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.

Improving Text-Independent Forced Alignment to Support Speech-Language Pathologists with Phonetic Transcription

Problem: Phonetic transcription is crucial in diagnosing speech sound disorders (SSDs) but is susceptible to transcriber experience and perceptual bias. Current forced alignment (FA) tools, which annotate audio files to determine spoken content and its placement, often require manual transcription, limiting their effectiveness. Method: We introduce a novel, text-independent forced alignment model that autonomously recognises individual phonemes and their boundaries, addressing these limitations. Our approach leverages an advanced, pre-trained wav2vec 2.0 model to segment speech into tokens and recognise them automatically. To accurately identify phoneme boundaries, we utilise an unsupervised segmentation tool, UnsupSeg. Labelling of segments employs nearest-neighbour classification with wav2vec 2.0 labels, before connectionist temporal classification (CTC) collapse, determining class labels based on maximum overlap. Additional post-processing, including overfitting cleaning and voice activity detection, is implemented to enhance segmentation. Results: We benchmarked our model against existing methods using the TIMIT dataset for normal speakers and, for the first time, evaluated its performance on the TORGO dataset containing SSD speakers. Our model demonstrated competitive performance, achieving a harmonic mean score of 76.88% on TIMIT and 70.31% on TORGO. Implications: This research presents a significant advancement in the assessment and diagnosis of SSDs, offering a more objective and less biased approach than traditional methods. Our model's effectiveness, particularly with SSD speakers, opens new avenues for research and clinical application in speech pathology.

The development of speech output processing skills in Greek-speaking children

There is a growing body of literature on phonological development in Greek-speaking children, either typically developing (TD) or with speech sound disorders (SSD). In this paper, a cross-sectional longitudinal approach was used to investigate the development of speech output processing skills in TD Greek-speaking preschool-aged children. Moreover, a group of Greek-speaking children with SSD were assessed to identify potential loci of impairment in atypical development. The developmental study involved two groups: group 1 (n = 16) aged 3;0-3;5 years and group 2 (n = 22) aged 4;6-5;0 years, assessed at three assessment points six months apart. Children with SSD (n = 15) aged 5;6-6;0 years were assessed to be compared with performance of group 2 TD children (at the third assessment point). Assessment tasks included (a) a picture naming task, (b) a task of real word repetition and (c) a task of nonword repetition. A strong time effect was found in both groups of TD children in the development of speech output processing abilities. Performance accuracy was higher on tasks including real words than nonwords; children performed more accurately on repetition rather than spontaneous naming of real words; repetition accuracy on 2-3 syllables items was significantly better than on 4-5 syllables items. Children with SSD were outperformed by TD children of the same age in all assessment tasks; lexicality and word length effect were found in the clinical group. Findings from the present study may be used as a starting point to diagnose children with speech production difficulties in Greece.

Oral diadochokinetic production in children with typical speech development and speech-sound disorders

BACKGROUND

AIMS: To investigate the developmental trajectory of the rate and perceptual assessment of oral diadochokinesis (DDK) in typically developing children compared with adults. Also to examine the characteristics of DDK productions in children with speech sound disorders (SSD) and the relationship between DDK production and percentage of consonants correct (PCC).

METHODS & PROCEDURES

Participants were 316 typically developing children and 90 children with SSD from 3 to 9 years old, as well as 20 adults with normal speech. The mono-, bi- and trisyllabic nonsense strings containing Korean tense consonants and the vowel [a] were used for DDK tasks. The number of iterations per s was measured as the DDK rate for each stimulus. The perceptual assessment of DDK productions was also performed for regularity, accuracy and rate.

OUTCOMES & RESULTS

The DDK rates increased throughout childhood, but the oldest children, 9-year-olds in the current study, did not achieve adult-like rates for all mono- and trisyllabic strings. Children with SSD also did not show significant differences from typically developing children when the DDK productions were analysed using only accurate tokens. The PCC of children with SSD showed higher correlations with regularity, accuracy and rate of perceptual ratings than the timed DDK rate.

CONCLUSIONS & IMPLICATIONS

This study highlighted the fact that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills.

WHAT THIS PAPER ADDS

What is already known on the subject Rates of DDK reflect the motor skills of the articulatory systems independently of phonological skills; therefore, the tasks are widely used in the diagnostic evaluations of speech disorders in both children and adult populations. However, a substantial number of studies have questioned the validity and usefulness of DDK rates for evaluating speech abilities. Also, the literature suggested that the measure of DDK rate alone does not provide a clear and useful indication of children's oral motor skills. DDK tasks should be analysed in terms of accuracy and consistency as well as rate. What this paper adds to the existing knowledge The literature reporting normative DDK performance has mainly been based on English speakers. As different consonants have different temporal characteristics, the linguistic and segmental features of DDK tasks can impact the DDK rate. This study established a norm for DDK rate for Korean-speaking children and investigated the developmental trajectory of DDK performance in typically developing children compared with adults. This study suggested that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills by examining the characteristics of DDK productions in children with SSD. What are the potential or actual clinical implications of this work? This study provided normative data of young Korean-speaking children aged 3-9 years. Normative data in children under 5 years of age are valuable given that the majority of children referred for speech difficulty assessments are between 3 and 5 years of age, but only a few studies have provided the normative data in young children. This study showed that many children could not complete DDK tasks correctly and provided additional support for the notion that other aspects of DDK performance, including accuracy and regularity, may yield more useful diagnostic indications than timed DDK rates alone.

Consensus on an assessment protocol for children with speech sound disorders in Sri Lanka

BACKGROUND

Speech sound disorders (SSDs) are the most common form of communication disorders in children. SSD have an impact on children's abilities to make themselves understood to their listeners and can influence a child's social and emotional well-being as well as their academic achievements. Therefore, it is important to identify children with an SSD early, in order to provide appropriate intervention. A wealth of information on best practice in the assessment of children with SSD is available in countries where the speech and language therapy profession is well established. In Sri Lanka, there is a paucity of research evidence supporting assessment practices that are culturally and linguistically appropriate in SSDs. Therefore, clinicians rely on informal assessment methods. There is a need to understand more about how clinicians in Sri Lanka assess this caseload in order to get general agreement regarding comprehensive and consistent procedures for assessment of paediatric SSD in Sri Lanka. This would support speech and language therapists' (SLTs') clinical decision-making in relation to choice of appropriate goals and intervention for this caseload.

AIM

To develop and gain consensus on an assessment protocol for Sri Lankan children with SSD that is culturally appropriate and based on existing research.

METHOD

A modified Delphi method was utilised to gather data from clinicians currently working in Sri Lanka. The research involved three rounds of data collection, exploring current assessment practices in Sri Lanka, ranking these in order of priority and establishing consensus on a proposed assessment protocol. The proposed assessment protocol was based on the results of the first and second rounds as well as previously published best practice guidelines.

OUTCOME AND RESULTS

The proposed assessment protocol achieved consensus in relation to content, format and cultural appropriateness. SLTs affirmed the usefulness of the protocol within the Sri Lankan context. Further research is required to assess the feasibility and effectiveness of this protocol in practice.

CONCLUSIONS & IMPLICATIONS

The assessment protocol supports practicing SLTs with a general guide to assessing children with suspected SSDs in Sri Lanka. The application of this protocol built upon consensus enables clinicians to improve their individual practice patterns based on best practice recommendations in the literature and the evidence on culturally and linguistically appropriate practices. This study has identified the need for further research in this area, including the development of culturally and linguistically specific assessment tools that would complement the use of this protocol.

