A procedure for phonetic transcription by consensus

The association between longitudinal declines in speech sound accuracy and speech intelligibility in speakers with amyotrophic lateral sclerosis

The purpose of this study was to examine how neurodegeneration secondary to amyotrophic lateral sclerosis (ALS) impacts speech sound accuracy over time and how speech sound accuracy, in turn, is related to speech intelligibility. Twenty-one participants with ALS read the Bamboo Passage over multiple data collection sessions across several months. Phonemic and orthographic transcriptions were completed for all speech samples. The percentage of phonemes accurately produced was calculated across each phoneme, sound class (i.e. consonants versus vowels), and distinctive feature (i.e. features involved in Manner of Articulation, Place of Articulation, Laryngeal Voicing, Tongue Height, and Tongue Advancement). Intelligibility was determined by calculating the percentage of words correctly transcribed orthographically by naive listeners. Linear mixed effects models were conducted to assess the decline of each distinctive feature over time and its impact on intelligibility. The results demonstrated that overall phonemic production accuracy had a nonlinear relationship with speech intelligibility and that a subset of features (i.e. those dependent on precise lingual and labial constriction and/or extensive lingual and labial movement) were more important for intelligibility and were more impacted over time than other features. Furthermore, findings revealed that consonants were more strongly associated with intelligibility than vowels, but consonants did not significantly differ from vowels in their decline over time. These findings have the potential to (1) strengthen mechanistic understanding of the physiological constraints imposed by neuronal degeneration on speech production and (2) inform the timing and selection of treatment and assessment targets for individuals with ALS.

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

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

Preliminary Speech Perception Performance Profiles of School-Age Children With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development

PURPOSE

Limited research exists assessing speech perception in school-age children with speech sound disorder (SSD) and childhood apraxia of speech (CAS); despite early evidence that speech perception may lead to error-prone motor planning/programming. In this study, we examine speech perception performance in school-age children with and without speech production deficits.

METHOD

Speech perception was assessed using the Wide Range Acoustic Accuracy Scale to determine the just-noticeable difference in discrimination for three consonant-vowel syllable contrasts (/bɑ/-/wɑ/, /dɑ/-/gɑ/, /ɹɑ/-/wɑ/), each varying along a single acoustic parameter for seven children with CAS with rhotic errors, seven children with SSD with rhotic errors, and seven typically developing (TD) children.

RESULTS

Findings revealed statistically significant mean differences between perceptual performance of children with CAS when compared to TD children for discrimination of /ɹɑ/-/wɑ/ contrasts. Large effect sizes were also observed for comparisons of /ɹɑ/-/wɑ/ contrasts between children with CAS, SSD, and TD peers. Additionally, large effect sizes were observed for /dɑ/-/gɑ/ contrasts between children with CAS and SSD and TD children despite nonsignificant mean differences in group performance.

CONCLUSIONS

Overall, mean outcome scores suggest that school-age children with CAS and persistent rhotic errors demonstrated less accurate speech perception skills relative to TD children for the /ɹɑ/-/wɑ/ contrasts. However, the relatively small sample sizes per group limit the extent to which these findings may be generalized to the broader population.

Predicting Language in Children with ASD Using Spontaneous Language Samples and Standardized Measures

This longitudinal study examined the degree to which standardized measures of language and natural language samples predicted later language usage in a heterogeneous sample of children with autism spectrum disorder (ASD), and how this relationship is impacted by ASD severity and interventions. Participants with a diagnosis of ASD (N = 54, 41 males) completed standardized assessments of language and social functioning; natural language samples were transcribed from play-based interactions. Findings indicated that standardized language measures, natural language measures, and ADOS severity were each unique predictors of later lexical use. Intervention types also appeared to impact later language; in particular, participation in mainstream inclusion accounted for significant amounts of variance in children's mean length of utterance at T3.

The Multilevel Word Accuracy Composite Scale: A Novel Measure of Speech Production in Childhood Apraxia of Speech

PURPOSE

The Multilevel word Accuracy Composite Scale (MACS) is a novel whole-word measure of speech production accuracy designed to evaluate behaviors commonly targeted in motor-based intervention for childhood apraxia of speech (CAS). The MACS yields a composite score generated through ratings of segmental accuracy, word structure maintenance, prosody, and movement transition. This study examined the validity of the MACS through comparison to established measures of speech accuracy. Reliability was also examined within and between practicing speech-language pathologists (SLPs).

METHOD

The MACS was used to rate 117 tokens produced by children with severe CAS. Ratings were performed in the laboratory setting by two expert raters and by practicing SLPs (N = 19). Concurrent validity was estimated through comparison of expert MACS ratings (i.e., MACS score and each component rating) to measures of speech accuracy (percent phoneme correct and the 3-point scale) using correlational analyses. Reliability was examined between expert raters and across SLP raters using the intraclass correlation coefficient to examine interrater reliability of expert ratings, in addition to inter- and intrarater reliability of SLP ratings.

RESULTS

Correlation analyses between MACS ratings (i.e., MACS score and component ratings) and existing measures of speech accuracy revealed small to large positive correlations between measures. Reliability analyses revealed moderate to excellent reliability for MACS ratings performed by expert raters and between (interrater) and within (intrarater) SLP raters.

CONCLUSIONS

Analyses of concurrent validity indicate that the MACS aligns with established measures, yet contributes novel elements for rating speech accuracy. Results further support the MACS as a reliable measure for rating speech accuracy in children with severe speech impairment for ratings performed by expert raters and practicing clinicians.

Variability, accuracy, and cross-linguistic transfer in bilingual children speaking Jamaican Creole and English

Due to the lack of normative data about bilingual speech development and limited availability of diagnostic tools optimised for this population, bilingual children under consideration for speech-language services are at an elevated risk of misdiagnosis. In the absence of validated assessment tools, speech-language pathologists may use measures of accuracy and variability of speech production to diagnose suspected speech sound disorders in bilingual children. Research in general motor development suggests that variability and accuracy may trade off in the course of maturation, whereby movement variability spikes before the transition to a more mature stage of motor control. Such variability-accuracy tradeoffs have been described in monolingual speech development but are understudied in bilingual populations, where cross-linguistic transfer occurs. This study aimed to examine variability, accuracy, and cross-linguistic transfer in the speech of 20 bilingual children speaking Jamaican Creole and English. We hypothesised that children who showed higher accuracy in their productions would also exhibit more variable speech, indicating a variability-accuracy tradeoff. The Word Inconsistency Assessment from the Diagnostic Evaluation of Articulation and Phonology was administered to measure accuracy and variability in the English context, where misdiagnosis is likely to occur. Contrary to our hypothesis, we observed that individuals with higher accuracy tended to be less variable in their productions. Future research should examine longitudinal trajectories of accuracy and variability and consider a more culturally-appropriate definition of 'accuracy' in documenting bilingual speech sound development.

