Developmental phonological disorders. I: A clinical profile

Production of the English /ɹ/ by Mandarin-English Bilingual Speakers

Rhotic sounds are some of the most challenging sounds for L2 learners to acquire. This study investigates the production of English rhotic sounds by Mandarin-English bilinguals with two English proficiency levels. The production of the English /ɹ/ by 17 Mandarin-English bilinguals was examined with ultrasound imaging and compared with the production of native English speakers. The ultrasound data show that bilinguals can produce native-like bunched and retroflex gestures, but the distributional pattern of tongue shapes in various contexts differs from that of native speakers. Acoustically, the English /ɹ/ produced by bilinguals had a higher F3 and F3-F2, as well as some frication noise in prevocalic /ɹ/, features similar to the Mandarin /ɹ/. Mandarin-English bilinguals did produce language-specific phonetic realizations for the English and Mandarin /ɹ/s. There was a positive correlation between language proficiency and English-specific characteristics of /ɹ/ by Mandarin-English bilinguals in both articulation and acoustics. Phonetic similarities facilitated rather than hindered L2 speech learning in production: Mandarin-English bilinguals showed better performance in producing the English /ɹ/ allophones that were more similar to the Mandarin /ɹ/ (syllabic and postvocalic /ɹ/s) than producing the English /ɹ/ allophone that was less similar to the Mandarin /ɹ/ (prevocalic /ɹ/). This study contributes to our understanding of the mechanism of speech production in late bilinguals.

Temporal, spectral and amplitude characteristics of the Greek fricative /s/ in hearing-impaired and normal-hearing speech

Fricatives, and especially sibilants, are very frequently misarticulated by speakers with hearing loss. Misarticulations can result in phonemic contrast weakening or loss, compromising intelligibility. The present study focuses on the examination of acoustic characteristics of the Greek alveolar fricative /s/, an articulatorily demanding sound, produced by young adult speakers with profound hearing impairment and with normal hearing. An array of variables was examined using mixed-effects and random forest models aiming to assess the effectiveness of various measures in differentiating hearing-impaired and normal-hearing /s/ production. Significant differences were found in spectral and amplitude measures, but not in temporal measures. In hearing-impaired speech, spectral slope and RMS amplitude had significantly lower values, indicating a more distributed spectrum, suggestive of decreased flow velocity through the fricative constriction. Also, a trend for concentration of energy at lower frequencies was observed suggesting more posterior fricative articulation than normal. Moreover, measures capturing the variation of frequency and amplitude over time revealed different patterns of sibilance development across time than normal, denoting the production of a less well-formed or less sibilant /s/ by speakers with hearing impairment. The investigation of contextual effects on /s/ in hearing-impaired speech showed increased spectral variance, negative skewness and lower kurtosis in the labial (rounded) context /u/ in relation to the nonlabial contexts /i/ and /a/, indicating a more diffuse, less compact spectrum with concentration at high frequencies. Findings are discussed in relation to previous literature on fricative production by speakers with hearing impairment and normal hearing in Greek and other languages.

Revisiting the definition of dyslexia

The International Dyslexia Association definition of dyslexia was updated 20 years ago and has been referenced frequently in research and practice. In this paper, researchers from the Florida Center for Reading Research consider the components of the definition and make recommendations for revisions. These include recognizing the persistence of word-reading, decoding, and spelling difficulties, acknowledging the multifactorial causal basis of dyslexia, clarifying exclusionary factors, and denoting comorbidity with other developmental disorders. It is also suggested that the academic and psychosocial consequences of dyslexia be highlighted to reinforce a preventive service delivery model. Lastly, the inclusion of dyslexia within a specific learning disability category is supported.

Substitution Errors and the Role of Markedness in Bilingual Phonological Acquisition

PURPOSE

The purpose of this study was to (a) provide evidence for a theoretical model of between-language interaction in bilingual phonological production through the examination of substitution error patterns and to (b) provide developmental data on bilingual children with and without speech sound impairments for use in clinical assessment and diagnosis. Through the lens of markedness, or relative featural complexity, patterns of between-language interaction were observed to provide a foundation for clinical decision making in phonological assessment.

METHOD

Seventy children, ages 3;11-6;7 (years; months), participated in this study: 63 typically developing bilingual Spanish-English-speaking children (x¯ = 5;2) and seven bilingual Spanish-English-speaking children with speech sound impairments (x¯ = 4;6). Substitution errors in single-word speech samples were analyzed in relation to their language-specific markedness values in terms of both targets avoided and substitutes produced. Both quantitative and descriptive analyses of substitution errors were performed.

