[Effects of cytomegalovirus infection on infants' hearing and speech development]

Objective:To investigate the effects of cytomegalovirus（CMV） infection on infants' hearing and speech development. Methods:A total of 192 infants with cytomegalovirus infection were selected as research objects（CMV group）. Among 320 normal infants who received physical examinations in the Second Affiliated Hospital of Zhengzhou University during the same period were selected as the control group. Using transiently evoked otoacoustic emission to conduct initial hearing screening. Jointing automatic auditory brainstem response screening method to follow up for infants infected with cytomegalovirus. Those who failed to pass the screening were diagnosed with auditory brainstem response and acoustic immittance examination. The two groups of infants were evaluated for follow-up at the age of 12, 24, 36 months using the Gesell Development scale. Results:Hearing screening（initial hearing screening and 42 d hearing re-screening）: CMV group retrospectively failed rates 28.65%（55/192）, 31.77%（61/192）, normal control group retrospectively failed rates 9.06%（29/320）, 4.06%（13/320）, the results of the two groups' hearing screening showed statistically significant differences（P<0.05）. 48 cases of diagnostic ABR were abnormal in CMV group in 3 month's hearing diagnosis, including 11 cases of secretory otitis media, 37 cases of sensorineural hearing loss. Follow-up for 36 months, 192 infants with CMV infection were confirmed congenital SNHL 37 cases（19.27%）, 21 cases of delayed SNHL（10.94%）, a total of diagnosis with SNHL 58 cases（30.21%）. The development quotient（DQ） of CMV group were respectively 92.05±4.68, 86.53±4.46, 85.92±4.82 in 12, 24, 36 months, and the DQ value of the normal control group were respectively 93.10±4.56, 94.35±4.52, 95.03±4.16. At the age of 24, 36 months, the DQ value of two groups' differences were statistically significant（P<0.05）. Conclusion:CMV infection is hearing loss' risk factors. It had the characteristics of volatility, delay and progressive decline. Follow-up should be strengthened for hearing and speech development.

Phonological acquisition of Brazilian Portuguese: Ages of customary production, acquisition and mastery

BACKGROUND

AIMS: To describe typical phonological development of Brazilian Portuguese (BP)-speaking children, considering the following parameters: age of customary production, acquisition and mastery.

METHODS & PROCEDURES

Data were collected from 857 children aged between 3 years and 8 years 11 months with typical language and speech development. The sample was grouped into 6-month age bands. The data were analysed using one-way analysis of variance (ANOVA) followed by Games-Howell post-hoc tests.

OUTCOMES & RESULTS

Stops (/p, b, t, d, k, g/), nasals (/m, n, ɲ/) and some fricatives (/f, v, s, z/) were mastered before the age of 3 years (age of mastery). The age of acquisition for phonemes /ʃ, ʒ/ was 3;6, though both were only mastered at 4;0 years. The liquid /l/ was acquired at 3;0 and mastered at age 3;6, while /x/ was acquired and mastered at age 3;6. The phoneme /ʎ/ was acquired at 7;0 and mastered at age 8;6. The tap /ɾ/ was acquired between the ages of 4;0 and 4;6, and mastered at 4;6. In coda position, /n, l/ were acquired at 3;0, while /s/ was mastered at 4;6 and /ɾ/ between 4;6 and 5;0 years. Clusters involving /ɾ/ were acquired at 6;0, while those with /l/ were acquired between the ages of 6;6 and 7;0.

CONCLUSIONS & IMPLICATIONS

This study presented acquisition for consonants in BP and can be used as a reference for the assessment of developmental speech disorders. In this study, stops and nasals were acquired first, followed by fricatives and, lastly, liquids. This finding is corroborated by previous studies in BP and other languages.

WHAT THIS PAPER ADDS

What is already known on the subject What this paper adds to existing knowledge What are the potential or actual clinical implications of this work?

