A follow-up study of children with phonologic disorders of unknown origin

Educational outcomes associated with persistent speech disorder

BACKGROUND

Children with persistent speech disorder (PSD) are at higher risk of difficulties with literacy, with some evidence suggesting an association with poorer educational attainment. However, studies to date have either used small clinical samples, which exclude children who have not been referred to clinical services, or relied on parent-teacher report of children's speech development. There is a need for an inclusive study to investigate the impact of PSD on educational outcomes using a population-based sample and robust measures of speech development.

AIM

Using a large prospective UK population-based study-the Avon Longitudinal Study of Parents and Children (ALSPAC)-this study investigated: (1) how children identified with PSD at age 8 years perform on educational attainment tests at ages 10-11 and 13-14 years in comparison with children without PSD; and (2) whether children identified with PSD at age 8 years are more likely to receive a label of special educational needs (SEN) in secondary school.

METHODS & PROCEDURES

We examined the data for 263 children with PSD and 6399 controls who had speech assessed at age 8 years in a research clinic. Educational attainment was measured using data from English school standard attainment tests. Data on SEN categorization were obtained between 11 and 13 years of age. Children with PSD and controls were compared using regression analyses adjusted for biological sex, maternal age, verbal, performance and full-scale IQ.

OUTCOMES & RESULTS

Children with PSD at age 8 years were more likely to achieve lower attainment scores at ages 10-11 years in English and mathematics and across all three subjects of English, mathematics and science at ages 13-14 years after controlling for biological sex and maternal education; score below target levels for English at both time points after controlling for verbal IQ, and at ages 13-14 years after controlling for performance IQ; and receive a label of SEN (typically for the category of cognition and learning needs or communication and interaction needs) in secondary school.

CONCLUSIONS & IMPLICATIONS

PSD identified at age 8 years is associated with poor educational attainment at ages 10-11 and 13-14 years in the core subjects of English, mathematics and science. Children with PSD at age 8 years are more likely to be identified with SEN at ages 11-13 years, particularly cognition and learning needs, and communication and interaction needs. We need to be aware of the potential for the long-term impact of PSD on educational attainment in providing appropriate and effective support throughout school. What this paper adds What is already known on the subject Speech-sound disorder is associated with reading and spelling difficulties, with some evidence to suggest that PSD is associated with a higher risk of literacy difficulties. Limited evidence also suggests that speech-sound disorder may be associated with poorer educational attainment. However, studies to date have used small clinical samples or parent-teacher report of speech development and there is a need to determine whether the association is observed in larger and more inclusive population-based samples. What this paper adds to existing knowledge This prospective, longitudinal study of a large community-based sample of English children has shown that PSD is associated with poorer educational attainment at the end of primary school and at ages 13-14 years. Children with PSD are also more likely to be identified as having SEN in secondary school, especially communication and interaction needs but also including cognition and learning needs. What are the potential or actual clinical implications of this work? Understanding the long-term implications of PSD on educational attainment highlights the importance of ongoing monitoring and support to enable children to reach their potential throughout primary and secondary school. The identification of children with a history of PSD during transition to secondary school will enable effective support to be put in place. The intervention for children with PSD should involve close collaboration between speech and language therapists and education professionals.

Home and Clinical Literacy Practices for Children With Cleft Lip and Palate

Objective:

The purpose of this study was to examine experiences and practices related to supporting literacy development and preventing reading difficulties in children with cleft lip and/or palate (CL/P).

Methods:

Via online surveys, 67 respondents including 35 parents/guardians of children with CL/P and 32 speech-language pathologists (SLPs) answered questions about home literacy practices, clinical practices, and perceptions of SLPs’ role in literacy.

Results:

The variability in responses highlights both the positive contributions of parents/guardians and SLPs in supporting literacy development and preventing reading disabilities in children with cleft and the need for increased education and efforts to meet their literacy needs.

Acquisition, retention, and generalization of rhotics with and without ultrasound visual feedback

PURPOSE

The purpose was to provide a preliminary within-participant comparison of speech therapy with and without exposure to ultrasound visual feedback for postvocalic rhotics (/r/- colored vowels). Effects of the two treatments on acquisition, retention, and generalization were explored. It was hypothesized that treatment with ultrasound would facilitate acquisition but hinder retention and generalization.

METHODS

A single subject randomized block design was replicated across four American English-speaking participants ages 7-9 years. Each participant was trained on postvocalic /r/. Each week for seven weeks, one session with ultrasound visual feedback and one session with no ultrasound were randomly ordered. A Training Probe and Generalization Probe were used to measure acquisition within each session as well as retention and generalization between two consecutive sessions. Graphical displays of the data, effect size calculation, and statistical results from a randomization test were used to analyze the results.

RESULTS

Two participants showed essentially no evidence of acquisition, retention or generalization of rhotics (<5%). Of the two who showed evidence of acquisition, one participant showed a significant advantage and large effect size for ultrasound sessions over no ultrasound sessions in acquisition of rhotics. However, no participants showed differences between treatment conditions in generalization or retention of rhotics.

CONCLUSION

For some children, acquisition may be facilitated by ultrasound visual feedback. Ultrasound visual feedback neither inhibited nor facilitated retention or generalization of rhotics. As a whole, the 14 treatment sessions (7 with ultrasound and 7 without) were effective for 2 of the 4 participants when comparing pre/post generalization scores. Future studies should evaluate the effectiveness of ultrasound visual feedback given a larger dose and differing age groups.

Patterns Of Development in Late Talkers: Preschool Years

A group of children was identified as “late talkers” (LT) on the basis of small expressive vocabulary size at 20–34 months of age and matched to a group of normally speaking age-mates. The subjects were followed yearly throughout the preschool period in order to track growth in language and related skills. Results showed that although significant improvement in speech and language skill occurred during the preschool period in the late talkers, a substantial minority of children retained deficits throughout the preschool years. By kindergarten age, these children, as a group, scored within, but at the low end of the normal range in terms of reading readiness. Data suggest that the longer a language delay persists into the third year of life, the less the chance of spontaneous recovery during the preschool period. Late talking girls seem to have less chance for spontaneous recovery than do late talking boys. The implications of these findings for making early intervention decisions will be discussed.

