Telepractice Parent Training of Enhanced Milieu Teaching With Phonological Emphasis (EMT+PE) For Persian-Speaking Toddlers With Nonsyndromic Cleft Palate: Protocol for a Randomized Controlled Trial

BACKGROUND

Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents' role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders.

OBJECTIVE

This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention.

METHODS

A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants' speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants).

RESULTS

The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received.

CONCLUSIONS

The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54426.

Considerations of dialect on the identification of speech sound disorder in Vietnamese-speaking children

BACKGROUND

The dialect spoken by children influences diagnostic decision-making regarding the identification and severity of speech sound disorder (SSD).

AIMS

The primary objective was to review papers that examined the influence of dialect on the identification of SSD in Vietnamese-speaking children.

METHODS & PROCEDURES

Five studies of mono- and multilingual Vietnamese-speaking children living in Vietnam and Australia were reviewed to examine the influence of dialect on the assessment and analysis children's speech. The main Vietnamese dialects (Standard, Northern, Central, Southern) differ in the production of consonants, vowels and tones.

MAIN CONTRIBUTION

Most speech assessments define correct production using the standard dialect of a language. Insights from recent studies of Vietnamese provide recommendations for also considering dialect in diagnostic decision-making. First, we recommend adding column(s) to the assessment score sheet that includes the dialectal variants spoken by adults in the child's family or community. Second, we calculate the accuracy of production twice, based on the standard form and dialectal form. Third, we report the percentage of consonants correct-standard (PCC-S) and percentage of consonants correct-dialect (PCC-D).

CONCLUSIONS & IMPLICATIONS

Diagnostic decision-making is influenced by dialectal variation in children's speech, so speech and language therapists need to compare standard and dialectal productions when undertaking assessments, analysis and diagnostic decision-making.

WHAT THIS PAPER ADDS

What is already known on the subject Most speech assessments use the standard form of a dialect as the correct production. The standard dialect is used for diagnosis of SSD and identification of intervention targets. What this paper adds to the existing knowledge This paper examines five research studies of Vietnamese to identify ways to consider dialect in speech and language therapy assessment and analysis. Vietnamese provides a complex environment for this examination since there are numerous Vietnamese dialects and they differ according to consonants, vowels and tones. What are the potential or actual clinical implications of this work? Speech and language therapists are encouraged to add column(s) to their assessment score sheet that includes the dialectal variants spoken by adults and to report the PCC-S and PCC-D.

Speech sound disorder or DLD (phonology)? Towards a consensus agreement on terminology

BACKGROUND

The publication of phase 2 of the CATALISE project in 2017 clarified terminology for children with developmental language disorder (DLD) or delay but unintentionally muddied the water for children with unintelligible speech. A diagnostic label of DLD (phonology) indicates poor prognosis and phonological disorder that persists into middle childhood. However, in contrast to other diagnostic labels that fall under the overarching term of speech sound disorder (SSD), DLD (phonology) does not elucidate the characteristics of the child's speech nor does it point us in the direction of appropriate intervention.

AIMS

The aim of this paper is to discuss terminology in SSD leading to an evidence-based model which builds on the model of DLD developed in CATALISE, supports descriptive diagnosis and signposts intervention.

METHODS

Following a focused review of literature proposing or describing terminology for SSD, an expert group of researchers in developmental SSD proposed a revised model of existing terminology. Groups of UK speech and language therapists (SLTs) who provide services for children with SSD were asked to comment on its acceptability and feasibility.

DISCUSSION

A three-level terminology model was developed. This comprised an overarching Level 1 term; Level 2 terms that differentiated SSD of unknown origin from SSD with associated or underlying conditions; and specific diagnostic terms at Level 3 to support further assessment and intervention decisions. Consulted SLTs generally expressed agreement with the proposed terminology and a willingness to adopt it in practice.

CONCLUSIONS

Existing terminology for childhood SSD provides a good basis for clinical decision-making. A modified version of Dodd's (2005) terminology was found to be acceptable to UK SLTs. There is an evident overlap of SSD with CATALISE terminology. However more detailed and specialist terminology than 'DLD (phonology)' is required to support clinical decision-making. It is proposed that endorsement by the UK Royal College of Speech and Language Therapists would obviate the need for a Delphi process.

WHAT THIS PAPER ADDS

What is already known on this subject Over nearly a hundred years, as our knowledge and understanding of speech sound disorder (SSD) has increased, so has the terminology that is used to describe those disorders. Current terminology not only describes subtypes of SSD but can also signpost us to effective interventions. With the publication, in 2017, of phase 2 of CATALISE a new term of 'developmental language disorder (DLD) (phonology)' was introduced with the unintentional consequence of challenging more specific descriptive terms for SSD. What this paper adds In the context of CATALISE and DLD (phonology), the history and nature of SSD terminology are reappraised. Building on the model of DLD developed in CATALISE, a tiered model that supports descriptive diagnosis and signposts intervention is proposed for discussion. Clinical implications of this study The proposed model of terminology for SSD provides descriptive and detailed labels that will support accuracy in differential diagnosis of developmental SSD by speech and language therapists. Furthermore, a decision-making tree for SSD demonstrates the pathway from diagnostic use of the terminology to the selection of evidence-based, effective interventions.

Understanding capacity for implementing new interventions: A qualitative study of speech and language therapy services for children with speech sound disorder

BACKGROUND

Many speech sound disorder (SSD) interventions with a long-term evidence base are 'new' to clinical practice, and the role of services in supporting or constraining capacity for practice change is underexplored. Innovations from implementation science may offer solutions to this research-practice gap but have not previously been applied to SSD.

AIM

To explain variation in speech and language therapy service capacity to implement new SSD interventions.

METHODS & PROCEDURES

We conducted an intensive, case-based qualitative study with 42 speech and language therapists (SLTs) in three NHS services (n = 39) and private practice (n = 3) in Scotland. We explored therapists' diverse experiences of SSD practice change through individual interviews (n = 28) or self-generated paired (n = 2) or focus groups (n = 3). A theoretical framework (Normalization Process Theory) helped us understand how the service context contributed to the way therapists engaged with different practice changes.

OUTCOMES & RESULTS

We identified six types ('cases') of practice change, two of which involved the new SSD interventions. We focus on these two cases ('Transforming' and 'Venturing') and use Normalization Process Theory's Cognitive participation construct to explain implementation (or not) of new SSD interventions in routine practice. Therapists were becoming aware of the new interventions through knowledge brokers, professional networks and an intervention database. In the Transforming case, new SSD interventions for selected children were becoming part of local routine practice. Transforming was the result of a favourable service structure, a sustained and supported 'push' that made implementation of the new interventions a service priority, and considerable collective time to think about doing it. 'Venturing' happened where the new SSD interventions were not a service priority. It involved individual or informal groups of therapists trying out or using one or more of the new interventions with selected children within the constraints of their service context.

CONCLUSIONS & IMPLICATIONS

New, evidence-based SSD interventions may be challenging to implement in routine practice because they have in common a need for therapists who understand applied linguistics and can be flexible with service delivery. Appreciating what it really takes to do routine intervention differently is vital for managers and services who have to make decisions about priorities for implementation, along with realistic plans for resourcing and supporting it.

WHAT THIS PAPER ADDS

What is already known on the subject Many SSD interventions have an evidence base but are not widely adopted into routine clinical practice. Addressing this is not just about individual therapists or education/training, as workplace pressures and service delivery models make it difficult to change practice. What this paper adds to the existing knowledge This paper applies innovations from implementation science to help explain how what is going on in services can support or constrain capacity for implementing evidence-based SSD interventions. What are the potential or actual clinical implications of this work? Service managers and therapists will have a clearer idea of the time and support they may realistically have to invest for new SSD interventions to be used routinely.

Intelligibility in Context Scale: Psychometric evidence and implications for Saudi Arabic-English-speaking preschoolers

Purpose: To evaluate the reliability, validity, and diagnostic accuracy (sensitivity, specificity) of the Intelligibility in Context Scale in Saudi Arabic (ICS-SA) and English (ICS-E) as potential measures of functional speech intelligibility in bilingual preschool-aged Saudi Arabian children.Method: The study included 36 parent-child (aged 3;0 to 6;5 years; months) dyads who were bilingual speakers of Saudi Arabic and English, which included two groups-typically developing (TD, n = 29) and suspected speech sound disordered (sSSD, n = 7). The children's intelligibility was evaluated in both languages using the ICS-SA and ICS-E. Children's single-word productions were collected in both languages and calculated for percentage of consonants, vowels, and phonemes correct (i.e. PCC/PVC/PPC) to establish their speech-sound competence.Result: The mean scores for the entire sample (n = 36) were 4.43 (SD = 0.79) for the ICS-SA and 4.48 (SD = 0.79) for the ICS-E, showing that parents rated their children's intelligibility in both languages similarly. Both the ICS-SA and ICS-E demonstrated excellent internal consistency (α = 0.96 and α = 0.95, respectively). There was high inter-rater and test-retest reliability for the ICS-SA, while there was fair to high inter-rater and test-retest reliability in ICS-E. Significant correlations were found for the ICS-SA, but weak correlations were noted for the ICS-E, which indicated fair to moderate evidence of criterion validity. Construct validity efforts indicated a weak correlation with age on both the ICS-SA and ICS-E. The findings also indicated high discriminant accuracy for both the ICS-SA (0.86, 0.86) and ICS-E (0.71, 0.69).Conclusion: This study provides initial validation and reliability evidence for using the ICS-SA and ICS-E with Saudi Arabic- and English-speaking preschoolers, however, ICS-E scores suggest further testing is warranted. By extension, these findings expand the bilingual knowledge base and offer new tools for identifying children in Saudi Arabia who may be at risk for having a speech sound disorder.