Designing and validating the Dubai Tool for Developmental Screening (DTDS)

BACKGROUND

Early detection of developmental problems is vital for facilitating early access to targeted intervention and augmenting its beneficial outcomes. Standardized developmental screening tools are known to enhance detection rates of developmental problems compared to clinical judgment alone and are widely recommended to be used in infants and young children. Most of the available developmental screening tools have been developed in Western countries. Many of their items may not be suitable for other cultures while others are expensive. Currently, none of the developmental screening tools have been validated in the United Arab Emirates (UAE), with only a few available in the Arabic language.

OBJECTIVE

To create and validate a developmental screening tool, in both English and Arabic, that is simple, quick to use, and culturally relevant to the United Arab Emirates (UAE) child population aged 9-48 months.

METHODS

The available literature was used to create a list of developmental milestones in five domains for children aged 9-48 months, divided into seven age groups. The selected milestones were used to create questionnaires in both English and Arabic, which were pilot tested twice. Each time, the results were analyzed and used to select, modify, and rephrase questions. Validation of the Dubai Tool for Developmental Screening (DTDS) was done against Parents' Evaluation of Developmental Status (PEDS) as a gold standard instrument. The DTDS and PEDS were administered cross-sectionally to parents of 1,400 children in seven age groups. Sensitivity, specificity, and kappa agreement of the DTDS compared with PEDS were calculated.

RESULTS

The DTDS had a sensitivity of 100% in four age groups and 75-78% in the other three age groups. Specificity ranged from 96 to 99% across all age groups. The kappa measure showed substantial agreement in five age groups, a moderate agreement in one age group, and a fair agreement in one age group.

CONCLUSIONS

The DTDS is a valid screening tool for early identification of developmental delays and disabilities in early childhood.

Exposure to electronic media was negatively associated with speech and language development at 18 and 24 months

AIM

This study evaluated early speech and language development at 18 and 24 months, and associated factors, based on parental reports.

METHOD

We followed up the CHILD-SLEEP birth cohort of 1667 Finnish-speaking families, who were randomly recruited in 2011-2013 during routine visits to maternity clinics in the Pirkanmaa Hospital District of Finland. The women were approximately 32 weeks' pregnant at enrolment. Parents reported the size of their child's expressive vocabulary, word combinations, intelligibility, finger-pointing and adherence to instructions. A subsample was studied using the Expressive Language subscale of the Bayley Scales of Infant and Toddler Development, Third Edition.

RESULTS

The children's vocabulary was smaller than previously reported. At 18 months of age, 68.8% of the 997 children had a vocabulary of 20 words or less and 35.7% used about five words at most. At 24 months, 32.4% of the 822 children had a vocabulary of 50 words or less and 18.4% used about 20 words at most. Longer child and parental exposure to electronic media was negatively associated with the size of the child's expressive vocabulary.

CONCLUSION

Vocabulary size at 18 and 24 months was smaller than previously reported and negatively associated with exposure to electronic media.

Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age

OBJECTIVE

To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft.

DESIGN

Prospective study.

PARTICIPANTS

Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children.

MAIN OUTCOME MEASURES

Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention.

RESULTS

A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP.

CONCLUSIONS

A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.

Maximum repetition rate in a large cross-sectional sample of typically developing Dutch-speaking children

Purpose: The current study aims to provide normative data for the maximum repetition rate (MRR) development of Dutch-speaking children based on a large cross-sectional study using a standardised protocol.Method: A group of 1014 typically developing children aged 3;0 to 6;11 years performed the MRR task of the Computer Articulation Instrument (CAI). The number of syllables per second was calculated for mono-, bi-, and trisyllabic sequences (MRR-pa, MRR-ta, MRR-ka, MRR-pata, MRR-taka, MRR-pataka). A two-way mixed ANOVA was conducted to compare the effects of age and gender on MRR scores in different MRR sequences.Result: The data analysis showed that overall MRR scores were affected by age group, gender and MRR sequence. For all MRR sequences the MRR increased significantly with age. MRR-pa was the fastest sequence, followed by respectively MRR-ta, MRR-pata, MRR-taka, MRR-ka and MRR-pataka. Overall MRR scores were higher for boys than for girls, for all MRR sequences.Conclusion: This study presents normative data of MRR of Dutch-speaking children aged 3;0 to 6;11 years. These norms might be useful in clinical practice to differentiate children with speech sound disorders from typically developing children. More research on this topic is necessary. It is also suggested to collect normative data for other individual languages, using the same protocol.

