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Storkel HL. Minimal, Maximal, or Multiple: Which Contrastive Intervention Approach to Use With Children With Speech Sound Disorders? Lang Speech Hear Serv Sch 2022; 53:632-645. [PMID: 35179980 DOI: 10.1044/2021_lshss-21-00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This tutorial contrasts a familiar and frequently used speech sound disorder (SSD) intervention approach, conventional minimal pair, with newer but less familiar and less frequently used variants that may be more effective: (a) maximal opposition and (b) multiple oppositions. METHOD This tutorial provides a general description of each contrastive approach, focusing on the evidence base and a small number of critical elements that define the approach and make it unique from all other approaches. Hypothetical cases are used to illustrate how the approaches can be tailored to child needs and speech-language pathologist (SLP) expertise. Supplemental materials enhance the reader's skill in using these approaches in their practice with a minimal initial investment. RESULTS The reader will be able to identify which children with SSD are appropriate for conventional minimal pair, maximal opposition, or multiple oppositions approaches and will be able to plan intervention (i.e., select target sounds and contrasting words or nonwords, develop intervention activities, write goals, and determine intervention intensity) for each of these approaches. CONCLUSIONS This tutorial highlights that using the conventional minimal pair approach should be restricted to children with a small number of errors (i.e., older children or children with mild SSD). There is an opportunity for SLPs to use newer, more efficacious approaches with younger children and children with more severe SSDs. The maximal opposition approach is well suited to children with multiple errors across multiple sound classes. The multiple oppositions approach specifically targets global phoneme collapses that impact intelligibility. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19178783.
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Affiliation(s)
- Holly L Storkel
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
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Sugden E, Baker E, Munro N, Williams AL, Trivette CM. Service delivery and intervention intensity for phonology-based speech sound disorders. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:718-734. [PMID: 29900638 DOI: 10.1111/1460-6984.12399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/16/2018] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND When planning evidence-based intervention services for children with phonology-based speech sound disorders (SSD), speech and language therapists (SLTs) need to integrate research evidence regarding service delivery and intervention intensity within their clinical practice. However, relatively little is known about the optimal intensity of phonological interventions and whether SLTs' services align with the research evidence. AIMS The aims are twofold. First, to review external evidence (i.e., empirical research evidence external to day-to-day clinical practice) regarding service delivery and intervention intensity for phonological interventions. Second, to investigate SLTs' clinical practice with children with phonology-based SSD in Australia, focusing on service delivery and intensity. By considering these complementary sources of evidence, SLTs and researchers will be better placed to understand the state of the external evidence regarding the delivery of phonological interventions and appreciate the challenges facing SLTs in providing evidence-based services. METHODS & PROCEDURES Two studies are presented. The first is a review of phonological intervention research published between 1979 and 2016. Details regarding service delivery and intervention intensity were extracted from the 199 papers that met inclusion criteria identified through a systematic search. The second study was an online survey of 288 SLTs working in Australia, focused on the service delivery and intensity of intervention provided in clinical practice. MAIN CONTRIBUTIONS There is a gap between the external evidence regarding service delivery and intervention intensity and the internal evidence from clinical practice. Most published intervention research has reported to provide intervention two to three times per week in individual sessions delivered by an SLT in a university clinic, in sessions lasting 30-60 min comprising 100 production trials. SLTs reported providing services at intensities below that found in the literature. Further, they reported workplace, client and clinician factors that influenced the intensity of intervention they were able to provide to children with phonology-based SSD. CONCLUSIONS & IMPLICATIONS Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice.