Speech impairment and literacy difficulties: Underlying links

Despite clinical observation of the problems in emergent literacy experienced by unintelligible children, there are conflicting data about the possible relationship of expressive speech problems to literacy acquisition. Several confounding factors may explain the inconsistency in results across studies. Potential confounds include specificity and severity of speech impairment, age of participants, and pattern of speech errors. It was hypothesised that the presence of nondevelopmental speech errors can be considered a symptom of a breakdown at the level of processing phonological information that has an impact on both speech and literacy development. A cohort of 21 specifically speech-impaired children entering Year 1 at school was selected and classified into subgroups based on pattern of speech errors. Phonological awareness measures were administered early in Year 1 and literacy measures in Year 3. The results confirmed thot the presence of nondevelopmental speech errors predicted poorer phonological awareness skills and weaker literacy outcomes, particularly spelling.

IEP goals for school-age children with speech sound disorders

PURPOSE

The purpose of the current study was to describe the current state of practice for writing Individualized Education Program (IEP) goals for children with speech sound disorders (SSDs).

METHOD

IEP goals for 146 children receiving services for SSDs within public school systems across two states were coded for their dominant theoretical framework and overall quality. A dichotomous scheme was used for theoretical framework coding: cognitive-linguistic or sensory-motor. Goal quality was determined by examining 7 specific indicators outlined by an empirically tested rating tool. In total, 147 long-term and 490 short-term goals were coded.

RESULTS

The results revealed no dominant theoretical framework for long-term goals, whereas short-term goals largely reflected a sensory-motor framework. In terms of quality, the majority of speech production goals were functional and generalizable in nature, but were not able to be easily targeted during common daily tasks or by other members of the IEP team. Short-term goals were consistently rated higher in quality domains when compared to long-term goals.

CONCLUSIONS

The current state of practice for writing IEP goals for children with SSDs indicates that theoretical framework may be eclectic in nature and likely written to support the individual needs of children with speech sound disorders. Further investigation is warranted to determine the relations between goal quality and child outcomes.

LEARNING OUTCOMES

(1) Identify two predominant theoretical frameworks and discuss how they apply to IEP goal writing. (2) Discuss quality indicators as they relate to IEP goals for children with speech sound disorders. (3) Discuss the relationship between long-term goals level of quality and related theoretical frameworks. (4) Identify the areas in which business-as-usual IEP goals exhibit strong quality.

A nationally representative study of the association between communication impairment at 4-5 years and children's life activities at 7-9 years

PURPOSE

To examine the longitudinal association between communication impairment (primary or secondary diagnosis) and children's Activities and Participation (International Classification of Functioning, Disability and Health--Children and Youth [ICF-CY]; World Health Organization [WHO], 2007).

METHOD

Participants were 4,329 children in the Longitudinal Study of Australian Children (LSAC; Australian Institute of Family Studies [AIFS], 2009): 1,041 (24.0%) of these children were identified with communication impairment at 4-5 years of age, and 3,288 (76.0%) of these children were not identified with a communication impairment. At age 7-9 years, Activities and Participation (WHO, 2007) outcomes across 5 ICF-CY domains were provided by (a) teachers (Academic Rating Scales [National Center for Education Statistics (NCES), 2002], Approach to Learning Scale [Gresham & Elliott, 1990], School Progress Scale (AIFS, 2009), Strengths and Difficulties Questionnaire [SDQ; Goodman, 1997], and Student-Teacher Relationship Scale [Pianta, 2001]); (b) parents (School-Age Inventory of Temperament [McClowry, 1995] and SDQ); (c) children (Marsh Self-Description Questionnaire-III [Marsh, 1992], School Liking [Ladd & Price, 1987], and Bullying [Kochenderfer & Ladd, 1997]); and (d) child assessment (Peabody Picture Vocabulary Test--III: Adapted; Rothman, 2003).

RESULTS

Children identified with communication impairment at age 4-5 years performed significantly poorer at age 7-9 years on all outcomes. Parents and teachers reported slower progression in reading, writing, and overall school achievement than peers. Children reported more bullying, poorer peer relationships, and less enjoyment of school than did their peers. Analyses of covariance tests confirmed significant associations between communication impairment and outcomes, over and above the effects of sex, age, Indigenous status, and socioeconomic status.

CONCLUSION

Consideration of the breadth and longevity of Activities and Participation outcomes reveals the potential extent and severity of communication impairment and directs future research and practice.

Subtyping Children With Speech Sound Disorders by Endophenotypes

PURPOSE: The present study examined associations of 5 endophenotypes (i.e., measurable skills that are closely associated with speech sound disorders and are useful in detecting genetic influences on speech sound production), oral motor skills, phonological memory, phonological awareness, vocabulary, and speeded naming, with 3 clinical criteria for classifying speech sound disorders: severity of speech sound disorders, our previously reported clinical subtypes (speech sound disorders alone, speech sound disorders with language impairment, and childhood apraxia of speech), and the comorbid condition of reading disorders. PARTICIPANTS AND METHOD: Children with speech sound disorders and their siblings were assessed at early childhood (ages 4-7 years) on measures of the 5 endophenotypes. Severity of speech sound disorders was determined using the z score for Percent Consonants Correct-Revised (developed by Shriberg, Austin, Lewis, McSweeny, & Wilson, 1997). Analyses of variance were employed to determine how these endophenotypes differed among the clinical subtypes of speech sound disorders. RESULTS AND CONCLUSIONS: Phonological memory was related to all 3 clinical classifications of speech sound disorders. Our previous subtypes of speech sound disorders and comorbid conditions of language impairment and reading disorder were associated with phonological awareness, while severity of speech sound disorders was weakly associated with this endophenotype. Vocabulary was associated with mild versus moderate speech sound disorders, as well as comorbid conditions of language impairment and reading disorder. These 3 endophenotypes proved useful in differentiating subtypes of speech sound disorders and in validating current clinical classifications of speech sound disorders.