WHAT THIS PAPER ADDS

What is already known on the subject The assessment of children with speech sound disorders (SSDs) requires a comprehensive and holistic approach due to their heterogeneous nature. Although there is evidence to support the assessment of paediatric SSDs in many countries where the profession of speech and language therapy is established, there is limited evidence to support the assessment of children with SSDs in Sri Lanka. What this study adds This study provides information about current assessment practices in Sri Lanka and consensus on a proposed culturally appropriate protocol for the assessment of children with SSDs in this country. What are the clinical implications of this work? The proposed assessment protocol provides speech and language therapists in Sri Lanka with a guide for assessment of paediatric SSDs to support more consistent practice in this area. Future evaluation of this preliminary protocol is required; however, the methodology used in this research could be applied to the development of assessment protocols for other range of practice areas in this country.

Speech processing and short term memory skills in preschoolers: Evidence from Greek-speaking children with and without speech sound disorders

Cognitive mechanisms such as short-term memory (STM) are considered to relate to speech development, yet the extent of potential limitations in children with speech sound disorders (SSD) is unknown and the nature of the relationship is debatable. The present paper explores the development of speech input and output processing skills along with STM skills in Greek-speaking children with SSD and typically developing (TD) controls. Potential relationships in performance between tasks that require phonological processing are explored. Participants with SSD aged 5;1-6;2 years (n = 30) and TD controls aged 5;1-5;11 years (n = 100) were monolingual Greek-speaking children. Speech processing skills and phonological storage were assessed as follows: (1) Input processing: a nonword auditory discrimination task was used to assess phoneme discrimination skills. Stimuli comprised 24 pairs of nonwords consisting of the same number of phonemes (2-7 phonemes) and syllables (1-3 syllables). (2) Output processing: a nonword repetition task was used to assess speech production skills. Stimuli comprised 24 nonwords of varying length (2-5 syllables). (3) STM: a task of immediate verbal recall was used to assess phonological storage. Stimuli comprised a chunk of five words; each word (2-4 syllables long) was semantically unrelated to others. The results showed that TD children outperformed children with SSD in all tasks; a significant correlation between performance in nonword repetition and immediate verbal recall was found for TD children. There were no significant correlations between performance on nonword auditory discrimination with nonword repetition or with immediate verbal recall for TD children or children with SSD.

Singleton consonant onset acquisition in monolingual Granada Spanish-speaking preschoolers with typical versus protracted phonological development: Impacts of word structure and feature constraints

While consonant acquisition clearly requires mastery of different articulatory configurations (segments), sub-segmental features and suprasegmental contexts influence both order of acquisition and mismatch (error) patterns (Bérubé, Bernhardt, Stemberger & Ciocca, 2020). Constraints-based nonlinear phonology provides a comprehensive framework for investigating the impact of sub- and suprasegmental impacts on acquisition (Bernhardt & Stemberger, 1998). The current study adopted such a framework in order to investigate these questions for Granada Spanish. Single-word samples of monolingual preschoolers in Granada (29 typically developing; 30 with protracted phonological development) were transcribed by native Spanish speakers in consultation with an international team. Beta regression analyses showed significant effects of age, developmental group, and word structure variables (word length, stress, position of consonants and syllables within the word); salience, markedness and/or frequency across the phonological hierarchy accounted for many patterns. The study further demonstrates the impacts of sub- and suprasegmental constraints of the phonological system on consonant acquisition.

Process-Oriented Profiling of Speech Sound Disorders

The differentiation between subtypes of speech sound disorder (SSD) and the involvement of possible underlying deficits is part of ongoing research and debate. The present study adopted a data-driven approach and aimed to identify and describe deficits and subgroups within a sample of 150 four to seven-year-old Dutch children with SSD. Data collection comprised a broad test battery including the Computer Articulation Instrument (CAI). Its tasks Picture Naming (PN), NonWord Imitation (NWI), Word and NonWord Repetition (WR; NWR) and Maximum Repetition Rate (MRR) each render a variety of parameters (e.g., percentage of consonants correct) that together provide a profile of strengths and weaknesses of different processes involved in speech production. Principal Component Analysis on the CAI parameters revealed three speech domains: (1) all PN parameters plus three parameters of NWI; (2) the remaining parameters of NWI plus WR and NWR; (3) MRR. A subsequent cluster analysis revealed three subgroups, which differed significantly on intelligibility, receptive vocabulary, and auditory discrimination but not on age, gender and SLPs diagnosis. The clusters could be typified as three specific profiles: (1) phonological deficit; (2) phonological deficit with motoric deficit; (3) severe phonological and motoric deficit. These results indicate that there are different profiles of SSD, which cover a spectrum of degrees of involvement of different underlying problems.

Consonants lost: a Swedish girl with protracted phonological development

This paper addresses the phonology of a Swedish girl, aged 3 years 10 months, with extensive phonological difficulties that include an unusual phonological pattern. She had relatively well-developed phonological building blocks in terms of features, stress pattern and word length (number of syllables), but had extensive difficulties regarding syllable and word shapes, with frequent deletions of both segments and whole syllables. Word-initial position was dominated by non-continuant consonants, both voiced and voiceless, with extensive deletion. Word-medial position was dominated by voiceless obstruents, with extensive use of [j] in place of voiced consonants. Word-final position was similar to word-medial, but with more deletion than [j]. Non-initial stressed syllables resemble word-initial syllables. Consonant clusters mirrored singletons, i.e. with similar substitution patterns or deletions. We present a non-linear analysis of her speech production, and a plan for intervention targeting her special difficulties.

A Polish five-year-old with protracted phonological development

This case study examines the phonology of a five-year-old Polish-speaking boy with protracted phonological development. A multi-tier analysis of his phonology revealed that word length, stress patterns, vowels and most consonants were largely compatible with the adult target while coronal consonants requiring fine control of tongue shape (fricatives, affricates, liquids) and most consonant clusters posed difficulty for the child in all word positions. Labial and dorsal features were well-established; in fact, [Labial] outcompeted other places of articulation in problematic sequences of both singletons and clusters. The case profile demonstrates asynchronous development of individual phonological elements and tiers. A proposed treatment plan exploits the child's strengths to address his needs and minimise the discrepancy between the tiers.

When codas trump onsets: an English-speaking child with atypical phonological development before and after intervention

This case study presents an English-speaking preschooler with severely protracted phonological development (PPD) before and after two six-week blocks of intervention (36 sessions). Pre-treatment (3;8), he showed very low whole word, singleton consonant, vowel, and word shape matches. He had two major uncommon patterns: (1) higher accuracy for word-final consonants compared with word-initial (WI) and word-medial (WM); and (2) frequent substitution of onset consonants with glottals [h] or [ʔ]. Goals and treatment strategies were selected using a nonlinear phonological approach. Post-treatment, there was a notable decrease in frequency of glottal substitutions and concomitant increase in word shape, consonant, and vowel match. Pre- and post-treatment data are presented and discussed in terms of theoretical and clinical implications.

Complexity resolved: profile of a Slovenian child with protracted phonological development over an intervention period

This paper describes the complex phonological patterns of one Slovenian-speaking girl with protracted phonological development who received phonological intervention. At 4;6, the child's word length, stress and vowels were age-level, but she showed reduced match levels (accuracy) for syllable structure and consonants. Unusual constraints on word position and sequences, particularly concerning fricatives and stops, resulted in many assimilations, reduplications and metatheses. Addressing these constraints in the first intervention period (to 4;9) led to higher overall accuracy and a transition from less typical to more typical mismatches ("errors"), e.g., sibilant grooving (stridency) and rhotic production as singletons and in clusters. The profile focuses on that initial pre- and post-treatment period, giving a brief overview of the follow-up intervention and outcomes and reflecting on implications for future research and clinical practice.¹¹ The abstract is available in Slovenian language (see Supplementary material).