Does the duration and frequency of dummy (pacifier) use affect the development of speech?

BACKGROUND

The current literature suggests a link between dummy (or pacifier) use and a number of both positive and detrimental consequences. Positive consequences include soothing effect and protection from sudden infant death syndrome (SIDS), while negative ones include increased risk of otitis media and dental malformation. However, there is little research surrounding the impact of dummy use on the development of speech sounds.

AIMS

To investigate whether duration (in number of months) and frequency per day of dummy use have an individual or combined effect on the development of a child's speech, and if so, in what way.

METHODS & PROCEDURES

A total of 100 British-English children aged 24-61 months and growing up in the UK were recruited through nurseries, playgroups and by word of mouth. Their parents were asked to complete a questionnaire about the duration and frequency of dummy use and factors known to influence the development of speech. Following this, the children's speech was assessed using the phonology section of the Diagnostic Evaluation of Articulation and Phonology (DEAP). Analysis of the DEAP was conducted to determine the percentage of consonants correct, number of age-appropriate, delayed and atypical errors. Dummy use and speech outcome measures were then analysed qualitatively and quantitatively using mean and median group comparisons alongside multivariate generalized least squares and generalized negative binomial modelling approaches to test for significant associations.

OUTCOMES & RESULTS

The results showed that the majority of speech outcomes are not significantly associated with dummy use, however measured, in bivariate or multivariate analyses. However, there is a significant association between increased atypical errors and greater frequency of daytime dummy use. This association is strengthened by restricted sampling within the younger members of the sample, with this association not observable within children older than 38 months, the median sample age.

CONCLUSIONS & IMPLICATIONS

The evidence base for any effects of dummy use on speech is very small. Dummy use may increase the number of atypical speech errors a young child makes. However, only the frequency of daytime use seems relevant, not the duration or night-time use, and these errors may resolve over time. What this paper adds What is already known on this subject The use of a dummy with infants in Western countries is comparatively high (between 36-85%). A number of positive and detrimental consequences of dummy use have been documented in the literature; however, research on the effect of dummy use on speech development is significantly lacking. Past studies have included small sample sizes or used single measures of speech outcomes, which may not be specific enough to reveal how speech may be affected. Many speech and language therapists speculate that the use of a dummy could be contributing to many of the conditions they treat, yet this claim remains largely unsubstantiated. Clinical implications of this study The study suggests that only prolonged use of a dummy over several hours and during the day may start to show any impact on speech; even then, professionals need to be aware that the evidence base for any speech effects is very small. Clinicians and other professionals who parents consult on dummy use should make sure to provide both the pros and cons of dummy use, in order to enable parents to make an informed decision.

Practice and experience predict coarticulation in child speech

Much research in child speech development suggests that young children coarticulate more than adults. There are multiple, not mutually-exclusive, explanations for this pattern. For example, children may coarticulate more because they are limited by immature motor control. Or they may coarticulate more if they initially represent phonological segments in larger, more holistic units such as syllables or feet. We tested the importance of several different explanations for coarticulation in child speech by evaluating how four-year-olds' language experience, speech practice, and speech planning predicted their coarticulation between adjacent segments in real words and paired nonwords. Children with larger vocabularies coarticulated less, especially in real words, though there were no reliable coarticulatory differences between real words and nonwords after controlling for word duration. Children who vocalized more throughout a daylong audio recording also coarticulated less. Quantity of child vocalizations was more predictive of the degree of children's coarticulation than a measure of receptive language experience, adult word count. Overall, these results suggest strong roles for children's phonological representations and speech practice, as well as their immature fine motor control, for coarticulatory development.

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.

Dental, Occlusal, and Craniofacial Features of Children With Microcephaly Due to Congenital Zika Infection: 3 Cases Report From Valle del Cauca, Cali-Colombia-2020

OBJECTIVE

Describes dental, occlusal, and craniofacial characteristics of 3 children aged 3 to 4 years with microcephaly due to congenital Zika infection in Cali Valle del Cauca, 2020.