Transcribing multilingual children's and adults' speech

Speech-language pathologists (SLPs) face challenges in transcription and diagnosis of speech sound disorders (SSD) in multilingual children due to ambient language influences and cross-linguistic transfer. The VietSpeech Multilingual Transcription Protocol, a 4-step process to undertake impressionistic transcription of multilingual speech was tested using data from Vietnamese-Australian children (n = 69) and adult family members (n = 85). The transcription team included an English-speaking SLP, a Vietnamese-English-speaking linguist and accredited interpreter, and two Vietnamese-English-speaking SLPs. (1) Training: The team completed training together in Vietnamese and English phonology. (2) Speech assessment: The participants were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) in English and the Vietnamese Speech Assessment (VSA). (3) Transcription comparison: Inter-rater reliability for 10 children and 12 adults was calculated using consonant-by-consonant agreement. For English the 3-way inter-rater agreement was 92.62% for children and 88.69% for adults. For Vietnamese the 4-way inter-rater agreement was 86.57% for children and 96.05% for adults. There was a significant correlation between speech accuracy and inter-rater reliability for children's consonants in English (r = 0.95) and Vietnamese (r = 0.91), and adults' consonants in English (r = 0.90), but not for Vietnamese (r = 0.49). Reliability was influenced by phoneme class and whether the target consonant was shared between languages. (4) Rule generation and consensus: Rules based on near functional equivalence were implemented to maintain consistency and reach consensus. SLPs who do not speak clients' home languages can be supported to transcribe multilingual speech by working with multilingual teams, and understanding personal limitations during multilingual speech assessments.

Effect of Predicate Types on the Production of Copula "Is" in 2-Year-Old Children Who Speak General American English

PURPOSE

Prior work has shown that subject types affected the production of copula BE in young children who spoke General American English (GAE). However, the role of predicate types on the production of copula BE remains unclear. This study examined how predicate types affected the production of copula "is" in young GAE-speaking children.

METHOD

Seventeen 2-year-old children with typical language development who spoke GAE were included in this study. Children's production rate of copula "is" in sentences with nominal (e.g., The dog is a king ), permanent-adjectival (e.g., The dog is white ), temporary-adjectival (e.g., The dog is very hot ), or locative (e.g., The dog is outside ) predicates was examined using an elicited repetition task.

RESULTS

Two-year-old children who spoke GAE were more likely to repeat copula "is" correctly with nominal, permanent-adjectival, and temporary-adjectival predicates than with locative predicates after sentence length was controlled. There were no other significant differences between predicate types.

CONCLUSIONS

Overall, locative predicates are the least facilitative for the production of copula "is" as compared to other predicate types. Predicate types, especially locative predicates, should be considered when the clinician creates sentences to evaluate the production of copula BE and to provide intervention for GAE-speaking children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22630726.

Review of methods for conducting speech research with minimally verbal individuals with autism spectrum disorder

The purpose of this paper was to review best-practice methods of collecting and analyzing speech production data from minimally verbal autistic speakers. Data on speech production data in minimally verbal individuals are valuable for a variety of purposes, including phenotyping, clinical assessment, and treatment monitoring. Both perceptual ("by ear") and acoustic analyses of speech can reveal subtle improvements as a result of therapy that may not be apparent when correct/incorrect judgments are used. Key considerations for collecting and analyzing speech production data from this population are reviewed. The definition of "minimally verbal" that is chosen will vary depending on the specific hypotheses investigated, as will the stimuli to be collected and the task(s) used to elicit them. Perceptual judgments are ecologically valid but subject to known sources of bias; therefore, training and reliability procedures for perceptual analyses are addressed, including guidelines on how to select vocalizations for inclusion or exclusion. Factors to consider when recording and acoustically analyzing speech are also briefly discussed. In summary, the tasks, stimuli, training methods, analysis type(s), and level of detail that yield the most reliable data to answer the question should be selected. It is possible to obtain rich high-quality data even from speakers with very little speech output. This information is useful not only for research but also for clinical decision-making and progress monitoring.

Characterizing Speech Sound Productions in Bilingual Speakers of Jamaican Creole and English: Application of Durational Acoustic Methods

PURPOSE

This study examined the speech acoustic characteristics of Jamaican Creole (JC) and English in bilingual preschoolers and adults using acoustic duration measures. The aims were to determine if, for JC and English, (a) child and adult acoustic duration characteristics differ, (b) differences occur in preschoolers' duration patterns based on the language spoken, and (c) relationships exist between the preschoolers' personal contextual factors (i.e., age, sex, and percentage of language [%language] exposure and use) and acoustic duration.

METHOD

Data for this cross-sectional study were collected in Kingston, Jamaica, and New York City, New York, United States, during 2013-2019. Participants included typically developing simultaneous bilingual preschoolers (n = 120, ages 3;4-5;11 [years;months]) and adults (n = 15, ages 19;0-54;4) from the same linguistic community. Audio recordings of single-word productions of JC and English were collected through elicited picture-based tasks and used for acoustic analysis. Durational features (voice onset time [VOT], vowel duration, whole-word duration, and the proportion of vowel to whole-word duration) were measured using Praat, a speech analysis software program.

RESULTS

JC-English-speaking children demonstrated developing speech motor control through differences in durational patterns compared with adults, including VOT for voiced plosives. Children's VOT, vowel duration, and whole-word duration were produced similarly across JC and English. The contextual factor %language use was predictive of vowel and whole-word duration in English.

CONCLUSIONS

The findings from this study contribute to a foundation of understanding typical bilingual speech characteristics and motor development as well as schema in JC-English speakers. In particular, minimal acoustic duration differences were observed across the post-Creole continuum, a feature that may be attributed to the JC-English bilingual environment.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21760469.

Say that again: Quantifying patterns of production for children with autism using recurrence analysis

The current research study characterized syntactic productivity across a range of 5-year-old children with autism and explored the degree to which this productivity was associated with standardized measures of language and autism symptomatology. Natural language samples were transcribed from play-based interactions between a clinician and participants with an autism diagnosis. Speech samples were parsed for grammatical morphemes and were used to generate measures of MLU and total number of utterances. We applied categorical recurrence quantification analysis, a technique used to quantify patterns of repetition in behaviors, to the children’s noun-related and verb-related speech. Recurrence metrics captured the degree to which children repeated specific lexical/grammatical units (i.e., recurrence rate) and the degree to which children repeated combinations of lexical/grammatical units (i.e., percent determinism). Findings indicated that beyond capturing patterns shown in traditional linguistic analysis, recurrence can reveal differences in the speech productions of children with autism spectrum disorder at the lexical and grammatical levels. We also found that the degree of repeating noun-related units and grammatical units was related to MLU and ADOS Severity Score, while the degree of repeating unit combinations (e.g., saying “the big fluffy dog” or the determiner-adjective-adjective-noun construction multiple times), in general, was only related to MLU.

