Conversational Speech Behaviors Are Context Dependent

PURPOSE

According to the interpersonal synergy model of spoken dialogue, interlocutors modify their communicative behaviors to meet the contextual demands of a given conversation. Although a growing body of research supports this postulation for linguistic behaviors (e.g., semantics, syntax), little is understood about how this model applies to speech behaviors (e.g., speech rate, pitch). The purpose of this study is to test the hypothesis that interlocutors adjust their speech behaviors across different conversational tasks with different conversational goals.

METHOD

In this study, 28 participants each engaged in two different types of conversations (i.e., relational and informational) with two partners (i.e., Partner 1 and Partner 2), yielding a total of 112 conversations. We compared six acoustic measures of participant speech behavior across conversational task and partner.

RESULTS

Linear mixed-effects models demonstrated significant differences between speech feature measures in informational and relational conversations. Furthermore, these findings were generally robust across conversations with different partners.

CONCLUSIONS

Results suggest that contextual demands influence speech behaviors. These findings provide empirical support for the interpersonal synergy model and highlight important considerations for assessing speech behaviors in individuals with communication disorders.

Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely

PURPOSE

Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events.

DESIGN

Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania.

PARTICIPANTS

Members aged ≥ 65 years who were continuously enrolled 6 months before and after undergoing cataract surgery from 2018 to 2021 and had approved surgery claims.

METHODS

Preoperative exams or tests occurring in the 30 days before surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., Current Procedural Terminology codes for blood panels and preprocedural International Classification of Diseases, 10th Revision, Clinical Modification codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling.

MAIN OUTCOME MEASURES

Total costs, prevalence, and strength of association as indicated by odds ratios.

RESULTS

Up to 42% of members undergoing cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed in isolation or along with clearance visits. The combined costs for the preoperative visits and tests were $4.3 million (approximately $107-$114 per impacted member). There was little difference in member characteristics between those receiving and not receiving preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member's care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two.

CONCLUSIONS

Rates of routine preoperative testing before cataract surgery appear similar to those prior to the implementation of the Choosing Wisely campaign, which was meant to reduce this use. Additionally, preoperative evaluations, many likely unnecessary, were common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Dimensions of caregiver strain may partially mediate the relationship between youth symptomology and counseling utilization among Latinxs

Whether Latinx families use youth mental health services (MHS) depends on complex influences of barriers and facilitators within and outside of the home. This research sought to shed light on caregiver strain as part of the equation focused on parental identification and responses to youth mental health needs. We examined multiple dimensions of caregiver strain as potential mediators between youth mental health symptom severity and psychological counseling utilization. The present sample consisted of 598 Latinx caregivers to youths ages 6-18 who provided information on youth internalizing and externalizing problems, caregiver strain, and youth psychological counseling service utilization within the last year. Our findings suggest that youth symptom severity (internalizing and externalizing problems) was generally positively associated with dimensions of caregiver strain. Youth symptom severity through objective and subjective internalized strain pathways were associated with greater odds of youth MHS utilization. In contrast, youth symptom severity through subjective externalized strain reduced the odds that Latinx caregivers would report utilizing youth MHS. These models only partially mediated the relationship between youth problems and service use. Findings suggest that Latinx caregivers may navigate conflicting sources of strain related to their child's mental health problem severity in ways that may differentially impact the odds that they access youth MHS. Along with addressing structural and systemic barriers to care, utilization of psychological counseling services may also be improved through interventions that help Latinx caregivers view youth services as avenues for addressing caregiver strain and providing psychoeducation that frames externalized strain within a mental health lens.

AI vs academia: Experimental study on AI text detectors' accuracy in behavioral health academic writing

Artificial Intelligence (AI) language models continue to expand in both access and capability. As these models have evolved, the number of academic journals in medicine and healthcare which have explored policies regarding AI-generated text has increased. The implementation of such policies requires accurate AI detection tools. Inaccurate detectors risk unnecessary penalties for human authors and/or may compromise the effective enforcement of guidelines against AI-generated content. Yet, the accuracy of AI text detection tools in identifying human-written versus AI-generated content has been found to vary across published studies. This experimental study used a sample of behavioral health publications and found problematic false positive and false negative rates from both free and paid AI detection tools. The study assessed 100 research articles from 2016-2018 in behavioral health and psychiatry journals and 200 texts produced by AI chatbots (100 by "ChatGPT" and 100 by "Claude"). The free AI detector showed a median of 27.2% for the proportion of academic text identified as AI-generated, while commercial software Originality.AI demonstrated better performance but still had limitations, especially in detecting texts generated by Claude. These error rates raise doubts about relying on AI detectors to enforce strict policies around AI text generation in behavioral health publications.

Lexical Alignment is Pervasive Across Contexts in Non-WEIRD Adult-Child Interactions

Lexical alignment, a communication phenomenon where conversational partners adapt their word choices to become more similar, plays an important role in the development of language and social communication skills. While this has been studied extensively in the conversations of preschool-aged children and their parents in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) communities, research in other pediatric populations is sparse. This study makes significant expansions on the existing literature by focusing on alignment in naturalistic conversations of school-aged children from a non-WEIRD population across multiple conversational tasks and with different types of adult partners. Typically developing children aged 5 to 8 years (n = 45) engaged in four semi-structured conversations that differed by task (problem-solving vs. play-based) and by partner (parent vs. university student), resulting in a corpus of 180 conversations. Lexical alignment scores were calculated and compared to sham conversations, representing alignment occurring at the level of chance. Both children and adults coordinated their conversational utterances by re-using or aligning each other's word choices. This alignment behavior persisted across conversational tasks and partners, although the degree of alignment was moderated by the conversational context. These findings suggest that lexical alignment is a robust phenomenon in conversations between school-age children and adults. Furthermore, this study extends lexical alignment findings to a non-WEIRD culture, suggesting that alignment may be a coordination strategy employed by adults and children across diverse linguistic and cultural backgrounds.

An ecological examination of early adolescent e-cigarette use: A machine learning approach to understanding a health epidemic

E-cigarette use among adolescents is a national health epidemic spreading faster than researchers can amass evidence for risk and protective factors and long-term consequences associated with use. New technologies, such as machine learning, may assist prevention programs in identifying at risk youth and potential targets for intervention before adolescents enter developmental periods where e-cigarette use escalates. The present study utilized machine learning algorithms to explore a wide array of individual and socioecological variables in relation to patterns of lifetime e-cigarette use during early adolescence (i.e., exclusive, or with tobacco cigarettes). Extant data was used from 14,346 middle school students (Mage = 12.5, SD = 1.1; 6th and 8th grades) who participated in the Utah Prevention Needs Assessment. Students self-reported their substance use behaviors and related risk and protective factors. Machine learning algorithms examined 112 individual and socioecological factors as potential classifiers of lifetime e-cigarette use outcomes. The elastic net algorithm achieved outstanding classification for lifetime exclusive (AUC = .926) and dual use (AUC = .944) on a validation test set. Six high value classifiers were identified that varied in importance by outcome: Lifetime alcohol or marijuana use, perception of e-cigarette availability and risk, school suspension(s), and perceived risk of smoking marijuana regularly. Specific classifiers were important for lifetime exclusive (parent's attitudes regarding student vaping, best friend[s] tried alcohol or marijuana) and dual use (best friend[s] smoked cigarettes, lifetime inhalant use). Our findings provide specific targets for the adaptation of existing substance use prevention programs to address early adolescent e-cigarette use.