When in doubt, glottal stop: A Mandarin-speaking three-year-old with protracted phonological development

As part of a special issue on case profiles in protracted phonological development (PPD), we present a Mandarin-speaking three-year-old boy from Shanghai with severe PPD and no other developmental concerns. In comparison with typically developing (TD) children and a peer group from Shanghai with PPD, he had a very low Whole Word Match score (3.7% of words matched the adult targets exactly), reflecting severe constraints on word structure, consonants and diphthongs/triphthongs. His phonological output resembled that of younger children in its absence of fricatives, liquids and diphthongs/triphthongs alongside fairly high match for word length, tones and monophthongs, labials /p/ and /m/ and dorsal /k/. However, less expected was a pervasive glottal stop substitution in onset. The analysis describes his needs in detail but also strengths that could be exploited in phonological intervention.

When consonants resemble vowels: investigating protracted phonological development in Akan

This paper addresses the phonology of an Akan-speaking child aged 5;3 with Protracted Phonological Development. His phonological system had many strengths, with most consonants accurate at least some of the time and with many long words, but with weaknesses that lead to a very low Whole Word Match. In addition to some difficulty with consonant and vowel sequences (leading to assimilation), there are issues relative to complex consonants that contain vowel features (consonants with secondary articulations, the labiopalatal glide, and /r/) and with syllabic consonants (nasals and /r/) that lead to deletion, epenthesis, and some extensive changes in output. One complex place of articulation (alveolopalatal) is well-established and frequently overgeneralized in the output. We present a non-linear analysis of his speech production and a plan for intervention targeting his difficulties.

Idiosyncratic consonant clusters: a Farsi-speaking child with protracted phonological development

This study presents a nonlinear phonological analysis of speech data from a Farsi-speaking child with protracted phonological development (aged 4;8) with very low accuracy on consonants. Results revealed some common phenomena (fricatives produced as stops; dorsals and non-anterior coronals produced as anterior coronals) and some uncommon phenomena (nasals produced as oral stops; voicing and devoicing of singleton obstruents in all word positions). These phenomena interacted in word-medial clusters to create an unusual sequence of two anterior-coronal or two bilabial stops, with C1 voiced and C2 voiceless, clusters which do not occur in the basic phonology of Farsi spoken by adults. We present a non-linear constraints-based analysis of the child's speech production and a plan for intervention targeting the child's special difficulties.

Individual profiles in protracted phonological development across languages: introduction to the special issue

Although group studies provide necessary information about the range and frequency of phenomena in phonological development, individual profiles (case studies) can be used to describe entire phonological systems in detail. Profiles from different languages can highlight similarities and differences across languages that may be less obvious in group studies. The current issue presents profiles of children with protracted phonological development (PPD: speech sound disorders) from 16 languages (Akan, Kuwaiti Arabic, Bulgarian, Canadian English, Farsi, Canadian French, German, Greek, Icelandic, Japanese, Mandarin, Polish, European Portuguese, Slovenian, Granada Spanish, Swedish). Utilising a constraints-based nonlinear phonological framework, each profile describes a child's strengths and needs in word structure, segments, features and their interactions and suggests an intervention plan. Where available, follow-up data from after clinical intervention are included. This introductory paper provides the theoretical background for the papers and reflects on the findings, drawing out particular themes and implications for phonological and developmental theories and clinical intervention.

Using peer-assessment to mitigate variability in graduate students' phonetic transcription skills

Phonetic transcription is a cornerstone skill in the practice of speech-language pathology. Several factors may impact transcription proficiency including when it was learned, how it was learned, and whether practice continued. Graduate student cohorts are often comprised of students from several different universities and vastly different experiences, resulting in differing levels of proficiency in phonetic transcription. Bringing students to the same proficiency level is time-consuming and often involves re-teaching this skill, which detracts from teaching advanced material. Therefore, the purpose of the present study was to explore the use of peer-assessment of phonetic transcription to mitigate these differences in proficiency. Thirty-four graduate students participated in an experimental study investigating proficiency in phonetic transcription as a result of peer-assessment activities. The students also rated and described their opinions about the peer-assessment process. The results of pretest to posttest measures indicated that students who were not at ceiling at pretest improved their phonetic transcription skills significantly. Results of the survey indicated that not only did students enjoy the process, but they also stated that it promoted self-reflection and improvement of their skills, regardless of proficiency at pretest. These findings suggest that peer-assessment is a beneficial way for students to engage in improving their phonetic transcription skills.

The integrity of underlying phonological representations of Greek-speaking children with speech sound disorders

Underlying representations are important for the development of spoken and written language. English-speaking children with speech sound disorders (SSD) have been reported to show significant difficulty with tasks tapping phonological representations. The present study describes the development of a task for the assessment of phonological representations in Greek-speaking children. The purpose of the study is twofold: to investigate the development of phonological representation in typically developing (TD) Greek-speaking children and to explore the possibility that children with SSD may have insufficiently defined phonological representations. Greek-speaking preschool aged children (4;0-5;5 years) with SSD receiving intervention (N = 20) were compared to their typically developing peers (N = 80) on their ability to complete a task of real-word auditory discrimination with picture choice. Performance differences were assessed across segmental properties and variation in word structure.TD children aged 4;0-4;5 scored lower than older TD children. A marginally significant difference in performance was found between children with SSD and TD controls. Quantitative analysis of mistakes indicated that children with SSD and TD children aged 4;0-4;5 opt for the phonological distractor. Stimuli tapping on the specification of underlying representations at a segmental level were more taxing compared to stimuli tapping on the integrity of stored word structures.Task materials and procedures used in the present study provide preliminary normative data and may be used for the assessment of Greek-speaking children with SSD. Children with SSD are at risk of developing underspecified phonological representations and therefore should receive assessment of underlying representations to guide intervention.

Simulating Speech Error Patterns Across Languages and Different Datasets

Children's speech acquisition is influenced by universal and language-specific forces. Some speech error patterns (or phonological processes) in children's speech are observed in many languages, but the same error pattern may have different effects in different languages. We aimed to explore phonological effects of the same speech error patterns across different languages, target audiences and discourse modes, using a novel method for large-scale corpus investigation. As an additional aim, we investigated the face validity of five different phonological effect measures by relating them to subjective ratings of assumed effects on intelligibility, as provided by practicing speech-language pathologists. Six frequently attested speech error patterns were simulated in authentic corpus data: backing, fronting, stopping, /r/-weakening, cluster reduction and weak syllable deletion-each simulation resulting in a "misarticulated" version of the original corpus. Phonological effects were quantified using five separate metrics of phonological complexity and distance from expected target forms. Using Swedish child-speech data as a reference, phonological effects were compared between this reference and a) child speech in Norwegian and English, and b) data representing different modes of discourse (spoken/written) and target audiences (adults/children) in Swedish. Of the speech error patterns, backing-the one atypical pattern of those included-was found to cause the most detrimental effects, across languages as well as across modes and speaker ages. However, none of the measures reflects intuitive rankings as provided by clinicians regarding effects on intelligibility, thus corroborating earlier reports that phonological competence is not translatable into levels of intelligibility.