Music and musical elements in the treatment of childhood speech sound disorders: A systematic review of the literature

PURPOSE

Music-based interventions are used in the treatment of childhood speech sound disorders (SSDs). Hypotheses on working mechanisms are being developed, focussing on shared neural processes. However, evidence of the effect of treatment with musical elements in SSDs in children is lacking. This study reviews the literature regarding the use of music-based interventions in the treatment of childhood SSDs.

METHOD

A systematic search in six databases was conducted, yielding 199 articles, eight of which met the inclusion criteria. Included articles were reviewed on study characteristics, patient characteristics, interventions, outcomes and methodological quality.

RESULT

This review included four case studies, three single-subject design studies and one cohort study. Seven studies reported positive outcomes on speech production, but outcome measures in the four studies with experimental design were not all aimed at the level of speech (motor) processes. Methodological quality was sufficient in one study.

CONCLUSION

Seven out of eight studies in this review report positive outcomes of music-based interventions in the treatment of SSDs. However, these outcomes are not sufficiently supported by evidence due to insufficient methodological quality. Suggestions for improving methodological quality in future research are presented.

How to cut the pie is no piece of cake: Toward a process-oriented approach to assessment and diagnosis of speech sound disorders

BACKGROUND

'Speech sound disorder' is an umbrella term that encompasses dysarthria, articulation disorders, childhood apraxia of speech and phonological disorders. However, differential diagnosis between these disorders is a persistent challenge in speech pathology, as many diagnostic procedures use symptom clusters instead of identifying an origin of breakdown in the speech and language system.

AIMS

This article reviews typical and disordered speech through the lens of two well-developed models of production-one focused on phonological encoding and one focused on speech motor planning. We illustrate potential breakdown locations within these models that may relate to childhood apraxia of speech and phonological disorders.

MAIN CONTRIBUTION

This paper presents an overview of an approach to conceptualisation of speech sound disorders that is grounded in current models of speech production and emphasises consideration of underlying processes. The paper also sketches a research agenda for the development of valid, reliable and clinically feasible assessment protocols for children with speech sound disorders.

CONCLUSION

The process-oriented approach outlined here is in the early stages of development but holds promise for developing a more detailed and comprehensive understanding of, and assessment protocols for speech sound disorders that go beyond broad diagnostic labels based on error analysis. Directions for future research are discussed.

WHAT THIS PAPER ADDS

What is already known on the subject Speech sound disorders (SSD) are heterogeneous, and there is agreement that some children have a phonological impairment (phonological disorders, PD) whereas others have an impairment of speech motor planning (childhood apraxia of speech, CAS). There is also recognition that speech production involves multiple processes, and several approaches to the assessment and diagnosis of SSD have been proposed. What this paper adds to existing knowledge This paper provides a more detailed conceptualisation of potential impairments in children with SSD that is grounded in current models of speech production and encourages greater consideration of underlying processes. The paper illustrates this approach and provides guidance for further development. One consequence of this perspective is the notion that broad diagnostic category labels (PD, CAS) may each comprise different subtypes or profiles depending on the processes that are affected. What are the potential or actual clinical implications of this work? Although the approach is in the early stages of development and no comprehensive validated set of tasks and measures is available to assess all processes, clinicians may find the conceptualisation of different underlying processes and the notion of potential subtypes within PD and CAS informative when evaluating SSD. In addition, this perspective discourages either/or thinking (PD or CAS) and instead encourages consideration of the possibility that children may have different combinations of impairments at different processing stages.

Benefits of a professional development course on transcription for practising speech-language pathologists

Purpose: Transcription of speech sounds is a fundamental skill used by speech-language pathologists. Little is known about the impact of professional development courses on transcription accuracy and confidence. This study explored speech-language pathologists' use and perceptions of transcription and the effect of a professional development course on their transcription accuracy and confidence.Method: A quasi-experimental, one-group pretest-posttest design was used. Twenty-two Australian speech-language pathologists working with children with speech sound disorders participated in the course. Participants transcribed single words and completed a survey about confidence, perceptions, and the use of transcription at both time points.Result: The number of participants who reported feeling confident about using transcription significantly increased from 36.84% pre-training to 68.42% post-training. Transcription accuracy of phonemes based on point-to-point accuracy was high pre-training (88.97%) and did not significantly improve. Participants identified strategies to maintain their transcription skills.Conclusion: This study suggests speech-language pathologists transcribe single words in typical speech with high accuracy using broad transcription, and that participating in a transcription professional development course increases their transcription confidence. Further research is needed to explore different delivery methods of professional development, the impact of professional development on transcription accuracy of disordered speech, and the long-term impacts of professional development on transcription accuracy and confidence.

Spelling Proficiency of Children with a Resolved Phonological Speech Sound Disorder Treated with an Integrated Approach-A Long-Term Follow-Up Randomized Controlled Trial

Phonological developmental speech sound disorders (pDSSD) in childhood are often associated with later difficulties in literacy acquisition. The present study is a follow-up of the randomized controlled trial (RCT) on the effectiveness of PhonoSens, a treatment for pDSSD that focuses on improving auditory self-monitoring skills and categorial perception of phoneme contrasts, which could have a positive impact on later spelling development. Our study examines the spelling abilities of 26 German-speaking children (15 girls, 11 boys; mean age 10.1 years, range 9.3-11.2 years) 3-6 years after their successful completion of the PhonoSens treatment. Spelling assessment revealed that only 3 out of 26 participants developed a spelling disorder. In the overall population of fourth-graders, one in five children showed a spelling deficit; in another study of elementary school children, with resolved pDSSD, 18 of 32 children had a spelling deficit. Thus, the applied pDSSD treatment method appears to be associated with positive spelling development. Multiple regression analysis revealed that among the potentially predictive factors for German-speaking children with resolved pDSSD to develop later spelling difficulties, parental educational level and family risk for developmental language disorder (DLD) had an impact on children's spelling abilities; gender and the child's phonological memory had not.

Diagnosing inconsistent phonological disorder: quantitative and qualitative measures

Studies of children's consistency of word production allow identification of speech sound disorder. Inconsistent errors are reported for two groups of children: childhood apraxia of speech (CAS) due to difficulty with the motoric precision and consistency of speech movements; and inconsistent phonological disorder (IPD) attributed to impaired phonological planning. This paper describes the inconsistent productions of children with IPD in comparison to typically developing children. In two studies of suspected SSD (N = 135), 22 children pronounced ≥40% of 25 words inconsistently on three repeated trials. No participant had symptoms of CAS. They were monolingual and spoke Australian- or Irish-English. Assessment determined the proportions of words said consistently (i.e. the same across productions: all correct or with the same error) or inconsistently (i.e. differently across productions: at least one correct and one error or different errors in productions). Qualitative analyses examined error types and explored the effect of target words' characteristics on inconsistency. Children with IPD produced 52% of words with different errors. While 56% of all phoneme errors were developmental (age appropriate or delayed), atypical errors typified inconsistency: default sounds and word structure errors. Words with more phonemes, syllables and consonant clusters were vulnerable to inconsistency, but their frequency of occurrence had no effect. TD children and those with IPD had different quantitative and qualitative error profiles, confirming IPD as a diagnostic category of SSD. Qualitative analyses supported the hypothesised deficit in phonological planning of words' production for children with IPD.

Preschool children's consistency of word production

Consistency of word production contributes to carers' ability to understand children's speech. Reports of the proportion of words produced consistently by typically developing preschool children, however, vary widely from 17% to 87%. This paper examines the quantitative (consistency count) and qualitative (e.g. phonemic analysis) characteristics of word consistency in 96 children aged 36-60 months. Children named 15 pictures twice, in separate trials, in the same assessment session. The mean consistency of the production for the whole group was 82%. Older children were more consistent than younger children. Girls were more consistent than boys. Words produced correctly in one trial and in error in another may indicate resolving error patterns. Words produced in error in two different ways provided useful evidence about the nature of inconsistent word production in typically developing children. The clinical and theoretical implications are discussed.