RESULTS

Bilingual children, regardless of impairment status, abided by the phonological rules of their languages in English and Spanish productions. Findings indicated both typically developing children and children with speech sound impairments preferred the use of unmarked sounds that are shared across languages over the use of marked, language-specific sounds.

CONCLUSIONS

Through the examination of substitution errors, evidence of between-language interaction and recognition of relative complexity emerged. These results have implications for clinical assessment and diagnosis of speech sound impairments in bilingual children.

SUPPLEMENTAL MATERIAL AND PRESENTATION VIDEO

https://doi.org/10.23641/asha.24640200.

Effect of Voice and Articulation Parameters of a Home-Based Serious Game for Speech Therapy in Children With Articulation Disorder: Prospective Single-Arm Clinical Trial

BACKGROUND

Articulation disorder decreases the clarity of language and causes a decrease in children's learning and social ability. The demand for non-face-to-face treatment is increasing owing to the limited number of therapists and geographical or economic constraints. Non-face-to-face speech therapy programs using serious games have been proposed as an alternative.

OBJECTIVE

The aim of this study is to investigate the efficacy of home therapy on logopedic and phoniatric abilities in children with articulation disorder using the Smart Speech game interface.

METHODS

This study is a prospective single-arm clinical trial. Children with articulation disorders, whose Urimal Test of Articulation and Phonology (U-TAP) was -2 SDs or less and the Receptive and Expressive Vocabulary Test score was -1 SD or more, were enrolled. A preliminary evaluation (E0) was conducted to check whether the children had articulation disorders, and for the next 4 weeks, they lived their usual lifestyle without other treatments. Prior to the beginning of the training, a pre-evaluation (E1) was performed, and the children trained at home for ≥30 minutes per day, ≥5 times a week, over 4 weeks (a total of 20 sessions). The Smart Speech program comprised oral exercise training, breathing training, and speech training; the difficulty and type of the training were configured differently according to the participants' articulation error, exercise, and vocal ability. After the training, postevaluation (E2) was performed using the same method. Finally, 8 weeks later, postevaluation (E3) was performed as a follow-up. A voice evaluation included parameters such as maximum phonation time (MPT), fundamental frequency (F0), jitter, peak air pressure (relative average perturbation), pitch, intensity, and voice onset time. Articulation parameters included a percentage of correct consonants (PCC; U-TAP word-unit PCC, U-TAP sentence-unit PCC, and three-position articulation test) and alternate motion evaluation (diadochokinesis, DDK). Data obtained during each evaluation (E1-E2-E3) were compared.

RESULTS

A total of 13 children with articulation disorders aged 4-10 years were enrolled in the study. In voice parameters, MPT, jitter, and pitch showed significant changes in repeated-measures ANOVA. However, only MPT showed significant changes during E1-E2 (P=.007) and E1-E3 (P=.004) in post hoc tests. Other voice parameters did not show significant changes. In articulation parameters, U-TAP, three-position articulation test (TA), and DDK showed significant changes in repeated-measures ANOVA. In post hoc tests, U-TAP (word, sentence) and TA showed significant changes during E1-E2 (P=.003, .04, and .01) and E1-E3 (P=.001, .03, and .003), and DDK showed significant changes during E1-E2 only (P=.03).

CONCLUSIONS

Home-based serious games can be considered an alternative treatment method to improve language function.

TRIAL REGISTRATION

Clinical Research Information Service KCT0006448; https://cris.nih.go.kr/cris/search/detailSearch.do/20119.

Neural Changes in Children With Residual Speech Sound Disorder After Ultrasound Biofeedback Speech Therapy

PURPOSE

Children with residual speech sound disorders (RSSD) have shown differences in neural function for speech production, as compared to their typical peers; however, information about how these differences may change over time and relative to speech therapy is needed. To address this gap, we used functional magnetic resonance imaging (fMRI) to examine functional activation and connectivity on adaptations of the syllable repetition task (SRT-Early Sounds and SRT-Late Sounds) in children with RSSD before and after a speech therapy program.

METHOD

Sixteen children with RSSD completed an fMRI experiment before (Time 1) and after (Time 2) a speech therapy program with ultrasound visual feedback for /ɹ/ misarticulation. Progress in therapy was measured via perceptual ratings of productions of untreated /ɹ/ word probes. To control for practice effects and developmental change in patterns of activation and connectivity, 17 children with typical speech development (TD) completed the fMRI at Time 1 and Time 2. Functional activation was analyzed using a region-of-interest approach and functional connectivity was analyzed using a seed-to-voxel approach.