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Affiliation(s)
- Eleanor Sugden
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Discipline of Speech Pathology, University of Sydney, Sydney, NSW, Australia
| | - Elise Baker
- Discipline of Speech Pathology, University of Sydney, Sydney, NSW, Australia
| | - Natalie Munro
- Discipline of Speech Pathology, University of Sydney, Sydney, NSW, Australia
| | - A Lynn Williams
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, USA
| | - Carol M Trivette
- Department of Early Childhood Education, East Tennessee State University, Johnson City, TN, USA
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McLeod S, Baker E, McCormack J, Wren Y, Roulstone S, Crowe K, Masso S, White P, Howland C. Cluster-Randomized Controlled Trial Evaluating the Effectiveness of Computer-Assisted Intervention Delivered by Educators for Children With Speech Sound Disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1891-1910. [PMID: 28672376 DOI: 10.1044/2017_jslhr-s-16-0385] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/20/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The aim was to evaluate the effectiveness of computer-assisted input-based intervention for children with speech sound disorders (SSD). METHOD The Sound Start Study was a cluster-randomized controlled trial. Seventy-nine early childhood centers were invited to participate, 45 were recruited, and 1,205 parents and educators of 4- and 5-year-old children returned questionnaires. Children whose parents and educators had concerns about speech were assessed (n = 275); 132 children who were identified with phonological pattern-based errors underwent additional assessment. Children with SSD and no difficulties with receptive language or hearing, typical nonverbal intelligence, and English as their primary language were eligible; 123 were randomized into two groups (intervention n = 65; control n = 58), and 3 withdrew. The intervention group involved Phoneme Factory Sound Sorter software (Wren & Roulstone, 2013) administered by educators over 9 weeks; the control group involved typical classroom practices. Participants were reassessed twice by a speech-language pathologist who was unaware of the initial assessment and intervention conditions. RESULTS For the primary outcome variable (percentage of consonants correct), the significant mean change from pre- to postintervention for the intervention group (mean change = +6.15, p < .001) was comparable in magnitude to the significant change for the control group (mean change = +5.43, p < .001) with a small between-groups effect size for change (Cohen's d = 0.08). Similar results occurred for measures of emergent literacy, phonological processing, participation, and well-being. CONCLUSION Computer-assisted input-based intervention administered by educators did not result in greater improvement than typical classroom practices.
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Affiliation(s)
| | | | | | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, United KingdomUniversity of Bristol, United Kingdom
| | - Sue Roulstone
- Bristol Speech and Language Therapy Research Unit, United KingdomUniversity of the West of England, Bristol, United Kingdom
| | | | | | - Paul White
- University of the West of England, Bristol, United Kingdom
| | - Charlotte Howland
- The University of Sydney, AustraliaCharles Sturt University, Sydney, Australia
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Tosh R, Arnott W, Scarinci N. Parent-implemented home therapy programmes for speech and language: a systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2017; 52:253-269. [PMID: 27943521 DOI: 10.1111/1460-6984.12280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Parent-delivered home programmes are frequently used to remediate speech and language difficulties in young children. However, the evidence base for this service delivery model is limited. AIMS The aim of this systematic review is to investigate the effectiveness of parent-implemented home programmes in facilitating the development of children's speech and language skills, and to evaluate the cost-effectiveness and feasibility of this service delivery method. METHODS & PROCEDURES A systematic search of the PsycINFO, CINAHL and ERIC databases was conducted. Quality appraisal of individual studies was conducted. Findings from each of the studies were then integrated to report on outcomes for the child, the parent and the service. OUTCOMES & RESULTS There is preliminary evidence that home programmes can lead to growth in a child's speech and language skills and are more effective than no intervention, provided the home programmes are used with high dosage rates and direct parent training. CONCLUSIONS & IMPLICATIONS Home programmes are a potentially useful service delivery model, but caution should be exercised when considering their use to address broader service delivery challenges. Further high-level evidence is needed across all facets of this service delivery model.