DESIGN

Three children case report with congenital Zika virus microcephaly.

SETTING

Institutional.

PATIENTS

Three children with maternal viral infection confirmed by polymerase chain reaction during first trimester of pregnancy were included and were born from 2016 to 2017.

INTERVENTIONS

Oral and mouth functional examination was performed including soft tissue examination; lingual and labial frenulum; evaluation of swallowing and chewing; craniofacial analysis; dimension of dental arch; intercanine and intermolar distance, palate form; relationship and growth of maxilla, mandible, and facial dental midline using plaster models; and complementary image analysis.

MAIN OUTCOME MEASURES

Child and mother sociodemographic features, craniofacial measurements; dental and oral features; maxillary and mandibular measures; and speech, swallowing, and chewing disorders.

RESULTS

Small head circumference at birth and at the time of clinical evaluation was compared to normal children of approximately their age. Upper third of the face was short, and presence of hypertonic masticatory muscles with hypotonic swallowing muscles, dysphagia, dyslalia, bruxism, lip incompetence, tongue interposition, and hypersalivation and epilepsy were the main medical problem. They have complete primary dentition with normal dental morphology, tooth eruption altered, dental caries, and dental malocclusion was identified.

CONCLUSION

There are no changes in the dental formula and dental morphology in the deciduous dentition. They present severe chewing and speaking limitation, facial disproportion, and occlusal problems that warrant dental and medical attention.

Optimal Outcomes Reporting (OOR): A New Value-Based Metric for Outcome Reporting Following Cleft Palate Repair

OBJECTIVE

Palatoplasty outcome measurements vary widely among institutions. A standardized outcome metric would help provide quality benchmarks.

DESIGN

Retrospective review of primary palatoplasty patients from 2007 to 2013.

SETTING

Tertiary care children's hospital.

MAIN OUTCOME MEASURES

We created a novel conceptual quality metric called "OOR" (Optimal Outcome Reporting). Optimal Outcome Reporting is designed to reflect the percentage of patients with cleft palate who experience the best outcomes: one operation, velar competence by age 5 years, and no unintended palatal fistula.

RESULTS

Optimal Outcome Reporting was 72.3% (68/94). Eight patients had "suboptimal" outcomes for having undergone more than one operation. Eighteen patients failed for velar incompetence. No additional patients fell out of the algorithm for fistula. A significantly higher proportion of nonsyndromic patients demonstrated an "optimal" result compared to syndromic patients (61/80, 76.3% vs 7/14, 50.0%; P = .04). Patients who required more than one procedure had significantly more clinic visits (32.6 vs 14.9; P < .01) and accrued higher costs compared to "optimal" patients (US$34 019.88 vs US$15 357.25; P < .01).

CONCLUSIONS

Optimal Outcome Reporting represents a novel quality metric that can provide meaningful information for patients with cleft palate. Optimal Outcome Reporting utilization can help cleft centers adopt changes that matter to patients and their families. By allowing for cross-institutional comparisons in a clear and objective manner, OOR can promote competition, innovation, and value in cleft palate care.

Canonical Babbling and Early Consonant Development Related to Hearing in Children With Otitis Media With Effusion With or Without Cleft Palate

OBJECTIVE

To investigate and compare babbling, early consonant production and proficiency from 10 to 36 months of age and its relationship with hearing in children with otitis media with effusion (OME) with or without cleft palate.

DESIGN

Prospective, longitudinal group comparison study.

SETTING

University hospital.

PARTICIPANTS

Fifteen children born with nonsyndromic cleft palate with or without cleft lip (CP±L) and 15 age-matched children with hearing loss (HL) associated with OME but without cleft palate (noncleft group).

MAIN OUTCOME MEASURES

Canonical babbling (CB) and early consonant variables (presence of oral stops, anterior stops, dental/alveolar stops, number of different true consonants) at 10 and 18 months, and percentage of consonants correct proficiency (PCC) at 36 months.

RESULTS

A total of 54% of the CP±L group and 77% of the noncleft group had CB. The noncleft group had a significantly higher prevalence of all consonant variables. Percentage of consonants correct was 61.9% in the CP±L group and 81.6% in the noncleft group. All early consonant variables except CB were significantly related to PCC. Hearing sensitivity at 18 and 30 months correlated with PCC and explained 40% of the variation.