Design and Evaluation of Korean Electropalatography (K-EPG)

Recently, the development of medical rehabilitation technology has resulted in an increased interest in speech therapy equipment. In particular, research on articulation therapy for communication disorders is being actively conducted. The existing methods for the diagnosis and treatment of speech disorders, such as traditional tactile perception tests and methods based on the empirical judgment of speech therapists, have many limitations. Moreover, the position and contact force of the tongue are key factors in speech disorders with regards to articulation. This is a very important factor in the distinction of Korean characters such as lax, tense and aspirated consonants. In this study, we proposed a Korean-electropalatography (EPG) system to easily measure and monitor the position and contact force of the tongue during articulation treatment and diagnosis. In our proposed K-EPG system, a sensor was fabricated using an AgCl electrode and biocompatible silicon. Furthermore, the measured signal was analyzed by implementing a bio-signal processing module and monitoring program. In particular, the bio-signal was measured by inserting the device into the palate of an experimental healthy test group (four subjects). Through these experiments, we confirmed that our K-EPG system could be applied to clinical treatment in speech therapy.

Effect of Complexity on Speech Sound Development: Evidence From Meta-Analysis Review of Treatment-Based Studies

In the current study, we aimed at understanding the effect of exposure to complex input on speech sound development, by conducting a systematic meta-analysis review of the existing treatment-based studies employing complex input in children with speech sound disorders. In the meta-analysis review, using a list of inclusion criteria, we narrowed 280 studies down to 12 studies. Data from these studies were extracted to calculate effect sizes that were plotted as forest plots to determine the efficacy of complexity-based treatment approaches. The outcome variables of interest were improvement on the treated and generalization to the untreated sounds. Meta-analysis revealed that the exposure to complex input not only promoted improvement in production of complex speech sounds (d = 1.08, CI = 0.98–1.19) but also facilitated the production of untreated simple speech sounds (d = 2.69, CI = 1.98–3.54). Overall, the current findings revealed that the exposure to complex input promotes acquisition of both complex and simple speech sounds. The current findings are in line with the models of language learnability. The current findings have implications in the treatment of speech sound disorders.

Use of ultrasound visual feedback in speech intervention for children with cochlear implants

The purpose of the present study was to evaluate the efficacy of ultrasound visual feedback in speech intervention for young children with cochlear implants. Although ultrasound technology has been used for intervention in children with speech sound disorders, there is little systematic evidence regarding relative efficacy of ultrasound visual feedback for young children with cochlear implants. Two children with cochlear implants participated in this study. The children's articulation was tested using Goldman-Fristoe Test of Articulation-2 and probes. Therapy was provided semi-weekly for 30-minute sessions over the course of nine to 10 weeks. Visual inspection showed an increasing trend in production accuracy to the criterion accuracy of 80% for target sounds. Maintenance of skills were observed at two weeks and two months post-intervention. The results of this study indicated that ultrasound visual feedback is likely an effective intervention tool for treating speech sound disorders in children with cochlear implants. Future studies including a larger sample size should be conducted to verify these findings.

Application of childhood apraxia of speech clinical markers to French-speaking children: A preliminary study

PURPOSE

Childhood apraxia of speech (CAS) is difficult to diagnose because there is little agreement on objective clinical markers. Since studies of phonological development in French-speaking children are scarce, there are even fewer recognised markers in French as compared to English. This study aims to determine if a set of operationalised, quantitative measures derived from clinical markers of CAS in English corroborate with clinical CAS diagnosis in French-speaking children. This research contributes to improving differential diagnosis of CAS and phonological disorder cross-linguistically.

METHOD

We collected data from five children diagnosed with CAS, nine children diagnosed with phonological disorder, and 75 typically-developing children aged 5.10-9.2 years old. All children were assessed on three speech production tasks: picture-naming, non-word repetition, and diadochokinesis. We extracted 20 quantitative measures corresponding to commonly accepted clinical features of CAS.

RESULT

Similar to English-speaking children, French-speaking children with CAS exhibited a high number of vowel errors, consonant and cluster errors, consonant epentheses, devoicing errors, slow diadochokinesis rate, more inconsistency and increased errors with longer words. Contrary to studies on English, these children with CAS did not produce intrusive schwas or vowels.

CONCLUSION

This multiple-case study highlights the need for cross-linguistic diagnostic criteria for CAS.

Waiting for speech-language pathology services: A randomised controlled trial comparing therapy, advice and device

Purpose: To compare children's speech, language and early literacy outcomes, and caregivers' empowerment and satisfaction following provision of 12 sessions of direct intervention (therapy), or face-to-face advice or a purpose-built website (device) while waiting for therapy.Method: A four-stage randomised controlled trial was undertaken involving three- to six-year-old children referred to speech-language pathology waiting lists at two Australian community health centres over eight months (n = 222). Stage 1 (screening): 149 were eligible to participate. Stage 2 (pre-assessment): 117 were assessed. Stage 3 (intervention): 110 were randomised to advice (33), device (39) or therapy (38). Stage 4 (post-assessment): 101 were re-assessed by a speech-language pathologist blinded to the intervention condition.Result: After controlling for baseline levels, children's speech (percentage of consonants correct) was significantly higher in the therapy group compared to the advice and device conditions. Caregivers' satisfaction was also significantly higher in the therapy condition compared to the device condition. There were no significant differences between the three conditions for children's intelligibility, language and early literacy or caregivers' empowerment.Conclusion: Therapy resulted in significantly higher speech outcomes than the advice and device conditions and was associated with significantly greater caregiver satisfaction. Provision of a website containing evidence-based material or a single session of advice may be a viable alternative while children wait for therapy targeting intelligibility, language and early literacy, and to empower caregivers.

Turkish stimulability treatment program for children with speech sound disorders: a preliminary study

PURPOSE

The objective of this study was to create a stimulability treatment program in Turkish language that targets Turkish consonants and vowels and to present the preliminary findings of the effectiveness of the program in a small group of Turkish children with speech sound disorder (SSD).

METHOD

Twenty-two children with SSD participated in the study. The Turkish Articulation and Phonology Test (SST) was used in the assessment of children. Intelligibility ratings were completed by their caregivers through the Turkish version of Intelligibility in Context Scale (ICS), and the stimulability assessments were completed. Stimulability intervention were given for a total of 12 sessions. Comparisons were made between the pre- and post-test results of children, and the preliminary data of treatment efficacy were collected.

RESULTS

The data analysis showed a significant difference in the total number of articulation errors of children between Time 1 and Time 2 (p < .0001), a statistically significant difference in auditory discrimination scores between the two measurements, (p < .05), and an increase in stimulability ratings from Time 1 to Time 2.

CONCLUSION

These findings provide initial data on the positive effect of the Turkish stimulability treatment program for children with SSD. This preliminary study would contribute toward designing the main trial for an evidence-based study for the Turkish stimulability treatment program, thereby leading to better practices in SSD.

Treating Children With Speech Sound Disorders: Development of a Tangible Artefact Prototype

BACKGROUND

A prototype of a tangible user interface (TUI) for a fishing game, which is intended to be used by children with speech sound disorders (SSD), speech and language therapists (SLTs), and kindergarten teachers and assistants (KTAs) and parents alike, has been developed and tested.

OBJECTIVE

The aim of this study was to answer the following question: How can TUIs be used as a tool to help in interventions for children with SSD?

METHODS

To obtain feedback and to ensure that the prototype was being developed according to the needs of the identified target users, an exploratory test was prepared and carried out. During this test using an ethnographic approach, an observation grid, a semistructured questionnaire, and interviews were used to gather data. A total of 4 different types of stakeholders (sample size of 10) tested the prototype: 2 SLTs, 2 KTAs, and 6 children.

RESULTS

The analysis of quantitative and qualitative data revealed that the prototype addresses the existing needs of SLTs and KTAs, and it revealed that 5 out of 6 (83%) children enjoyed the activity. Results also revealed a high replay value, with all children saying they would play more.