Phonological processing skills in children with speech sound disorder: A multiple case study approach

BACKGROUND

Children with speech sound disorder (SSD) are at increased risk of reading difficulties due to poor phonological processing skills. However, the extent to which children with SSD demonstrate weaknesses on specific or all phonological processing tasks is not well understood.

AIMS

To examine the phonological processing abilities of a clinically identified sample of children with SSD, with and without reading difficulties. To determine the extent to which the proportion of children with concomitant SSD and reading difficulties exhibited weaknesses in specific areas of phonological processing, or a more general phonological deficit.

METHODS & PROCEDURES

Data were obtained from 157 school-aged children (M_age = 77 months, SD = 7.01) in receipt of school-based speech therapy. Approximately 25% of the sample was identified as poor readers, based on a standardized measure of word decoding. We compared the proportion of children who scored at or below 1 SD below the mean, or the bottom 16th percentile, on measures of phonological awareness, rapid automatized naming and verbal short-term memory among those identified as poor readers and good readers.

OUTCOMES & RESULTS

Children with SSD demonstrated a range of phonological processing difficulties, particularly on the measure of verbal short-term memory. No specific skill differentiated groups of children with SSD with and without reading difficulties; however, those classified as poor readers on the word-decoding measure exhibited more widespread difficulties, even after controlling for language ability.

CONCLUSIONS & IMPLICATIONS

Results support a cumulative risk model such that children with SSD and reading difficulties are likely to demonstrate generally poor phonological processing abilities.

WHAT THIS PAPER ADDS

What is already known on the subject Children with SSD are at heightened risk of reading difficulties, particularly if their SSD persists into school age. However, not all children with SSD experience reading problems. Research aimed at determining which children are at the highest risk is mixed as to how best to identify which children with SSD are most likely to experience reading difficulties. What this paper adds to existing knowledge The study used a multiple case study approach to determine if performance on phonological processing skills might differentiate children with SSD who were poor readers from those who were good readers. As a group, children with SSD exhibited poor verbal short-term memory but relatively intact rapid automatized naming skills. No one phonological processing skill differentiated children who were poor readers from good readers. However, children with reading difficulties appeared to experience more general difficulties across phonological processing tasks, even after controlling for language abilities. What are the potential or actual clinical implications of this work? A single deficit (i.e., speech sound production) is not sufficient data to make a complete diagnosis or treatment decisions. Multiple sources of data, including several aspects of phonological processing, should be obtained to understand reading risk in children with SSD.

Characterizing sensorimotor profiles in children with residual speech sound disorder: a pilot study

PURPOSE

Children with speech errors who have reduced motor skill may be more likely to develop residual errors associated with lifelong challenges. Drawing on models of speech production that highlight the role of somatosensory acuity in updating motor plans, this pilot study explored the relationship between motor skill and speech accuracy, and between somatosensory acuity and motor skill in children. Understanding the connections among sensorimotor measures and speech outcomes may offer insight into how somatosensation and motor skill cooperate during speech production, which could inform treatment decisions for this population.

METHOD

Twenty-five children (ages 9-14) produced syllables in an /ɹ/ stimulability task before and after an ultrasound biofeedback treatment program targeting rhotics. We first tested whether motor skill (as measured by two ultrasound-based metrics of tongue shape complexity) predicted acoustically measured accuracy (the normalized difference between the second and third formant frequencies). We then tested whether somatosensory acuity (as measured by an oral stereognosis task) predicted motor skill, while controlling for auditory acuity.

RESULTS

One measure of tongue shape complexity was a significant predictor of accuracy, such that higher tongue shape complexity was associated with lower accuracy at pre-treatment but higher accuracy at post-treatment. Based on the same measure, children with better somatosensory acuity produced /ɹ/ tongue shapes that were more complex, but this relationship was only present at post-treatment.

CONCLUSION

The predicted relationships among somatosensory acuity, motor skill, and acoustically measured /ɹ/ production accuracy were observed after treatment, but unexpectedly did not hold before treatment. The surprising finding that greater tongue shape complexity was associated with lower accuracy at pre-treatment highlights the importance of evaluating tongue shape patterns (e.g., using ultrasound) prior to treatment, and has the potential to suggest that children with high tongue shape complexity at pre-treatment may be good candidates for ultrasound-based treatment.

Word structure and consonant interaction in a French-speaking child with protracted phonological development

This paper presents data from a Québec French-speaking child with protracted phonological development (PPD) who received phonological intervention based on a nonlinear phonological framework. At 5;3, he showed relative strengths in word structure compared with consonants (e.g., /s, f, v, k, ɡ/). Addressing segmental constraints in intervention led to higher overall accuracy and more consistent production of singleton consonants and word-medial consonant sequences and further gains in word structure. As part of a special cross-linguistic issue on individual profiles in PPD, the current paper provides an in-depth pre/post-treatment phonological analysis and contributes to emerging normative French-Canadian data on assessment and treatment.

Speech perception in noise in children with dyslexia: Does speech sound disorder matter?

The aim of this observational cohort study with a control group is to compare consonant perception skills in quiet and in noise in children with typical language and learning development and in children with dyslexia, with and without Speech Sound Disorder (SSD). Three groups were included: A control group of twenty children with normal reading abilities and typical language development, twelve children with dyslexia and typical language development and thirteen children with dyslexia and SSD. All subjects received a consonant recognition test in three different listening conditions (quiet, + 10 and 0 Signal-to-Noise Ratio). In all test conditions, children with dyslexia and SSD had significantly lower consonant recognition scores than the control group and the children with dyslexia and typical language development (p < .0001). The poorer performances observed in children with dyslexia and SSD may be explained by impaired phonological processing underlying both conditions.

Phonological complexity in intervention for Spanish-speaking children with speech sound disorder

The efficiency of intervention for children with speech sound disorder may be influenced by linguistic complexity of the phonological intervention target. Complex targets, particularly, later-acquired, less-known consonants and consonant clusters, have been linked to greater post-intervention generalization to untargeted phonological structures. Yet there is little direct evidence to support target selection based on linguistic complexity for Spanish-speaking children with speech sound disorder. This intervention study utilizes an experimental single-case design to examine the efficacy of intervention in Spanish using different complex targets (i.e. /ɡɾ/, /bɾ/, and /l/). For each of the four Spanish-speaking children with speech sound disorder, sounds at 0% accuracy during baseline were monitored across the baseline period, during and post-intervention, and at one- and two-month follow-up visits. Over the course of intervention, only one participant achieved mastery of the targeted structure in practiced words. However, all participants demonstrated some amount of broad phonological generalization to untargeted consonants or clusters. Variable learning trajectories and broad phonological generalization are discussed as they relate to participant characteristics and linguistic complexity.

Investigation into the effectiveness of electropalatography in treating persisting speech sound disorders in adolescents with co-occurring developmental language disorder

This study aimed to assess the effectiveness of electropalatography (EPG) intervention in targeting specific phonemes/words in seven adolescents aged 14:10-18:06 with co-occurring speech sound and language disorders. Progress on individualised targets versus controls was evaluated following intervention undertaken as part of the participants' usual speech and language therapy provision. As a group, the participants showed significantly greater progress on their targets than controls, indicating that the EPG intervention was effective. However, performance varied between participants, targets and school terms. Factors that may have influenced the effectiveness of intervention include spending more time on targets and focusing on a specific phoneme. Overall, the results suggest EPG should be considered as an intervention approach for this client group, even in the late teenage years.

Differentiating phonological delay from phonological disorder: Executive function performance in preschoolers

BACKGROUND

The conversational speech of most children can be understood by people outside the family by the time they reach 4 years. However, for some children, speech sound disorders (SSDs) persist into their early school years, and beyond, despite adequate hearing, oromotor function, and language learning opportunities. One explanation for children's SSDs are domain-general cognitive-linguistic deficits that impair the child's ability to correctly derive rules governing how speech sounds legally combine to form words in a specific language.

AIMS

To explore whether there are differences in performance on executive function tasks between children who make speech errors characteristic of phonological delay and those who make speech errors characteristic of phonological disorder.

METHODS & PROCEDURES

Twenty-six children aged from 3;6 to 5;2 (13 with phonological delay and 13 with phonological disorder), matched pairwise for age and sex (nine males), were assessed on tasks measuring cognitive flexibility (rule abstraction and cognitive shift) and phonological working memory.

OUTCOME & RESULTS

For the cognitive flexibility tasks, the performance of children with phonological delay was significantly better than that for children with phonological disorder, but there were no group differences for the phonological working memory task.

CONCLUSIONS & IMPLICATIONS

Children with phonological disorders might benefit from intervention programmes that incorporate training in cognitive flexibility.