CONCLUSIONS

Mild HL impacted presence of CB at 10 months and was related to consonant proficiency at 36 months in children with HL associated with OME and children with cleft palate. The noncleft group showed results at 36 months similar to children with normal hearing; however, the CP±L group did not. Although the cleft palate may have a bigger impact on the speech development, management of hearing sensitivity would also be beneficial.

Management of Velopharyngeal Insufficiency in Cleft Patients With and Without Multidisciplinary Team Care

OBJECTIVE

To evaluate the effect of an American Cleft Palate-Craniofacial Association (ACPA)-approved multidisciplinary team on velopharyngeal insufficiency (VPI) diagnosis and treatment.

DESIGN

Retrospective cohort setting; tertiary children's hospital patients; children with cleft palate repair identified through procedure codes.

MAIN OUTCOME MEASURES

Velopharyngeal insufficiency diagnosis was assigned based on surgeon or team assessment. Age at diagnosis and surgery was recorded. Difference in age and rate of VPI diagnosis and surgery was analyzed with t test. Multivariate linear and logistic regression adjusted for confounding variables.

RESULTS

Nine hundred forty patients were included with 71.5% cared for by an ACPA-approved multidisciplinary team. More (38.8% ) team care patients were found to have a diagnosis of VPI in comparison to 10% in independent care (P < .001). Team care was associated with an almost 6-fold increase in VPI diagnosis (P < .001). Team care was associated with a higher proportion of speech surgery (21% vs 10%, P < .001). Among children receiving team care, each visit was associated with 25% increased odds of being diagnosed with VPI (P < .001) and 20% increased odds of receiving speech surgery (P < .001). Age at VPI diagnosis and speech surgery were similar between groups (P = .55 and .29).

DISCUSSION

Team care was associated with more accurate detection of VPI, resulting in more VPI speech therapy visits and surgical management. A higher number of team visits were similarly associated.

CONCLUSION

Further studies of the clinical implication of timely and accurate VPI diagnosis, including quality of life assessments, are recommended to provide stronger guidance on team visit and evaluation planning.

Effects of a naturalistic intervention on the speech outcomes of young children with cleft palate

Purpose: The purpose of this study was to investigate the extent to which a naturalistic communication intervention, Enhanced Milieu Teaching with Phonological Emphasis (EMT + PE) improved the speech outcomes of toddlers with cleft palate with or without cleft lip (CP ± L)Method: This study was a stratified randomised controlled trial.Setting: Treatment was delivered in a university clinic by a trained speech-language pathologist.Thirty children aged between 15 and 36 months (M = 25) with nonsyndromic CP ± CL and typical cognitive development were randomly assigned to a treatment (EMT + PE) or business as usual comparison condition.Participants in the EMT + PE treatment group received 48, 30-min sessions, over a 6-month period. Fidelity of treatment was high across participants.The primary outcome measures were percent consonants correct (PCC), consonant inventory, compensatory articulation errors, and nasal emission.Result: Regression analyses controlling for pre-intervention child characteristics were conducted for PCC and consonant inventory. Intervention was not a significant predictor of post-intervention outcome. Words per minute differentiated the children who benefitted from the intervention from those who did not. Reduction in compensatory errors and nasal emission occurred in both groups but to a greater degree in the EMT + PE group.Conclusion: EMT + PE is a promising early speech intervention for young children with CP ± L, especially for children with higher rates of word use.

An Exploratory Study of Speech and Language Therapy Intervention for Children Born With Cleft Palate ± Lip

INTRODUCTION

Children born with a cleft palate ± lip are at risk of developing speech and language difficulties, which may require intervention from a speech and language therapist (SLT). To date, there is no strong evidence to support one approach to intervention over another, neither is it clear which approaches or methods of provision are commonly used.

OBJECTIVES

To describe the range of speech and language therapy interventions being used with children born with cleft palate in the United Kingdom up to 5 years of age. To explore the different ways, interventions are being delivered.