Measurement Properties of Mean Length of Utterance in School-Age Children

PURPOSE

Mean length of utterance (MLU) is one of the most widely reported measures of syntactic development in the developmental literature, but its responsiveness in young school-age children's language has been questioned, and it has been shown to correlate with nonsyntactic measures. This study tested the extent to which MLU shows measurement properties of responsiveness and construct validity when applied to language elicited from elementary school children.

METHOD

Thirty-two typically developing children in two age groups (5 and 8 years) provided four short language samples each. Language samples were elicited in a question-answer context and a narrative context. MLU was calculated with both morpheme and word counts. Other established measures of syntactic complexity (clausal density [CD], developmental level [D-Level], mean length of clause [MLC]) and lexical diversity (lexical density, moving-average type-token ratio, number of different words) were also calculated.

RESULTS

Linear mixed-effects analyses revealed that MLU varied systematically with discourse context and children's age group. The syntactic measures, CD and MLC, were found to vary systematically with MLU. None of the lexical diversity measures varied systematically with MLU.

CONCLUSION

Results suggest that MLU is a responsive and valid measure of children's syntactic development across age and discourse context during the early school-age years.

Consonant Cluster Productions in Preschool Children Who Speak African American English

PURPOSE

The aim of this study was to compare word-initial and word-final consonant cluster productions in young children who speak African American English (AAE) and compare their productions to what we know about cluster productions in children who speak Mainstream American English (MAE), in order to minimize misdiagnosis of speech sound disorders.

METHOD

Twenty-two children (ages 2;10-5;4 [years;months]) labeled pictures whose names contained at least one consonant cluster in word-initial and/or word-final position. Most two-element clusters of English were sampled, the majority in two or more words. The participants' responses were transcribed using a consensus transcription procedure. Each cluster attempt was analyzed for its similarity with MAE.

RESULTS

Percentage matching scores were significantly higher for word-initial than word-final clusters. Word-final clusters produced as singletons were significantly more common than word-final cluster substitutions. However, word-initial cluster substitutions were significantly more common than word-initial clusters produced as singletons. Word-initial cluster mismatches were consistent with markedness theory and the sonority sequencing principle (SSP). By contrast, word-final cluster mismatches were not consistent with the SSP, while the voicing generalization seen in adult speakers of AAE was evident.

CONCLUSION

Culturally and linguistically appropriate assessment of phonological development in children who speak AAE requires an understanding of the contrastive and noncontrastive features exemplified in their consonant cluster productions.

Speech-Language Pathologists' Ratings of Speech Accuracy in Children With Speech Sound Disorders

PURPOSE

Forming accurate and consistent speech judgments can be challenging when working with children with speech sound disorders who produce a large number and varied types of error patterns. Rating scales offer a systematic approach to assessing the whole word rather than individual sounds. Thus, these scales can be an efficient way for speech-language pathologists (SLPs) to monitor treatment progress. This study evaluated the interrater reliability of an existing 3-point rating scale using a large group of SLPs as raters.

METHOD

Utilizing an online platform, 30 SLPs completed a brief training and then rated single words produced by children with typical speech patterns and children with speech sound disorders. Words were closely balanced across the three rating categories of the scale. The interrater reliability of the SLPs ratings to a consensus judgment was examined.

RESULTS

The majority of SLPs (87%) reached substantial interrater reliability to a consensus judgment using the 3-point rating scale. Correct productions had the highest interrater reliability. Productions with extensive errors had higher agreement than those with minor errors. Certain error types, such as vowel distortions, were especially challenging for SLPs to judge.

CONCLUSIONS

This study demonstrated substantial interrater reliability to a consensus judgment among a large majority of 30 SLPs using a 3-point rating. The clinical implications of the findings are discussed along with proposed modifications to the training procedure to guide future research.

The influence of child-based factors and parental inputs on expressive language abilities in children with autism spectrum disorder

LAY ABSTRACT

Language impairment is one of the early signs of Autism Spectrum Disorder (ASD) that alerts parents to take their children for early diagnosis and intervention. Little is known about how children's autism traits, IQ, initial language abilities and parental inputs influence their language abilities. In addition, only a few studies have compared the relative influence of these factors. The present study addressed these issues by examining the structural language in parent-child spontaneous interactions. Forty-two Cantonese (Chinese)-speaking autistic children aged four to eight were recruited. Their expressive language skills grew rapidly more than 9 months, but their development trajectories varied. Initial expressive language ability is the only significant predictor of child language outcomes and language growth trajectories. In contrast, nonverbal cognition, autism traits, and parents' input do not affect language outcomes in children with ASD. Therefore, early language intervention is crucial for autistic children at all severity and IQ levels.

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.

Examining Phenotypical Heterogeneity in Language Abilities in Chinese-Speaking Children with Autism: A Naturalistic Sampling Approach

Phenotypical heterogeneity in language abilities is a hallmark of autism but remains poorly understood. The present study collected naturalistic language samples from parent-child interactions. We quantified verbal abilities (mean length of utterance, tokens, types) of 50 Chinese-speaking children (M = 5; 6) and stratified subgroups based on their autism traits, IQ, and language abilities. Using hierarchical cluster analysis, four groups were identified. Group 1, the least affected group, had mild autism, the highest IQ, and the strongest verbal abilities. Group 2, the severely affected group, had the lowest IQ, most severe autism symptoms, and weakest verbal abilities. Group 3 and Group 4 displayed average levels of verbal abilities and IQ. These findings may characterize the heterogeneous profiles of verbal abilities in Chinese-speaking children.

Conversation Skills in Chinese-Speaking Preschoolers with Autism: The Contributing Role of Parents' Verbal Responsiveness

Children with autism spectrum disorder (ASD) have conversation deficits, yet the growth of conversation abilities is understudied, especially in Chinese-speaking populations. Little is known about whether their parents' verbal responsiveness and redirectives are related to their conversation skills. Children with ASD (N = 37; M = 5;5) and their parents contributed their language samples. These children interacted with their parents at four time points over nine months. The number of conversational turns and the proportion of child-initiated conversation (but not the proportion of children's appropriate responses) grew over nine months. After controlling for time, autism severity, and language skills, parents' verbal responsiveness positively predicted children's appropriate responses. Parents' redirectives negatively predicted the proportion of children's appropriate responses and the number of conversational turns.

Variability across repeated productions in bilingual children speaking Jamaican Creole and English

PURPOSE

Previous work suggests that variability across repeated productions of the same word may be useful in diagnosing speech sound disorder (SSD) in bilingual children. However, there is debate over what level of variability in transcribed productions should be considered typical even in monolingual speech development. High variability in the input represents a factor that could promote increased production variability in bilinguals. For this reason, the current study examines transcription-based token-to-token variability in bilingual children speaking Jamaican Creole (JC) and English.