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Affiliation(s)
- Rachel Tosh
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Wendy Arnott
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
- The Hear and Say Centre, Brisbane, QLD, Australia
| | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
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Sugden E, Baker E, Munro N, Williams AL. Involvement of parents in intervention for childhood speech sound disorders: a review of the evidence. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2016; 51:597-625. [PMID: 27017993 DOI: 10.1111/1460-6984.12247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/15/2015] [Accepted: 01/06/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Internationally, speech and language therapists (SLTs) are involving parents and providing home tasks in intervention for phonology-based speech sound disorder (SSD). To ensure that SLTs' involvement of parents is guided by empirical research, a review of peer-reviewed published evidence is needed. AIMS To provide SLTs and researchers with a comprehensive appraisal and analysis of peer-reviewed published intervention research reporting parent involvement and the provision of home tasks in intervention studies for children with phonology-based SSD. METHODS & PROCEDURES A systematic search and review was conducted. Academic databases were searched for peer-reviewed research papers published between 1979 and 2013 reporting on phonological intervention for SSD. Of the 176 papers that met the criteria, 61 were identified that reported on the involvement of parents and/or home tasks within the intervention. These papers were analysed using a quality appraisal tool. Details regarding the involvement of parents and home tasks were extracted and analysed to provide a summary of these practices within the evidence base. MAIN CONTRIBUTION Parents have been involved in intervention research for phonology-based SSD. However, most of the peer-reviewed published papers reporting this research have provided limited details regarding what this involved. This paucity of information presents challenges for SLTs wishing to integrate external evidence into their clinical services and clinical decision-making. It also raises issues regarding treatment fidelity for researchers wishing to replicate published intervention research. CONCLUSIONS & IMPLICATIONS The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.
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Affiliation(s)
| | - Elise Baker
- The University of Sydney, Sydney, NSW, Australia
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Dobbelsteyn C, Kay-Raining Bird E, Parker J, Griffiths C, Budden A, Flood K, Stilson A. Effectiveness of the Corrective Babbling Speech Treatment Program for Children with a History of Cleft Palate or Velopharyngeal Dysfunction. Cleft Palate Craniofac J 2014; 51:129-44. [DOI: 10.1597/12-188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effectiveness of a phonetic-based, parent-administered treatment to reduce cleft-related speech errors. Design Immediate treatment (IT) versus delayed treatment (DT) comparison followed by analysis of gains over approximately 4 months and again after a longer period of treatment for participants in both groups. Participants Thirteen participants with a history of cleft palate or velopharyngeal dysfunction and speech disorder. Intervention After training, parents were instructed to conduct daily 10-minute sessions of phonetic drills with their children. Main Outcome Measures Group differences in percent consonants correct (PCC) were compared between those who did and those who did not receive the treatment. Pre- and posttreatment PCC comparisons were made after approximately 4 months of treatment and after termination of treatment. Results Participants receiving Corrective Babbling therapy showed significant gains in PCC in limited contexts after 4 months of therapy. However, gains were not significantly greater for the IT versus DT group. Participants who continued with the treatment for longer than 4 months showed the greatest gains in PCC and had significant improvements in all speech contexts assessed. Parents reported satisfaction with the program. Conclusions The results of this study indicate that this treatment shows promise for at least some children with a history of cleft palate and velopharyngeal dysfunction.
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Affiliation(s)
- Cindy Dobbelsteyn
- Speech-Language Pathologist, Nova Scotia Hearing and Speech Centres, Halifax, Nova Scotia, Canada
| | | | - Jennifer Parker
- Nova Scotia Hearing and Speech Centres, Halifax, Nova Scotia, Canada
| | - Charlotte Griffiths
- Department of Education and Early Childhood Development, Charlottetown, Prince Edward Island, Canada
| | | | - Kristina Flood
- Horizon Health Network, St. Stephen, New Brunswick, Canada
| | - Amie Stilson
- Alberta Health Services, Barrhead, Alberta, Canada
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Baker E, McLeod S. Evidence-Based Practice for Children With Speech Sound Disorders: Part 1 Narrative Review. Lang Speech Hear Serv Sch 2011; 42:102-39. [PMID: 20844274 DOI: 10.1044/0161-1461(2010/09-0075)] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
This article provides a comprehensive narrative review of intervention studies for children with speech sound disorders (SSD). Its companion paper (Baker & McLeod, 2011) provides a tutorial and clinical example of how speech-language pathologists (SLPs) can engage in evidence-based practice (EBP) for this clinical population.
Method
Studies reporting speech sound intervention for children with SSDs published from 1979 to 2009 were identified and coded.