DESIGN

A prospective study to conduct 9 semi-structured focus groups. Iterative content analysis was completed.

SETTING

Regional Cleft Lip and Palate Centers in the United Kingdom.

PARTICIPANTS

Sixty-two speech and language therapy professionals from specialist cleft teams and community services.

RESULTS

Four main codes were identified: "intervention approaches," "service delivery models," "decision-making and rationale," and "patient-centered care." Participants frequently discussed how they adopt an eclectic style when delivering intervention, the importance of an individualized approach for each child and service delivery constraints, such as a lack of resources.

CONCLUSION

Insight into the multitude of intervention approaches used by SLTs, aspects which influence their decision-making and the variability of service delivery models were gained. Uncertainty regarding which intervention approaches and methods for delivery are most effective provides rationale for future research, to improve the effectiveness of speech and language intervention for children with cleft palate ± lip.

Crowdsourcing to Assess Speech Quality Associated With Velopharyngeal Dysfunction

OBJECTIVE

To assess crowdsourced responses in the evaluation of speech outcomes in children with velopharyngeal dysfunction (VPD).

DESIGN

Fifty deidentified speech samples were compiled. Multiple pairwise comparisons obtained by crowdsourcing were used to produce a rank order of speech quality. Ratings of overall and specific speech characteristics were also collected. Twelve speech-language pathologists (SLPs) who specialize in VPD were asked to complete the same tasks. Crowds and experts completed each task on 2 separate occasions at least 1 week apart.

SETTING

On-line crowdsourcing platform.

PARTICIPANTS

Crowdsource raters were anonymous and at least 18 years of age, North American English speakers with self-reported normal hearing. Speech-language pathologists were recruited from multiple cleft/craniofacial teams.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE(S)

Correlation of repeated assessments and comparison of crowd and SLP assessments.

RESULTS

We obtained 6331 lay person assessments that met inclusion criteria via crowdsourcing within 8 hours. The crowds provided reproducible Elo rankings of speech quality, ρ(48) = .89; P <.0001, and consistent ratings of intelligibility and acceptability (intraclass correlation coefficient [ICC] = .87 and .92) on repeated assessments. There was a significant correlation of those crowd rankings, ρ(10) = .86; P = .0003, and ratings (ICC = .75 and .79) with those of SLPs. The correlation of more specific speech characteristics by the crowds and SLPs was moderate to weak (ICC < 0.65).

CONCLUSIONS

Crowdsourcing shows promise as a rapid way to obtain large numbers of speech assessments. Reliability of repeated assessments was acceptable. Large groups of naive raters yield comparable evaluations of overall speech acceptability, intelligibility, and quality, but are not consistent with expert raters for specific speech characteristics such as resonance and nasal air emission.

Augmentative and Alternative Communication (AAC) Use Among Patients Followed by a Multidisciplinary Cleft and Craniofacial Team

OBJECTIVE

To establish preliminary data describing the number of patients who visit a multidisciplinary cleft and craniofacial team who use augmentative and alternative communication (AAC) supports.

DESIGN

This retrospective study consisted of chart reviews for all patients who visited a single site's multidisciplinary cleft and craniofacial team for 1 calendar year.

SETTING

A single multidisciplinary craniofacial team at a tertiary teaching hospital.

PARTICIPANTS

Four hundred sixty-four patients met the inclusion criteria for this study. Of these, 59.9% (n = 278) were male and 40.1% (n = 186) were female.

RESULTS

Of the sample population, 6.9% (n = 32) were AAC users as they received AAC intervention in a therapeutic context, while 93.1% (n = 432) were not. The AAC group had a mean age of 5.1 years (standard deviation [SD]: 4.2) and was 68.8% (n = 22) male. The non-AAC group had a mean age of 6.3 (SD: 4.9) and was 59.3% (n = 256) male. Within the AAC group, 40.6% (n = 13) were found to have an identified syndromic diagnosis in comparison to 17.6% (n = 76) of the non-AAC group (P = .003).

CONCLUSIONS

This is the first study to report the prevalence of AAC use among patients in the care of multidisciplinary cleft and craniofacial teams. Our findings suggest that a subset of craniofacial team patients may have complex communication disorders that require AAC supports. Craniofacial teams should be aware of resources available for these patients so that the patients' communication needs are met in the hospital, in school, and in the community.