METHOD

Twenty-five bilingual children aged 3;4-5;1 and twenty-five monolingual children aged 2;9-4;1 from a previous study were recorded producing eleven items in three repetitions.

RESULT

Contrary to our hypothesis, bilingual children showed similar rates of token-to-token variability compared to the monolingual children. In a separate analysis of bilingual data across languages, bilingual children were more variable in JC compared to English productions.

CONCLUSION

The difference between language contexts suggests that creole languages, which exist on a usage continuum, may be associated with increased variability in production. Our findings suggest that token-to-token production variability may be of similar clinical utility for bilingual and monolingual populations.

Explaining Individual Differences in Trajectories of Simultaneous Bilingual Development: Contributions of Child and Environmental Factors

Effects of child and environmental factors in moderating the course of bilingual development were investigated using longitudinal data, from age 2.5 to 5 years, on 126 U.S.-born children with early exposure to Spanish and English. Multilevel models of Spanish and English expressive vocabulary identified children's phonological memory ability as a significant predictor of both outcomes, while also replicating the effect of the relative amount of language exposure. In addition, nonverbal IQ was a significant predictor of English vocabulary; birth order and maternal education in Spanish were significant predictors of Spanish vocabulary. These findings expand our understanding of the sources of the wide heterogeneity in bilingual development and of the requirements that language acquisition makes of learners and their environments.

Acquisition and Acoustic Patterns of Southern American English /l/ in Young Children

Purpose The aim of the current study was to examine /l/ developmental patterns in young learners of Southern American English, especially in relation to the effect of word position and phonetic contexts. Method Eighteen children with typically developing speech, aged between 2 and 5 years, produced monosyllabic single words containing singleton /l/ in different word positions (pre- vs. postvocalic /l/) across different vowel contexts (high front vs. low back) and cluster /l/ in different consonant contexts (/pl, bl/ vs. /kl, gl/). Each production was analyzed for its accuracy and acoustic patterns as measured by the first two formant frequencies and their difference (F1, F2, and F2-F1). Results There was great individual variability in /l/ acquisition patterns, with some 2- and 3-year-olds reaching 100% accuracy for prevocalic /l/, while others were below 70%. Overall, accuracy of prevocalic /l/ was higher than that of postvocalic /l/. Acoustic patterns of pre- and postvocalic /l/ showed greater differences in younger children and less apparent differences in 5-year-olds. There were no statistically significant differences between the acoustic patterns of /l/ coded as perceptually acceptable and those coded as misarticulated. There was also no apparent effect of vowel and consonant contexts on /l/ patterns. Conclusion The accuracy patterns of this study suggest an earlier development of /l/, especially prevocalic /l/, than has been reported in previous studies. The differences in acoustic patterns between pre- and postvocalic /l/, which become less apparent with age, may suggest that children alter the way they articulate /l/ with age. No significant acoustic differences between acceptable and misarticulated /l/, especially postvocalic /l/, suggest a gradient nature of /l/ that is dialect specific. This suggests the need for careful consideration of a child's dialect/language background when studying /l/.

Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth

Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Language Growth in Young Children with Autism: Interactions Between Language Production and Social Communication

Young children with autism spectrum disorder (ASD) present with a broad range of spoken language abilities, as well as delays in precursor skills such as gesture production and joint attention skills. While standardized assessments describe language strengths, the Communication and Symbolic Behavior Scales (CSBS-DP) is a particularly robust measure as it additionally characterizes precise aspects of social communication. This study provides a unique contribution by assessing the interactional effects of CSBS-DP Social Composite performance with early language samples on later language outcomes. Our results indicate that multiple social communication elements significantly interact with early spoken language to predict later language. Our findings also highlight the transactional relationship between early spoken vocabulary and social communication skills that bolster language development growth.

Sampling Utterances and Grammatical Analysis Revised (SUGAR): Quantitative Values for Language Sample Analysis Measures in 7- to 11-Year-Old Children

Purpose The purpose of this study was to document whether mean length of utterance_SUGAR (MLU_S), total number of words (TNW), clauses per sentence (CPS), and/or words per sentence (WPS) demonstrated age-related changes in children with typically developing language, aged 7;0-10;11 (years;months). Method Participants were 132 typically developing children (aged 7;0-10;11), with a final sample size of 112 participants (57 boys and 55 girls). Fifty utterance conversational language samples were collected using a language sampling protocol. Four language sample analysis metrics (i.e., MLU_S, TNW, CPS, and WPS) were calculated from the samples. Results Results indicated statistically significant age-related increases in three (MLU_S, TNW, and WPS) of the four metrics. Conclusions MLU_S, TNW, CPS, and WPS may be used with other assessment data to document age-related language changes in children aged 7;0-10;11. When combined with previous data from younger (aged 3;0-7;11) children (Pavelko & Owens, 2017), the data suggest that these metrics offer a set of measures that can be used to assess children's conversational language skills from preschool through late elementary school.

Revisiting Reliability: Using Sampling Utterances and Grammatical Analysis Revised (SUGAR) to Compare 25- and 50-Utterance Language Samples

Purpose The goal of this study was to determine whether the results obtained from a 25-utterance conversational language sample were as reliable as those obtained from a 50-utterance sample. Method Robust conversational language samples from 220 children with typically developing language (106 boys, 114 girls) ranging in age from 3;2 to 7;10 (years;months) were collected. The language samples were randomly assigned to one of two conditions: a 25-utterance condition and a 50-utterance condition. Transcripts were examined for three metrics, including mean length of utterance_SUGAR, words per sentence, and clauses per sentence. Results Data were analyzed using two methods. A linear mixed-model analysis was used to assess absolute and relative reliability, and the Bland-Altman procedure was used to assess absolute reliability and clinical acceptability. Results of the mixed-model analysis indicated that mean length of utterance_SUGAR and words per sentence demonstrated relative reliability; however, none of the metrics demonstrated absolute reliability. In contrast, results of the Bland-Altman scatter plots indicated that all three metrics demonstrated absolute reliability because 94%-96% of participants' scores fell within the limits of agreement. Taken together, the results suggested that the statistically significant differences indicated by the mixed-model analysis were not clinically significant. Conclusion These results highlighted the importance of using different methods of analysis in studies of reliability. The findings indicated that reliable language sample results can be obtained from 25-utterance samples. Furthermore, by including practices already in use (e.g., collecting samples ≤ 50 utterances) and including only minimal changes to current practices, the methods used in this study are feasible for school-based clinicians, could be easily integrated into clinical practice, and could increase the use of evidence-based assessment practices in schools.