Speech-language characteristics of children with neurofibromatosis type 1

Delays in speech and articulation development have been found in school-aged children and adolescents with neurofibromatosis type 1 (NF1). This report examines speech and language skills of preschool children with NF1. Nineteen 3- to 5-year-old children diagnosed with NF1 were assessed using measures of articulation (GFTA-2), and receptive and expressive language (CELF-P2). Significant differences were observed between mean scores obtained by the group of children with NF1 compared to the validated controls from the speech and language instruments (P < or = 0.009). Sixty-eight percent of the children exhibited delays in speech and/or language. Thirty-two percent demonstrated delays in articulation, 37% percent demonstrated delays in receptive language, and 37% exhibited delays in expressive language. Sixteen percent of the children exhibited a voice disorder and 42% were judged to have a resonance problem. No significant differences were observed on any of the measures of speech and language for children with non-familial versus familial NF1. Results of this study support the need for early assessment of speech and language problems for children diagnosed with NF1 and implementation of appropriate timely intervention as needed.

What influences literacy outcome in children with speech sound disorder?

PURPOSE

In this study, the authors evaluated literacy outcome in children with histories of speech sound disorder (SSD) who were characterized along 2 dimensions: broader language function and persistence of SSD. In previous studies, authors have demonstrated that each dimension relates to literacy but have not disentangled their effects. Methods Two groups of children (86 SSD and 37 controls) were recruited at ages 5-6 and were followed longitudinally. The authors report the literacy of children with SSD at ages 7-9, compared with controls and national norms, and relative to language skill and SSD persistence (both measured at age 5-6).

RESULTS

The SSD group demonstrated elevated rates of reading disability. Language skill but not SSD persistence predicted later literacy. However, SSD persistence was associated with phonological awareness impairments. Phonological awareness alone predicted literacy outcome less well than a model that also included syntax and nonverbal IQ.

CONCLUSIONS

Results support previous literature findings that SSD history predicts literacy difficulties and that the association is strongest for SSD + language impairment (LI). Magnitude of phonological impairment alone did not determine literacy outcome, as predicted by the core phonological deficit hypothesis. Instead, consistent with a multiple deficit approach, phonological deficits appeared to interact with other cognitive factors in literacy development.

Evaluation of Visual Motor Perception in Children with Developmental Articulation and Phonological Disorders

The aim of this study is to compare the visual-motor perceptual skills of children who have a developmental articulation and phonological disorder, with children who do not have such disorders. A group of 21 children between the ages 5:6 and 9:1 yr. (13 boys, 8 girls) was compared to a control group of 21 children matched on sex, age, and socioeconomic level using the Bender Visual-Motor Gestalt Test. Children with disorders had significantly more Bender errors.

The genetic bases of speech sound disorders: evidence from spoken and written language

The purpose of this article is to review recent findings suggesting a genetic susceptibility for speech sound disorders (SSD), the most prevalent communication disorder in early childhood. The importance of genetic studies of SSD and the hypothetical underpinnings of these genetic findings are reviewed, as well as genetic associations of SSD with other language and reading disabilities. The authors propose that many genes contribute to SSD. They further hypothesize that some genes contribute to SSD disorders alone, whereas other genes influence both SSD and other written and spoken language disorders. The authors postulate that underlying common cognitive traits, or endophenotypes, are responsible for shared genetic influences of spoken and written language. They review findings from their genetic linkage study and from the literature to illustrate recent developments in this area. Finally, they discuss challenges for identifying genetic influence on SSD and propose a conceptual framework for study of the genetic basis of SSD.

The Age at Which Young Deaf Children Receive Cochlear Implants and Their Vocabulary and Speech-Production Growth: Is There an Added Value for Early Implantation?

OBJECTIVE

The age at which a child receives a cochlear implant seems to be one of the more important predictors of his or her speech and language outcomes. However, understanding the association between age at implantation and child outcomes is complex because a child's age, length of device use, and age at implantation are highly related. In this study, we investigate whether there is an added value to earlier implantation or whether advantages observed in child outcomes are primarily attributable to longer device use at any given age.

DESIGN

Using hierarchical linear modeling, we examined latent-growth curves for 100 children who had received their implants when they were between 1 and 10 yr of age, had used oral communication, and had used their devices for between 1 and 12 yr. Children were divided into four groups based on age at implantation: between 1 and 2.5 yr, between 2.6 and 3.5 yr, between 3.6 and 7 yr, and between 7.1 and 10 yr.

RESULTS

Investigation of growth curves and rates of growth over time revealed an additional value for earlier implantation over and above advantages attributable to longer length of use at any given age. Children who had received their implants before the age of 2.5 yr had exhibited early bursts of growth in consonant-production accuracy and vocabulary and also had significantly stronger outcomes compared with age peers who had received their implants at later ages. The magnitude of the early burst diminished systematically with increasing age at implantation and was not observed for children who were older than 7 yr at implantation for consonant-production accuracy or for children who were over 3.5 yr old at implantation for vocabulary. The impact of age at implantation on children's growth curves differed for speech production and vocabulary.

CONCLUSIONS

There seems to be a substantial benefit for both speech and vocabulary outcomes when children receive their implant before the age of 2.5 yr. This benefit may combine a burst of growth after implantation with the impact of increased length of use at any given age. The added advantage (i.e., burst of growth) diminishes systematically with increasing age at implantation.