Barriers to accessing telepsychology services questionnaire: Structure and language-based performance in a sample of Latinx caregivers

A lack of validated measures to examine barriers to youth telepsychology services among Latinx families limits research that could identify targets for reducing mental health disparities. We developed and validated the Latinx Barriers to Accessing Telepsychology Services (Latinx BATS) questionnaire, a brief multidimensional measure for caregivers of youths. Participants included 511 Latinx caregivers of youths Ages 6-18 (English n = 275, Spanish n = 236) who completed the Latinx BATS and reported on telepsychology service utilization and youth mental health problems. Caregivers whose youths had clinically elevated mental health problems were more likely to report barriers to accessing youth telepsychology services compared to nonclinical youths. Commonly endorsed barriers included concerns that the child would be distracted and not get much benefit, and that providers would be unfamiliar with the family's culture or would not pick up on nuances and emotions. Loadings from an exploratory graph analysis returned four-factors: relational, acceptability, quality, and access concerns. Network centrality measures identified provider knowledge regarding community resources and Latinx culture as important targets for reducing barriers to youth telepsychology services. Confirmatory factor analyses were then conducted and found that the four-factor structure outperformed a single-factor solution. The four-factor structure was similar for the English and Spanish versions of the Latinx BATS, but the strength of item loadings varied across languages. Implications for the use of the Latinx BATS in research and clinical practice are discussed including specific strategies for reducing these obstacles to care among Latinx families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL): validation with hearing aid users

OBJECTIVE

Individuals who are deaf or hard of hearing (DHH) may find adherence to their hearing devices difficult due to internal experiences related to their hearing loss such as sadness or frustration. The Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL) is the only measure available to assess psychological inflexibility as it relates to hearing loss. The purpose of this study was to confirm the single latent structure of the AAQ-AHL (through confirmatory factory analysis) and test convergent and discriminant validity.

DESIGN

Cross-sectional data was used to further validate the AAQ-AHL.

STUDY SAMPLE

Participants were 146 adults who had diagnosed hearing loss and used a hearing aid.

RESULTS

Results revealed the AAQ-AHL has a single latent structure, correlated to other similar constructs (psychological flexibility and hearing aid efficacy), and not correlated to unrelated constructs (hearing loss severity). These results suggest that the AAQ-AHL is a valid instrument to assess psychological flexibility as it relates to hearing aid use.

CONCLUSION

Together, the findings imply the AAQ-AHL has strong psychometric properties and justification to use in a clinical setting.

Perceptual Learning of Dysarthria in Adolescence

PURPOSE

As evidenced by perceptual learning studies involving adult listeners and speakers with dysarthria, adaptation to dysarthric speech is driven by signal predictability (speaker property) and a flexible speech perception system (listener property). Here, we extend adaptation investigations to adolescent populations and examine whether adult and adolescent listeners can learn to better understand an adolescent speaker with dysarthria.

METHOD

Classified by developmental stage, adult (n = 42) and adolescent (n = 40) listeners completed a three-phase perceptual learning protocol (pretest, familiarization, and posttest). During pretest and posttest, all listeners transcribed speech produced by a 13-year-old adolescent with spastic dysarthria associated with cerebral palsy. During familiarization, half of the adult and adolescent listeners engaged in structured familiarization (audio and lexical feedback) with the speech of the adolescent speaker with dysarthria; and the other half, with the speech of a neurotypical adolescent speaker (control).

RESULTS

Intelligibility scores increased from pretest to posttest for all listeners. However, listeners who received dysarthria familiarization achieved greater intelligibility improvements than those who received control familiarization. Furthermore, there was a significant effect of developmental stage, where the adults achieved greater intelligibility improvements relative to the adolescents.

CONCLUSIONS

This study provides the first tranche of evidence that adolescent dysarthric speech is learnable-a finding that holds even for adolescent listeners whose speech perception systems are not yet fully developed. Given the formative role that social interactions play during adolescence, these findings of improved intelligibility afford important clinical implications.

The Influence of Sensorineural Hearing Loss on the Relationship Between the Perception of Speech in Noise and Dysarthric Speech

PURPOSE

The ability to understand speech under adverse listening conditions is highly variable across listeners. Despite this, studies have found that listeners with normal hearing display consistency in their ability to perceive speech across different types of degraded speech, suggesting that, for at least these listeners, global skills may be involved in navigating the ambiguity in speech signals. However, there are substantial differences in the perceptual challenges faced by listeners with normal and impaired hearing. This study examines whether listeners with sensorineural hearing loss demonstrate the same type of consistency as normal-hearing listeners when processing neurotypical (i.e., control) speech that has been degraded by external noise and speech that is neurologically degraded such as dysarthria.

METHOD

Listeners with normal hearing (n = 31) and listeners with sensorineural hearing loss (n = 36) completed an intelligibility task with neurotypical speech in noise and with dysarthric speech in quiet.

RESULTS

Findings were consistent with previous work demonstrating a relationship between the ability to perceive neurotypical speech in noise and dysarthric speech for listeners with normal hearing, albeit at a higher intelligibility level than previously observed. This relationship was also observed for listeners with hearing loss, although listeners with more severe hearing losses performed better with dysarthric speech than with neurotypical speech in noise.

CONCLUSIONS

This study demonstrated a high level of consistency in intelligibility performance for listeners across two different types of degraded speech, even when those listeners were further challenged by the presence of sensorineural hearing loss. Clinical implications for both listeners with hearing loss and their communication partners with dysarthria are discussed.

Step edge highlighters and illuminance changes influence stair descent in a real-world setting

Studies investigating the effect of tread edge highlighters on descent speed differ, but collectively report the potential benefit of reduced fall risk. Here we examine the impact of adding high-contrast black vinyl striping to the front edge of each step's tread and its impact on descending gait speed (intervention), while controlling for illumination. Descending gait speed was estimated from 5,824 video observations using the stairway length and entry and exit times. A second stairway was unaltered (control) to compare to the intervention. Stair users were primarily 18-30 years old with a small percentage being middle-aged and older adults. Descending gait speed was significantly slower on the intervention stairway (Linear mixed effects model: standardised coefficient = -0.07, 95% CI = [-0.12, -0.02], p = .010) compared to the control and may be impacted by illuminance. We propose that the slowed gait speed could be due to changes in gait kinematics (e.g. foot clearance) and may reduce fall-risk. Practitioner summary: Tread-edge contrast enhancement could be a low-cost means to reduce fall-risk on stairways, but its impact on gait kinematics is not well understood. We found that contrast enhancement reduced descending gait speed, but descending gait speed's impact on fall risk reduction ultimately requires further investigation.

Speech Entrainment in Adolescent Conversations: A Developmental Perspective

PURPOSE

Defined as the similarity of speech behaviors between interlocutors, speech entrainment plays an important role in successful adult conversations. According to theoretical models of entrainment and research on motoric, cognitive, and social developmental milestones, the ability to entrain should develop throughout adolescence. However, little is known about the specific developmental trajectory or the role of speech entrainment in conversational outcomes of this age group. The purpose of this study is to characterize speech entrainment patterns in the conversations of neurotypical early adolescents.

METHOD

This study utilized a corpus of 96 task-based conversations between adolescents between the ages of 9 and 14 years and a comparison corpus of 32 task-based conversations between adults. For each conversational turn, two speech entrainment scores were calculated for 429 acoustic features across rhythmic, articulatory, and phonatory dimensions. Predictive modeling was used to evaluate the degree of entrainment and relationship between entrainment and two metrics of conversational success.

RESULTS

Speech entrainment increased throughout early adolescence but did not reach the level exhibited in conversations between adults. Additionally, speech entrainment was predictive of both conversational quality and conversational efficiency. Furthermore, models that included all acoustic features and both entrainment types performed better than models that only included individual acoustic feature sets or one type of entrainment.

CONCLUSIONS

Our findings show that speech entrainment skills are largely developed during early adolescence with continued development possibly occurring across later adolescence. Additionally, results highlight the role of speech entrainment in successful conversation in this population, suggesting the import of continued exploration of this phenomenon in both neurotypical and neurodivergent adolescents. We also provide evidence of the value of using holistic measures that capture the multidimensionality of speech entrainment and provide a validated methodology for investigating entrainment across multiple acoustic features and entrainment types.