Finite Verb Morphology Composite Between Age 4 and Age 9 for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

Purpose

The purpose of this study was to provide reference data and evaluate the psychometric properties for the finite verb morphology composite (FVMC) measure in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005 ).

Method

Participants included 377 children between age 4 and age 9, including 300 children with typical language and 77 children with language impairment (LI). Narrative samples were collected using a story generation task. FVMC scores were computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for FVMC were further evaluated.

Results

Children's performance on FVMC increased significantly between age 4 and age 9 in the typical language and LI groups. Moreover, the correlation coefficients for the split-half reliability and concurrent criterion validity of FVMC were medium to large ( r s ≥ .429, p s < .001) at each age level. The diagnostic accuracy of FVMC was good or acceptable from age 4 to age 7, but it dropped to a poor level at age 8 and age 9.

Conclusion

With the empirical evidence, FVMC is appropriate for identifying children with LI between age 4 and age 7. The reference data of FVMC could also be used for monitoring treatment progress.

Supplemental Material

https://doi.org/10.23641/asha.10073183

Percent Grammatical Utterances Between 4 and 9 Years of Age for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

Purpose The purpose of this article was to provide the reference data and evaluate psychometric properties for the percent grammatical utterances (PGU; Eisenberg & Guo, 2013) in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005). Method Participants were 377 children who were between 4 and 9 years of age, including 300 children with typical language (TL) and 77 children with language impairment (LI). Narrative samples were collected using the ENNI protocol (i.e., a story generation task). PGU was computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for PGU were further evaluated. Results PGU increased significantly in children between 4 and 9 years of age in both the TL and LI groups. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of PGU were all large (rs ≥ .557, ps < .001). The diagnostic accuracy of PGU was also good or acceptable from ages 4 to 9 years. Conclusions With the attested psychometric properties, PGU computed from the ENNI could be used as an assessment tool for identifying children with LI between 4 and 9 years of age. The reference data of PGU could also be used for monitoring treatment progress. Supplemental Material https://doi.org/10.23641/asha.9630590.

Perceptual Characteristics of Consonant Production in Apraxia of Speech and Aphasia

Purpose This retrospective analysis examined group differences in error rate across 4 contextual variables (clusters vs. singletons, syllable position, number of syllables, and articulatory phonetic features) in adults with apraxia of speech (AOS) and adults with aphasia only. Group differences in the distribution of error type across contextual variables were also examined. Method Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia participated in this study. In the context of a 2-group experimental design, the influence of 4 contextual variables on error rate and error type distribution was examined via repetition of 29 multisyllabic words. Error rates were analyzed using Bayesian methods, whereas distribution of error type was examined via descriptive statistics. Results There were 4 findings of robust differences between the 2 groups. These differences were found for syllable position, number of syllables, manner of articulation, and voicing. Group differences were less robust for clusters versus singletons and place of articulation. Results of error type distribution show a high proportion of distortion and substitution errors in speakers with AOS and a high proportion of substitution and omission errors in speakers with aphasia. Conclusion Findings add to the continued effort to improve the understanding and assessment of AOS and aphasia. Several contextual variables more consistently influenced breakdown in participants with AOS compared to participants with aphasia and should be considered during the diagnostic process. Supplemental Material https://doi.org/10.23641/asha.9701690.

Concurrent Validity of the Fluharty Preschool Speech and Language Screening Test-Second Edition at Age 3: Comparison With Four Diagnostic Measures

Purpose The aim of this study was to examine the concurrent validity of the Fluharty Preschool Speech and Language Screening Test-Second Edition (Fluharty-2; Fluharty, 2001) for mass screenings of language at age 3 years. Method Participants were sixty-two 3-year-old children, 31 who had failed and 31 who had passed the Fluharty-2. Performance on the screening was compared to 4 diagnostic measures: Structured Photographic Expressive Language Test-Preschool, Second Edition; mean length of utterance in morphemes (MLUm), finite verb morphology composite, and Index of Productive Syntax (IPSyn). Results Children who failed the Fluharty-2 scored significantly lower on each of the diagnostic measures than children who passed the Fluharty-2, but the effect size for MLUm was small. Scores on the Fluharty-2 were significantly correlated with scores on the diagnostic measures. There was significant agreement for pass/fail decisions between the Fluharty-2 and diagnostic measures only for IPSyn. However, even for the IPSyn, the agreement rate for passing was only moderate (80%) and the agreement rate for failing was only fair (68%). Conclusion The Fluharty-2 showed limited agreement for pass/fail decisions with all 4 of the diagnostic measures. There was reason to question the validity of 2 of the diagnostic measures-Structured Photographic Expressive Language Test-Preschool, Second Edition and MLUm-for diagnosing language impairment in 3-year-old children. However, there were no such concerns about finite verb morphology composite or IPSyn to account for the limited agreement. Thus, it seems reasonable to conclude that the Fluharty-2 would refer both too few at-risk children and too many nonrisk children for a follow-up assessment, making it an inefficient tool for mass screenings of language.

Stages in the Development and Validation of a Belgian Dutch Outcome Tool for the Perceptual Evaluation of Speech in Patients With Cleft Palate

Objective:

To develop and validate a Belgian Dutch outcome tool for the perceptual evaluation of speech in patients with cleft palate.

Setting:

Cleft palate team in a tertiary university hospital.

Methods:

The tool was based on the Cleft Audit Protocol for Speech–Augmented (John et al., 2006; Sell et al., 2009), with adaptations to some of the speech variables and the structured listening protocol. Following a preliminary listening experiment in phase 1, the tool was optimized. In the second phase, a listening experiment with 4 experienced listeners was set up to assess face validity, inter- and intrarater reliability and criterion validity.

Results:

Results of phase 1 indicated good to very good inter- and intrarater reliability for the majority of the speech variables, good discriminant validity, and varying sensitivity and specificity based on a comparison with nasalance values and the Nasality Severity Index 2.0 (criterion validity). Results of phase 2 showed good to very good interrater reliability for 5 of the 14 variables and good intrarater reliability in 3 of the 4 experienced listeners. Sensitivity and specificity were sufficient, except the specificity of the hypernasality judgments in comparison with the nasalance values of the oral text. Overall, listeners positively judged the face validity of the tool.

Conclusion:

The 2-phase evaluation indicated varying validity and reliability results. Future studies will aim to optimize validity and reliability of the developed tool based on adaptations to the listening protocol, the addition of speech variables, and the inclusion of a more elaborate training.

Diagnostic Accuracy of the Sampling Utterances and Grammatical Analysis Revised (SUGAR) Measures for Identifying Children With Language Impairment

Purpose

The purpose of this study was twofold: (a) to determine the diagnostic accuracy of the four Sampling Utterances and Grammatical Analysis Revised (SUGAR) metrics, including total number of words, mean length of utterance SUGAR , words per sentence, and clauses per sentence in differentiating children with language impairment (LI) from those with typical language development, and (b) to compare the average time to collect, transcribe, and analyze 50-utterance language samples for children with LI to those with typical language development.