CONCLUSIONS

Serious games and tangible interaction for learning and problem solving serve both teachers and children, as children enjoy playing, and, through a playful approach, learning is facilitated. A clear pattern was observed: Children enjoyed playing, and numerous valid indicators showed the transposition of the traditional game into the TUI artefact was successful. The game is varied and rich enough to be attractive and fun. There is a clear need and interest in similar objects from SLTs and educators. However, the process should be even more iterative, with a multidisciplinary team, and all end users should be able to participate as co-designers.

Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders

BACKGROUND

As cost and access barriers to ultrasound technology have decreased, interest in using ultrasound visual biofeedback (U-VBF) as a tool for remediating speech sound disorders (SSD) has increased. A growing body of research has investigated U-VBF in intervention for developmental SSD; however, diversity in study design, participant characteristics, clinical methods and outcomes complicate the interpretation of this literature. Thus, there is a need for a synthesis and review of the evidence base for using U-VBF in intervention for SSD.

AIMS

To synthesise and evaluate the research evidence for U-VBF in intervention for developmental SSD.

METHODS

A systematic review was conducted. Eight electronic databases were searched for peer-reviewed articles published before 2018. Details about study design, participants, intervention procedures, service delivery, intervention intensity and outcomes were extracted from each study that met the inclusion criteria. The included studies were rated using both a critical appraisal tool and for their reporting of intervention detail.

MAIN CONTRIBUTIONS

Twenty-eight papers, comprising 29 studies, met the inclusion criteria. The most common research design was single-case experimental design (44.8% of studies). The studies included between one and 13 participants (mean = 4.1) who had a mean age of approximately 11 years (range = 4;0-27 years). Within the research evidence, U-VBF intervention was typically provided as part of, or as an adjunct to, other articulatory-based therapy approaches. A range of lingual sounds were targeted in intervention, with 80.6% of participants across all reviewed studies receiving intervention targeting rhotics. Outcomes following therapy were generally positive with the majority of studies reporting that U-VBF facilitated acquisition of targets, with effect sizes ranging from no effect to a large effect. Difficulties with generalisation were observed for some participants. Most studies (79.3%) were categorised as efficacy rather than effectiveness studies and represented lower levels of evidence. Overall, the reviewed studies scored more highly on measures of external validity than internal validity.

CONCLUSIONS

The evidence base for U-VBF is developing; however, most studies used small sample sizes and lower strength designs. Current evidence indicates that U-VBF may be an effective adjunct to intervention for some individuals whose speech errors persist despite previous intervention. The results of this systematic review underscore the need for more high-quality and large-scale research exploring the use of this intervention in both controlled and community contexts.

Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement

BACKGROUND

Treatment outcome data for children with severe speech sound disorders with motor speech involvement (SSD-MSI) are derived from Phase I clinical research studies. These studies have demonstrated positive improvements in speech production. Currently there is no research examining the optimal treatment dose frequency for this population. The results of this study, which is the first of its kind, will inform the delivery of effective services for this population.

AIMS

To investigate optimal treatment dose frequency for the Motor Speech Treatment Protocol (MSTP) for children with SSD-MSI.

METHODS & PROCEDURES

A total of 48 children (aged 43-47 months) with SSD-MSI participated in the study. Participants received 45-min MSTP intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Blinded outcome assessments were carried out at pre- and post-intervention.

OUTCOMES & RESULTS

Treatment-related change was assessed at body structures, functions and activities participation level as per the World Health Organization's International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework WHO (2007). These measures are related to articulation, functional communication and speech intelligibility. One-way analysis of variance (ANOVA) revealed that for all variables the baseline scores were not statistically different (p > 0.05) between the two dose-frequency groups. Overall, there was a significant main effect of Time (pre-post) across all variables (p < 0.01). However, repeated-measures ANOVA did not result in any statistical interactions (Time × Dose frequency) for any of the variables tested (p > 0.05). Only marginal clinical advantages (< 4% change in intelligibility) were noted with the 10 extra sessions.

CONCLUSIONS & IMPLICATIONS

Overall, the MSTP intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. Clinical effects were examined using effect sizes, as well as changes in articulation, speech intelligibility and functional communication; these differed marginally between the two dose frequencies. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech-language therapists and policy-makers perform a cost-benefit analysis before determining the dose frequency, when considering additional sessions per block.

A frequent acoustic sign of speech motor delay (SMD)

Recent studies report prevalence, phenotype, and persistence findings for a paediatric motor speech disorder in addition to childhood dysarthria and childhood apraxia of speech termed Speech Motor Delay (SMD). The aim of the present study was to determine if there is a frequent acoustic sign of SMD, with implications for theory, assessment, and treatment. We examined the frequency of 19 acoustic signs of SMD in audio recordings of continuous speech and word-imitation tasks in three groups of speakers with SMD: 50 children (mean age 5.1 years) with idiopathic Speech Delay (SD) from 6 USA cities; 87 children, adolescents, and adults with eight types of complex neurodevelopmental disorders; and 9 children (mean age 8.8 years) with persistent idiopathic SD from a population-based study of children in the South West of England. The 19 acoustic signs of imprecise or unstable speech, prosody, and voice were standardized on typical speakers of the appropriate dialect. The criterion for a frequent acoustic sign was that it occurred in at least 50% of participants with SMD in each of the three groups. Findings indicated that lengthened mid-vowels and diphthongs was the one sign that met criteria, occurring in 64.4% of the 146 participants with SMD, including 71% of the 87 participants with complex neurodevelopmental disorders. Findings are interpreted to support the potential of this acoustic sign, and possibly several others associated with temporal dimensions of speech sound development, to inform explication of the neuromotor substrates of SMD.

The Table to Tablet (T2T) Speech and Language Therapy Software Development Roadmap

Background

Few studies have analyzed gains in using computers in speech and language therapy interventions for children with speech and/or language disorders when compared to a control group, but virtual tutors and computer-based visual feedback have been gaining interest in the literature. Previous systematic reviews mainly focused on development technological details of computer-based speech training systems or the potential of integrating mobile technology into education and rehabilitation, but recent systematic reviews have also evaluated the efficacy of computer-based speech and language therapy for children and how digital technology can support different activities, at school or elsewhere.

Objective

This study aimed to analyze a continuous communication and joint team approach to develop solutions focused on the real needs of end users, which digitally emulate reliable and validated physical intervention materials for children with speech sound disorders (SSD).

Methods

The Table to Tablet (T2T) software was developed using a design-based research methodology, which included four phases: activities development; ethnographic pretesting with a sample from the target population; software development; and beta-testing. The technology used to develop the software, the method used to ensure satisfaction and replay ability of the intervention materials, and results from the ethnographic and beta-testing phases are presented.

Results

Nineteen activities were developed during the first phase, which were then tested, with 7 service users, using a physical prototype. The beta-test approach included extensive testing and reformulation, supported by direct, nonparticipant observation and data collection using a questionnaire designed for children. Feedback was used to improve the software and interaction with users.

Conclusions

The use of T2T-based intervention programmes by speech and language therapists (SLTs) will allow these professionals to make a better and more effective communication intervention, based on proven methodologies, that coexists in a structured physical and a digital version. These versions provide a full, 6-week intervention program, with minimal effort in preparing the session by the SLTs while delivering a very consistent intervention, with high replay value. A continuous communication and joint team approach was beneficial to the project and to the development of a solution focused on the real needs of SLTs and children with SSD. All problems were approached as a team with different skills and expertise, which minimized errors (eg, the developer making choices that would save him from spending time doing something that would not be used) and time spent. To add to this, the importance of integrating the end users as testers and collecting their opinions and actions per session allowed the production of better-targeted activities.