Speech perception and short-term memory deficits in persistent developmental speech disorder

Children with developmental speech disorders may have additional deficits in speech perception and/or short-term memory. To determine whether these are only transient developmental delays that can accompany the disorder in childhood or persist as part of the speech disorder, adults with a persistent familial speech disorder were tested on speech perception and short-term memory. Nine adults with a persistent familial developmental speech disorder without language impairment were compared with 20 controls on tasks requiring the discrimination of fine acoustic cues for word identification and on measures of verbal and nonverbal short-term memory. Significant group differences were found in the slopes of the discrimination curves for first formant transitions for word identification with stop gaps of 40 and 20 ms with effect sizes of 1.60 and 1.56. Significant group differences also occurred on tests of nonverbal rhythm and tonal memory, and verbal short-term memory with effect sizes of 2.38, 1.56, and 1.73. No group differences occurred in the use of stop gap durations for word identification. Because frequency-based speech perception and short-term verbal and nonverbal memory deficits both persisted into adulthood in the speech-impaired adults, these deficits may be involved in the persistence of speech disorders without language impairment.

Assessment of information processing in children with functional articulation disorders

OBJECTIVE

The aim of this study was to investigate the information processing skills in children who have functional articulation disorder by using a cognitive-linguistic test battery.

MATERIAL-METHODS

Thirty-three children with functional articulation disorder were enrolled in this study. They ranged in age from 6 to 10 years. A control group without articulation disorders was composed of 160 children with similar properties. In the first stage of this study, both groups were administered the Ross Information Processing Assessment Test-Primary. In this test, the scores obtained from eight subtests; namely immediate memory, recent memory, recall of general information, spatial orientation, temporal orientation, organization, problem solving and abstract reasoning, was calculated for both groups. The scores of the eight subtests are combined to form the four composites. These composites are memory quotient, orientation quotient, thinking and reasoning quotient and information processing quotient. Information processing quotient is the best and the most comprehensive estimate of a child's overall information processing ability. In the second stage of the study the articulation-disordered group was divided into two subgroups according the number of the mistakes, which was done at the level of the phoneme. The scores obtained from both subgroups were compared with the scores of the control group.

RESULTS

The overall statistical analysis of the scores revealed that; the study group had significantly lower scores than the control group from memory quotient, thinking and reasoning quotient and information processing quotient. When compared to control group, the subgroup who cannot pronounce one phoneme had similar scores from all four composites. Moreover, the children who cannot pronounce multiple phonemes had significantly lower scores from memory quotient, thinking and reasoning quotient and information processing quotient. The results obtained from this study seem to be suggesting that information processing skills of children with functional articulation disorder are significantly low as compared to normal children.

CONCLUSIONS

These results are revealing that the information processing skills of children with functional articulation disorder should be investigated in a detailed manner. According to the results obtained from this investigation these children should be put on deficit oriented education programs in addition to articulation therapy.

Pleiotropic effects of a chromosome 3 locus on speech-sound disorder and reading

Speech-sound disorder (SSD) is a complex behavioral disorder characterized by speech-sound production errors associated with deficits in articulation, phonological processes, and cognitive linguistic processes. SSD is prevalent in childhood and is comorbid with disorders of language, spelling, and reading disability, or dyslexia. Previous research suggests that developmental problems in domains associated with speech and language acquisition place a child at risk for dyslexia. Recent genetic studies have identified several candidate regions for dyslexia, including one on chromosome 3 segregating in a large Finnish pedigree. To explore common genetic influences on SSD and reading, we examined linkage for several quantitative traits to markers in the pericentrometric region of chromosome 3 in 77 families ascertained through a child with SSD. The quantitative scores measured several processes underlying speech-sound production, including phonological memory, phonological representation, articulation, receptive and expressive vocabulary, and reading decoding and comprehension skills. Model-free linkage analysis was followed by identification of sib pairs with linkage and construction of core shared haplotypes. In our multipoint analyses, measures of phonological memory demonstrated the strongest linkage (marker D3S2465, P=5.6 x 10(-5), and marker D3S3716, P=6.8 x 10(-4)). Tests for single-word decoding also demonstrated linkage (real word reading: marker D3S2465, P=.004; nonsense word reading: marker D3S1595, P=.005). The minimum shared haplotype in sib pairs with similar trait values spans 4.9 cM and is bounded by markers D3S3049 and D3S3045. Our results suggest that domains common to SSD and dyslexia are pleiotropically influenced by a putative quantitative trait locus on chromosome 3.

Use of cloze and contrast word procedures in repeated storybook reading: targeting multiple domains

The purposes of this study were: (1) to implement an intervention approach for children with language and phonological impairments, targeting multiple linguistic domains within a unitary activity, and (2) to investigate whether any observed changes in selected outcome measures were associated with particular scaffolding procedures. The intervention approach employed a variety of scaffolding procedures (cloze procedures; cloze procedures with expansions; contrast words) within an interactive repeated storybook reading activity. It was delivered across 12 sessions to three kindergarten children with language and phonological impairments. Pre-treatment and post-treatment probes, together with treatment data, provided indices of the semantic and phonological complexity of the participants' utterances. Changes in complexity levels were observed in all participants. Associations between increases in outcome measures and use of particular scaffolding techniques were identified.

LEARNING OUTCOMES

(1) The reader will learn a rationale for use of cloze procedures, cloze procedures with expansions, and contrast words during repeated storybook reading as an intervention for some children with both language and phonological disorders. (2) The reader will learn how to implement cloze procedures, cloze procedures with expansions, and contrast words during repeated storybook reading. (3) The reader will learn how various outcome measures (e.g., level of semantic complexity) may be used to track change in performance over time.