WHAT IS ALREADY KNOWN ON THE SUBJECT

Children with phonological delay and phonological disorder comprise the two largest SSD subgroups that present to speech-language therapy clinics. Evidence suggests domain-general cognitive processes (e.g., phonological working memory, ability to revise faulty underlying representations, rule abstraction, and cognitive shift) influence phonological development. Differences between the two subgroups in the types of speech errors, linguistic abilities, developmental trajectories, and responses to intervention have been reported, yet little is known about the underlying cognitive-linguistic deficits.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

The results of this study suggest that children with phonological delay and phonological disorder have distinct patterns of performance on executive function tasks: Children with phonological disorder showed deficits in domain general rule-abstraction and cognitive shift when compared to children with phonological delay. WHAT ARE THE POTENTIAL OR ACTUAL CLINICAL IMPLICATIONS OF THIS WORK?: The findings draw attention to: (1) the importance of differential diagnosis of phonological delay and phonological disorder; (2) the role of domain-general cognitive processes in explaining why children make particular types of errors; and (3) the need to develop innovative and tailored intervention techniques that target specific underlying deficits.

Phonological productive processes in full-term schoolchildren and small for gestational age: a case-control study

PURPOSE

To characterize the use of phonological productive processes in a group of full-term children and small for gestational age and compare it with children appropriate for gestational age.

METHODS

Observational, analytical, case-control and non-paired study, nested in a cohort with the outcome of phonological disorder. We assessed 36 children according to the predetermined sample calculation, 24 (66.7%) without phonological disorders and 12 (33.3%) with phonological disorders. Of these, 24 (66.7%) children were classified as small for gestational age (SGA) and 12 (33%) as appropriate for gestational age (AGA). Phonological aspects of oral language were assessed by the ABFW children's language test (2004). The results were subjected to descriptive analysis and, in order to assess the existence of an association among categorical variables, we used Fisher's exact test for association.

RESULTS

The SGA group revealed a significantly higher number of phonological processes that change the syllable structure when compared to the AGA group. We noted that the phonological processes present and unexpected for age in the SGA population were: fricative plosivation, liquid simplification, palatal posteriorization and frontalization, plosive and fricative deafening, in addition to simplifying the consonant cluster and simplifying the final consonant, which were the most frequent in both groups.

CONCLUSION

Although no association was found between phonological disorders and SGA children, we have noted a greater use of productive phonological processes in this group.

Vowel errors produced by preschool-age children on a single-word test of articulation

Eighty-four children, age 4-5 years, with and without speech sound disorder (SSD) completed a battery of standardized speech and language tests, including the Goldman-Fristoe Test of Articulation, Third Edition (GFTA-3). Children with SSD produced more vowel errors than children with typical speech abilities. Percentage vowels correct and consonant error variability were highly correlated, suggesting that poorly specified phonological representations affect both consonants and vowels within a child's phonological system. However, the GFTA-3 did not contain sufficient target words to determine full vowel inventory. Using words from the GFTA-3, we present a case study of a child with vowel errors along with a sample analysis of these errors, primarily in terms of consonant-vowel feature interactions. Children who exhibit vowel errors on standardized single-word tests of speech accuracy may benefit from further vowel probes to determine how vowel and consonant errors interact in their phonological systems for more targeted therapy.

Making the case for the collection of a minimal dataset for children with speech sound disorder

BACKGROUND

NHS case note data are a potential source of practice-based evidence which could be used to investigate the effectiveness of different interventions for individuals with a range of speech, language and communication needs. Consistency in pre- and post-intervention data as well as the collection of relevant variables would need to be demonstrated as a precursor to adopting this approach in future investigations of speech and language therapy intervention.

AIMS

To explore whether routine clinical data collection for children with speech sound disorder (SSD) could be a potential source for examining the effectiveness of intervention(s).

METHODS & PROCEDURES

We examined case notes from three UK NHS services, reviewing 174 sets of case notes and 234 blocks of therapy provided for school-age children with SSD.

MAIN CONTRIBUTION

We found there was significant variation in pre- and post-intervention data and variables collected by the services. The assessment data available in the case notes across all sites were insufficient to be used to compare the effectiveness of different interventions. Specific issues included lack of consistent reporting of pre- and post-intervention data, and use of a variety of both formal and informal assessment tools.

CONCLUSIONS & IMPLICATIONS

The case notes reviewed were from three sites and may not represent wider clinical practice, nevertheless the findings suggest the sample explored indicates the need for more consistent and contemporaneous collection of data for children with SSD to facilitate the investigation of different interventions in practice. Researchers should work with the clinical community to determine a minimal dataset that includes a core outcome set and potential variables. This should be feasible to collect in clinical practice and provide a dataset for future investigations of clinically relevant research questions. This would provide an invaluable resource to the clinical academic and research communities enabling research questions to be addressed that have the potential to lead to improved outcomes and more cost-effective services.

WHAT THIS PAPER ADDS

What is already known on the subject While there is some evidence for the efficacy of therapy for children with SSD, studies typically focus on very specific populations who meet strict selection criteria and take place in university clinics or laboratory-style settings which do not reflect typical clinical practice in the UK and elsewhere. An alternative approach to investigating the effectiveness of interventions would be to use NHS case note data. It is not clear from the existing literature whether case note data are sufficiently robust to facilitate such an analysis. What this paper adds to existing knowledge This study found that case note data, in particular assessment data, were highly variable across services and would be insufficient to compare different interventions for this population. Agreement on what should be included in a minimal dataset for children with SSD is required to maximize the potential for NHS clinical case notes to become a resource for future research. What are the actual or potential clinical implications of this work? This study indicates that current clinical practice in SLT for children with SSD is inconsistent with regards to the reporting of pre- and post-intervention assessment data and other important variables in case notes. We make the case for agreeing a minimal dataset with a need for clinicians to work with researchers to determine core outcomes and additional relevant data, which can be feasibly collected in clinical practice.

Speech inconsistency and its association with speech production, phonological awareness and nonword repetition skills

The purpose of this study was to investigate relationships between speech inconsistency, speech production skills, phonological awareness and nonword repetition (NWR) in 24 preschool-aged Finnish-speaking children with speech sound disorder (SSD) and in 31 children with typical speech and language development (TD). Speech inconsistency was assessed by a picture-naming task repeated three times during one assessment session. The participants' speech production skills were assessed with the Finnish Test for Phonology and a diadochokinetic (DDK) task. Phonological awareness was investigated by the tasks of Rhyme and initial syllable awareness and Syllable segmentation, and NWR by ten 2-4-syllabic nonwords. The findings indicated that the children with SSD were less accurate in speech production and NWR than the children with TD. No difference was found in phonological awareness. Among the children with SSD, speech inconsistency was correlated with accuracy in overall speech production, DDK task, and NWR. Among the children with TD, speech inconsistency was correlated with accuracy in overall speech production, partly with phonological awareness, and with NWR. The results provide support for the idea that when assessing speech inconsistency in children with SSD, a process-oriented approach may be needed in order to obtain an adequately broad picture of their skill profiles.

Development of a speech production test in Azeri Turkish speaking children

Due to the lack of appropriate tests for the assessment of speech sounds of Azeri Turkish speaking children, the present study aimed to develop and validate a single word test. A total of 150 typically developing children were recruited in the study (30 children for investigating the name agreement and 120 children to establish construct validity). In the first step, a test with 31 items was developed in terms of suggested criteria in the literature including word frequency, word length, syllabic structure, familiarity, and picturability of words. Then, we asked the expert panel's opinion for the test items. The value of the content validity ratio for each target word was 1.00 except for one item. To administer the test, we asked the participants to name images. Name agreement of the items was determined through administrating the test. The percentages for the indices of name agreement were 87.68 and 0.17, respectively. The findings of the item-by-item test-retest and inter-rater reliability showed satisfactory values in terms of consonants in the initial and final positions. Also, the value of the internal consistency was calculated to be kr = 0.78 (p < 0.001). The psychometric properties of this scale with 31 items proved that it is appropriate for quantifying the speech sound production in Azeri Turkish typically developing children.

Executive functions in Persian-speaking preschool children with speech sound disorders and comparison with their typically developing peers

This study aimed to compare working memory, inhibitory control, and cognitive flexibility, the core components of executive functions, among two prevalent subtypes of preschool children with speech sound disorder, i.e., phonological delay (n = 16) and consistent phonological disorder (n = 15), and a group of typically developing children (n = 18). The correlation between executive function components and the accuracy of speech sound production were also investigated. Nonword repetition task and syllable repetition task were used to evaluate the phonological loop of working memory. Backward digit span was administered to examine the central executive of working memory. Cognitive flexibility was assessed using the second selection of the flexible item selection task and inhibitory control using Stroop-like and Go/No-Go tasks. The percentage consonants correct was applied to calculate the accuracy of speech sound production. Results of a one-way multivariate analysis of covariance revealed statistically significant differences between groups in the combined dependent variables after controlling for age (F(14, 80) = 17.289, p < .001, Pillai's trace = 1.503, partial ηƞ² = .752). Typically developing children outperformed in all measurements of executive functions than both speech sound disorder subgroups. Moreover, children with phonological delay performed better in nonword repetition and corrected responses of Stroop-like than consistent phonological disorder group. All executive function measurements also correlated with speech sound production. The results of the present study highlight the importance of including domain-general cognitive skills in current assessment protocols for children with phonological delay and consistent phonological disorders.