RESULTS

Children with RSSD showed a range of responses to therapy. After correcting for multiple comparisons, we did not observe any statistically significant cross-sectional differences or longitudinal changes in functional activation. A negative relationship between therapy effect size and functional activation in the left visual association cortex was on the SRT-Late Sounds after therapy, but it did not survive correction for multiple comparisons. Significant longitudinal changes in functional connectivity were observed for the RSSD group on SRT-Early Sounds and SRT-Late Sounds, as well as for the TD group on the SRT-Early Sounds. RSSD and TD groups showed connectivity differences near the left insula on the SRT-Late Sounds at Time 2.

CONCLUSION

RSSD and treatment with ultrasound visual feedback may thus be associated with neural differences in speech motor and visual association processes recruited for speech production.

A randomized study of parent- versus child-directed intervention for Dutch toddlers with DLD

BACKGROUND

Indirect speech and language therapy, such as parent-implemented intervention, has been shown to be an effective approach for young children with speech and language disorders. However, relatively few studies have compared outcomes of parent-directed therapy with child-directed intervention, that is, individual therapy of a child delivered by a speech and language therapist (SLT). Although speech and language therapists (SLTs) regard parental engagement as imperative for successful intervention, currently they predominantly use child-directed intervention.

AIM

To evaluate the effect of parent- versus child-directed speech-language therapy embedded in usual care intervention for young children with developmental language disorder (DLD).

METHODS & PROCEDURES

In a randomized trial, forty-six 3-year-old monolingual children with DLD were assigned to parent-directed intervention or child-directed intervention groups. In addition, all children received usual care in special-language daycare centres. Outcomes included children's language development and functional communication, parents' language output, parents' perceptions and their self-efficacy. These were assessed at three time intervals, that is, at baseline, immediately after 6 months of treatment, and 1 year after baseline. The parent-directed intervention consisted of twelve 50-min sessions every 2 weeks with parent and child, consisting of parental training with immediate feedback by (SLTs. Children in the child-directed intervention group received individual speech-language therapy in weekly 30-min sessions for 6 months.

OUTCOMES & RESULTS

Intervention in both groups was equally effective. All children improved significantly in receptive and expressive language measures as well as in functional communication at all intervals. All parents used significantly more language support strategies and were less concerned about their child's participation in communication. Parents in the parent-directed intervention group reported increased self-efficacy in stimulating their child's language development. In contrast, parents in the child-directed intervention group reported a decrease in self-efficacy. Though modest, these group differences were significant in both the short and long terms. Both parents and SLTs were positive about the parent-directed intervention.

CONCLUSIONS & IMPLICATIONS

The effects of parent- and child-directed intervention for young children with DLD are similar. The parent-directed intervention adds to treatment options for parents as well as for SLTs and creates choices for shared decision-making.

WHAT THIS PAPER ADDS

What is already known on the subject Language therapy for young children with DLD comprises various delivery models. Two of these are child- and parent-directed therapy by SLTs. Compared with no treatment, both delivery models are effective, but it is unclear if one of these results in better language outcomes than the other. SLTs value child-directed intervention more highly than indirect approaches where treatment is delivered by others. This study aims to compare the relative effectiveness of parent-directed intervention with child-directed intervention, both parts of multi-component usual care intervention. What this paper adds to existing knowledge This randomized trial indicates that a parent-directed intervention model is as effective as child-directed intervention by SLTs for children's language development and functional communication. Parents' use of language support strategies was also similar in both intervention models, in the short and long terms. Like in child-directed therapy, parent-directed intervention reduces parents' concerns. Contrary to child-directed treatment, parent-directed intervention increases parents' self-efficacy, that is, supporting their child's language development. What are the potential or actual clinical implications of this work? Though SLTs predominantly choose a child-directed intervention model, the study results show that they can consider parent-directed approaches too. There are no significant differences in children's language outcomes as a function of parent- or child-directed intervention. Furthermore, parents and SLTs were positive about the parent-directed intervention program and the SLTs evaluated it as valuable and feasible.