The Application of Time-Frequency Masking To Improve Intelligibility of Dysarthric Speech in Background Noise

PURPOSE

Background noise reduces speech intelligibility. Time-frequency (T-F) masking is an established signal processing technique that improves intelligibility of neurotypical speech in background noise. Here, we investigated a novel application of T-F masking, assessing its potential to improve intelligibility of neurologically degraded speech in background noise.

METHOD

Listener participants (N = 422) completed an intelligibility task either in the laboratory or online, listening to and transcribing audio recordings of neurotypical (control) and neurologically degraded (dysarthria) speech under three different processing types: speech in quiet (quiet), speech mixed with cafeteria noise (noise), and speech mixed with cafeteria noise and then subsequently processed by an ideal quantized mask (IQM) to remove the noise.

RESULTS

We observed significant reductions in intelligibility of dysarthric speech, even at highly favorable signal-to-noise ratios (+11 to +23 dB) that did not impact neurotypical speech. We also observed significant intelligibility improvements from speech in noise to IQM-processed speech for both control and dysarthric speech across a wide range of noise levels. Furthermore, the overall benefit of IQM processing for dysarthric speech was comparable with that of the control speech in background noise, as was the intelligibility data collected in the laboratory versus online.

CONCLUSIONS

This study demonstrates proof of concept, validating the application of T-F masks to a neurologically degraded speech signal. Given that intelligibility challenges greatly impact communication, and thus the lives of people with dysarthria and their communication partners, the development of clinical tools to enhance intelligibility in this clinical population is critical.

Posttraumatic Cognitions Differ Between Men and Women after Military Sexual Assault Revictimization in Their Contribution to PTSD Symptoms

Sexual revictimization is heightened among military service members and veterans and is associated with greater posttraumatic stress symptoms (PTSS) and severity. The heightened distress following revictimization may be due to posttraumatic cognitions (PTC), which include negative beliefs about the self and world, and self-blame. Moreover, it is unclear whether men and women experience different levels of PTC. The current study tested PTC (overall and subdomains) as a possible mediator between sexual revictimization and PTSS severity, and gender as a possible moderator of these associations. Revictimization was defined across time periods (military sexual assault [MSA] only vs. premilitary sexual trauma + MSA) and in military rape frequency (0, 1, 2+). Participants were 400 (n = 200 [50%] male) service members/veterans with a history of MSA and completed online, anonymous, self-report questionnaires. PTC mediated the association between revictimization and PTSS severity. A significant interaction of gender suggested that men reported high overall PTC and PTC about the self regardless of revictimization; by contrast, overall PTC and PTC about the self were lower for women in response to MSA only and increased with revictimization. Results also showed men were more sensitive to PTC about self-blame as it pertains to more severe PTSS compared to women. There were no unique gender interactions when assessing revictimization by rape frequency, although PTC (overall, all subdomains) significantly mediated the association between rape frequency and PTSS severity. PTC may be a beneficial target when treating PTSS in men, and may be especially heightened in women who have experienced revictimization.

Functional near-infrared spectroscopy measures of neural activity in children with and without developmental language disorder during a working memory task

INTRODUCTION

Children with developmental language disorder (DLD) exhibit cognitive deficits that interfere with their ability to learn language. Little is known about the functional neuroanatomical differences between children developing typically (TD) and children with DLD.

METHODS

Using functional near-infrared spectroscopy, we recorded oxygenated hemoglobin (O₂ hb) concentration values associated with neural activity in children with and without DLD during an auditory N-back task that included 0-back, 1-back, and 2-back conditions. Analyses focused on the left dorsolateral prefrontal cortex (DLPFC) and left inferior parietal lobule (IPL). Multilevel models were constructed with accuracy, response time, and O₂ hb as outcome measures, with 0-back outcomes as fixed effects to control for sustained attention.

RESULTS

Children with DLD were significantly less accurate than their TD peers at both the 1-back and 2-back tasks, and they demonstrated slower response times during 2-back. In addition, children in the TD group demonstrated significantly greater sensitivity to increased task difficulty, showing increased O₂ hb to the IPL during 1-back and to the DLPFC during the 2-back, whereas the DLD group did not. A secondary analysis revealed that higher O₂ hb in the DLPFC predicted better task accuracy across groups.

CONCLUSION

When task difficulty increased, children with DLD failed to recruit the DLPFC for monitoring information and the IPL for processing information. Reduced memory capacity and reduced engagement likely contribute to the language learning difficulties of children with DLD.

Sexual Violence in Military Service Members/Veterans Individual and Interpersonal Outcomes Associated with Single and Multiple Exposures to Civilian and Military Sexual Violence

Sexual harassment and violence is a grave public health concern and risk for revictimization increases following initial exposure. Studies of sexual revictimization in military samples are generally limited to women and are focused on rates of posttraumatic stress disorder (PTSD), with no examination of how revictimization relates to interpersonal outcomes, such as relationship or sexual satisfaction. The current study addressed these gaps in a sample of 833 women and 556 men service members/veterans. Self-reported outcomes of PTSD, depression, suicidal ideation, sexual function, and relationship satisfaction were compared across those reporting exposure to sexual harassment and violence before the military only (i.e., pre-military), during the military only (i.e., military sexual harassment and violence [MSV]), before and during the military (i.e., revictimization), and to no exposure. More than half of women (51.14%, n = 426) reported revictimization and only 5.79% (n = 28) of men reported revictimization. Among women, those reporting MSV or revictimization tended to report higher PTSD, depression, and suicidal ideation relative to pre-military sexual violence and no sexual violence exposure. No interpersonal outcomes were significantly different among these sexual violence groups. Among men, revictimization was associated with higher PTSD, depression, and sexual compulsivity. PTSD and depression were also higher among those reporting MSV only. No effects were found for premilitary sexual trauma exposure only or relationship satisfaction for either group. Findings highlight the particularly bothersome nature of MSV, whether it occurred alone or in tandem with premilitary sexual violence. Findings also show unique gender differences across outcomes, suggesting interventions following sexual harassment and violence may differ for men and women.

Cognitive Predictors of Perception and Adaptation to Dysarthric Speech in Young Adult Listeners

PURPOSE

Although recruitment of cognitive-linguistic resources to support dysarthric speech perception and adaptation is presumed by theoretical accounts of effortful listening and supported by cross-disciplinary empirical findings, prospective relationships have received limited attention in the disordered speech literature. This study aimed to examine the predictive relationships between cognitive-linguistic parameters and intelligibility outcomes associated with familiarization with dysarthric speech in young adult listeners.

METHOD

A cohort of 156 listener participants between the ages of 18 and 50 years completed a three-phase perceptual training protocol (pretest, training, and posttest) with one of three speakers with dysarthria. Additionally, listeners completed the National Institutes of Health Toolbox Cognition Battery to obtain measures of the following cognitive-linguistic constructs: working memory, inhibitory control of attention, cognitive flexibility, processing speed, and vocabulary knowledge.

RESULTS

Elastic net regression models revealed that select cognitive-linguistic measures and their two-way interactions predicted both initial intelligibility and intelligibility improvement of dysarthric speech. While some consistency across models was shown, unique constellations of select cognitive factors and their interactions predicted initial intelligibility and intelligibility improvement of the three different speakers with dysarthria.

CONCLUSIONS

Current findings extend empirical support for theoretical models of speech perception in adverse listening conditions to dysarthric speech signals. Although predictive relationships were complex, vocabulary knowledge, working memory, and cognitive flexibility often emerged as important variables across the models.