Clinical experience and categorical perception of children's speech

BACKGROUND

Accurate and detailed records of children's speech are a critical component of competent service delivery in speech-language pathology/speech and language therapy (SLP/SLT). Previous research has shown that during speech-sound acquisition, children gradually learn to produce sounds in adult-like manners. Continuous rating scales are a way to track this gradual learning.

AIMS

To examine whether clinical experience affects the ability and willingness to rate children's speech production using continuous rating scales.

METHODS & PROCEDURES

An online survey was administered to 81 US-based SLPs/SLTs, binned into more- and less-experienced groups, and 20 non-SLPs/SLTs. The survey included a speech-sound rating task in which participants rated the production of place of articulation in children's productions of word-initial /θ/, /s/, /ʃ/, /d/, /ɡ/, /t/ and /k/ on a nine-point equally appearing interval scale. We examined the extent to which these were accurate (i.e., the extent to which they matched laboratory measures of production characteristics) and the extent to which the ratings were gradual (i.e., they used the entire rating scales, rather than just the endpoints).

MAIN CONTRIBUTION

There were no consistent differences between non-SLPs/SLTs, less-experienced SLPs/SLTs and more-experienced SLPs/SLTs in a measure of the accuracy of responses. More consistent differences were found in the extent to which listeners used the endpoints of the scale: greater experience was associated with greater use of the endpoint values.

CONCLUSIONS & IMPLICATIONS

More-experienced SLPs/SLTs are less likely to use the entire range of continuous rating scales to rate children's speech accuracy than less-experienced SLPs/SLTs or clinically untrained listeners. Implications for service delivery are discussed. What this paper adds What is already known on the subject Children's productions of individual sounds, like /k/, become gradually more adult-like over the course of development. For a child who has a [t] for /k/ error, this gradual development means that children's productions become progressively less like /t/ and more like /k/ over development. Phonetic transcription does not capture this gradual development. In contrast, studies have shown that continuous ratings of children's speech (such as rating productions on a scale anchored by the text "the 't' sound" at one end and "the 'k' sound" at the other end) can capture this gradual development. What this paper adds to existing knowledge To determine continuous ratings are clinically feasible, we must first determine whether clinical experience affects people's use of continuous rating scales to rate children's speech. We conducted an on-line speech perception experiment in which 81 speech-language pathologists/speech and language therapists (SLPs/SLTs) and 20 non-SLPs/SLTs rated 60 productions by children on continuous rating scales. The 60 stimuli included many sounds that had been independently verified to be intermediate productions (i.e., a target /k/ that was neither completely /k/-like nor completely /t/-like). Non-SLPs/SLTs and less-experienced SLPs/SLTs rated those intermediate sounds with intermediate ratings (i.e., somewhere on the midpoint of a continuous scale). In contrast, more-experienced SLPs/SLTs were more likely to rate those sounds as instances of endpoints (i.e., as either /k/ or /t/). What are the potential or actual clinical implications of this work? This finding suggests that clinical experience is paradoxically associated with a reduced tendency to use the entire range of responses on continuous rating scales. This finding suggests that we must better understand the cause of this reduced tendency, so that clinicians at all levels can use continuous rating scales equally effectively.

Intelligibility in Context Scale: Sensitivity and specificity in the Jamaican context

The present study investigated the sensitivity and specificity of the English Intelligibility in Context Scale (ICS) and the ICS-Jamaican Creole (ICS-JC) translation with bilingual preschool-aged Jamaican children. Participants in this study were 262 English-Jamaican Creole simultaneous bilingual children (aged 3;3 to 6;3, M = 4;11, SD = 7.8). The ICS and ICS-JC were administered to parents in auditory form, rather than written form. Although recent evidence has demonstrated the validity and reliability of the ICS as an assessment tool in various languages, further data are needed to determine diagnostic accuracy of the ICS and ICS-JC in Jamaican children. The sensitivity and specificity of both tools were high in this cohort of children, indicating that in the Jamaican context, these versions of the ICS could be used as screening tools to identify children who require further assessment of speech sound disorders. A cut-off score of 4.12 was used for both tools to achieve high sensitivity (0.84) and specificity (0.70) values for the ICS, as well as high sensitivity (0.84) and specificity (0.71) for the ICS-JC. The results of this study also demonstrate that administration of the auditory ICS is a valid way of collecting parent reports about children's speech intelligibility, which has implications for use of the ICS in languages with no written form or with parents who have a low level of literacy in the languages they use. This investigation is relevant not only to this underserved population but broadens knowledge of research-based tools for working with bilingual children.

Orofacial function in children with Speech Sound Disorders persisting after the age of six years

Purpose: The aim was to investigate, describe and analyse speech characteristics, intelligibility, orofacial function and co-existing neurodevelopmental symptoms in children with SSD of unknown origin, persisting after six years of age.Method: The study included 61 children with SSD (6-17 years) of unknown origin, referred for a speech and oral motor examination. The severity of SSD was estimated using Percentage Consonants Correct (PCC) and Percentage Vowels Correct (PVC) and assessments of resonance based on Swedish Articulation and Nasality Test (SVANTE). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Parents completed the Intelligibility in Context Scale (ICS) and a questionnaire including questions about heredity, medical and neurodevelopmental conditions, and speech development.Result: SSD varied according to PCC (8-95%) and PVC (55-100%) measurements. Percentages of co-occurring disorders included: 51% resonance deviations, 90% intelligibility issues, and 87% orofacial difficulties. The most affected orofacial domains were "Chewing and swallowing" (41%), "Masticatory muscles and jaw function" (38%) and "Sensory function" (38%). The majority (64%) had co-existing dysfunctions relating to general motor and neurodevelopmental disorders.Conclusion: Children with persistent SSD are at risk for orofacial dysfunction, general motor difficulties and other neurodevelopmental disorders and therefore should be screened for co-occurring disorders.

Audience Response System-Based Evaluation of Intelligibility of Children's Connected Speech - Validity, Reliability and Listener Differences

PURPOSE

We assessed audience response systems (ARS)-based evaluation of intelligibility, with a view to find a valid and reliable intelligibility measure that is accessible to non-trained participants. In addition, we investigated potential listener differences between pediatric speech and language pathologists (SLPs) and untrained adults.

METHOD

Sixteen one-minute samples of connected speech were compiled, collected from 14 children with a speech sound disorder (SSD) and two children with typical speech. 16 SLPs and 13 untrained adults participated in a series of ARS listening sessions, where they were fitted with headphones and hand controls, and instructed to click a button whenever they did not understand the child speaking. Listeners' button clicks were registered and, for each speech sample, totaled into an (un)intelligibility index. The proportion of syllables perceived correctly - based on orthographic listener transcripts - was used as a reference score of intelligibility.

RESULTS

The ARS-based intelligibility scores correlated strongly with the intelligibility reference score. Reliability was high across listener groups and weaker for single listeners. No significant difference was found between the evaluations of SLPs and untrained adults.

CONCLUSIONS

ARS-based evaluation offers a valid and reliable measure of intelligibility of particular value in research as a practical tool for collecting input from listeners without experience or knowledge of SSDs. We stress that the ARS design presupposes a listener panel, and that evaluations obtained from individual listeners are predictably inadequate in terms of reliability.

Intra-word accuracy and consistency in Finnish-speaking children with speech sound disorder compared to their typically developing peers

This study examined intra-word accuracy and consistency in 32 preschool-aged Finnish-speaking children with speech sound disorder (SSD) compared to their typically developing (TD) age- and gender-matched peers. Accuracy and consistency of speech production were assessed by a picture-naming task repeated three times in one assessment session. Responses were classified into four categories: 1) consistently correct, 2) consistently incorrect, 3) variable with hits (when a child's variable responses included at least one matched with the adult target), and 4) variable with no hits (when responses included at least two different response types without the matched adult target). In addition, relationships between intra-word accuracy and consistency and children's receptive vocabulary knowledge and articulatory ability based on spontaneous speech samples were investigated. The findings showed that the children with SSD produced significantly more often 'consistently incorrect' and 'variable with no hits' responses than the TD children. There was a significant negative correlation between 'variable with no hits' responses and receptive vocabulary knowledge and articulatory abilities among the children with SSD. As intra-word accuracy and consistency has not previously been studied in Finnish children with SSD, the findings highlighted the need for drafting guidelines for assessment and intervention by paying close attention to high intra-word variability without correct word forms already from age three onwards.