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

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

Shared characteristics of intervention techniques for oral vocabulary and speech comprehensibility in preschool children with co-occurring features of developmental language disorder and a phonological speech sound disorder: protocol for a systematic review with narrative synthesis

INTRODUCTION

Evidence suggests that over one-third of young children with developmental language disorder (DLD) or speech sound disorder (SSD) have co-occurring features of both. A co-occurring DLD and SSD profile is associated with negative long-term outcomes relating to communication, literacy and emotional well-being. However, the best treatment approach for young children with this profile is not understood. The aim of the proposed review is to identify intervention techniques for both DLD and SSD, along with their shared characteristics. The findings will then be analysed in the context of relevant theory. This will inform the content for a new or adapted intervention for these children.

METHODS AND ANALYSIS

This search will build on a previous systematic review by Roulstone et al (2015) but with a specific focus on oral vocabulary (DLD outcome) and speech comprehensibility (SSD outcome). These outcomes were identified by parents and speech and language therapists within the prestudy stakeholder engagement work. The following databases will be searched for articles from January 2012 onwards: Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, Communication Source and ERIC. Two reviewers will independently perform the title/abstract screening and the full-text screening with the exclusion criteria document being revised in an iterative process. Articles written in languages other than English will be excluded. Data will be extracted regarding key participant and intervention criteria, including technique dosage and delivery details. This information will then be pooled into a structured narrative synthesis.

ETHICS AND DISSEMINATION

Ethical approval is not needed for a systematic review protocol. Dissemination of findings will be through peer-reviewed publications, social media, and project steering group networks.

PROSPERO REGISTRATION NUMBER

CRD4202237393.

Where Do You Anchor Your Beliefs? An Invitation to Interrogate Dominant Ideologies of Language and Languaging in Speech-Language Pathology

PURPOSE

Ideologies are like rocks onto which individuals and institutions anchor their thoughts about what it means to be an "ideal language user" and what "standardized languaging" is. These deeply ingrained beliefs, influenced by colonial legacies and sociopolitical contexts, invisibly enforce a hierarchical order between people and their access to rights and privilege within societies. They inferiorize, marginalize, racialize, and nullify students and their families. The purposes of this tutorial are to reflect upon common dominant ideologies about language and languaging that are present in definitions, practices, and materials used in school-based settings by speech-language pathologists (SLPs) and to offer an invitation to interrupt the practices that are birthed from upholding these beliefs and are dehumanizing to children and families living at the intersections of marginalization. To illustrate how these beliefs about language are enacted in the field of speech-language pathology, a selection of materials and approaches are presented and related to their ideological roots while implementing a critical stance.

CONCLUSIONS

Ideologies uphold idealized versions of "normality" and constructions of "deviance." Left unexamined, these beliefs remain encoded in traditionally considered scientific categories, policies, approaches, and materials. Critical reflexivity and action are key in the process of up-anchoring and shifting perspectives for ourselves and our institutions. The hope is that, through this tutorial, SLPs can increase their critical consciousness while envisioning how to interrupt oppressive dominant ideologies and, therefore, conceive of a future path that advocates for liberated languaging.

The Relationship Between Speech Perception, Speech Production, and Vocabulary Abilities in Children: Insights From By-Group and Continuous Analyses

PURPOSE

The purpose of this study was to explore the relationship between speech perception, speech production, and vocabulary abilities in children with and without speech sound disorders (SSDs), analyzing the data both by group and continuously.

METHOD

Sixty-one Australian English-speaking children aged 48-69 months participated in this study. Children's speech production abilities ranged along the continuum from SSDs through to typical speech. Their vocabulary abilities ranged along the continuum from typical to above average ("lexically precocious"). Children completed routine speech and language assessments in addition to an experimental Australian English lexical and phonetic judgment task.

RESULTS

When analyzing data by group, there was no significant difference between the speech perception ability of children with SSDs and that of children without SSDs. Children with above-average vocabularies had significantly better speech perception ability than children with average vocabularies. When analyzing data continuously, speech production and vocabulary were both significant positive predictors of variance in speech perception ability, both individually in simple linear regression and when combined in multiple linear regression. There was also a significant positive correlation between perception and production of two of the four target phonemes tested (i.e., /k/ and /ʃ/) among children in the SSD group.

CONCLUSIONS

Results from this study provide further insight into the complex relationship between speech perception, speech production, and vocabulary abilities in children. While there is a clinical and important need for categorical distinctions between SSDs and typically developing speech, findings further highlight the value of investigating speech production and vocabulary abilities continuously and categorically. By capturing the heterogeneity among children's speech production and vocabulary abilities, we can advance our understanding of SSDs in children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22229674.