Values engagement as a predictor of eating disorder severity in a residential sample of female adolescents with eating disorders

Values are freely chosen life directions and/or qualities of being that can motivate behavior change. There is nascent support for the utility of values work as a part of the therapeutic process across treatments, particularly in third wave therapy approaches (e.g., acceptance and commitment therapy). However, therapeutic values work is underresearched in clinical samples of youth. The aim of the present study is to examine the role of the two distinct values processes (engagement and obstruction), body image inflexibility, alongside other common comorbid symptoms of eating disorders (anxiety, depression) in a sample of female adolescents with eating disorders attending a residential eating disorder treatment program. Participants (N = 75) were patients at a residential eating disorder treatment facility and completed a battery of measures at time of admission. Correlational analyses and multiple regression were performed. Results found correlations between eating disorder severity, values engagement, values obstruction, body image flexibility, anxiety, and depression in the expected directions. Regression results found body image inflexibility, progression towards values, and anxiety as significant predictors of eating disorder severity (adjusted R² = .54). This study points to the importance of emphasizing values engagement in youth with eating disorders, highlighting a potential treatment target for future research.

Cortical Activation of Swallowing Using fNIRS: A Proof of Concept Study with Healthy Adults

The purpose of this study was to determine whether functional near-infrared spectroscopy (fNIRS) could reliably identify cortical activation patterns as healthy adults engaged in single sip and continuous swallowing tasks. Thirty-three right-handed adults completed two functional swallowing tasks, one control jaw movement task, and one rest task while being imaged with fNIRS. Swallowing tasks included a single sip of 5 mL of water via syringe and continuous straw drinking. fNIRS patches for acquisition of neuroimaging data were placed parallel over left and right hemispheres. Stimuli presentation was controlled with set time intervals and audio instructions. Using a series of linear mixed effect models, results demonstrated clear cortical activation patterns during swallowing. The continuous swallowing task demonstrated significant differences in blood oxygenation and deoxygenation concentration values across nearly all regions examined, but most notably M1 in both hemispheres. Of note is that there were areas of greater activation, particularly on the right hemisphere, when comparing the single sip swallow to the jaw movement control and rest tasks. Results from the current study support the use of fNIRS during investigation of swallowing. The utilization of healthy adults as a method for acquiring normative data is vital for comparison purposes when investigating individuals with disorders, but also in the development of rehabilitation techniques. Identifying activation areas that pertain to swallowing will have important implications for individuals requiring dysphagia therapy.

Supporting Emergent Bilinguals Who Use Augmentative and Alternative Communication and Their Families: Lessons in Telepractice From the COVID-19 Pandemic

PURPOSE

The purpose of this project was to examine the effect of the COVID-19 pandemic on speech-language pathologist (SLP) service provision for emergent bilinguals who use augmentative and alternative communication (AAC). One prominent issue in AAC service delivery is the efficacy and feasibility of providing AAC services via telepractice. The COVID-19 pandemic intensified this issue as most providers, clients, and families adjusted to remote service delivery models. While emerging evidence supports telepractice in AAC, little is known about the potential benefits and challenges of telepractice for emergent bilinguals who use AAC and their families.

METHOD

Data were collected via a nationwide survey. Licensed SLPs (N = 160) completed an online questionnaire with Likert-type, multiple-choice, and open-ended questions, analyzed using mixed methods.

RESULTS

Findings illustrated a shift in service delivery from in-person to telepractice and hybrid (both telepractice and in-person) models. Overall, child intervention outcomes declined for emergent bilinguals who used AAC during the COVID-19 pandemic, regardless of service delivery format. However, collaboration increased for many providers and families. Qualitative analyses highlighted barriers to AAC service provision for emergent bilinguals who use AAC that were exacerbated by the COVID-19 pandemic, as well as factors that facilitated collaboration and family engagement.

CONCLUSION

These findings suggest that, despite challenges, telepractice or hybrid services may be a promising approach to provide more culturally responsive, family-centered care for emergent bilinguals who use AAC.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20405673.

Safe stairway negotiation: Role of distractions and handrail use

INTRODUCTION

This study sought to examine stairway safety by identifying associations between fall-related events on stairways, distractions, gait speed, drifting, as well as handrail use and proximity.

METHOD

Video recordings captured 11,137 observations of stair users in two public stairways and recorded distractions (e.g., looking at a mobile device, talking on a mobile device, using earbuds or headphones, holding a mobile device, or talking with a peer), gait speed (m/s), drifting (change of direction), as well as handrail use and proximity to a handrail.

RESULTS

In our sample, consisting of primarily young adults (observed 18-40 years old), we found that when a distraction was present, gait speed was reduced (p <.001), drifting increased (p <.001), and handrail use negatively impacted (p <.001) compared to stair users who were not distracted.

CONCLUSIONS

These results indicate that distractions, such as mobile devices, used during stair negotiation can reduce handrail use and increase behaviors associated with fall-related events.

PRACTICAL APPLICATIONS

Mobile device use during stairway negotiation increases the likelihood of distraction-induced events. Stair users should be encouraged to limit or avoid mobile device use in public stairway environments. Mobile manufacturers and mobile app developers could aim to develop strategies or mobile app alerts to reduce the impact of distractions (e.g., mobile device use) during stair negotiation to lessen the health and financial burden associated with fall-related events on stairways.

Examining a mediation model of body image-related cognitive fusion, intuitive eating, and eating disorder symptom severity in a clinical sample

PURPOSE

This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms.

METHODS

This study includes cross-sectional analyses with data from 100 adult females and 75 adolescent females seeking residential treatment for an ED. Self-reported demographic information, ED symptoms, IE behaviors, and body image-related cognitive fusion were collected from participants within the first week of treatment following admission to the same residential ED treatment facility.

RESULTS

ED symptom severity was significantly negatively associated with three of the four domains of IE; unconditional permission to eat, reliance on hunger and satiety cues, and body-food choice congruence. A significant mediational effect of IE on the relationship between body image-related fusion and ED symptoms through IE behaviors was observed (β = 11.3, SE = 0.003, p < 0.001). This effect was only observed for the unconditional permission to eat (β = 0.13, p = 0.003) and reliance on hunger and satiety cues (β = 0.10, p = 0.005) domains of IE when the domains were subsequently analyzed individually.

CONCLUSION

Unconditional permission to eat and reliance on hunger and satiety cues appear to be particularly influential domains of IE in the relationship between body image-related fusion and ED symptom severity. It is possible that changes in these IE domains may be mechanisms through which body image-related fusion influences ED symptoms. Future longitudinal research is needed to better understand the relationship between body image-related cognitive fusion and IE and the potential for targeting these constructs specifically in the context of ED treatment.

LEVEL OF EVIDENCE

Level V, cross-sectional analysis from descriptive study.

Rhythm Perception, Speaking Rate Entrainment, and Conversational Quality: A Mediated Model

PURPOSE

Acoustic-prosodic entrainment, defined as the tendency for individuals to modify their speech behaviors to more closely align with the behaviors of their conversation partner, plays an important role in successful interaction. From a mechanistic perspective, acoustic-prosodic entrainment is, by its very nature, a rhythmic activity. Accordingly, it is highly plausible that an individual's rhythm perception abilities play a role in their ability to successfully entrain. Here, we examine the impact of rhythm perception in speaking rate entrainment and subsequent conversational quality.

METHOD

A round-robin paradigm was used to collect 90 dialogues from neurotypical adults. Additional assessments determined participants' rhythm perception abilities, social competence, and partner familiarity (i.e., whether the conversation partners knew each other prior to the interaction. Mediation analysis was used to examine the relationships between rhythm perception scores, speaking rate entrainment (using a measure of static local synchrony), and a measure of conversational success (i.e., conversational quality) based on third-party listener observations. Findings were compared to the same analysis with three additional predictive factors: participant gender, partner familiarity, and social competence.

