-language development. Infant sign training in combination with verbal input expands the natural communication of young children including multimodal speech-language input (i.e., verbal and manual input) via caregivers who act as co-therapists. AIMS To determine the effectiveness of infant sign training in 1-year-old children with CP ± L by comparing different interventions. METHODS & PROCEDURES This is a two-centre, randomized, parallel-group, longitudinal, controlled trial. Children are randomized to either an infant sign training group (IST group), a verbal training group (VT group) or no intervention control group (C group). Caregivers of children who are assigned to the IST group or VT group will participate in three caregiver training meetings to practise knowledge and skills to stimulate speech-language development. Outcome measures include a combination of questionnaires, language tests and observational analyses of communicative acts. OUTCOMES & RESULTS It is hypothesized that speech-language development of children with CP ± L will benefit more from IST compared with VT and no intervention. Additionally, the number and quality of communicative acts of both children and caregivers are expected to be higher after IST. CONCLUSIONS & IMPLICATIONS This project will contribute to the development of evidence-based clinical practice guidelines regarding early speech-language intervention in children with CP ± L under the age of 3 years. WHAT THIS PAPER ADDS What is already known on the subject Children with CP ± L are known to be at risk for speech-language delays that impact educational and social emotional growth. Given the limited scientific prove of the impact of early speech-language intervention, no standardized clinical practice guidelines are available yet for children with CP ± L under the age of 3 years. Early intervention in this population mostly focuses on improving verbal input via caregivers or professionals without including a multimodal language input. A growing scientific interest has been seen in the use of infant signs to support speech-language development and caregiver-child interaction in typically developing children and children with developmental delays. What this study adds to existing knowledge No evidence is yet available for the effectiveness and feasibility of early intervention based on infant sign training in combination with verbal input to improve speech-language skills in young children with CP ± L. The current project will investigate the effect of infant sign training on the speech-language development in this population. Outcome measures are compared with those of two control groups: verbal training only and no intervention. It is hypothesized that infant signs may support the intelligibility of verbal utterances produced by children with CP ± L. Improving children's intelligibility may increase the opportunities for these children to engage in early, frequent and high-quality interactions with their caregivers resulting in a richer social and linguistic environment. As a result, infant sign training may result in better speech-language skills compared with the control interventions. What are the potential or actual clinical implications of this work? If providing early intervention based on infant sign training is effective, there is the potential for improved speech-language outcomes in early childhood, resulting in increased speech intelligibility, increased well-being of the child and family and less need for speech-language therapy on the long-term. This project will contribute to the development of evidence-based clinical practice guidelines regarding early speech-language intervention in children with CP ± L under the age of 3 years.
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Affiliation(s)
- Mira De Ryck
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Greet Hens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Cleft Lip and Palate Team, University Hospitals Leuven, Leuven, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
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Okhiria Å, Persson C, Johansson MB, Hakelius M, Nowinski D. Longitudinal data on speech outcomes in internationally adopted children compared with non-adopted children with cleft lip and palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1440-1453. [PMID: 36929536 DOI: 10.1111/1460-6984.12869] [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: 05/24/2022] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7-8 years, but later development remains unstudied. AIMS To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non-adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. METHODS & PROCEDURES In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow-ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC-Sum) for single words and rated on a three-point scale (VPC-Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in-depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s-errors. Information on secondary palatal surgery and number of visits to an SLP was collected. OUTCOMES & RESULTS VPF differed significantly between the groups at both ages when assessed with VPC-Sum, but not with VPC-Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s-errors at age 5 years, and CSCs and s-errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. CONCLUSIONS & IMPLICATIONS CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre-school years. WHAT THIS PAPER ADDS What is already known on this subject At the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7-8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft-related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledge This longitudinal study provides additional knowledge based on longer follow-ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft-related articulation errors. What are the potential or actual clinical implications of this work? Speech and language therapy should target both cleft-related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre-school years, not least for adopted children.