Complexity and cross-linguistic transfer in intervention for Spanish–English bilingual children with speech sound disorder

With bilingual children, intervention for speech sound disorders must consider both of the child’s phonological systems, which are known to interact with each other in development. Further, cross-linguistic generalization following intervention for bilingual children with speech sound disorders (i.e. the impact of treatment in one language on the other) has been documented to varying degrees in some prior studies. However, none to date have documented the cross-linguistic impact of treatment with complex targets (e.g. consonant clusters) for bilingual children. Because complex phonological targets have been shown to induce system-wide generalization within a single language, the potential for bilingual children to generalize learning across languages could impact the efficiency of intervention in this population. This pilot intervention study examines the system-wide, cross-linguistic effects of treatment targeting consonant clusters in Spanish for two Spanish–English bilingual children with phonological disorder. Treatment was provided with 40-minute sessions in Spanish via teletherapy, three times per week for six weeks. Comprehensive phonological probes were administered in English and Spanish prior to intervention and across multiple baselines. Pre-intervention data were compared to data from probes administered during and after intervention to generate qualitative and quantitative measures of treatment outcomes and cross-linguistic generalization. Results indicate a medium effect size for system-wide generalization in Spanish (the language of treatment) and English (not targeted in treatment), for both participants (mean effect size in Spanish: 3.6; English 4.3). These findings have implications for across-language transfer and system-wide generalization in treatment for bilingual children. 

Consonant Age of Acquisition Reveals Nonlinear Effects in Nonword Repetition Performance

Recent work has shown significant sublexical effects of long-term memory in nonword repetition (NWR) using a dichotomous consonant age of acquisition (CAoA) variable (Moore, 2018; Moore, Fiez, and Tompkins, 2017). Performance consistently decreased when stimuli comprised consonants acquired later versus earlier in speech development. To address potential confounds related to stimulus design and linearity, the purpose of this study was to test whether performance decreases as the CAoA value of stimuli increases in various linguistic tasks using a continuous CAoA variable. Thirty-one college students completed NWR and other linguistic tasks in which the stimuli varied in average CAoA values. Data were analyzed using multilevel modeling. After accounting for phonotactic probability, CAoA was a statistically significant predictor of performance across the models reported. The relationship was more complex in some of the models in which CAoA showed a statistically significant nonlinear relationship with the outcome measure. Results from this study support previous work showing that CAoA affects performance on NWR and other linguistic tasks that vary in their memory, auditory perceptual, and articulatory demands. Importantly, this line of work was extended here by demonstrating that the CAoA effect is robust across novel stimulus sets and study designs, and may be more complex than previously understood when using a dichotomous CAoA variable. Quadratic results suggest that the CAoA variable has a differential effect on performance for low to moderate CAoA values, but for higher CAoA values the effect is similarly negative. The nonlinear relationship between CAoA and measures of speed and accuracy on some of the tasks warrants further study into the complex relationship between various predictive factors that contribute to language performance.

Spectral degradation influences phonological memory in typically hearing adults

Phonological processing is a fundamental component of language, can be impaired in people with hearing loss, and involves several confounded subprocesses. The purpose of this study was to systematically examine several phonological subprocesses - i.e., the spectral quality of auditory input and phonological short-term and long-term memory - in order to better understand how they interact with one another in basic linguistic tasks. Using an experimental, within-subjects design, 30 typically-hearing adults completed nonword repetition (NWR) and auditory lexical decision (ALD) tasks varying in spectral quality (normal versus spectrally-degraded), consonant age of acquisition (CAoA; i.e. early-acquired versus late-acquired consonants), syllable length (NWR task), and lexical status (ALD task). In NWR, spectral degradation muted the word length effect, though performance differed depending on how familiar participants were with the degraded stimuli. ALD findings showed that the magnitude of the degradation effect varied between stimuli comprising early-acquired versus late-acquired consonants. The robust effect of spectral degradation on phonological short-term and long-term memory provides a model of the interactive nature of these subprocesses in typical adults. Future work with populations with hearing loss can provide a comparison to help understand how the typical and clinical phonological systems differ.

Interventions for pre-school children with co-occurring phonological speech sound disorder and expressive language difficulties: A scoping review

BACKGROUND

Recent evidence suggests that pre-school children with co-occurring phonological speech sound disorder (SSD) and expressive language difficulties are at a higher risk of ongoing communication and literacy needs in comparison with children with these difficulties in isolation. However, to date there has been no systematic or scoping review of the literature specific to interventions for children with this dual profile.