RESULTS

Results revealed a relationship between rhythm perception and speaking rate entrainment. In unfamiliar conversation partners, there was a relationship between speaking rate entrainment and conversational quality. The relationships between entrainment and each of the three additional factors (i.e., gender, partner familiarity, and social competence) were nonsignificant.

CONCLUSIONS

In unfamiliar conversation partners, better rhythm perception abilities were indicative of increased conversational quality mediated by higher levels of speaking rate entrainment. These results support theoretical postulations specifying rhythm perception abilities as a component of acoustic-prosodic entrainment, which, in turn, facilitates conversational success. Knowledge of this relationship contributes to the development of a causal framework for considering a mechanism by which rhythm perception deficits in clinical populations may impact conversational success.

Moderators and predictors in a parent hearing aid management eHealth program

Objective: Consistent hearing aid use is essential for spoken language development of children who are hard of hearing. A recent randomised controlled trial of an eHealth hearing aid management education program found the intervention increased knowledge, perceptions, confidence, and device monitoring among parents of young children. Yet, it is not known which variables can be a point of emphasis to improve treatment outcomes. The purpose of this study was to investigate potential moderators and predictors in the eHealth program.Design: Randomised controlled trialStudy Sample: Parents (N = 78) of children (42 months or younger) were randomised to the intervention or treatment-as-usual (TAU) group.Results: Results revealed that high psychological inflexibility, low parent activation, and low hours of hearing aid use may moderate device monitoring frequency and knowledge; parents in the intervention improved over time compared to the TAU group. Psychological inflexibility and parent activation also predicted treatment outcomes.Conclusion: The findings suggest the need to address parent psychological inflexibility related to hearing loss management, parents' role in their child's hearing aid management, and reported hours of hearing aid use as part of hearing aid service delivery. Identification of barriers to hearing aid management can assist audiologists in adjusting support to improve outcomes.

A Non-randomized, Quasi-Experimental Comparison of Effects Between an In-person and Online Delivery of a College Mental Health Literacy Curriculum

Mental health literacy (MHL) training is essential in college environments. These programs are commonly delivered in-person via workshops or for-credit courses. Campuses now seek high-quality online options. We compare the effectiveness of a for-credit MHL course against a comparison course, focusing on whether online asynchronous delivery was as effective as in-person synchronous delivery. This quasi-experimental pretest/posttest treatment/comparison study included 1049 participants across five semesters (pre-COVID-19) who were 18 years or older and self-selected enrollment in a Mental Health Awareness and Advocacy (MHAA) course (treatment; n = 474) or a general lifespan development course (comparison; n = 575). Using linear mixed effect modeling, changes in MHL were compared across groups and across online/in-person modalities. Students in the treatment group significantly increased their MHL knowledge (β_Identifying = .49, p < .001; β_Locating = .32, p < .001; β_Responding = .46, p < .001) and self-efficacy (β = .27, p < .001), and treatment effects did not differ across modalities. With increased concern regarding mental health issues of isolated college students during the COVID-19 pandemic, this study supports the efficacy of delivering MHL courses online.

From Speech Acoustics to Communicative Participation in Dysarthria: Toward a Causal Framework

PURPOSE

We proposed and tested a causal instantiation of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework, linking acoustics, intelligibility, and communicative participation in the context of dysarthria.

METHOD

Speech samples and communicative participation scores were collected from individuals with dysarthria (n = 32). Speech was analyzed for two acoustic metrics (i.e., articulatory precision and speech rate), and an objective measure of intelligibility was generated from listener transcripts. Mediation analysis was used to evaluate pathways of effect between acoustics, intelligibility, and communicative participation.

RESULTS

We observed a strong relationship between articulatory precision and intelligibility and a moderate relationship between intelligibility and communicative participation. Collectively, data supported a significant relationship between articulatory precision and communicative participation, which was almost entirely mediated through intelligibility. These relationships were not significant when speech rate was specified as the acoustic variable of interest.

CONCLUSION

The statistical corroboration of our causal instantiation of the ICF framework with articulatory acoustics affords important support toward the development of a comprehensive causal framework to understand and, ultimately, address restricted communicative participation in dysarthria.

Psychometric Evaluation of a Barriers to Mental Health Treatment Questionnaire for Latina/o/x Caregivers of Children and Adolescents

Background

Knowledge regarding barriers faced by Latina/o/x caregivers in accessing youth mental health services (MHS) have largely depended on resource intensive interview-based assessments.

Objective

We evaluated a questionnaire for Latina/o/x caregivers of youths that presents a briefer and more feasible alternative.

Method

We conducted a psychometric evaluation of the Barriers to Treatment Questionnaire - Latina/o/x Caregivers (BTQ-LC) with a sample of 598 Latina/o/x caregivers from across the United States. Descriptive statistics and confirmatory factor analyses were used to identify common barriers to services, confirm the factor structure of the scale, and establish construct validity.

Results

Descriptive statistics suggest that not knowing where and how to access services, and normalization of youth psychopathology were the most frequently reported barriers among caregivers of youth with clinically elevated problems on the CBCL. Confirmatory factor analysis suggests that the BTQ-LC was best represented by a three-factor structure: (1) structural, (2) perceptions regarding mental health problems, and (3) services. Our finding suggest that the BTQ-LC could also be used as a single factor as fit indices ranged from acceptable to poor. BTQ-LC scales were all negatively correlated with the utilization of common youth MHS (i.e., psychological counseling, medical doctors, school professionals).

Conclusions

The BTQ-LC represents an important step towards improving our understanding and assessment of barriers to services contributing to mental health disparities among Latina/o/x youths.

Listener impressions of alaryngeal communication modalities

Purpose: Following a total laryngectomy in which the larynx is completely removed, individuals in the USA have three primary options for alaryngeal verbal communication including tracheoesophageal speech (TES), oesophageal speech (ES) and electrolarynx (EL). Using a large sample of participants from across the USA, this study investigated listener impressions of each primary type of alaryngeal communication. As these are the individuals more likely to be participating in social interactions and in positions of hiring for employment, the general public's impressions of TES, ES and EL may be a vital consideration during the treatment process.Method: A total of 381 individuals rated eight speech samples, including samples from speakers of each alaryngeal communication modality as well samples from age and sex matched laryngeal speakers, with regards to three outcome measures: intelligence, likability and employability.Result: Listener impressions of alaryngeal speech samples were modulated by the type of communication mode. Further, the patterns of results differed by speaker sex, with ES speech rated consistently more favourable for female speakers across all outcome measures and TES rated consistently more favourable for male speakers across all outcome measures.Conclusion: An overall preference for laryngeal speech was noted, particularly with male speakers. The female ES stimuli, interestingly, was the highest rated alaryngeal communication modality. Regardless of speaker sex, all alaryngeal modes greatly affected impressions of employability relative to impressions of likeability and intelligence.

Confirmatory factor analysis and measurement invariance of the Cognitive Fusion Questionnaire-Body Image in a clinical eating disorder sample

Individuals with eating disorders (EDs) may be particularly susceptible to body image related cognitive fusion (i.e., excessive entanglement with one's body image related thoughts such that they unduly influence on behavior). The Cognitive Fusion Questionnaire-Body Image (CFQ-BI) is the only existing measure of this construct, yet its psychometric properties have not been examined within a clinically diagnosed ED sample. The current study used confirmatory factor analysis and explored measurement invariance, construct validity, and incremental validity of the CFQ-BI when used with adolescent (n = 75) and adult (n = 100) females admitting to residential ED treatment. A modified version of the single-factor structure of the CFQ-BI best fit the data and configural, metric, and scalar invariance were supported across age groups (i.e., adolescents or adults) and ED behavioral presentations (i.e., restrictive behaviors or binge/purge behaviors). Adults' and individuals with binge/purge behavioral presentations reported significantly more body image related fusion compared to adolescents and adults, respectively. Body image related psychological flexibility and ED severity were both significantly correlated CFQ-BI scores in expected directions. These findings suggest the CFQ-BI is a valid measure for assessing body image related fusion among adolescent and adult females with varying ED behavioral presentations. Implications and future research directions are discussed.