Predictors of phonological change following intervention

To date, predictor variables strongly associated with phonological change as a result of intervention have not been identified. The purpose of this study was to determine the best predictor or combination of predictors of change in percentage of consonants correct (PCC; L. D. Shriberg and J. Kwiatkowski, 1982) as a result of speech-language intervention for a group of 20 participants and to replicate this procedure with a second group of 20. Participants were preschool children, ages 3;0 (years;months) to 5;11, with impairments in phonology and morphosyntax who received intervention focused on both phonology and morphosyntax in different goal attack configurations. The relationship of predictor variables chronological age, inventory size, error consistency, and expressive language to the criterion variable, change in PCC, was investigated. In both the initial study and the replication, the mean change in PCC following a 24-week intervention period was 13.1%. In the initial study, error consistency and a finite morpheme composite (FMC; L. M. Bedore and L. B. Leonard, 1998) accounted for 52% of the variance for the criterion variable. Error consistency at the first step in the regression accounted for 31.6% of the variance. In the replication, error consistency was the only variable related to PCC change, again accounting for 31% of the variance. Further research examining overall error consistency is warranted.

Speech, vocabulary, and the education of children using cochlear implants: oral or total communication?

This study examines the relationship between the teaching method, oral or total communication, used at children's schools and children's consonant-production accuracy and vocabulary development over time. Children who participated in the study (N = 147) demonstrated profound sensorineural hearing loss and had used cochlear implants for between 6 months and 10 years. Educational programs that used an oral communication (OC) approach focused on the development of spoken language, whereas educational programs that used a total communication (TC) approach focused on the development of language using both signed and spoken language. Using Hierarchical Linear Modeling (HLM) we compared the consonant-production accuracy, receptive spoken vocabulary, and expressive spoken and/or signed vocabulary skills, over time, of children who were enrolled in schools that used either OC or TC approaches, while controlling for a number of variables. These variables included age at implantation, preoperative aided speech detection thresholds, type of cochlear implant device used, and whether a complete or incomplete active electrode array was implanted. The results of this study indicated that as they used their implants the children demonstrated improved consonant-production accuracy and expressive and receptive vocabulary over time, regardless of whether their school employed a TC or OC teaching method. Furthermore, there appeared to be a complex relationship among children's performance with the cochlear implant, age at implantation, and communication/teaching strategy employed by the school. Controlling for all variables, children in OC programs demonstrated, on average, superior consonant-production accuracy, with significantly greater rates of improvement in consonant-production accuracy scores over time compared to children in TC programs. However, there was no significant difference between OC and TC groups in performance or rate of growth in consonant-production accuracy when children received their implants before the age of 5 years. There was no significant difference between the OC and TC groups in receptive spoken vocabulary scores or in rate of improvement over time. However, children in the TC group achieved significantly higher receptive spoken vocabulary scores than children in the OC group if they received their implant before the age of 5 years. The TC group demonstrated superior scores and rates of growth on the expressive vocabulary measure (spoken and/or signed) when compared to the OC group if they received their implants during their preschool or early elementary school years. There was no significant difference if the children received their implants during middle elementary school. Regardless of whether children were in the OC or TC group, children who received their implants during preschool demonstrated stronger performance, on average, on all measures over time than children who received their implants during their elementary school years. The results of this study suggest that children may benefit from using cochlear implants regardless of the communication strategy/teaching approach employed by their school program and that other considerations, such as the age at which children receive implants, are more important. Implications and future research needs are discussed.

Academic outcomes in children with histories of speech sound disorders

Tests of phonology, semantics, and syntax were administered to 52 preschool children (19 girls and 33 boys, age 4-6 years) with moderate to severe speech sound disorders. The children's performance on these tests was used to predict language, reading, and spelling abilities at school age (age 8-11 years). Language impairment at school age was related to poor performance on preschool tests of syntax and nonsense word repetition, while reading impairment was predicted by poor performance in all preschool test domains (phonology, semantics, and syntax). In contrast, spelling impairment was predicted by deficits in preschool tests of phonological processing as measured by the Word Discrimination subtest of the Test of Language Development - Primary 2. Family history for speech and language disorders did not predict language, reading, or spelling impairment at school age. However, family history for reading disorders was a good predictor of school-age spelling difficulties.

Fourteen-year follow-up of children with and without speech/language impairments: speech/language stability and outcomes

This report concerns the speech and language outcomes of young adults (N = 242) who participated in a 14-year, prospective, longitudinal study of a community sample of children with (n = 114) and without (n = 128) speech and/or language impairments. Participants were initially identified at age 5 and subsequently followed at ages 12 and 19. Direct assessments were conducted in multiple domains (communicative, cognitive, academic, behavioral, and psychiatric) at all three time periods. Major findings included (a) high rates of continued communication difficulties in those with a history of impairment; (b) considerable stability in language performance over time; (c) better long-term outcomes for those with initial speech impairments than for those with language impairments; and (d) more favorable prognoses for those with specific language impairments than for those with impairments secondary to sensory, structural, neurological, or cognitive deficits. These general conclusions held when either a liberal or a more stringent criterion for language impairment was employed. Some of these findings are consistent with those from earlier follow-up studies, which used less optimal methods. Thus, the present replication and extension of these findings with a sound methodology enables greater confidence in their use for prognostic, planning, and research purposes.

Undifferentiated lingual gestures in children with articulation/phonological disorders

Previous research using electropalatography (EPG) has shown that a distinctive articulatory characteristic of lingual consonants in the speech of school-age children with articulation/phonological disorders (APD) is a high amount of tongue-palate contact. Consonants produced in this way have been referred to as undifferentiated lingual gestures. This article reviews the EPG literature on undifferentiated gestures with 4 overarching goals: (a) to provide a precise articulatory description of undifferentiated gestures, (b) to estimate the rate of occurrence of undifferentiated gestures in children with APD, (c) to propose an original.interpretation of undifferentiated gestures, and (d) to discuss the significance of the gestures in the light of current theories of APD. Undifferentiated gestures typically occur during productions of lingual consonant targets and are characterized by contact that lacks clear differentiation between the tongue apex, tongue body, and lateral margins of the tongue. The EPG literature reports 17 school-age children with APD, of whom 12 (71%) show evidence of undifferentiated gestures. Standard transcriptions do not reliably detect undifferentiated gestures, which are transcribed as speech errors (e.g., phonological substitutions, phonetic distortions) in some contexts, but are transcribed as correct productions in other contexts. Undifferentiated gestures are interpreted as reflecting a speech motor constraint involving either delayed or deviant control of functionally independent regions of the tongue. The limitations of the current EPG literature are stated, and the need for research into undifferentiated gestures in preschool children is discussed.