Relationship between temporal processing and phonological awareness in children with speech sound disorders

Temporal processing ability contributes to the identification of small phonetic elements that is important for speech perception. Difficulty in these interferes with normal speech perception and phoneme recognition. The present study aimed to assess the temporal and phonological processing abilities in children with speech sound disorders (SSD). Temporal processing and phonological skills were evaluated in 32 participants in the age range of 6-10 years, equally divided into two groups. Group I included typically developing children, and Group II included children with SSD. Gap detection test and duration pattern test were used to assess temporal processing abilities, and phonological sensitivity training kit in Kannada (PhoST-K) assessed phonological processing abilities. The results showed that there was a significant difference in temporal and phonological processing between the two groups of children. A significant correlation between gap detection ability and deletion tasks and between duration pattern ability and oddity tasks was obtained. Based on the results, it is recommended to assess the temporal process pertinent to central auditory processing in children with SSD, as a close relationship between temporal processing abilities and phonological awareness exists.

[Current status of initial diagnosis of speech sound disorder in a child healthcare clinic]

OBJECTIVE

To investigate the understanding of speech sound disorder (SSD) among child health practitioners.

METHODS

The clinical data of 506 children with an initial diagnosis of SSD from January 2017 to May 2019 were retrospectively analyzed.

RESULTS

Of the 506 SSD children, 90.5% had a description of developmental behavior in their medical records; 97.6% received a developmental-behavioral evaluation, mostly intellectual and developmental screening tests, which were given to 95.8% (485/506) of the total children. A total of 116 (22.9%) children also had neurodevelopmental disorders, commonly presenting with language disorder, global developmental delay, and intellectual disability; however, 53 (45.7%) of the 116 children had no history records of such abnormal developmental behavior. The incidence of neurodevelopmental disorders was significantly higher in the children with abnormal hearing reported by their families than in the children with normal hearing reported by their families (P<0.001). The children with abnormal response to sound stimulation on physical examination had significantly more frequent neurodevelopmental disorders than those with normal response to sound stimulation (P<0.05). Among the 506 children with SSD, hearing condition was ignored in 33.2% in history records, and in 31.2% on physical examination. Ninety-two children (18.2%) completed the diagnostic hearing test, 12% (11/92) of whom were diagnosed with hearing loss. Of the 11 children with hearing loss, three had passed a hearing screening, three had family-reported normal hearing, and seven had normal response to sound stimulation on physical examination.

CONCLUSIONS

SSD is frequently comorbid with neurodevelopmental disorders in children. Children's communication performance is a key to the diagnosis of neurodevelop-mental disorders. It's necessary to the diagnosis of SSD to perform a medical history collection about neuropsychological development and a developmental-behavior evaluation. There is a high proportion of children with SSD receiving the developmental-behavioral evaluation, suggesting that child health practitioners pay close attention to the neuropsychological development of SSD children, but mostly, the evaluation merely involves intellectual developmental screening tests. The detection rate of hearing loss in children with SSD is high. However, child health practitioners underestimate this problem, and have an insufficient understanding of the importance of the diagnostic hearing test. The diagnostic hearing test should be the preferred recommendation for assessing hearing ability rather than past hearing screening results or children's response to sound stimulation in life scenes.

Retrospective video analysis of the early speech sound development of infants and toddlers later diagnosed with lateralisation errors

Purpose: Although lateralisation errors (LEs) are a common speech sound disorder, no studies have examined their early development. The purpose of this exploratory small-scale investigation was to compare the early (birth-24 months) speech sound development between children later diagnosed with LEs and typically developing children.Method: This was a between-group case-controlled design with six monolingual English-speaking participants. Participants were White, non-Hispanic girls with at least one college-educated parent. As children, three had been diagnosed with lateralisation speech sound errors and three demonstrated typical speech sound development. Participants' parents provided home video-recordings of the participants as infants/toddlers between birth and age 2. These videos were then analysed for the amount, type and diversity of sounds, and canonical babbling onset.Result: There was no statistically significant between-group difference in the volubility (i.e. combined frequency of non-resonant and resonant utterances) or in the age at which [s] or [z] emerged. However, infants/toddlers who were later diagnosed with LEs showed reduced frequency/minute in production of resonant utterances and consonants (including [s, z]), used fewer different consonants/minute, and used fewer syllable shapes/minute compared to typically developing infants/toddlers. At 7-12 months, none of the infants/toddlers later diagnosed with LEs, but all participants in the comparison group had reached the canonical babbling stage.Conclusion: Children who have LEs may have had a less robust speech sound system as infants/toddlers than their typically developing peers. However, these findings must be considered with caution due to the significant limitations of this investigation.

Validation of the Intelligibility in Context Scale for Korean-speaking pre-school children

Purpose: The Intelligibility in Context Scale (ICS) is a parent-reported screening tool focussed on parents' perception of their child's speech intelligibility. The purposes of this study were to evaluate the psychometric properties of the Korean version of the ICS (ICS-K) and to investigate whether the ICS-K is a useful tool for distinguishing between Korean-speaking children with typical development (TD) and those with speech sound disorder (SSD). Method: A total of 178 Korean-speaking pre-school children (145 children with TD and 33 children with SSD) participated in this study. Speech skills were assessed using the Assessment of Phonology and Articulation for Children. The parents of the children completed the ICS-K. Result: The ICS-K showed high internal consistency and test-retest reliability. Criterion validity was established through a significant correlation between the ICS-K and the percentage of consonants correct. Construct validity was also established through significant correlations between the ICS-K mean scores and the item scores. A discriminant analysis revealed that the ICS-K had high sensitivity (90.9%) and adequate specificity (77.9%) in classifying children into either the TD or the SSD group. Conclusion: The psychometric properties of the ICS-K support its clinical value in measuring functional speech intelligibility in Korean-speaking children with SSD.

Treatment Targets for Co-Occurring Speech-Language Impairment: A Case Study

PURPOSE

The intersection of speech and language impairments is severely understudied. Despite repeatedly documented overlap and co-occurrence, treatment research for children with combined phonological and morphosyntactic deficits is limited. Especially little is known about optimal treatment targets for combined phonological-morphosyntactic intervention. We offer a clinically focused discussion of the existing literature pertaining to interventions for children with combined deficits and present a case study exploring the utility of a complex treatment target in word-final position for co-occurring speech and language impairment.

METHOD

Within a school setting, a kindergarten child (age 5;2) with co-occurring phonological disorder and developmental language disorder received treatment targeting a complex consonant cluster in word-final position inflected with third-person singular morphology.

RESULTS

For this child, training a complex consonant cluster in word-final position resulted in generalized learning to untreated consonants and clusters across word positions. However, morphological generalization was not demonstrated consistently across measures.

CONCLUSION

These preliminary findings suggest that training complex phonology in word-final position can result in generalized learning to untreated phonological targets. However, limited improvement in morphology and word-final phonology highlights the need for careful monitoring of cross-domain treatment outcomes and additional research to identify the characteristics of treatment approaches, techniques, and targets that induce cross-domain generalization learning in children with co-occurring speech-language impairment.

Tongue shapes for rhotics in school-age children with and without residual speech errors

Speakers of North American English use variable tongue shapes for rhotic sounds. However, quantifying tongue shapes for rhotics can be challenging, and little is known about how tongue shape complexity corresponds to perceptual ratings of rhotic accuracy in children with residual speech sound errors (RSE). In this study, 16 children aged 9-16 with RSE and 14 children with typical speech (TS) development made multiple productions of 'Let Robby cross Church Street'. Midsagittal ultrasound images were collected once for children with TS and twice for children in the RSE group (once after 7 h of speech therapy, then again after another 7 h of therapy). Tongue contours for the rhotics in the four words were traced and quantified using a new metric of tongue shape complexity: the number of inflections. Rhotics were also scored for accuracy by four listeners. During the first assessment, children with RSE had fewer tongue inflections than children with TS. Following 7 h of therapy, there were increases in the number of inflections for the RSE group, with the cluster items cross and Street reaching tongue complexity levels of those with TS. Ratings of rhotic accuracy were correlated with the number of inflections. Therefore, the number of inflections in the tongue, an index of tongue shape complexity, was associated with perceived accuracy of rhotic productions.

Effect of dialect on phonological analysis

It is important to understand a child's language background, to ensure appropriate assessment, diagnosis and treatment of speech sound disorders. Singapore is home to various cultures and languages, and local speech norms are needed to provide an accurate reference for assessing phonological disorders in the local population. This study aims to establish normative data and better understand the English phonological development of English-Mandarin bilingual preschoolers in Singapore, aged 3; 6-4; 5 years. The Articulation and Phonology subtests of the Diagnostic Evaluation of Articulation and Phonology - UK were used to collect speech data from 146 preschoolers. Responses were scored against two standards - British Standard English (BSE) and Singapore English (SGE), in terms of speech sound accuracy, and the frequency and type of error patterns present. The effect of language dominance on the children's English phonological abilities was explored. Results showed that the preschoolers' speech sound accuracy increased significantly when scored against SGE versus BSE targets. The number of children identified to be using several error patterns was reduced when SGE targets were used instead of BSE targets. English-dominant children scored significantly higher than their Mandarin-dominant peers on measures of speech sound accuracy. The identification of error patterns also differed between the two groups. These results show that it is important to take dialectal variation and language dominance into account in assessment, to determine if speech characteristics are due to a speech sound disorder or just normal dialectal variations.