Method

Participants were 306 children (LI, 36; typical language development, 270) who ranged in age from 3;0 (years;months) to 7;11. Fifty-utterance conversational language samples were obtained using a conversational protocol. The four SUGAR metrics were calculated from the samples.

Results

Cut scores of −1 SD for mean length of utterance SUGAR and −1.25 cut score for clauses per sentence resulted in sensitivity of 97.22%, specificity of 82.96%, a positive likelihood ratio of 5.71, and a negative likelihood ratio of 0.03. On average, it took a total time of 20:20 min ( SD = 4:37, range: 13:11–30:25) to collect, transcribe, and analyze language samples for children with LI. Children with LI took significantly less time to produce 50 utterances, when compared to their typically developing peers. There were no significant differences in the time to transcribe and analyze language samples of children with LI compared to their typically developing peers.

Conclusions

The SUGAR metrics, in combination with other data sources (e.g., standardized testing, dynamic assessment, observation), can be used to identify preschool- and early elementary–aged children with LI. Furthermore, for children with LI, language sampling and analysis using the SUGAR method can be completed in approximately 20 min. The results of this study indicated the SUGAR measures can effectively and efficiently help in identifying LI.

Supplemental Material

https://doi.org/10.23641/asha.7728638

Relationship between mean length of utterance and vocabulary in children with typical language development

ABSTRACT Purpose: to investigate the existence of a relationship between vocabulary and measures of mean length of utterance in children in their language development phase. Methods: the sample consisted of 72 children aged 2 to 4 years, 11 months and 29 days, 36 boys and 36 girls, with typical language development, evenly distributed into age groups, enrolled in kindergartens with the public school system, in Santa Maria, RS, Brazil. Videos of the spontaneous speech of each subject were made, and then, the analysis of the vocabulary and Mean Length of Utterance took place. Statistical analysis was performed using the Statistical Analysis System program, version 9.2 and Spearman correlation coefficient, with a significance level of p <0.05. Results: the influence of gender in the Mean Length of Utterance correlation and vocabulary was observed. There was a difference between the ages of 2 and 4 years. Conclusion: vocabulary development promotes mean length utterance, indicating positive correlation between gender and age range.

Phonological Development in a Bilingual Arabic-English-Speaking Child With Bilateral Cochlear Implants: A Longitudinal Case Study

PURPOSE

This longitudinal study examined the phonological development of a bilingual Arabic-English-speaking child with bilateral cochlear implants (CIs). The focus of the study was to observe the interaction between her two languages and to observe the effect of CIs on the acquisition of two speech sound systems.

METHOD

This study followed a 3;6-year-old (2;5 hearing age) bilingual Arabic-English-speaking child with bilateral CIs to age 4;4 (3;2 hearing age). Single-word samples were collected bimonthly in both languages. Phon software (Rose et al., 2006) was used to transcribe and analyze speech samples. Measures derived included Percent Consonants Correct-Revised (Shriberg & Kwiatkowski, 1994), percent vowels correct, phonetic inventory complexity, and common phonological patterns for both English and Arabic.

RESULTS

Our findings supported previous research on phonological development exhibited by children with CIs, with the gradual suppression of typical and atypical error patterns and gradual increase in segmental accuracy with maturation. In addition, language interaction and separation between English and Arabic were found, supporting previous cross-linguistic work on bilingual phonological acquisition (e.g., Fabiano-Smith & Goldstein, 2010b).

CONCLUSION

Bilingual children with CIs have the capability to learn both of their languages and perform similarly to, and even surpass in accuracy, monolingual children with CIs; however, it is also possible to exhibit a slower rate of acquisition of segmental accuracy as compared to their typically developing, hearing peers. Clinical implications of bilingual early intervention are discussed.

Dynamic Assessment of Narratives Among Navajo Preschoolers

PURPOSE

This study examined whether the Predictive Early Assessment of Reading and Language (PEARL), a dynamic assessment of narratives that measures language comprehension and production, accurately classifies Navajo preschoolers with typically developing (TD) language or with language impairment (LI).

METHOD

Ninety 4- and 5-year-old Navajo preschoolers were identified as having LI or are TD (n = 45 each) via a 5-measure battery: parent report, teacher report, English narrative, independent educational plan, and the Clinical Evaluation of Language Fundamental Preschool-Second Edition (Wiig, Secord, & Semel, 2004). Children completed a PEARL pretest, a narrative mediation phase providing principles of narrative structure, and a PEARL posttest. A modifiability score reflected responsiveness to mediation.

RESULTS

The PEARL pretest and posttest each distinguished children with LI versus TD children with 89% accuracy; modifiability scores identified children with 100% accuracy. The PEARL story grammar subtest at pretest and posttest best distinguished LI versus TD. A revised cutoff score on the PEARL pretest decreased the diagnosis of TD children as having LI; the standard PEARL posttest cutoff was retained.

CONCLUSION

The PEARL is a promising assessment for accurately differentiating Navajo preschool children with LI from those with TD language, particularly with a revised pretest cutoff score.

Eliciting the Language Sample for Developmental Sentence Scoring: A Comparison of Play With Toys and Elicited Picture Description

PURPOSE

This study investigated whether language samples elicited during play and description of pictured events would yield the same results for developmental sentence scoring (DSS).

METHOD

Two language samples were elicited from 58 three-year-olds. One sample was elicited during play with a parent, and the other sample was elicited by an examiner asking children to talk about pictured events in response to elicitation questions.

RESULTS

DSS scores were not significantly different between the play and event description samples. However, sentence points were significantly higher for the play sample than for the event description sample. Although there was a correlation between sample types for both DSS and sentence points, the correlation for DSS (r = .52) was below an acceptable level, and the correlation for sentence points (r = .71) was at a minimally acceptable level. Agreement between sample types for pass-fail decisions on the DSS scores using the 10th percentile cutoff recommended by Lee (1974) was only moderate (78%).

CONCLUSION

The current study shows that type of language samples could affect DSS and sentence point scores of 3-year-olds and, hence, the passing and failing decisions for their performance on DSS.

Speech outcomes following Sommerlad primary palatoplasty: Results of the Ghent University Hospital

OBJECTIVE AND SUBJECTS

Speech outcomes were described for 16 patients with cleft palate (mean age: 5.4 years) following Sommerlad primary palatoplasty performed by a single surgeon of the Ghent University Hospital. These speech outcomes were compared with those of an age and gender matched control group without cleft palate (mean age: 5.3 years).

METHODS

Speech intelligibility/distinctiveness, resonance, nasal airflow and articulation, were perceptually evaluated. Additionally, nasalance values and the NSI 2.0 were determined.