Speech-Language Hearing Interventions in the Schools

Prevalence of studies of speech, language, and hearing disorders do not yet adequately define the frequency of specific communication disorders in children. Such data are needed to provide a strong rationale for funding of research on the effectiveness of our interventions. Establishing the effectiveness of our treatments is critical to continued support of our services. This article emphasizes the importance of collecting prevalence data and of measuring both the short-term and long-term impact of our interventions in the schools.

Treatment efficacy: functional phonological disorders in children

This report addresses the efficacy of treatment for functional phonological disorders in children. The definition of phonological disorders and their incidence and prevalence are first presented. The impact of this disorder on the lives of children and the role that speech-language pathologists play in treating this disorder are then discussed. Evidence of the positive outcome of phonological treatment is reviewed, with particular emphasis on treatment procedures that have been deemed effective, the specific effects of these treatments on improving intelligibility, and comparisons between treatments in facilitating improved sound production.

The Relationship Between Multiple Birth Children’s Early Phonological Skills and Later Literacy

Previous studies have shown that multiple birth children (MBC) are prone to early phonological difficulties and later literacy problems. However, to date, there has been no systematic long-term follow-up of MBC with phonological difficulties in the preschool years to determine whether these difficulties predict later literacy problems. In this study, 20 MBC whose early speech and language skills had been previously documented were compared to normative data and 20 singleton controls on tasks assessing phonological processing and literacy. The major findings indicated that MBC performed significantly more poorly on some tasks of phonological processing than singleton controls did. Further, the early phonological skills of MBC (i.e., the number of inappropriate phonological processes used) were correlated with poor performance on visual rhyme recognition, word repetition, and phoneme detection tasks 5 years later. There was no significant relationship between early biological factors (birth weight and gestation period) and performance on the phonological processing and literacy-related subtests. These results support the hypothesis that MBC’s early speech and language difficulties are not merely a transient phase of development, but a real disorder, with consequences for later academic achievement.

Temperament in late talkers

This study examines the temperamental characteristics of children who were identified at age two as being slow in expressive language development, and those of peers with normal language history. When the children were in first grade (approximately age six), parents and clinicians rated subjects' temperamental characteristics, using a standardized temperament assessment instrument. Subjects with a history of slow expressive language development were rated significantly lower on Approach/Withdrawal--indicating shyness, aloofness, or reduced outgoingness--than peers with normal language history. Approach/Withdrawal scores were significantly correlated with average sentence length in spontaneous speech, and this measure also predicted Approach/Withdrawal scores in regression analyses. The clinical and theoretical implications of these findings for early language delay are discussed.

Reading and metaphonological outcomes in late talkers

Children with a history of slow expressive language development (SELD) were followed to second grade, at which point outcomes in terms of speech, language, cognitive skills, reading achievement, and metaphonological performance were evaluated. Although there were some statistically significant differences between groups, children with a history of SELD generally performed within the normal range on the measures collected. Relations among speech, reading, and metaphonology in the SELD cohort appeared to operate in a manner similar to that seen in groups with typical language development. The implications of these findings for understanding the nature of specific language impairments and for treating early circumscribed language delays are discussed.

Subgrouping children with familial phonologic disorders

Familial aggregation of speech and language disorders was examined as a basis of subgrouping children with phonologic disorders. Fifty-nine children with phonologic disorders were subgrouped according to whether or not other nuclear family members reported a history of speech/language disorders. Thirty-four subjects (58%) reported at least one other nuclear family member affected and 25 subjects (42%) reported no other nuclear family members affected. Groups were compared on measures of articulation, phonology, language, and oral motor skills to determine if the familial phonologic subgroup presented a unique profile of speech and language deficits. Significant group differences were not observed. However, children with positive nuclear family histories tended to perform more poorly than children without histories on all tasks, although not reaching significance. Although all parents were considered to have achieved normal adult articulation, parents of children with positive family histories also tended to perform more poorly than parents of children with negative histories. Results suggested that poorer oral motor coordination and productive phonology may distinguish individuals with familial phonologic disorders from individuals with phonologic disorders of unknown origin.

Phonologic impairment and prereading: update on a longitudinal study

This study examined the effects of overt phonologic impairment (disordered speech) on phonological awareness, verbal working memory, and letter knowledge. Forty-five children--29 with moderate to severe productive phonologic impairment at the inception of the project and 16 without impairment--were followed from mean age 3-6 to age 6-0. Fifteen participants with impairment were matched on gender and mental age to 15 without impairment for certain aspects of the analysis. The children with phonologic impairment performed significantly worse than their controls on tasks of verbal working memory, phoneme segmentation, and letter identification. In addition, a path analysis revealed working memory to be a potentially important mediating variable. The investigators also measured productive syntax, which, although associated with productive phonology and working memory, was not associated with letter identification.

Expanding Language Norms for School-Age Children and Adolescents

Despite decades of research, we currently have only limited norms of pragmatic development and use. These generally consist of skills that are aspects of pragmatic functioning, but in themselves do not capture the pragmatic difficulties exhibited by children in classroom, home, and social environments. A discussion of some of the problems associated with deriving pragmatic norms is presented, along with some of the current insights we have concerning the pragmatic abilities of older children and adolescents. These diverse findings are organized into a single coherent model for analyzing and comparing pragmatic performance across tasks. Implications for further research also are presented.