Trial Registration

ClinicalTrials.gov NCT02490826; https://clinicaltrials.gov/ct2/show/NCT02490826

Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay

The goal of this research was to obtain initial estimates of the prevalence of each of four types of motor speech disorders in children with idiopathic Speech Delay (SD) and to use findings to estimate the population-based prevalence of each disorder. Analyses were completed on audio-recorded conversational speech samples from 415 children recruited for research in idiopathic SD in six USA cities during the past three decades. The speech and motor speech status of each participant was cross-classified using standardized measures in the finalized version of the Speech Disorders Classification System described in the Supplement. Population-based prevalence estimates for the four motor speech disorders were calculated from epidemiological studies of SD conducted in Australia, England, and the USA. A total of 82.2% of the 415 participants with SD met criteria for No Motor Speech Disorder at assessment, 12% met criteria for Speech Motor Delay, 3.4% met criteria for Childhood Dysarthria, 2.4% met criteria for Childhood Apraxia of Speech, and 0% met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech. The estimated population-based prevalence of each of the first three motor speech disorders at 4 to 8 years of age were Speech Motor Delay: 4 children per 1,000; Childhood Dysarthria: 1 child per 1,000; and Childhood Apraxia of Speech: 1 child per 1,000. The latter finding cross-validates a prior prevalence estimate for Childhood Apraxia of Speech of 1-2 children per 1,000. Findings are interpreted to indicate a substantial prevalence of motor speech disorders in children with idiopathic SD. Abbreviations: CAS, childhood apraxia of speech; CD, childhood dysarthria; CND, complex neurodevelopmental disorders; DI, dysarthria index; DSI, dysarthria subtype indices; MSD, motor speech disorder; No MSD, no motor speech disorder; NSA, normal(ized) speech acquisition; PEPPER, programs to examine phonetic and phonologic evaluation records; PM, pause marker; PMI, pause marker index; PSD, persistent speech delay; PSE, persistent speech errors; SD, speech delay; SDCS, speech disorders classification system; SDCSS, speech disorders classification system summary; SE, speech errors; SMD, speech motor delay.

Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders

Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders (CND) can inform research in the biobehavioural origins and treatment of CND. The goal of this research was to use measures and analytics in a diagnostic classification system to estimate the prevalence of speech and motor speech disorders in convenience samples of speakers with one of eight types of CND. Audio-recorded conversational speech samples from 346 participants with one of eight types of CND were obtained from a database of participants recruited for genetic and behavioural studies of speech sound disorders (i.e., excluding dysfluency) during the past three decades. Data reduction methods for the speech samples included narrow phonetic transcription, prosody-voice coding, and acoustic analyses. Standardized measures were used to cross-classify participants' speech and motor speech status. Compared to the 17.8% prevalence of four types of motor speech disorders reported in a study of 415 participants with idiopathic Speech Delay (SD), 47.7% of the present participants with CND met criteria for one of four motor speech disorders, including Speech Motor Delay (25.1%), Childhood Dysarthria (13.3%), Childhood Apraxia of Speech (4.3%), and concurrent Childhood Dysarthria and Childhood Apraxia of Speech (4.9%). Findings are interpreted to indicate a substantial prevalence of speech disorders, and notably, a substantial prevalence of motor speech disorders in persons with some types of CND. We suggest that diagnostic classification information from standardized motor speech assessment protocols can contribute to research in the pathobiologies of CND. Abbreviations: 16p: 16p11.2 deletion and duplication syndrome; 22q: 22q11.2 deletion syndrome; ASD: Autism Spectrum Disorder; CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; CND: Complex Neurodevelopmental Disorder; DS: Down syndrome; FXS: Fragile X syndrome; GAL: Galactosemia; IID: Idiopathic Intellectual Disability; MSD: Motor Speech Disorder; No MSD: No Motor Speech Disorder; NSA: Normal(ized) Speech Acquisition; PEPPER: Programs to Examine Phonetic and Phonologic Evaluation Records; PSD: Persistent Speech Delay; PSE: Persistent Speech Errors; SD: Speech Delay; SDCS: Speech Disorders Classification System; SDCSS: Speech Disorders Classification System Summary; SE: Speech Errors; SMD: Speech Motor Delay; SSD: Speech Sound Disorders; TBI: Traumatic Brain Injury.

Introduction: Motor Speech Disorders in Idiopathic Speech Delay and in Complex Neurodevelopmental Disorders: Introduction

This introduction to a special issue of Clinical Linguistics & Phonetics includes an overview of the contents of each of the six articles. Each of the articles use the finalized version of the Speech Disorders Classification System (SDCS).

Initial studies of the phenotype and persistence of speech motor delay (SMD)

Speech Motor Delay (SMD) is a recently proposed childhood motor speech disorder characterized by imprecise and unstable speech, prosody, and voice that does not meet criteria for either Childhood Dysarthria or Childhood Apraxia of Speech. The goals of the present research were to obtain information on the phenotype of SMD and initial information on the persistence of SMD in children receiving treatment for idiopathic Speech Delay (SD). Five questions about the phenotype and persistence of SMD were posed using a database of audio-recordings and participant records and longitudinal data from audio-recordings of children with early SMD treated for SD. Three phenotype questions examined associations between participant risk factors and prevalence of SMD, and described the most frequent speech, prosody, and voice signs of early SMD. To provide initial estimates of the persistence of SMD, two questions examined associations between the persistence of SMD and participant risk factors using the audio-recordings of 14 participants with SMD treated for idiopathic SD. Phenotype findings indicated that SMD is characterized by across-the-board delays in the spatiotemporal precision and stability of speech, prosody, and voice production. Persistence findings indicated that although most participants normalized early SMD by 6 years of age, SMD persisted until at least late adolescence in 21.4% of participants. Findings are interpreted to support the construct validity of SMD and the potential for research using additional assessment modalities to explicate its genomic and neuromotor causal pathways. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; MSD: Motor Speech Disorder; No MSD: No Motor Speech Disorder; PSI: Precision-Stability Index; SD: Speech Delay; SMD: Speech Motor Delay; SSD: Speech Sound Disorders.

Selecting an acoustic correlate for automated measurement of American English rhotic production in children

Purpose: A current need in the field of speech-language pathology is the development of reliable and efficient techniques to evaluate accuracy of speech targets over the course of treatment. As acoustic measurement techniques improve, it should become possible to use automated scoring in lieu of ratings from a trained clinician in some contexts. This study asks which acoustic measures correspond most closely with expert ratings of children's productions of American English /ɹ/ in an effort to develop an automated scoring algorithm for use in treatment targeting rhotics. Method: A series of ordinal mixed-effects regression models were fit over a large sample of children's productions of words containing /ɹ/ that had previously been rated by three trained clinicians. Akaike/Bayesian Information Criteria were used to select the best-fitting model. Result: Controlling for age, sex, and allophonic contextual differences, the measure that accounted for the most variance in speech rating was F3-F2 distance normalised relative to a sample of age- and sex-matched speakers. Conclusion: We recommend this acoustic measure for use in future automated scoring of children's production of American English rhotics. We also suggest that computer-based treatment with automated scoring should facilitate increases in treatment dosage by improving options for home practice.