Automated speech analysis tools for children's speech production: A systematic literature review

PURPOSE

A systematic search and review of published studies was conducted on the use of automated speech analysis (ASA) tools for analysing and modifying speech of typically-developing children learning a foreign language and children with speech sound disorders to determine (i) types, attributes, and purposes of ASA tools being used; (ii) accuracy against human judgment; and (iii) performance as therapeutic tools.

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Across nine databases, 32 articles published between January 2007 and December 2016 met inclusion criteria: (i) focussed on children's speech; (ii) tools used for speech analysis or modification; and (iii) reporting quantitative data on accuracy.

RESULT

Eighteen ASA tools were identified. These met the clinical threshold of 80% agreement with human judgment when used as predictors of intelligibility, impairment severity, or error category. Tool accuracy was typically <80% accuracy for words containing mispronunciations. ASA tools have been used effectively to improve to children's foreign language pronunciation.

CONCLUSION

ASA tools show promise for automated analysis and modification of children's speech production within assessment and therapeutic applications. Further work is needed to train automated systems with larger samples of speech to increase accuracy for assessment and therapeutic feedback.

Comparing Feedback Types in Multimedia Learning of Speech by Young Children With Common Speech Sound Disorders: Research Protocol for a Pretest Posttest Independent Measures Control Trial

Children with speech sound disorders benefit from feedback about the accuracy of sounds they make. Home practice can reinforce feedback received from speech pathologists. Games in mobile device applications could encourage home practice, but those currently available are of limited value because they are unlikely to elaborate "Correct"/"Incorrect" feedback with information that can assist in improving the accuracy of the sound. This protocol proposes a "Wizard of Oz" experiment that aims to provide evidence for the provision of effective multimedia feedback for speech sound development. Children with two common speech sound disorders will play a game on a mobile device and make speech sounds when prompted by the game. A human "Wizard" will provide feedback on the accuracy of the sound but the children will perceive the feedback as coming from the game. Groups of 30 young children will be randomly allocated to one of five conditions: four types of feedback and a control which does not play the game. The results of this experiment will inform not only speech sound therapy, but also other types of language learning, both in general, and in multimedia applications. This experiment is a cost-effective precursor to the development of a mobile application that employs pedagogically and clinically sound processes for speech development in young children.

Intervention for bilingual speech sound disorders: A case study of an isiXhosa-English-speaking child

BACKGROUND

 Bilingualism is common in South Africa, with many children acquiring isiXhosa as a home language and learning English from a young age in nursery or crèche. IsiXhosa is a local language, part of the Bantu language family, widely spoken in the country. Aims: To describe changes in a bilingual child's speech following intervention based on a theoretically motivated and tailored intervention plan. Methods and procedures: This study describes a female isiXhosa-English bilingual child, named Gcobisa (pseudonym) (chronological age 4 years and 2 months) with a speech sound disorder. Gcobisa's speech was assessed and her difficulties categorised according to Dodd's (2005) diagnostic framework. From this, intervention was planned and the language of intervention was selected. Following intervention, Gcobisa's speech was reassessed. Outcomes and results: Gcobisa's speech was categorised as a consistent phonological delay as she presented with gliding of/l/in both English and isiXhosa, cluster reduction in English and several other age appropriate phonological processes. She was provided with 16 sessions of intervention using a minimal pairs approach, targeting the phonological process of gliding of/l/, which was not considered age appropriate for Gcobisa in isiXhosa when compared to the small set of normative data regarding monolingual isiXhosa development. As a result, the targets and stimuli were in isiXhosa while the main language of instruction was English. This reflects the language mismatch often faced by speech language therapists in South Africa. Gcobisa showed evidence of generalising the target phoneme to English words. Conclusions and implications: The data have theoretical implications regarding bilingual development of isiXhosa-English, as it highlights the ways bilingual development may differ from the monolingual development of this language pair. It adds to the small set of intervention studies investigating the changes in the speech of bilingual children following intervention. In addition, it contributes to the small amount of data gathered regarding typical bilingual acquisition of this language pair.

The human right to communicate and our need to listen: Learning from people with a history of childhood communication disorder

PURPOSE

In 2013, the Australian Government Senate formed a committee for inquiry and report into the prevalence of speech, language, and communication disorders and speech pathology services in Australia. Submissions were sought from individuals and organisations. In this paper, submissions made by individuals with a history of childhood communication disorder were examined to explore their life experiences and the impact on their lives when the right to communicate could not be enacted.

METHOD

There were 305 submissions to the Australian Government Senate Committee Inquiry, of which 288 were publically accessible. In this study, the submissions (n = 17) from children or adults with a history of communication disorder (including speech, language and stuttering), who provided personal accounts of their experiences, were analysed using an interpretative phenomenological approach.

RESULT

Four themes emerged relating to: personal identity, life with communication disorder, the importance of help, and how life would be different without a communication disorder.

CONCLUSIONS

This paper gives voice to children and adults with communication disorder. In listening to these voices, the impact of communication disorder on the right to communicate and on other human rights can be heard, and the need for a response is clear. However, the challenge is to determine how the voices of these individuals, and others like them, can be enabled to exert real influence on practice and policy so communication disorder will no longer be a barrier to attainment of their human rights.

Speech therapy in adolescents with Down syndrome: In pursuit of communication as a fundamental human right

PURPOSE

The achievement of speech intelligibility by persons with Down syndrome facilitates their participation in society. Denial of speech therapy services by virtue of low cognitive skills is a violation of their fundamental human rights as proclaimed in the Universal Declaration of Human Rights in general and in Article 19 in particular. Here, we describe the differential response of an adolescent with Down syndrome to three speech therapy interventions and demonstrate the use of a single subject randomisation design to identify effective treatments for children with complex communication disorders.

METHOD

Over six weeks, 18 speech therapy sessions were provided with treatment conditions randomly assigned to targets and sessions within weeks, specifically comparing auditory-motor integration prepractice and phonological planning prepractice to a control condition that included no prepractice. All treatments involved high intensity practice of nonsense word targets paired with tangible referents.

RESULT

A measure of generalisation from taught words to untaught real words in phrases revealed superior learning in the auditory-motor integration condition.

CONCLUSION

The intervention outcomes may serve to justify the provision of appropriate supports to persons with Down syndrome so that they may achieve their full potential to receive information and express themselves.

The German Intelligibility in Context Scale (ICS-G): reliability and validity evidence

BACKGROUND

In 2012 the Intelligibility in Context Scale (ICS) was published as a parent-report screening assessment that considers parents' perceptions of their children's functional intelligibility with a range of communication partners that differ in levels of authority and familiarity in real-life situations. To date, the ICS has been translated into 60 languages (including German).

AIMS

To evaluate the psychometric properties of the German translation of the ICS ( = ICS-G), especially its reliability and validity, using four objective measures of speech sound disorder (SSD) severity: percentage of consonants correct (PCC); percentage of initial consonants correct (PICC); percentage of vowels correct (PVC); and percentage of phonemes correct (PPC).

METHODS & PROCEDURES

Children who were typically developing (TD) and children with SSD (n = 181; 90 males, 81 females; mean age = 4.18 years, SD = 0.79 years, range = 3;0-5;11 years) were recruited through 13 kindergartens and 15 speech-language pathologists (SLPs) in Germany. All children's parents completed the ICS-G. To obtain an insight into the severity of SSD (n = 30), children's speech skills were assessed with PLAKSS-II. For the analysis of test-retest reliability the ICS-G was re-administered with a subsample of parents (n = 36) after 1 week.

OUTCOMES & RESULTS

The ICS-G had high internal consistency (α = .95, p < .001) and high test-retest reliability (r = .998, p < .001). The ICS-G total scores and item scores for both samples showed significant correlations, indicating good construct validity. Analyses revealed low but significant correlations with external factors (e.g., age, social class). Criterion validity was established through significant correlations between the ICS-G and scores for PCC (r = .43), PICC (r = .43), PVC (r = .62) and PPC (r = .47). The discriminatory ability of the ICS-G was indicated by significantly higher mean scores for the TD group (mean = 4.49, SD = 0.47) than the SSD group (mean = 3.97, SD = 0.63).

CONCLUSIONS & IMPLICATIONS

The overall good psychometric properties of the ICS-G support its use by SLPs for clinical and research purposes with German-speaking children.

Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series

PURPOSE

There is a paucity of evidence to guide treatment for children with co-occurring stuttering and speech sound disorder. Some guidelines suggest treating the two disorders simultaneously using indirect treatment approaches; however, the research supporting these recommendations is over 20 years old. In this clinical case series, we investigate whether these co-occurring disorders could be treated concurrently using direct treatment approaches supported by up-to-date, high-level evidence, and whether this could be done in an efficacious, safe and efficient manner.

METHOD

Five pre-school-aged participants received individual concurrent, direct intervention for both stuttering and speech sound disorder. All participants used the Lidcombe Program, as manualised. Direct treatment for speech sound disorder was individualised based on analysis of each child's sound system.

RESULT

At 12 months post commencement of treatment, all except one participant had completed the Lidcombe Program, and were less than 1.0% syllables stuttered on samples gathered within and beyond the clinic. These four participants completed Stage 1 of the Lidcombe Program in between 14 and 22 clinic visits, consistent with current benchmark data for this programme. At the same assessment point, all five participants exhibited significant increases in percentage of consonants correct and were in alignment with age-expected estimates of this measure. Further, they were treated in an average number of clinic visits that compares favourably with other research on treatment for speech sound disorder.

CONCLUSION

These preliminary results indicate that young children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct treatment approaches. This method of service delivery may have implications for cost and time efficiency and may also address the crucial need for early intervention in both disorders. These positive findings highlight the need for further research in the area and contribute to the limited evidence base.

SVANTE - The Swedish Articulation and Nasality Test - Normative data and a minimum standard set for cross-linguistic comparison

Normative language-based data are important for comparing speech performances of clinical groups. The Swedish Articulation and Nasality Test (SVANTE) was developed to enable a detailed speech assessment. This study's aim was to present normative data on articulation and nasality in Swedish speakers. Single word production, sentence repetition and connected speech were collected using SVANTE in 443 individuals. Mean (SD) and prevalences in the groups of 3-, 5-, 7-, 10-, 16- and 19-year-olds were calculated from phonetic transcriptions or ordinal rating. For the 3- and 5-year-olds, a consonant inventory was also determined. The mean percent of oral consonants correct ranged from 77% at age 3 to 99% at age 19. At age 5, a mean of 96% was already reached, and the consonant inventory was established except for /s/, /r/, /ɕ/. The norms on the SVANTE, also including a short version, will be useful in the interpretation of speech outcomes.

An exploration of the role of executive functions in preschoolers' phonological development

There is limited yet compelling evidence that domain-general processes may contribute to speech sound change. This study explored whether executive functions contribute to the achievement of adult-like speech production. Children who are 4 to 5 years old, 42 with high-average speech production skills, 11 with low-average and nine with speech sound disorder (SSD), participated in a battery of executive function and speech production tasks. Performance accuracy was compared across groups and also correlated with speech sound accuracy from a single-word naming task. Children with SSD demonstrated poorer performance than other groups on forward digit span, whereas children with low-average speech skills underperformed their peers on the Flexible Item Selection Task (FIST). These preliminary results suggest that children with speech errors may have less mature working memory than peers who have mastered phonological targets earlier in development.

Motor speech treatment protocol for developmental motor speech disorders

OBJECTIVE

This study examines the effect of the Motor Speech Treatment Protocol (MSTP), a multi-sensory hybrid treatment approach on five children (mean: 3;3 years; S.D. 0;1) with severe to profound speech sound disorders with motor speech difficulties.

METHODS

A multiple probe design, replicated over five participants, was used to evaluate the effects of treatment on improving listeners' auditory and visual judgements of speech accuracy.

RESULTS

All participants demonstrated significant change between baseline and maintenance conditions, with the exception of KM, who may have had underlying psychosocial, regulation and/or attention difficulties. The training- (practiced in treatment) and test-words (not practiced in treatment) both demonstrated positive change in all participants, indicating generalization of target features to untrained words.

CONCLUSION

These results provide preliminary evidence that the MSTP, which integrates multi-sensory information and utilizes hierarchical goal selection, may positively impact speech sound production by improving speech motor control in this population.

Parent-rated measures of bilingual children's speech accuracy: Implications for a universal speech screen

PURPOSE

This study investigated whether parents were reliable in judging their bilingual children's speech and whether parent-rated measure of children's speech could be used as a tool for a universal speech screen to identify children with speech sound disorder (SSD).

METHOD

Single word samples from 33 Korean-English bilingual (KEB) pre-school children were analysed for percentage of consonants correct (PCC). Their parents completed the Intelligibility in Context Scale and a similarly constructed scale devised by Stertzbach and Gildersleeve-Neumann. Spearman rank correlations were used to examine the association between the PCC scores and the parent-rated measures.

RESULT

A number of factors influenced parents' reliability in judging their bilingual children's speech, including language dominance and the nature of the questions that were asked. The perception of strangers on a child's speech problems, as judged by the parents, could be significant in identifying children with SSD. When the cut-off ICS mean score derived from a previous monolingual research was applied to KEB children, over 40% of the sample was identified as requiring a comprehensive clinical assessment.

CONCLUSION

Implementation of a universal speech screen utilising parent-rated measures of children's speech cannot be introduced without further research.

7q11.23 Duplication syndrome: Physical characteristics and natural history

In order to describe the physical characteristics, medical complications, and natural history of classic 7q11.23 duplication syndrome [hereafter Dup7 (MIM 609757)], reciprocal duplication of the region deleted in Williams syndrome [hereafter WS (MIM 194050)], we systematically evaluated 53 individuals aged 1.25-21.25 years and 11 affected adult relatives identified in cascade testing. In this series, 27% of probands with Dup7 had an affected parent. Seven of the 26 de novo duplications that were examined for inversions were inverted; in all seven cases one of the parents had the common inversion polymorphism of the WS region. We documented the craniofacial features of Dup7: brachycephaly, broad forehead, straight eyebrows, broad nasal tip, low insertion of the columella, short philtrum, thin upper lip, minor ear anomalies, and facial asymmetry. Approximately 30% of newborns and 50% of older children and adults had macrocephaly. Abnormalities were noted on neurological examination in 88.7% of children, while 81.6% of MRI studies showed structural abnormalities such as decreased cerebral white matter volume, cerebellar vermis hypoplasia, and ventriculomegaly. Signs of cerebellar dysfunction were found in 62.3%, hypotonia in 58.5%, Developmental Coordination Disorder in 74.2%, and Speech Sound Disorder in 82.6%. Behavior problems included anxiety disorders, ADHD, and oppositional disorders. Medical problems included seizures, 19%; growth hormone deficiency, 9.4%; patent ductus arteriosus, 15%; aortic dilation, 46.2%; chronic constipation, 66%; and structural renal anomalies, 18%. We compare these results to the WS phenotype and offer initial recommendations for medical evaluation and surveillance of individuals who have Dup7.

[The phonological profile of children with speech sound disorders]

Concern over reduced intelligibility in a child is a common reason for consulting a speech-language pathologist. Nevertheless, there is little published research on speech sound disorders among French-speaking children. As a result, speech-language pathologists must rely on their clinical expertise or on research involving children who speak other languages, often the English language. The aim of this article is to contribute to the literature on French-speaking children with reduced intelligibility. In this study we describe the phonological profiles of seven children with a speech sound disorder. We use the Phon phonological assessment tool, which provides a rapid and precise analysis of phonological productions. Three distinct phonological profiles are identified on the basis of the severity of the disorder.

Children with 7q11.23 duplication syndrome: psychological characteristics

To begin to delineate the psychological characteristics associated with classic 7q11.23 duplication syndrome (duplication of the classic Williams syndrome region; hereafter classic Dup7), we tested 63 children with classic Dup7 aged 4-17 years. Sixteen toddlers aged 18-45 months with classic Dup7 and 12 adults identified by cascade testing also were assessed. For the child group, median General Conceptual Ability (similar to IQ) on the Differential Ability Scales-II was 85.0 (low average), with a range from severe disability to high average ability. Median reading and mathematics achievement standard scores were at the low average to average level, with a range from severe impairment to high average or superior ability. Adaptive behavior was considerably more limited; median Scales of Independent Behavior-Revised Broad Independence standard score was 62.0 (mild impairment), with a range from severe adaptive impairment to average adaptive ability. Anxiety disorders were common, with 50.0% of children diagnosed with Social Phobia, 29.0% with Selective Mutism, 12.9% with Separation Anxiety Disorder, and 53.2% with Specific Phobia. In addition, 35.5% were diagnosed with Attention Deficit/Hyperactivity Disorder and 24.2% with Oppositional Defiant Disorder or Disruptive Behavior Disorder-Not Otherwise Specified. 33.3% of the children screened positive for a possible Autism Spectrum Disorder and 82.3% were diagnosed with Speech Sound Disorder. We compare these findings to previously reported results for children with Williams syndrome and argue that genotype/phenotype studies involving the Williams syndrome region offer important opportunities to understand the contribution of genes in this region to common disorders affecting the general population.