Familial aggregation of phonological disorders: results from a 28-year follow-up

This investigation is a follow-up to a longitudinal speech and educational outcome study involving approximately 400 normally developing children that was initiated in 1960. From this database, two groups of subjects (now aged 32-34), their spouses, and all of their offspring over the age of 3:0 (years:months) completed a battery of cognitive-linguistic and interview measures. One group (probands) consisted of 24 adults with a documented history of a moderate phonological-language disorder that persisted through at least the end of the first grade. The other group (controls) consisted of 28 adults who were known to have had normal articulation abilities as children. Results of this study demonstrated that, in comparison to the children of controls, the children of the proband subjects performed significantly more poorly on all tests of articulation and expressive language functioning and were significantly more likely to have received articulation treatment. There was, however, no evidence that specific misarticulations or phonological processes traveled within proband families. These results are in agreement with those of most previous family studies that have demonstrated an increased rate of occurrence of speech-language disorders of unknown origin in families including a first-degree relative who is similarly affected.

Durational analysis of stridency errors in children with phonological impairment

This study investigated children's knowledge, evidenced acoustically, of contrasts involving stridents as related to treatment progress. Durational measures (VOT) were used to examine possible acoustic markers of /s/ + stop clusters vs. stop singleton contrasts and initial fricative vs. stop contrasts in six pre-school children with phonological impairment. Other aspects of the children's phonological knowledge were examined for their correspondence to acoustic findings and to treatment progress. One of three stopping subjects produced a durational acoustic distinction between stop and fricative targets prior to treatment. This subject, who also had more knowledge of the fricative class, required the shortest treatment period to establish a contrast between initial stops and fricatives in comparison to two subjects who had less knowledge of fricatives and no acoustic distinction. All three cluster subjects produced long lag VOTs in stops that replaced /s/ + stop clusters; one of these children displayed a weak signilicant difference in VOT means for is/ + stop cluster and singleton targets, but was not the subject with the lowest number of treatment sessions. Results are discussed in reference to the utility of acoustic measures and the convergence of those measures with other sources of knowledge as it relates to treatment outcomes.

A 28-year follow-up of adults with a history of moderate phonological disorder: educational and occupational results

The present investigation is a follow-up to a longitudinal study involving approximately 400 normally developing children begun in 1960. From this large database, two groups of subjects (now aged 32-34) were asked to participate in the present project: (a) a group of 24 adults with a documented history of a moderate phonological/language disorder that persisted through at least the end of first grade (probands), and (b) a group of 28 adults from the same birth cohort and schools who were known to have had at least average articulation skills over the same period (controls). As part of a larger project, these adults were interviewed about their educational and occupational accomplishments and those of their siblings. Results revealed that, in comparison to control subjects, the proband adults reported that they had received lower grades in high school, required more remedial academic services throughout their school careers, and completed fewer years of formal education. Occupationally, although the groups did not differ in employment status, the proband subjects tended to occupy jobs considered semiskilled or unskilled with a much greater frequency than both the control subjects and their gender-matched siblings. When asked to indicate general satisfaction with educational and occupational outcomes, however, subjects in both groups tended to rate themselves as either "very" or "fairly" satisfied.

Developmental phonological disorders. II. Short-term speech-sound normalization

A companion paper (Shriberg & Kwiatkowski, 1994) provides a descriptive profile of three samples of children (n = 178) with developmental phonological disorders. The present paper describes a conceptual framework for short-term and long-term speech-sound normalization research and reports 1-year normalization outcomes for 54 of the children described in the companion paper. Although certain individual speech variables were significantly associated with normalization, there were no speech, prosody-voice, or risk-factor variables that discriminated children who achieved short-term speech-sound normalization in 1 year. Findings are discussed in relation to a two-factor framework to study and predict speech-sound normalization in developmental phonological disorders (Kwiatkowski & Shriberg, 1993; Shriberg, Kwiatkowski, & Gruber, 1992).

Preschoolers With Phonological and Language Disorders

Six preschoolers aged 3:6 to 4:8 (years:months), with moderate-to-severe disorders in both language and phonology, received intervention that differentially focused on language, phonology, or both domains, Phonological intervention involved elicited imitation techniques and minimal pair contrasting. Language intervention involved an indirect narrative approach with focused stimulation The combination approach involved features of both. All subjects had both language and phonology goals, but the emphasis for these differed in the different treatments. Regardless of the intervention approach, a modified "cycles" approach was incorporated for phonology goals. Extensive phonological and morphological generalization probes, spontaneous language sampling, and use of the proportional change index for mean length of utterance served as measures of progress. Subjects who received direct phonological intervention showed a moderate improvement in both phonology and language. Subjects who received language intervention demonstrated small improvement in language and negligible improvement in phonology Subjects who received the combined intervention approach showed marked improvement in both domains.

Effects of grammar facilitation on the phonological performance of children with speech and language impairments

Although there is a great deal of evidence for a significant developmental relationship between grammar and phonology, the nature of this relationship and its implications for the intervention of children with impairments in both grammar and phonology are unclear. The purpose of this investigation was to determine whether two approaches to grammar facilitation that placed no emphasis on phonology would have indirect effects on the phonological output of preschoolers with speech and language impairments. All 26 subjects, ages 44-70 months, had impairments both in grammar and in phonology. Ten subjects took part in a clinician-administered intervention program, eight subjects received a similar intervention program implemented by their parents, and eight children served as delayed intervention controls (Fey, Cleave, Long, & Hughes, 1993). The results indicated that despite a strong effect for the intervention on the children's grammatical output, there were no indirect effects on the subjects' phonological production. It is concluded that despite a close relationship between the development of grammar and phonology, language intervention approaches for children approximately 4 to 6 years of age should address phonological problems directly if significant effects on phonology are to be expected.