South African English Speech Development: Preliminary Data from Typically Developing Preschool Children in Cape Town

English is one of eleven official languages in South Africa, but there is limited information on children's acquisition of English and other languages in this context. This paper describes speech development in 308 children aged 3;0-5;11 acquiring South African English in Cape Town. The study focused on English speech acquisition, although children were grouped by language background into monolingual, isiXhosa bilingual, Afrikaans bilingual and trilingual groups. The primary objective was to describe phonetic and phonological acquisition (percentage consonants and vowels correct (PCC and PVC); phonetic inventory and phonological processes) by children's age and language background. As a secondary objective we described the prevalence of speech disorders in the sample using Dodd's (2005) framework. The Diagnostic Evaluation of Articulation and Phonology was used to assess participants with modified scoring criteria appropriate for the context. Phonological processes and inventories were broadly comparable to normative data for English speech acquisition documented in the literature, and a progression was observed with increasing age. PCC and PVC were similar for children within age bands despite different language backgrounds. Bilingual children showed aspects of English phonological development linked to their L1, and some differences in phonological processes were observed. Approximately 9% of children (n = 28) had speech difficulties, with 75% of this group having a speech delay. The study highlights the importance of adapting speech assessments for use with populations that differ from the originally intended audience. This work contributes to knowledge of typical speech development in South Africa and in multilingual contexts more generally.

Working memory in school-age children with and without a persistent speech sound disorder

PURPOSE

The aim of this study was to explore the role of working memory processes as a possible cognitive underpinning of persistent speech sound disorders (SSD).

METHOD

Forty school-aged children were enrolled; 20 children with persistent SSD (P-SSD) and 20 typically developing children. Children participated in three working memory tasks - one to target each of the components in Baddeley's working memory model: phonological loop, visual spatial sketchpad and central executive.

RESULT

Children with P-SSD performed poorly only on the phonological loop tasks compared to their typically developing age-matched peers. However, mediation analyses revealed that the relation between working memory and a P-SSD was reliant upon nonverbal intelligence.

CONCLUSION

These results suggest that co-morbid low-average nonverbal intelligence are linked to poor working memory in children with P-SSD. Theoretical and clinical implications are discussed.

Impact of communication partner familiarity and speech accuracy on parents' ratings of their child for the Intelligibility in Context Scale: Dutch

PURPOSE

The aim of this study was to examine the role of familiarity of a communication partner on Dutch parents' perception of their child's intelligibility, for children with typically-developing speech (TD) or speech sound disorder (SSD).

METHOD

Participants were 67 Dutch-speaking children (48-84 months), 48 with TD and 19 with SSD. Item scores on the parent-rated Intelligibility in Context Scale: Dutch (ICS-NL) were compared between groups and related to naive listeners' ratings of children's intelligibility (IR), and a measure of speech accuracy (i.e. percentage of consonants correct-adjusted, PCC-A).

RESULT

Statistical analysis yielded a significant Group by Familiarity interaction on the ICS-NL. Parents rated the intelligibility of their child with SSD as higher with more familiar communication partners than less familiar, more so than parents of children with TD. In the SSD group, IR was more strongly correlated with ICS-NL item scores for less familiar partners. PCC-A was only correlated with ICS-NL item 7 (strangers).

CONCLUSION

Parents perceive their children as more intelligible with people in close relationships, likely due to their higher familiarity with the child's speech. Children's relationships should be considered with respect to communicative participation. PCC-A may be a less reliable predictor of participation in family and community life.

Fostering human rights through TalkBank

In accord with articles 19 and 27 of the Universal Declaration of Human Rights, people with speech and language disorders have the right to receive maximal benefit from academic research on speech and language acquisition and disorders. To evaluate the diverse nature of speech and language disorders, this research must have access to large datasets, as well as to refined tools for the systematic analysis of these datasets. The TalkBank system addresses this need by providing researchers with thousands of hours of open-access database archives of digital audio, video and transcript files documenting typical and disordered language use in dozens of languages and cultures. In this paper, we review the TalkBank system, with an emphasis on the AphasiaBank, PhonBank and FluencyBank databases. We describe how specialised assessment tools can be used to study issues in speech and language acquisition and disorders recorded within these databases. We then provide illustrations of how assessments support the needs of researchers, clinicians, developers, and educators, whose combined work contributes solutions for people with speech, language and language learning disorders worldwide.

The effect of different speaker accents on sentence comprehension in children with speech sound disorder

There is substantial evidence that a speaker's accent, specifically an unfamiliar accent, can affect the listener's comprehension. In general, this effect holds true for both adults and children as well as those with typical and impaired language. Previous studies have investigated the effect of different accents on individuals with language disorders, but children with speech sound disorders (SSDs) have received little attention. The current study aims to learn more about the ability of children with SSD to process different speaker accents. Fifteen children with SSD aged between 4;01 and 5;11 years, and 16 typically developing children matched on language ability, age, socioeconomic status, gender and cognitive ability participated in the current study. A sentence comprehension task was carried out with each child, requiring them to follow instructions of increasing length spoken in three different accents - (i) a local Irish (Cork) accent, (ii) a regional North American accent and (iii) a non-native Indian English accent. Results showed no significant group difference and speaker accent did not significantly impact children's performance on the task. The results are discussed in relation to factors that influence accent comprehension, and their implications for children's underlying phonological representations.

Deriving individualised /r/ targets from the acoustics of children's non-rhotic vowels

In visual-acoustic biofeedback for rhotic errors, learners are guided to match the third formant (F3) location to a visual target on a real-time acoustic spectrum. As the acoustic properties of correct English /r/differ across speakers, this study aimed to improve target selection by investigating the validity of individualised targets derived from children's non-rhotic vowels. A previously proposed prediction formula was adjusted using data from a child normative sample and tested in two groups of children. Study 1 found that predicted values were unexpectedly higher than actual F3 values in children whose /r/ errors had been remediated. To understand this discrepancy, Study 2 applied the formula to typically developing children and found that predicted values were also higher than actual F3 values, suggesting that different normative data might better represent the current samples. An updated formula is proposed, which can be used to generate individualised targets within acoustic biofeedback applications.

The phonological memory profile of preschool children who make atypical speech sound errors

Previous research indicates that children with speech sound disorders (SSD) have underlying phonological memory deficits. The SSD population, however, is diverse. While children who make consistent atypical speech errors (phonological disorder/PhDis) are known to have executive function deficits in rule abstraction and cognitive flexibility, little is known about their memory profile. Sixteen monolingual preschool children with atypical speech errors (PhDis) were matched individually to age-and-gender peers with typically developing speech (TDS). The two groups were compared on forward recall of familiar words (pointing response), reverse recall of familiar words (pointing response), and reverse recall of digits (spoken response) and a receptive vocabulary task. There were no differences between children with TDS and children with PhDis on forward recall or vocabulary tasks. However, children with TDS significantly outperformed children with PhDis on the two reverse recall tasks. Findings suggest that atypical speech errors are associated with impaired phonological working memory, implicating executive function impairment in specific subtypes of SSD.

Implementation fidelity of a computer-assisted intervention for children with speech sound disorders

BACKGROUND

Implementation fidelity refers to the degree to which an intervention or programme adheres to its original design. This paper examines implementation fidelity in the Sound Start Study, a clustered randomised controlled trial of computer-assisted support for children with speech sound disorders (SSD).

METHOD

Sixty-three children with SSD in 19 early childhood centres received computer-assisted support (Phoneme Factory Sound Sorter [PFSS] - Australian version). Educators facilitated the delivery of PFSS targeting phonological error patterns identified by a speech-language pathologist. Implementation data were gathered via (1) the computer software, which recorded when and how much intervention was completed over 9 weeks; (2) educators' records of practice sessions; and (3) scoring of fidelity (intervention procedure, competence and quality of delivery) from videos of intervention sessions.

RESULT

Less than one-third of children received the prescribed number of days of intervention, while approximately one-half participated in the prescribed number of intervention plays. Computer data differed from educators' data for total number of days and plays in which children participated; the degree of match was lower as data became more specific. Fidelity to intervention procedures, competency and quality of delivery was high.

CONCLUSION

Implementation fidelity may impact intervention outcomes and so needs to be measured in intervention research; however, the way in which it is measured may impact on data.