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Affiliation(s)
- Åsa Okhiria
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Christina Persson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monica Blom Johansson
- Department of Public Health and Caring Sciences, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - Malin Hakelius
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Daniel Nowinski
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
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Willadsen E, Jørgensen LD, Alaluusua S, Pedersen NH, Nielsen JB, Hölttä E, Hide Ø, Hayden C, Havstam C, Hammarström IL, Davies J, Boers M, Andersen HS, Aukner R, Jackson Morris D, Nielsen SF, Semb G, Lohmander A, Persson C. Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:892-909. [PMID: 36541222 DOI: 10.1111/1460-6984.12830] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/21/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND & AIM To assess consonant proficiency and velopharyngeal function in 10-year-old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project. METHODS & PROCEDURES Three parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B-Lip and soft palate closure at 3-4 months, hard palate closure at 36 months, Arm C-Lip closure at 3-4 months, hard and soft palate closure at 12 months, and Arm D-Lip closure at 3-4 months combined with a single-layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A-Lip and soft palate closure at 3-4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non-syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC-Rate), and a composite measure (VPC-Sum) were reported. OUTCOMES & RESULTS The mean levels of consonant proficiency (PCC score) in the trial arms were 86-92% and between 58% and 83% of the children had VPC (VPC-Sum). Only 50-73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%). CONCLUSIONS & IMPLICATIONS The speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years. WHAT THIS PAPER ADDS What is already known on the subject Speech outcomes at 10 years of age in children treated for UCLP are sparse and contradictory. Previous studies have examined speech outcomes and the relationship with surgical intervention in 5-year-olds. What this study adds to the existing knowledge Speech outcomes based on standardized assessment in a large group of 10-year-old children born with UCLP and surgically treated according to different protocols are presented. While speech therapy had been provided, a large proportion of the children across treatment protocols still needed further speech therapy. What are the potential or actual clinical implications of this work? Aspects other than surgery and speech function might add to the understanding of what affects speech outcome. Effective speech therapy should be available for children in addition to primary surgical repair of the cleft and secondary surgeries if needed.
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Affiliation(s)
- E Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - L D Jørgensen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - S Alaluusua
- Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | - E Hölttä
- Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Ø Hide
- Department of Speech and Language Disorders, Statped sørøst, Oslo, Norway
| | - C Hayden
- The Royal Hospital for Sick Children, Belfast, UK
| | - C Havstam
- Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I L Hammarström
- Division of Speech and Language Pathology, Linköping University, Linköping, Sweden
| | - J Davies
- Greater Manchester Cleft Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - M Boers
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - H S Andersen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - R Aukner
- Department of Speech and Language Disorders, Statped sørøst, Oslo, Norway
| | - D Jackson Morris
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - S F Nielsen
- Copenhagen Business School, Center for Statistics, Copenhagen, Denmark
| | - G Semb
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - A Lohmander
- Division of Speech and Language Pathology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - C Persson
- Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bettens K, Alighieri C, Bruneel L, D'haeseleer E, Luyten A, Sseremba D, Musasizib D, Ojok I, Hodges A, Galiwango G, Vermeersch H, Van Lierde K. Better speech outcomes after very early palatal repair?-A longitudinal case-control study in Ugandan children with cleft palate. JOURNAL OF COMMUNICATION DISORDERS 2022; 96:106198. [PMID: 35217335 DOI: 10.1016/j.jcomdis.2022.106198] [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: 06/28/2021] [Revised: 01/11/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Children born with cleft palate with or without cleft lip (CP±L) tend to use less oral pressure consonants and more glottal sounds in their babbling. The purpose of very early palatal repair (i.e., one-stage palatal closure prior to 6 months of age) is to make the palate functional before the onset of speech acquisition to reduce the anchoring of wrong patterns in the child's developing phonological system. As a result, less compensatory articulation errors are expected to be present. Currently, no detailed longitudinal speech outcomes after very early palatal closure are available. This study aimed to provide longitudinal speech outcomes in Ugandan children with CP±L who received palatal closure prior to the age of 6 months. METHODS Ten children with CP±L were assessed at a mean age of 5 and 10 years old. Speech understandability, speech acceptability, resonance, nasal airflow and articulation were perceptually rated by two experienced speech-language pathologists. Velopharyngeal function was estimated using the velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary (speech) surgery was collected. The outcomes were compared with the longitudinal outcomes of an age- and gender-matched control group of 10 Ugandan children without CP±L. RESULTS Speech understandability and acceptability improved significantly over time in the group with CP±L (all p's ≤ 0.05, all Z's > -2.43). At both test dates, significantly worse judgments were found for the group with CP±L compared to the control group for these variables and variables related to passive speech errors (all p's ≤ 0.05, all Z's > 2.49). A statistically significant difference with the control group was found for the presence of compensatory articulation errors at the age of 5 years but not at the age of 10 years, indicating a catch up by the children with CP±L. CONCLUSION Whether a one-stage palatal closure prior to the age of 6 months is more favorable for speech outcomes compared to one-stage palatal closure at 12 months is still not clear. Speech of the children with CP±L improved over time, but significantly differed from the control group at the age of 5 and 10 years old. Limited access to health care facilities and possible influence of malnutrition on wound healing need to be considered when interpreting the results. Whether palatal closure prior to the age of 6 months is transferable to other countries is subject for further research, including both longitudinal and prospective designs with larger samples.