The relationship between speech-language impairments and reading disabilities

A group of children with speech-language impairments was identified in kindergarten and given a battery of speech-language tests and measures of phonological awareness and rapid automatized naming. Subjects were followed in first and second grades and administered tests of written word recognition and reading comprehension. The children with speech-language impairments were found to perform less well on reading tests than a nonimpaired comparison group. Subjects' performance on standardized measures of language ability in kindergarten was observed to be closely related to reading outcome, especially reading comprehension. Measures of phonological awareness and rapid automatized naming, on the other hand, were found to be the best predictors of written word recognition. The implications of these findings for the early identification and remediation of reading disabilities are discussed.

Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders

Research in developmental phonological disorders, particularly emerging subgroup studies using behavioral and molecular genetics, requires qualitative and continuous measurement systems that meet a variety of substantive and psychometric assumptions. This paper reviews relevant issues underlying such needs and presents four measurement proposals developed expressly for causal-correlates research. The primary qualitative system is the Speech Disorders Classification System (SDCS), a 10-category nosology for dichotomous and hierarchical polychotomous classification of speech disorders from 2 years of age through adulthood. The three quantitative measures for segmental and suprasegmental analyses are (a) the Articulation Competence Index (ACI), an interval-level severity index that adjusts a subject's Percentage of Consonants Correct (PCC) score for the relative percentage of distortion errors; (b) Speech Profiles, a series of graphic-numeric displays that profile a subject's or group's severity-adjusted consonant and vowel-diphthong mastery and error patterns; and (c) the Prosody-Voice Profile, a graphic-numeric display that profiles a subject's or group's status on six suprasegmental domains divided into 31 types of inappropriate prosody-voice codes. All data for the four measures are derived from one sample of conversational speech, which obviates the limitations of citation-form testing; enables speech assessment as a qualitative, semi-continuous, and continuous trait over the life span; and provides a context for univariate and multivariate statistical analyses of phonetic, phonologic, prosodic, and language variables in multiage, multidialectal, and multicultural populations. Rationale, procedures, validity data, and examples of uses for each measure are presented.

Consideration of Error Types

In this article the use of the term phonological to describe disordered speech patterns is discussed. In adopting the term, it seems important to give equal consideration to both the articulatory aspects and the more cognitive aspects of the problem. Viewing the phonological system as a whole highlights the different types of errors within the system. It is suggested that phonological disorders include both phonetic and phonemic error types and that the distinction between the two error types is useful in both assessment and treatment. Describing errors as either phonetic or phonemic types may lead to differential treatment procedures that are most appropriate for specific error types.

Synergistic Development of Phonetic Skill

Fey (1985; reprinted 1992, this issue) described children’s disordered speech sound production using a combination of phonological and traditional articulatory constructs that are not specifically related to levels of language organization higher than the morpheme or word form. This theoretical viewpoint coincides with current testing and treatment procedures that focus on production, perception, and categorization of word pairs that have been selected by the clinician because of their phonological properties. This article will argue that such an approach is not necessarily the most efficacious for preschool children with phonological delay who also exhibit delayed semantic-syntactic development. A model of verbal communication that unites phonetic, phonological, and higher organizational levels will be described. Treatment strategies related to this model will be exemplified.

Effects of Phonological Impairment on Word, Syllable, and Phoneme Segmentation and Reading

The primary purpose of this study was to compare the phonological awareness ability of children with persistent phonological impairment to that of phonologically normal children. We also studied the impact of speech intelligibility on beginning reading skills. Eleven moderate to severely unintelligible children and 11 phonologically normal children between the ages of 6:5 (years:months) and 8:6 were administered four measures of phonological awareness and one measure of word recognition (reading) ability. Phonologically normal children scored significantly higher on three of the four phonological awareness measures. There were no significant differences for word recognition. Multiple regression analysis yielded speech intelligibility as a highly significant predictor of performance on three of the four phonological awareness tasks. We concluded that phonological awareness is closely associated with productive phonological ability independent of mental age, chronological age, and educational experience.

Early identification of dyslexia: Evidence from a follow-up study of speech-language impaired children

A group of speech-language impaired children was administered a battery of standardized language tests and measures of phonological processing in kindergarten. Performance on these language measures was then compared to reading ability in first grade. Results indicated that children with semantic-syntactic language deficits had more difficulties in reading than did children with primarily speech articulation impairments. In addition, phonological processing measures were found to be good predictors of reading achievement. Results are discussed in terms of their implications for the early identification of developmental dyslexia.

Self-Monitoring and Generalization in Preschool Speech-Delayed Children

Self-monitoring and generalization were observed as eight preschool children progressed in management programs for their developmental phonological disorders. Changes in the production of target and non-target sounds and behaviors presumed to reflect self-monitoring were tallied as they occurred concurrently in conversational speech samples. With some notable exceptions, generalization data for target and non-target sound changes were consistent with linguistic patterns reported in the literature. Self-monitoring behaviors were observed to vary in type, frequency, and point of onset in relation to generalization data. A consistent observation across children was that self-monitoring behaviors neither always nor only occurred in temporal association with generalization. Alternative hypotheses concerning the occurrence of self-monitoring behaviors in stimulus and response generalization are considered.

Comparison of Process Targeting and Whole Language Treatments for Phonologically Delayed Preschool Children

Two, 4-year-old phonologically delayed children were treated using two intervention approaches for a 6-week period. The phonological approach targeted cluster reduction through practice in production and perception of affected minimal pair contrasts in words, phrases, sentences, and story-telling tasks. The whole language approach targeted production of narratives without specific attention to the cluster reduction error pattern. Similar improvements were seen in the phonological performance of both children; however, the child in the whole language treatment showed greater improvements in expressive language performance. Results are discussed with respect to the holistic nature of language and its implications for phonological treatment.