RESULTS

In seven patients, speech intelligibility/distinctiveness was disordered. Hypernasality was present in twelve participants, whereas nasal emission and nasal turbulence were perceived in thirteen and five patients respectively. Both perceptual and instrumental speech evaluations were significantly poorer in the patient group in comparison to the control group.

CONCLUSIONS

Patients still present with both obligatory and compensatory speech disorders following Sommerlad's palatoplasty. In the future, a Dutch speech assessment protocol will be developed in order to standardize follow-up of these patients and to allow for within-center and inter-center comparisons.

Changing the Subject: The Place of Revisions in Grammatical Development

PURPOSE

This article focuses on toddlers' revisions of the sentence subject and tests the hypothesis that subject diversity (i.e., the number of different subjects produced) increases the probability of subject revision.

METHOD

One-hour language samples were collected from 61 children (32 girls) at 27 months. Spontaneously produced, active declarative sentences (ADSs) were analyzed for subject diversity and the presence of subject revision and repetition. The number of different words produced, mean length of utterance, tense/agreement productivity score, and the number of ADSs were also measured.

RESULTS

Regression analyses were performed with revision and repetition as the dependent variables. Subject diversity significantly predicted the probability of revision, whereas the number of ADSs predicted the probability of repetition.

CONCLUSION

The results support the hypothesis that subject diversity increases the probability of subject revision. It is proposed that lexical diversity within specific syntactic positions is the primary mechanism whereby revision rates increase with grammatical development. The results underscore the need to differentiate repetition from revision in the classification of disfluencies.

Percent Grammatical Responses as a General Outcome Measure: Initial Validity

Purpose

This report investigated the validity of using percent grammatical responses (PGR) as a measure for assessing grammaticality. To establish construct validity, we computed the correlation of PGR with another measure of grammar skills and with an unrelated skill area. To establish concurrent validity for PGR, we computed the correlation of PGR with a previously validated measure of grammaticality, percent grammatical utterances (PGU), and examined the extent to which PGR and PGU agreed upon pass/fail decisions for children.

Method

Participants included 79 3-year-olds from mostly middle socioeconomic status homes. Language samples were elicited by asking children to describe 15 pictures in response to 4 questions per picture. To calculate PGU, children's responses to all 4 questions were segmented into communication units, and each communication unit was evaluated for grammatical errors. To calculate PGR, the entire response to just the first question was evaluated for grammatical errors.

Results

PGR scores significantly correlated with a standardized test of grammar (r = .70), but not with a measure of vocabulary (i.e., type-token ratio; r = .11). In addition, PGR scores were significantly correlated with PGU scores (r = .88). Agreement between PGR and PGU was 92% for pass decisions and 94% for fail decisions.

Conclusions

The current study establishes the construct validity of PGR as a measure of grammar and supports the use of PGR as a measure to assess grammaticality.

The Cleft Audit Protocol for Speech—Augmented: A Validated and Reliable Measure for Auditing Cleft Speech

Objectives

To develop an assessment tool for use in intercenter audit studies of cleft speech and to test its acceptability, validity, and reliability. The tool is to be used systematically to record and report speech outcomes, providing an indication of treatment needs and continuing burden of care.

Setting

Regional Cleft Center, U.K.

Methods

The Cleft Audit Protocol for Speech—Augmented (CAPS-A) was developed by three cleft speech experts who identified the key features required from existing assessment measures. Criterion validity was assessed by comparing the Cleft Audit Protocol for Speech—Augmented outcomes reported for 20 cases with clinical assessment results and other investigations. Intra- and interrater reliability were tested following the training of specialist speech and language therapists who used the Cleft Audit Protocol for Speech—Augmented on two occasions to assess 10 cases. The raters evaluated acceptability and ease of using a questionnaire.

Results

The mean percentage agreement for criterion validity in each section was 87% (range 70% to 100%). Both intra- and interexaminer reliability were rated as good/very good (Kappa 0.61 to 1.00) for seven sections and moderate (Kappa 0.41 to 0.60) for three sections. Raters reported that the Cleft Audit Protocol for Speech—Augmented was acceptable and easy to use with appropriate training.

Conclusion

An acceptable, valid, and reliable cleft speech audit tool has been developed based on a small sample. The Cleft Audit Protocol for Speech—Augmented is recommended for use in intercenter audit studies in the U.K. and Ireland and could be used in other English-speaking countries. In addition, it has wider applicability for use in reporting speech outcomes of surgical procedures.

Comparing Methodologies in a Series of Speech Outcome Studies

Background:

Development of the speech audit tool Cleft Audit Protocol for Speech Augmented (CAPS-A) facilitated intercenter comparison of speech outcomes following cleft palate repair. The CAPS-A protocol recommends consensus listening by 3 speech and language therapists, 2 of whom must be CAPS-A trained. Allowing 15 minutes per sample, 15 to 20 samples can be assessed each day. Centers typically have resources to audit 15 to 75 samples per year but not to report speech outcomes of larger data sets for research. This 3-phased outcome study examines how the implementation of the CAPS-A protocol might be modified without compromising reliability.

Methodology:

In phase 1, 2 external listeners independently rated 42 speech samples; in phase 2, 2 external listeners consensus listened 25% of 140 samples before 1 listener independently rated the remainder; phase 3 compared 124 Great Ormond Street Speech Assessment (GOS.SP.ASS’98) records from live assessments with CAPS-A-rated video samples.

Results:

Hypernasality, nasal airflow, and passive cleft speech characteristics were rated to identify signs of velopharyngeal dysfunction across all phases. Phase 1 demonstrated suboptimal correlation, intraclass correlation coefficient (ICC) ranging between 0.39 and 0.72. However, the “modified” CAPS-A consensus listening process in phase 2 achieved a mean ICC of 0.91. Phase 3 revealed only moderate agreement between GOS.SP.ASS’98 and CAPS-A.

Conclusion:

A large data set of speech samples was successfully managed by establishing good interrater reliability on 25% of the data, which calibrated the listeners and validated a decision for only 1 of 2 listeners to rate the remaining speech samples. The recommended implementation of the CAPS-A protocol can therefore be modified for more efficient speech outcome reporting.

Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate

AIMS

Unrepaired clefts still regularly occur in resource-poor countries as a result of limited health-care access. The purpose of the present study was to report resonance, airflow and articulation characteristics following delayed (≥8years) primary palatal closure.

METHODS

Fifteen Ugandan participants with cleft (lip and) palate (CP±L) were included as well as 15 age- and gender-matched Ugandan subjects without clefts. Palatal closure was performed at a mean age of 15;10 years using the Sommerlad technique. Speech evaluations were carried out on a single occasion postoperatively (mean age: 18;10 years). Resonance and nasal airflow were perceptually evaluated and detailed phonetic and phonological assessments were carried out. Additionally, nasalance values were determined.