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Affiliation(s)
- Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium.
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Anke Luyten
- Speech Pathology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Daniel Sseremba
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Duncan Musasizib
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Isaac Ojok
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Andrew Hodges
- Department of Plastic and Reconstructive Surgery, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - George Galiwango
- Department of Plastic and Reconstructive Surgery, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Hubert Vermeersch
- Department of Head and Skin, Ghent University, Ghent, Belgium; Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South-Africa
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The maturational gradient of infant vocalizations: Developmental stages and functional modules. Infant Behav Dev 2021; 66:101682. [PMID: 34920296 DOI: 10.1016/j.infbeh.2021.101682] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/29/2022]
Abstract
Stage models have been influential in characterizing infant vocalizations in the first year of life. These models are basically descriptive and do not explain why certain types of vocal behaviors occur within a particular stage or why successive patterns of vocalization occur. This review paper summarizes and elaborates a theory of Developmental Functional Modules (DFMs) and discusses how maturational gradients in the DFMs explain age typical vocalizations as well as the transitions between successive stages or other static forms. Maturational gradients are based on biological processes that effect the reconfiguration and remodeling of the respiratory, laryngeal, and craniofacial systems during infancy. From a dynamic systems perspective, DFMs are part of a complex system with multiple degrees of freedom that can achieve stable performance with relatively few control variables by relying on principles such as synergies, self-organization, nonlinear performance, and movement variability.
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Gipson TT, Ramsay G, Ellison EE, Bene ER, Long HL, Oller DK. Early Vocal Development in Tuberous Sclerosis Complex. Pediatr Neurol 2021; 125:48-52. [PMID: 34628143 DOI: 10.1101/2021.01.06.21249364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Our goal was to assess for the first time early vocalizations as precursors to speech in audio-video recordings of infants with tuberous sclerosis complex (TSC). METHODS We randomly selected 40 infants with TSC from the TSC Autism Center of Excellence Research Network dataset. Using human observers, we analyzed 74 audio-video recordings within a flexible software-based coding environment. During the recordings, infants were engaged in developmental testing. We determined syllables per minute (volubility), the number of consonant-vowel combinations, such as 'ba' (canonical babbling), and the canonical babbling ratio (canonical syllables/total syllables) and compared the data with two groups of typically developing (TD) infants. One comparison group's data had come from a laboratory setting, while the other's had come from all-day Language Environment Analysis recordings at home. RESULTS Compared with TD infants in laboratory and all-day Language Environment Analysis recordings, entry into the canonical babbling stage was delayed in the majority of infants with TSC, and the canonical babbling ratio was low (TD mean = 0.346, SE = 0.19; TSC mean = 0.117, SE = 0.023). Volubility level in infants with TSC was less than half that of TD infants (TD mean = 9.82, SE = 5.78; TSC mean = 3.99, SE = 2.16). CONCLUSIONS Entry into the canonical stage and other precursors of speech development were delayed in infants with TSC and may signal poor language and developmental outcomes. Future studies are planned to assess prediction of language and developmental outcomes using these measures in a larger sample and in more precisely comparable recording circumstances.
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Affiliation(s)
- Tanjala T Gipson
- University of Tennessee Health Sciences Center, Boling Center for Disabilities, Le Bonheur Children's Hospital, Memphis, Tennessee.
| | - Gordon Ramsay
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ellen E Ellison
- University of Tennessee Health Sciences Center, Boling Center for Disabilities, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Edina R Bene
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee
| | - Helen L Long
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee
| | - D Kimbrough Oller
- University of Memphis, School of Communication Sciences and Disorders, Institute for Intelligent Systems, Memphis, Tennessee; Konrad Lorenz Institute for Evolution and Cognition Research, Klosterneuburg, Austria
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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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