Differences between the production of [s] and [ʃ] in the speech of adults, typically developing children, and children with speech sound disorders: An ultrasound study

This study describes the criteria that are used in ultrasound to measure the differences between the tongue contours that produce [s] and [ʃ] sounds in the speech of adults, typically developing children (TDC), and children with speech sound disorder (SSD) with the phonological process of palatal fronting. Overlapping images of the tongue contours that resulted from 35 subjects producing the [s] and [ʃ] sounds were analysed to select 11 spokes on the radial grid that were spread over the tongue contour. The difference was calculated between the mean contour of the [s] and [ʃ] sounds for each spoke. A cluster analysis produced groups with some consistency in the pattern of articulation across subjects and differentiated adults and TDC to some extent and children with SSD with a high level of success. Children with SSD were less likely to show differentiation of the tongue contours between the articulation of [s] and [ʃ].

An exploratory study of the influence of load and practice on segmental and articulatory variability in children with speech sound disorders

This exploratory treatment study used phonetic transcription and speech kinematics to examine changes in segmental and articulatory variability. Nine children, ages 4 to 8 years old, served as participants, including two with childhood apraxia of speech (CAS), five with speech sound disorder (SSD) and two who were typically developing. Children practised producing agent + action phrases in an imitation task (low linguistic load) and a retrieval task (high linguistic load) over five sessions. In the imitation task in session one, both participants with CAS showed high degrees of segmental and articulatory variability. After five sessions, imitation practice resulted in increased articulatory variability for five participants. Retrieval practice resulted in decreased articulatory variability in three participants with SSD. These results suggest that short-term speech production practice in rote imitation disrupts articulatory control in children with and without CAS. In contrast, tasks that require linguistic processing may scaffold learning for children with SSD but not CAS.

Differential Effects of Visual-Acoustic Biofeedback Intervention for Residual Speech Errors

Recent evidence suggests that the incorporation of visual biofeedback technologies may enhance response to treatment in individuals with residual speech errors. However, there is a need for controlled research systematically comparing biofeedback versus non-biofeedback intervention approaches. This study implemented a single-subject experimental design with a crossover component to investigate the relative efficacy of visual-acoustic biofeedback and traditional articulatory treatment for residual rhotic errors. Eleven child/adolescent participants received ten sessions of visual-acoustic biofeedback and 10 sessions of traditional treatment, with the order of biofeedback and traditional phases counterbalanced across participants. Probe measures eliciting untreated rhotic words were administered in at least three sessions prior to the start of treatment (baseline), between the two treatment phases (midpoint), and after treatment ended (maintenance), as well as before and after each treatment session. Perceptual accuracy of rhotic production was assessed by outside listeners in a blinded, randomized fashion. Results were analyzed using a combination of visual inspection of treatment trajectories, individual effect sizes, and logistic mixed-effects regression. Effect sizes and visual inspection revealed that participants could be divided into categories of strong responders (n = 4), mixed/moderate responders (n = 3), and non-responders (n = 4). Individual results did not reveal a reliable pattern of stronger performance in biofeedback versus traditional blocks, or vice versa. Moreover, biofeedback versus traditional treatment was not a significant predictor of accuracy in the logistic mixed-effects model examining all within-treatment word probes. However, the interaction between treatment condition and treatment order was significant: biofeedback was more effective than traditional treatment in the first phase of treatment, and traditional treatment was more effective than biofeedback in the second phase. This is consistent with existing theory and data suggesting that detailed knowledge of performance feedback is most effective in the early stages of motor learning. Further research is needed to confirm that an initial phase of biofeedback has a facilitative effect, and to determine the optimal duration of biofeedback treatment. In addition, there is a strong need for correlational studies to examine which individuals with residual speech errors are most likely to respond to treatment.

Involvement of parents in intervention for childhood speech sound disorders: a review of the evidence

BACKGROUND

Internationally, speech and language therapists (SLTs) are involving parents and providing home tasks in intervention for phonology-based speech sound disorder (SSD). To ensure that SLTs' involvement of parents is guided by empirical research, a review of peer-reviewed published evidence is needed.

AIMS

To provide SLTs and researchers with a comprehensive appraisal and analysis of peer-reviewed published intervention research reporting parent involvement and the provision of home tasks in intervention studies for children with phonology-based SSD.

METHODS & PROCEDURES

A systematic search and review was conducted. Academic databases were searched for peer-reviewed research papers published between 1979 and 2013 reporting on phonological intervention for SSD. Of the 176 papers that met the criteria, 61 were identified that reported on the involvement of parents and/or home tasks within the intervention. These papers were analysed using a quality appraisal tool. Details regarding the involvement of parents and home tasks were extracted and analysed to provide a summary of these practices within the evidence base.

MAIN CONTRIBUTION

Parents have been involved in intervention research for phonology-based SSD. However, most of the peer-reviewed published papers reporting this research have provided limited details regarding what this involved. This paucity of information presents challenges for SLTs wishing to integrate external evidence into their clinical services and clinical decision-making. It also raises issues regarding treatment fidelity for researchers wishing to replicate published intervention research.

CONCLUSIONS & IMPLICATIONS

The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.

Covert contrast and covert errors in persistent velar fronting

Acoustic and articulatory studies demonstrate covert contrast in perceptually neutralised phonemic contrasts in both typical children and children with speech disorders. These covert contrasts are thought to be relatively common and symptomatic of phonetic speech disorders. However, clinicians in the speech therapy clinic have had no easy way of identifying this covertness. This study uses ultrasound tongue imaging to compare tongue contours for /t/and /k/in seven children with persistent velar fronting. We present a method of overlaying tongue contours to identify covert contrast at the articulatory level. Results show that all seven children, contrary to expectations, produced both /t/and /k/with near-identical tongue shapes showing no evidence of covert contrast. However, further analysis of one of the participants showed highly variable tongue shapes for /t/and /k/, including retroflex productions of both. Although not phonologically conditioned, this covert error is evidence of speech disorder at the phonetic level.

Added syllable complexity in a child's developmental speech and clinical implications

Added syllable complexity, whereby a non-targeted consonant is added next to a targeted consonant in the syllable, has received relatively little attention in studies of children with speech sound disorders (SSD) and typically developing children. Despite the scarcity and subtlety of the pattern, evidence in child and adult data indicates universality. The present article examines the pattern in a bilingual child's longitudinal speech in English from age 2;7 to 4;0, focusing on word-initial consonant addition. The purpose is to identify phonological and psycholinguistic processes associated with the pattern. It is suggested that the complexity pattern with both legal and illegal outputs is a systemic developmental behaviour linked to the child's level of phonological acquisition, facilitating acquisition of the complex CCV rule as well as of non-acquired singleton consonants. Implications of the results for children's SSD intervention techniques and for adult degenerative speech are discussed.

Acquiring rhoticity across languages: An ultrasound study of differentiating tongue movements

Rhotics in many languages develop late and show clinically significant misarticulations. The English approximant and Spanish trill rhotics exhibit both a primary constriction along the palate and a secondary constriction in the pharynx. We speculate that the secondary constriction might be a cross-linguistic characteristic of rhotics and thus potentially a factor in delayed articulatory development/misarticulations. We describe an exploratory study analyzing rhotic tongue configurations in ultrasound videos from a small sample of native adult speakers of English, Malayalam, French, Persian and Spanish. Our findings confirm that rhotic sounds most subject to late development also involve tongue root movement towards a pharyngeal constriction, but this conclusion must remain tentative without further research. In the meantime, clinical strategies that include attention to primary and secondary constrictions should be explored for remediation of rhotic misarticulations across languages.