RESULTS

Nasal emission occurred postoperatively in only 27% (4/15) of the patients, whereas resonance disorders and articulation errors were prevalent in 87% (13/15) of the patient group. Compared with the control group, a significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the CP±L group. Moreover, significantly smaller consonant inventories and significantly more phonetic and phonological disorders were observed.

CONCLUSIONS

Delayed palatal repair (≥8years) seems to be insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders. In order to prevent patients' late presentation at specialized centers, the availability of high quality surgical cleft palate treatment should increase as well as people's awareness of the possibility and importance of early surgical intervention. Moreover, speech therapy following delayed palatal closure would be beneficial. Furthermore, a standardized and validated protocol for speech assessment in future studies is advocated.

The Nature of Error Consistency in Individuals With Acquired Apraxia of Speech and Aphasia

PURPOSE

The primary characteristics used to define acquired apraxia of speech (AOS) have evolved to better reflect a disorder of motor planning/programming. However, there is debate regarding the feature of relatively consistent error location and type.

METHOD

Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia without AOS participated in this study. In the context of a 2-group experimental design, error consistency was examined via 5 repetitions of 30 multisyllabic words. The influence of error rate, severity of impairment, and stimulus presentation condition (blocked vs. random) on error consistency was also explored, as well as between-groups differences in the types of errors produced.

RESULTS

Groups performed similarly on consistency of error location; however, adults with AOS demonstrated greater variability of error type in a blocked presentation condition only. Stimulus presentation condition, error rate, and severity of impairment did not influence error consistency in either group. Groups differed in the production of phonetic errors (e.g., sound distortions) but not phonemic errors.

CONCLUSIONS

Overall, findings do not support relatively consistent errors as a differentiating characteristic of AOS.

Grammatical Language Impairment in Autism Spectrum Disorder: Exploring Language Phenotypes Beyond Standardized Testing

Linguistic and cognitive abilities manifest huge heterogeneity in children with autism spectrum disorder (ASD). Some children present with commensurate language and cognitive abilities, while others show more variable patterns of development. Using spontaneous language samples, we investigate the presence and extent of grammatical language impairment in a heterogeneous sample of children with ASD. Findings from our sample suggest that children with ASD can be categorized into three meaningful subgroups: those with normal language, those with marked difficulty in grammatical production but relatively intact vocabulary, and those with more globally low language abilities. These findings support the use of sensitive assessment measures to evaluate language in autism, as well as the utility of within-disorder comparisons, in order to comprehensively define the various cognitive and linguistic phenotypes in this heterogeneous disorder.

Development of Grammatical Accuracy in English-Speaking Children With Cochlear Implants: A Longitudinal Study

PURPOSE

We sought to evaluate the development of grammatical accuracy in English-speaking children with cochlear implants (CIs) over a 3-year span.

METHOD

Ten children who received CIs before age 30 months participated in this study at 3, 4, and 5 years postimplantation. For the purpose of comparison, 10 children each at ages 3, 4, and 5 years with typical hearing were included as well. All children participated in a story-retell task. We computed percent grammatical communication units (PGCU) in the task.

RESULTS

Children with CIs showed significant improvement in PGCU over the 3-year span. However, they produced lower PGCU than children with typical hearing who had matched hearing age at 4 and 5 years postimplantation. At the individual level, some children with CIs were able to produce PGCU comparable to children with typical hearing as early as 3 years after implantation. Better speech-perception skills at earlier time points were associated with higher PGCU at later time points. Moreover, children with and without CIs showed similar rankings in the types of grammatical errors.

CONCLUSION

Despite having auditory-perceptual and information-processing constraints, children who received CIs before age 30 months were able to produce grammatical sentences, albeit with a delayed pattern.

Diversity matters: parent input predicts toddler verb production

The contribution of parent input to children's subsequent expressive verb diversity was explored in twenty typically developing toddlers with small verb lexicons. Child developmental factors and parent input measures (i.e. verb quantity, verb diversity, and verb-related structural cues) at age 1;9 were examined as potential predictors of children's verb production in spontaneous language samples at age 2;3. Parent verb input diversity, rather than input quantity, was the primary input factor contributing to children's subsequent verb diversity. Regression analysis showed that verb diversity in parent input at age 1;9 accounted for 30% of the variance in children's verb production six months later, with children's total vocabulary size at age 1;9 accounting for an additional 16% of the variance. These findings demonstrate the relative contributions of developmental and input factors to individual differences in toddlers' language development and establish the importance of input diversity to verb acquisition.

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

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

Language Sampling for Preschoolers With Severe Speech Impairments

Purpose

The purposes of this investigation were to determine if measures such as mean length of utterance (MLU) and percentage of comprehensible words can be derived reliably from language samples of children with severe speech impairments and if such measures correlate with tools that measure constructs assumed to be related.

Method

Language samples of 15 preschoolers with severe speech impairments (but receptive language within normal limits) were transcribed independently by 2 transcribers. Nonparametric statistics were used to determine which measures, if any, could be transcribed reliably and to determine if correlations existed between language sample measures and standardized measures of speech, language, and cognition.

Results

Reliable measures were extracted from the majority of the language samples, including MLU in words, mean number of syllables per utterance, and percentage of comprehensible words. Language sample comprehensibility measures were correlated with a single word comprehensibility task. Also, language sample MLUs and mean length of the participants' 3 longest sentences from the MacArthur-Bates Communicative Development Inventory (Fenson et al., 2006) were correlated.

Conclusion

Language sampling, given certain modifications, may be used for some 3-to 5-year-old children with normal receptive language who have severe speech impairments to provide reliable expressive language and comprehensibility information.

Gesture Use in 14-Month-Old Toddlers With Hearing Loss and Their Mothers' Responses

PURPOSE

This study examined the gesture use of 14-month-old toddlers with hearing loss (HL) and mothers' responses to children's early gesture use. Comparisons were made to symbolic language and to dyads in which the toddler had normal hearing (NH).

METHOD

Participants were 25 mother-toddler dyads in which the child had HL and a socioeconomic-status matched group of 23 mother-toddler dyads in which the child had NH. Thirty-minute mother-child interactions were video-recorded, transcribed for spoken language, sign, and gesture use, and coded for maternal responses to children's gestures. Mothers also reported on children's gestural and spoken language abilities.

RESULTS

Toddlers with HL used gesture similarly to their peers with NH, but demonstrated delays in spoken language. Spoken language and gesture were not significantly related for either group. Hearing levels were related to spoken language, but not gesture for the HL group. Maternal and child gesture were only related for signing mothers. Mothers of children with HL were more likely than their counterparts to provide no response to children's gestures.

CONCLUSION

Although toddlers' gesture abilities remain intact in the presence of HL, mothers were not maximally responsive to those gestures and thus should be coached to increase their provision of contingent feedback.