The Effect of Talker Familiarity on Sentence Recognition Accuracy in Complex Noise

The familiar talker advantage is the finding that a listener's ability to perceive and understand a talker is facilitated when the listener is familiar with the talker. However, it is unclear when the benefits of familiarity emerge and whether they strengthen over time. To better understand the time course of the familiar talker advantage, we assessed the effects of long-term, implicit voice learning on 89 young adults' sentence recognition accuracy in the presence of four-talker babble. A university professor served as the target talker in the experiment. Half the participants were students of the professor and familiar with her voice. The professor was a stranger to the remaining participants. We manipulated the listeners' degree of familiarity with the professor over the course of a semester. We used mixed effects modeling to test for the effects of the two independent variables: talker and hours of exposure. Analyses revealed a familiar talker advantage in the listeners after 16 weeks (∼32 h) of exposure to the target voice. These results imply that talker familiarity (outside of the confines of a long-term, familial relationship) seems to be a much quicker-to-emerge, reliable cue for bootstrapping spoken language perception than previous literature suggested.

Gender as a moderator of the association of military sexual trauma and posttraumatic stress symptoms

OBJECTIVE

The current study examined the moderating role of gender on the association of military sexual trauma (MST) type (harassment-only vs. assault) and posttraumatic stress symptoms (PTSS) using the 6-factor Anhedonia Model.

METHODS

Participants were 1321 service members/veterans. Two-part hurdle models assessed the moderating role of gender on the association of MST type with the presence (at least "moderate" symptoms endorsed within each cluster) or severity of PTSS and symptom clusters.

RESULTS

Among those who experienced assault MST, women were at higher risk for the presence of intrusive, avoidance, negative affect, and anhedonia symptoms, and higher risk for more severe negative affect symptoms. Among those who experienced harassment-only MST, men were at higher risk of more severe PTSS symptoms overall and in the intrusive and dysphoric arousal symptom clusters. No other significant differences were observed.

CONCLUSIONS

Gathering information on MST type may be helpful in treatment planning.

Healthy Communication Partners Modify Their Speech When Conversing With Individuals With Parkinson's Disease

Purpose For individuals with Parkinson's disease (PD), conversational interactions can be challenging. Efforts to improve the success of these interactions have largely fallen on the individual with PD. Successful communication, however, involves contributions from both the individual with PD and their communication partner. The current study examines whether healthy communication partners naturally engage in different acoustic-prosodic behavior (speech compensations) when conversing with an individual with PD and, further, whether such behavior aids communication success. Method Measures of articulatory precision, speaking rate, and pitch variability were extracted from the speech of healthy speakers engaged in goal-directed dialogue with other healthy speakers (healthy-healthy dyads) and with individuals with PD (healthy-PD dyads). Speech compensations, operationally defined as significant differences in healthy speakers' acoustic-prosodic behavior in healthy-healthy dyads versus healthy-PD dyads, were calculated for the three speech behaviors. Finally, the relationships between speech behaviors and an objective measure of communicative efficiency were examined. Results Healthy speakers engaged in speech characterized by greater articulatory precision and slower speaking rate when conversing with individuals with PD relative to conversations with other healthy individuals. However, these adaptive speech compensations were not predictive of communicative efficiency. Conclusions Evidence that healthy speakers naturally engage in speech compensations when conversing with individuals with PD is novel, yet consistent with findings from studies with other populations in which conversation can be challenging. In the case of PD, these compensatory behaviors did not support communication outcomes. While preliminary in nature, the results raise important questions regarding the speech behavior of healthy communication partners and provide directions for future work.

A Clinical Advantage: Experience Informs Recognition and Adaptation to a Novel Talker With Dysarthria

Purpose Perceptual training paradigms, which leverage the mechanism of perceptual learning, show that naïve listeners, those with no prior experience with dysarthria, benefit from explicit familiarization with a talker with dysarthria. It is theorized that familiarization affords listeners an opportunity to acquire distributional knowledge of the degraded speech signal. Here, we extend investigations to clinically experienced listeners, speech-language pathologists (SLPs), and advance models of listener recognition and adaptation to dysarthric speech. Method Forty-seven SLPs completed a standard three-phase perceptual training protocol (pretest, familiarization, and posttest) with a novel talker with dysarthria. Intelligibility scores were compared with historical data from naïve listeners. Potential relationships between intelligibility scores and characteristics of clinical experience were examined. Results Intelligibility scores of SLPs improved by an average of 19% from pretest to posttest. This intelligibility improvement was lower than naïve listeners, although the difference was small. Moreover, clinical characteristics related to level of dysarthria experience (e.g., percent of caseload composed of dysarthria) predicted pretest/initial intelligibility. No predictive relationships between clinical characteristics and intelligibility improvement were revealed. Conclusions As a group, SLPs benefitted from perceptual training, suggesting that, despite prior experience, the opportunity to acquire knowledge of talker-specific cue distributions is crucial for optimal adaptation. However, SLPs with greater dysarthria experience were better at initially understanding the talker with dysarthria. This suggests that, through regular interaction with individuals with dysarthria, clinicians acquire knowledge of the cue distributions of dysarthric speech more generally and can generalize this group-specific knowledge to aid in understanding other talkers with dysarthria. Consistent with theoretical models of perceptual learning, both talker- and group-specific knowledge informed recognition and adaptation to dysarthric speech.

eHealth parent education for hearing aid management: a pilot randomized controlled trial

OBJECTIVE

Parents frequently experience challenges implementing daily routines important for consistent hearing aid management. Education that supports parents in learning new information and gaining confidence is essential for intervention success. We conducted a pilot study to test an eHealth program to determine if we could implement the program with adherence and affect important behavioural outcomes compared to treatment as usual.

DESIGN

Randomised controlled trial.

STUDY SAMPLE

Parents of children birth to 42 months who use hearing aids. Eighty-two parents were randomly assigned to the intervention or treatment-as-usual group. Four parents assigned to the intervention group did not continue after baseline testing.

RESULTS

The intervention was delivered successfully with low drop out (10%), high session completion (97%), and high program adherence. The intervention conditions showed significantly greater gains over time for knowledge, confidence, perceptions, and monitoring related to hearing aid management. Significant differences between groups were not observed for hearing aid use time.

CONCLUSION

We found that we could successfully implement this eHealth program and that it benefitted the participants in terms of knowledge and confidence with skills important for hearing aid management. Future research is needed to determine how to roll programs like this out on a larger scale.

Generalized Learning of Dysarthric Speech Between Male and Female Talkers

Purpose Perceptual training is a listener-targeted means for improving intelligibility of dysarthric speech. Recent work has shown that training with one talker generalizes to a novel talker of the same sex and that the magnitude of benefit is maximized when the talkers are perceptually similar. The current study expands previous findings by investigating whether perceptual training effects generalize between talkers of different sex. Method Forty new listeners were recruited for this study and completed a pretest, familiarization, and posttest perceptual training paradigm. Historical data collected using the same three-phase protocol were included in the data analysis. All listeners were exposed to the same talker with dysarthria during the pretest and posttest phases. For the familiarization phase, listeners were exposed to one of four talkers with dysarthria, differing in sex and level of perceptual similarity to the test talker or a control talker. During the testing phases, listener transcribed phrases produced by the test talker with dysarthria. Listener transcriptions were then used to calculate a percent words correct intelligibility score. Results Multiple linear regression analysis revealed that intelligibility at posttest was not predicted by sex of the training talker. Consistent with earlier work, the magnitude of intelligibility gain was greater when the familiarization and test talkers were perceptually similar. Additional analyses revealed greater between-listeners variability in the dissimilar conditions as compared to the similar conditions. Conclusions Learning as a result of perceptual training with one talker with dysarthria generalized to another talker regardless of sex. In addition, listeners trained with perceptually similar talkers had greater and more consistent intelligibility improvement. Together, these results add to previous evidence demonstrating that learning generalizes to novel talkers with dysarthria and that perceptual training is suitable for many listeners.

Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019

OBJECTIVES

To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes.

STUDY DESIGN

A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability.

RESULTS

Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybrid-design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support.

CONCLUSIONS

Hospital restrictions have significantly limited parental presence for NICU admitted infants, although single-family room design may attenuate this effect.

Conversational Coordination of Articulation Responds to Context: A Clinical Test Case With Traumatic Brain Injury

Purpose Coordination of communicative behavior supports shared understanding in conversation. The current study brings together analysis of two speech coordination strategies, entrainment and compensation of articulation, in a preliminary investigation into whether strategy organization is shaped by a challenging communicative context-conversing with a person who has a communication disorder. Method As an initial clinical test case, an automated measure of articulatory precision was analyzed in a corpus of spoken dialogue, where a confederate conversed with participants with traumatic brain injury (n = 28) and participants with no brain injury (n = 48). Results Overall, the confederate engaged in significant entrainment and high compensation (hyperarticulation) in conversations with participants with traumatic brain injury relative to significant entrainment and low compensation (hypoarticulation) in conversations with participants with no brain injury. Furthermore, the confederate's articulatory precision changed over the course of the conversations. Conclusions Findings suggest that the organization of conversational coordination is sensitive to context, supporting synergistic models of spoken dialogue. While corpus limitations are acknowledged, these initial results point to differences in the way in which speech strategies are realized in challenging communicative contexts, highlighting a viable and important target for investigation with clinical populations. A framework for investigating speech coordination strategies in tandem and ideas for advancing this line of inquiry serve as key contributions of this work.

When Additional Training Isn't Enough: Further Evidence That Unpredictable Speech Inhibits Adaptation

Purpose Robust improvements in intelligibility following familiarization, a listener-targeted perceptual training paradigm, have been revealed for talkers diagnosed with spastic, ataxic, and hypokinetic dysarthria but not for talkers with hyperkinetic dysarthria. While the theoretical explanation for the lack of intelligibility improvement following training with hyperkinetic talkers is that there is insufficient distributional regularity in the speech signals to support perceptual adaptation, it could simply be that the standard training protocol was inadequate to facilitate learning of the unpredictable talker. In a pair of experiments, we addressed this possible alternate explanation by modifying the levels of exposure and feedback provided by the perceptual training protocol to offer listeners a more robust training experience. Method In Experiment 1, we examined the exposure modifications, testing whether perceptual adaptation to an unpredictable talker with hyperkinetic dysarthria could be achieved with greater or more diverse exposure to dysarthric speech during the training phase. In Experiment 2, we examined feedback modifications, testing whether perceptual adaptation to the unpredictable talker could be achieved with the addition of internally generated somatosensory feedback, via vocal imitation, during the training phase. Results Neither task modification led to improved intelligibility of the unpredictable talker with hyperkinetic dysarthria. Furthermore, listeners who completed the vocal imitation task demonstrated significantly reduced intelligibility at posttest. Conclusion Together, the results from Experiments 1 and 2 replicate and extend findings from our previous work, suggesting perceptual adaptation is inhibited for talkers whose speech is largely characterized by unpredictable degradations. Collectively, these results underscore the importance of integrating signal predictability into theoretical models of perceptual learning.

Exploring Early Childhood Language Environments: A Comparison of Language Use, Exposure, and Interactions in the Home and Childcare Settings

Purpose This study was conducted in a large Midwestern metropolitan area to examine the language environments at home and in center-based childcare for young children who are living in poverty. We compared child language use and exposure in the home and childcare settings using extended observations with automated Language Environment Analysis to gain a deeper understanding of the environmental factors that may affect change in language outcomes for young children. Method Thirty-eight children, along with parents (n = 38) and childcare providers (n = 14) across five childcare centers, participated in this study. Each child completed a standardized language assessment and two daylong recordings with Language Environment Analysis to determine the number of adult words, conversational turns, and child vocalizations that occurred in each setting. Data were analyzed at 5-min intervals across each recording. Results Comparisons between home recordings in this sample and a comparison group showed reliably higher rates of adult words and conversational turns in the home setting. Linear mixed-effects regression models showed significant differences in the child language environments, with the home setting providing higher levels of language input and use. These effects were still meaningful after accounting for the time of day, participant demographic characteristics, and child language ability. Conclusions Practical implications for supporting child language development across settings are discussed, and suggestions for further research are provided. Supplemental Material https://doi.org/10.23641/asha.12042678.

Sync Pending: Characterizing Conversational Entrainment in Dysarthria Using a Multidimensional, Clinically Informed Approach

Purpose Despite the import of conversational entrainment to successful spoken dialogue, the systematic characterization of this behavioral syncing phenomenon represents a critical gap in the field of speech pathology. The goal of this study was to acoustically characterize conversational entrainment in the context of dysarthria using a multidimensional approach previously validated in healthy populations (healthy conversations; Borrie, Barrett, Willi, & Berisha, 2019). Method A large corpus of goal-oriented conversations between participants with dysarthria and healthy participants (disordered conversations) was elicited using a "spot the difference" task. Expert clinical assessment of entrainment and a measure of conversational success (communicative efficiency) was obtained for each of the audio-recorded conversations. Conversational entrainment of acoustic features representing rhythmic, articulatory, and phonatory dimensions of speech was identified using cross-recurrence quantification analysis with clinically informed model parameters and validated with a sham condition involving conversational participants who did not converse with one another. The relationship between conversational entrainment and communicative efficiency was examined. Results Acoustic evidence of entrainment was observed in phonatory, but not rhythmic and articulatory, behavior, a finding that differs from healthy conversations in which entrainment was observed in all speech signal dimensions. This result, that disordered conversations showed less acoustic entrainment than healthy conversations, is corroborated by clinical assessment of entrainment in which the disordered conversations were rated, overall, as being less in sync than healthy conversations. Furthermore, acoustic entrainment was predictive of communicative efficiency, corroborated by a relationship between clinical assessment and the same outcome measure. Conclusions The findings confirm our hypothesis that the pathological speech production parameters of dysarthria disrupt the seemingly ubiquitous phenomenon of conversational entrainment, thus advancing entrainment deficits as an important variable in dysarthria, one that may have causative effects on the success of everyday communication. Results further reveal that while this approach provides a broad overview, methodologies for characterizing conversational entrainment in dysarthria must continue to be developed and refined, with a focus on clinical utility. Supplemental Material https://osf.io/ktg5q.

Regularity Matters: Unpredictable Speech Degradation Inhibits Adaptation to Dysarthric Speech

Purpose Listener-targeted perceptual training paradigms, which leverage the mechanism of perceptual learning, show strong promise for improving intelligibility in dysarthria, offsetting the communicative burden from the speaker onto the listener. Theoretical models of perceptual learning underscore the importance of acoustic regularity (i.e., signal predictability) for listener adaptation to degraded speech. The purpose of the current investigation was to evaluate intelligibility outcomes following perceptual training with hyperkinetic dysarthria, a subtype characterized by reduced signal predictability. Method Forty listeners completed the standard 3-phase perceptual training protocol (pretest, training, and posttest) with 1 of 2 talkers with hyperkinetic dysarthria. Perceptual data were compared to a historical data set for 1 other talker with hyperkinetic dysarthria to examine the effect of perceptual training on intelligibility. Results When controlling for pretest intelligibility, regression results suggest listeners of the 2 novel talkers with hyperkinetic dysarthria performed comparably to the listeners of the original talker on the posttest following training. Furthermore, differences between pretest and posttest intelligibility failed to reach clinical significance for all 3 talkers and statistical significance for 2 of the 3. Conclusion The current findings are consistent with theoretical models of perceptual learning and suggest that listener adaptation to degraded speech may be negligible for talkers with dysarthria whose speech is marked by reduced signal predictability.