Neural Indices of Vowel Discrimination in Monolingual and Bilingual Infants and Children

OBJECTIVES

To examine maturation of neural discriminative responses to an English vowel contrast from infancy to 4 years of age and to determine how biological factors (age and sex) and an experiential factor (amount of Spanish versus English input) modulate neural discrimination of speech.

DESIGN

Event-related potential (ERP) mismatch responses (MMRs) were used as indices of discrimination of the American English vowels [ε] versus [I] in infants and children between 3 months and 47 months of age. A total of 168 longitudinal and cross-sectional data sets were collected from 98 children (Bilingual Spanish-English: 47 male and 31 female sessions; Monolingual English: 48 male and 42 female sessions). Language exposure and other language measures were collected. ERP responses were examined in an early time window (160 to 360 msec, early MMR [eMMR]) and late time window (400 to 600 msec, late MMR).

RESULTS

The eMMR became more negative with increasing age. Language experience and sex also influenced the amplitude of the eMMR. Specifically, bilingual children, especially bilingual females, showed more negative eMMR compared with monolingual children and with males. However, the subset of bilingual children with more exposure to English than Spanish compared with those with more exposure to Spanish than English (as reported by caretakers) showed similar amplitude of the eMMR to their monolingual peers. Age was the only factor that influenced the amplitude of the late MMR. More negative late MMR was observed in older children with no difference found between bilingual and monolingual groups.

CONCLUSIONS

Consistent with previous studies, our findings revealed that biological factors (age and sex) and language experience modulated the amplitude of the eMMR in young children. The early negative MMR is likely to be the mismatch negativity found in older children and adults. In contrast, the late MMR amplitude was influenced only by age and may be equivalent to the Nc in infants and to the late negativity observed in some auditory passive oddball designs.

Musical Training for Auditory Rehabilitation in Hearing Loss

Despite the overall success of cochlear implantation, language outcomes remain suboptimal and subject to large inter-individual variability. Early auditory rehabilitation techniques have mostly focused on low-level sensory abilities. However, a new body of literature suggests that cognitive operations are critical for auditory perception remediation. We argue in this paper that musical training is a particularly appealing candidate for such therapies, as it involves highly relevant cognitive abilities, such as temporal predictions, hierarchical processing, and auditory-motor interactions. We review recent studies demonstrating that music can enhance both language perception and production at multiple levels, from syllable processing to turn-taking in natural conversation.

[Verification results of objective newborn hearing screening]

Sufficient hearing is the cornerstone of the development of children's complex sensory perception, sound recognition, speech development and optimal communication skills. Hearing screening of newborns is necessary to detect congenital hearing disorders. Compulsory objective hearing screening in Hungary is a significant improvement in early diagnosis. The Audiological Department of Otorhinolaryngology, Head and Neck Surgery Clinic at Semmelweis University serves as a verification center for children identified via the compulsory objective newborn hearing screening and necessitates more detailed assessment. The goal of this study was to summarize the verification results of the year 2018. Case history, ENT examination, electric response measurement, impedance tests, otoacoustic emission measurement, surdopedagogical examination, and genetic examination are the basics of the diagnosis and the therapy as well. Altogether 261 newborns were examined in 2018 and 164 were subjected to audiological tests during the analyzed seven-month period. Normal hearing was detected in both ears in 77% of the cases, while hearing loss has been verified in 37 patients (23% of cases). Permanent hearing loss has been diagnosed in 19 cases, 4 unilateral and 15 bilateral. Hearing loss of sensorineural origin was confirmed in 17, conductive in 2 children. Temporary hearing loss caused by otitis media with effusion was found in further 18 children which healed spontaneously in most cases. Organized neonatal objective hearing examination has been established in Hungary in 2015. As a result, we can diagnose and provide care for children with hearing loss at the earliest stage. The National Newborn Hearing Screening Registry ensures a well-coordinated and smooth process. Orv Hetil. 2019; 160(47): 1850-1855.