Results
One hundred thirty-four intervention studies were identified. Intervention typically was conducted by an SLP in a one-to-one individual format for 30- to 60-min sessions 2 to 3 times per week. Total duration of intervention (from assessment to discharge) was reported for 10 studies and ranged from 3 to 46 months. Most studies were either Level IIb (quasi-experimental studies, 41.5%) or Level III (nonexperimental case studies, 32.6%). Single-case experimental design (29.6%) was the most frequently used experimental research design. There were 7 distinct approaches to target selection and 46 distinct intervention approaches, with 23 described in more than 1 publication. Each approach was associated with varying quantities and levels of evidence, according to research design.
Conclusion
Collaborative research reflecting higher levels of evidence using rigorous experimental designs is needed to compare the relative benefits of different intervention approaches.
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Keating D, Syrmis M, Hamilton L, McMahon S. Paediatricians: referral rates and speech pathology waiting lists. J Paediatr Child Health 1998; 34:451-5. [PMID: 9767509 DOI: 10.1046/j.1440-1754.1998.00273.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aimed to examine paediatricians' training in and understanding of communication development and disabilities and their attitudes to speech pathology waiting lists and management practices. The relationship between these factors and referral rates was also investigated. METHODOLOGY A total of 229 paediatricians registered with the Australian College of Paediatrics participated in the study in November 1996. They answered 15 multiple-choice questions designed to collect demographic information and data pertaining to their training and understanding of communication development and disabilities. The survey also obtained data on referral rates to public and private speech pathology services and on paediatricians' perceptions of speech pathology waiting lists and possible management strategies. RESULTS Referral rate to public and private speech pathology services was found to be associated with the quality of paediatricians' training in and knowledge of communication development and disabilities. Paediatricians who had regular contact with speech pathologists were also more likely to make more referrals. Waiting lists had a negative influence on referral rate. Treatment rather than assessment waiting lists were preferred. Paediatricians believed the best solution to speech pathology waiting lists was an increase in staffing levels particularly in community health centres. Respondents reported that 1-4 months was an acceptable time to wait for speech pathology care and indicated the order of importance of factors for prioritising children. CONCLUSIONS The results have important implications for developing best practice models for improving referral processes and access to speech pathology services for children with communication disabilities.
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Affiliation(s)
- D Keating
- Royal Children's Hospital and District Health Service, Herston, Queensland, Australia
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Shriberg LD. Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. JOURNAL OF SPEECH AND HEARING RESEARCH 1993; 36:105-40. [PMID: 8450654 DOI: 10.1044/jshr.3601.105] [Citation(s) in RCA: 208] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Research in developmental phonological disorders, particularly emerging subgroup studies using behavioral and molecular genetics, requires qualitative and continuous measurement systems that meet a variety of substantive and psychometric assumptions. This paper reviews relevant issues underlying such needs and presents four measurement proposals developed expressly for causal-correlates research. The primary qualitative system is the Speech Disorders Classification System (SDCS), a 10-category nosology for dichotomous and hierarchical polychotomous classification of speech disorders from 2 years of age through adulthood. The three quantitative measures for segmental and suprasegmental analyses are (a) the Articulation Competence Index (ACI), an interval-level severity index that adjusts a subject's Percentage of Consonants Correct (PCC) score for the relative percentage of distortion errors; (b) Speech Profiles, a series of graphic-numeric displays that profile a subject's or group's severity-adjusted consonant and vowel-diphthong mastery and error patterns; and (c) the Prosody-Voice Profile, a graphic-numeric display that profiles a subject's or group's status on six suprasegmental domains divided into 31 types of inappropriate prosody-voice codes. All data for the four measures are derived from one sample of conversational speech, which obviates the limitations of citation-form testing; enables speech assessment as a qualitative, semi-continuous, and continuous trait over the life span; and provides a context for univariate and multivariate statistical analyses of phonetic, phonologic, prosodic, and language variables in multiage, multidialectal, and multicultural populations. Rationale, procedures, validity data, and examples of uses for each measure are presented.
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Affiliation(s)
- L D Shriberg
- Waisman Center on Mental Retardation and Human Development, University of Wisconsin-Madison 53705
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