Do Conversational Partners Entrain on Articulatory Precision?

The communication phenomenon known as conversational entrainment occurs when dialogue partners align or adapt their behavior to one another while conversing. Associated with rapport, trust, and communicative efficiency, entrainment appears to facilitate conversational success. In this work, we explore how conversational partners entrain or align on articulatory precision or the clarity with which speakers articulate their spoken productions. Articulatory precision also has implications for conversational success as precise articulation can enhance speech understanding and intelligibility. However, in conversational speech, speakers tend to reduce their articulatory precision, preferring low-cost, imprecise speech. Speakers may adapt their articulation and become more precise depending on feedback from their listeners. Given the potential of entrainment, we are interested in how conversational partners adapt or entrain their articulatory precision to one another. We explore this phenomenon in 57 task-based dialogues. Controlling for the influence of speaking rate, we find that speakers entrain on articulatory precision, with significant alignment on articulation of consonants. We discuss the potential applications that speaker alignment on precision might have for modeling conversation and implementing strategies for enhancing communicative success in human-human and human-computer interactions.

Syncing Up for a Good Conversation: A Clinically Meaningful Methodology for Capturing Conversational Entrainment in the Speech Domain

Purpose Conversational entrainment, the phenomenon whereby communication partners synchronize their behavior, is considered essential for productive and fulfilling conversation. Lack of entrainment could, therefore, negatively impact conversational success. Although studied in many disciplines, entrainment has received limited attention in the field of speech-language pathology, where its implications may have direct clinical relevance. Method A novel computational methodology, informed by expert clinical assessment of conversation, was developed to investigate conversational entrainment across multiple speech dimensions in a corpus of experimentally elicited conversations involving healthy participants. The predictive relationship between the methodology output and an objective measure of conversational success, communicative efficiency, was then examined. Results Using a real versus sham validation procedure, we find evidence of sustained entrainment in rhythmic, articulatory, and phonatory dimensions of speech. We further validate the methodology, showing that models built on speech signal entrainment measures consistently outperform models built on nonentrained speech signal measures in predicting communicative efficiency of the conversations. Conclusions A multidimensional, clinically meaningful methodology for capturing conversational entrainment, validated in healthy populations, has implications for disciplines such as speech-language pathology where conversational entrainment represents a critical knowledge gap in the field, as well as a potential target for remediation.

Autoscore: An open-source automated tool for scoring listener perception of speech

Speech perception studies typically rely on trained research assistants to score orthographic listener transcripts for words correctly identified. While the accuracy of the human scoring protocol has been validated with strong intra- and inter-rater reliability, the process of hand-scoring the transcripts is time-consuming and resource intensive. Here, an open-source computer-based tool for automated scoring of listener transcripts is built (Autoscore) and validated on three different human-scored data sets. Results show that not only is Autoscore highly accurate, achieving approximately 99% accuracy, but extremely efficient. Thus, Autoscore affords a practical research tool, with clinical application, for scoring listener intelligibility of speech.

Understanding dysrhythmic speech: When rhythm does not matter and learning does not happen

A positive relationship between rhythm perception and improved understanding of a naturally dysrhythmic speech signal, ataxic dysarthria, has been previously reported [Borrie, Lansford, and Barrett. (2017). J. Speech Lang. Hear. Res. 60, 3110-3117]. The current follow-on investigation suggests that this relationship depends on the nature of the dysrhythmia. When the corrupted rhythm cues are relatively predictable, affording some learnable acoustic regularity, the relationship is replicated. However, this relationship is nonexistent, along with any intelligibility improvements, when the corrupted rhythm cues are unpredictable. Findings highlight a key role for rhythm perception and distributional regularities in adaptation to dysrhythmic speech.

Speech-material and talker effects in speech band importance

Band-importance functions created using the compound method [Apoux and Healy (2012). J. Acoust. Soc. Am. 132, 1078-1087] provide more detail than those generated using the ANSI technique, necessitating and allowing a re-examination of the influences of speech material and talker on the shape of the band-importance function. More specifically, the detailed functions may reflect, to a larger extent, acoustic idiosyncrasies of the individual talker's voice. Twenty-one band functions were created using standard speech materials and recordings by different talkers. The band-importance functions representing the same speech-material type produced by different talkers were found to be more similar to one another than functions representing the same talker producing different speech-material types. Thus, the primary finding was the relative strength of a speech-material effect and weakness of a talker effect. This speech-material effect extended to other materials in the same broad class (different sentence corpora) despite considerable differences in the specific materials. Characteristics of individual talkers' voices were not readily apparent in the functions, and the talker effect was restricted to more global aspects of talker (i.e., gender). Finally, the use of multiple talkers diminished any residual effect of the talker.

Trends in Hearing Loss Among Adolescents

OBJECTIVES

Our aim with this article is to evaluate whether the prevalence of hearing loss is increasing among adolescents living in the United States.

METHODS

All available data about hearing loss among adolescents from the large, federally funded National Health and Nutrition Examination Survey (NHANES) were analyzed. By using the 4 data releases between 1994 and 2010 (a total of 6891 adolescents), the prevalence of adolescent hearing loss >15 and ≥25 dB at low frequencies (0.5, 1, and 2 kHz) and high frequencies (3, 4, 6, and 8 kHz) for bilateral, unilateral, and any loss were calculated.

RESULTS

Only 13 of 90 comparisons of prevalence across combinations of degree, frequency, and laterality of hearing loss revealed a statistically significant increase at P < .05. Among the 18 subgroups of degree, frequency, and laterality, 61% had a lower prevalence of hearing loss in 2010 than in 1994, and 100% of the subgroups had a lower prevalence in 2010 than in 2006.

CONCLUSIONS

With previous analyses of NHANES data from 1994 to 2006, researchers showed that hearing loss among US adolescents was increasing. Based on the NHANES data from 1994 to 2010 that are now available, there is no consistent evidence that hearing loss among adolescents in the United States is increasing. Results reveal that conclusions about trends using data from 2 time points can be misleading. NHANES should resume collecting audiometric data as part of their data collection protocol so that trends in the prevalence of childhood hearing loss can be documented.

Generalized Adaptation to Dysarthric Speech

PURPOSE

Generalization of perceptual learning has received limited attention in listener adaptation studies with dysarthric speech. This study investigated whether adaptation to a talker with dysarthria could be predicted by the nature of the listener's prior familiarization experience, specifically similarity of perceptual features, and level of intelligibility.

METHOD

Following an intelligibility pretest involving a talker with ataxic dysarthria, 160 listeners were familiarized with 1 of 7 talkers with dysarthria-who differed from the test talker in terms of perceptual similarity (same, similar, dissimilar) and level of intelligibility (low, mid, high)-or a talker with no neurological impairment (control). Listeners then completed an intelligibility posttest on the test talker.

RESULTS

All listeners benefited from familiarization with a talker with dysarthria; however, adaptation to the test talker was superior when the familiarization talker had similar perceptual features and reduced when the familiarization talker had low intelligibility.

CONCLUSION

Evidence for both generalization and specificity of learning highlights the differential value of listeners' prior experiences for adaptation to, and improved understanding of, a talker with dysarthria. These findings broaden our theoretical knowledge of adaptation to degraded speech, as well as the clinical application of training paradigms that exploit perceptual processes for therapeutic gain.