Speech development after cochlear implantation in infants with isolated large vestibular aqueduct syndrome

Background: Few studies on speech performance of children after cochlear implantation (CI) described isolated large vestibular aqueduct syndrome (LVAS). Objective: To investigate speech developmental trajectories of infants with LVAS after CI, and to compare with those who have structurally normal inner ears. Materials and methods: 1112 infants with congenital severe to profound hearing loss participated in this study. 150 infants in group A were diagnosed with LVAS, 962 infants in group B with structurally normal inner ear. The speech performance was assessed via the Meaningful Use of Speech Scale (MUSS). The evaluations were performed pre-implant, 1, 3, 6, 9, 12, 24, 36, 48 and 60 months after CI. Results: The mean scores of the MUSS improved over a 5-year period after implantation in both groups A and B. The LVAS group presented similar speech developmental trajectory to the non-LVAS group at each assessment interval, except pre-operation. There were significant differences in mean scores between vocalizing behavior and oral communication skills, clarification skills of infants in both two groups. Conclusions and significance: Speech performance of infants with LVAS developed rapidly after CI and was similar to infants with structurally normal inner ear. For infants with isolated LVAS, CI had a significant effect and should be recommended as a therapeutic option.

INVESTIGATING METRICAL CONTEXT EFFECTS ON ANTICIPATORY COARTICULATION IN CONNECTED SPEECH DEVELOPMENT

If rhythm acquisition is influenced by the development of articulatory timing, then metrical structure might be expected to condition this timing. This study tested this hypothesis by investigating anticipatory effects of an upcoming noun on the production of a preceding determiner, under the assumption that anticipatory coarticulation indexes chunking. Simple S-V-O sentences were elicited from 5-year-olds, 8-year-olds, and adults. The V was either monosyllabic packed or disyllabic patted. The O was a determiner phrase where nouns varied either in onset place-of-articulation (POA; tack vs. cat) or in their rhymes (tack vs. toot). Acoustic analyses of determiner schwa F1 and F2 showed no effect of verb on schwa coarticulation. Given other results, including an interaction between age group and POA, the findings suggest that the acquisition of articulatory timing is independent of metrical structure, even if this timing is related to speech rhythm acquisition.

Obligatory Nasal Turbulence as a Trigger for the Development of Posterior Nasal Fricatives in a Child With Repaired Cleft Palate

Posterior nasal fricatives (PNFs) are unusual articulations that occur in some children with and without cleft palate. The etiology of PNFs is unclear. A young girl with repaired cleft palate is described who exhibited inconsistent obligatory nasal turbulence during production of stops at 2 years of age. At 3 years of age, she exhibited various phonological processes and used PNFs to replace sibilants and affricates. Pressure-flow testing showed a relatively small velopharyngeal area during production of stops. These observations are consistent with obligatory nasal turbulence triggering the development of PNFs as an unusual phonological process, perhaps facilitated by reduced hearing.

Auditory-Motor Mapping Training in a More Verbal Child with Autism

We tested the effect of Auditory-Motor Mapping Training (AMMT), a novel, intonation-based treatment for spoken language originally developed for minimally verbal (MV) children with autism, on a more-verbal child with autism. We compared this child’s performance after 25 therapy sessions with that of: (1) a child matched on age, autism severity, and expressive language level who received 25 sessions of a non-intonation-based control treatment Speech Repetition Therapy (SRT); and (2) a matched pair of MV children (one of whom received AMMT; the other, SRT). We found a significant Time × Treatment effect in favor of AMMT for number of Syllables Correct and Consonants Correct per stimulus for both pairs of children, as well as a significant Time × Treatment effect in favor of AMMT for number of Vowels Correct per stimulus for the more-verbal pair. Magnitudes of the difference in post-treatment performance between AMMT and SRT, adjusted for Baseline differences, were: (a) larger for the more-verbal pair than for the MV pair; and (b) associated with very large effect sizes (Cohen’s d > 1.3) in the more-verbal pair. Results hold promise for the efficacy of AMMT for improving spoken language production in more-verbal children with autism as well as their MV peers and suggest hypotheses about brain function that are testable in both correlational and causal behavioral-imaging studies.