AIMS

To explore the evidence regarding interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties, including the content/delivery of such interventions, areas of speech and language targeted, and a broad overview of study quality.

METHODS & PROCEDURES

A scoping review methodology was used in accordance with the guidance from the Joanna Briggs Institute. Following a systematic search of Ovid Medline, Ovid Emcare, OVID Embase, CINAHL, Psychinfo and ERIC, 11 studies were included in the review. A researcher-developed data extraction form was used to extract specific information about each intervention, with the JBI appraisal tools used to provide a broad overview of the quality of each study.

MAIN CONTRIBUTION

Included papers consisted of six randomized controlled trials (RCTs), two cohort studies, two case studies and one case series. Interventions fell into two main categories: (1) integrated interventions that combined content for both speech and language targets and/or explicitly used the same type of technique to improve both domains; and (2) single-domain interventions that explicitly included content to target speech or language only, but also aimed to improve the other domain indirectly. Study quality varied, with detail on the content, context and delivery of interventions often underspecified, hampering the replication and clinical applicability of findings.

CONCLUSIONS & IMPLICATIONS

Early emerging evidence was identified to support both integrated speech and language interventions as well as single-domain interventions. However, caution should be exercised due to the variation in the quality and level of detail reported for the interventions. Future intervention studies may seek to address this by reporting in accordance with Template for Intervention Description and Replication (TIDieR) reporting guidelines. This approach would enable clinicians to consider the applicability of the intervention to individual children within differing settings.

WHAT THIS PAPER ADDS

What is already known on the subject Pre-school children with co-occurring phonological SSD and expressive language difficulties frequently present within speech and language therapy services. These children are at a higher risk of long-term communication and literacy difficulties compared with children with these needs in isolation. Some emerging evidence suggests that interventions for children with this co-occurring profile may exist within the literature; however, this evidence may not be known to clinicians in everyday practice. What this paper adds to existing knowledge This review is the first to systematically examine evidence of interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties. The review identified a small number of intervention studies that varied in research quality and level of detail provided regarding the content and delivery of interventions. What are the potential or actual clinical implications of this work? The findings of this study highlight published evidence for interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties. These may take the form of integrating techniques for speech/language into a single intervention, or the explicit targeting of one domain with the aim of also influencing the other. However, there is a need for further high-quality research in this area. Such studies should provide sufficient detail to enable replication. This would enable clinicians to understand the relevance and applicability of such intervention findings to the individual children they see within their clinical practice.

Rapid naming ability in adults with stuttering

The investigation of phonological encoding abilities in persons with stuttering has gained importance recently. There is limited information available on the rapid automatized naming ability in adults with stuttering. In the present study, rapid naming ability was assessed in 32 persons with stuttering and 32 persons without stuttering in the age range of 18-30 years on Rapid Automatized Naming and Rapid Alternating Stimulus test. The study findings indicated that the persons with stuttering took a longer time to complete the tasks as compared to persons without stuttering, suggestive of a possible breakdown in phonological encoding ability. Among the subtasks, the longer completion time was observed for the rapid alternating stimulus 3-set task and the color subtasks. The findings of the study clearly propose the need to encompass rapid naming skills, as a part of the assessment and management protocol for individuals with stuttering.

The Bouba-Kiki Effect in Children With Childhood Apraxia of Speech

PURPOSE

The bouba-kiki (BK) effect refers to associations between visual shapes and auditory pseudonames. Thus, when tested, people tend to associate the pseudowords bouba and kiki with round or spiky shapes, respectively. This association requires cross-modal sensory integration. The ability to integrate information from different sensory modalities is crucial for speech development. A clinical population that may be impaired in cross-modal sensory integration is children with childhood apraxia of speech (CAS). The purpose of this study was to examine the involvement of cross-modal sensory integration in children with (CAS).

METHOD

The BK effect was assessed in participants with CAS (n = 18) and two control groups: One control group was composed of children with developmental language disorder (DLD), also termed specific language impairment (n = 15), and a second group included typically developing (TD) children (n = 22). The children were presented with 14 pairs of novel visual displays and nonwords. All the children were asked to state which shape and nonword correspond to one another. In addition, background cognitive (Leiter-3) and language measures (Hebrew PLS-4) were determined for all children.

RESULTS

Children in the CAS group were less successful in associating between visual shapes and corresponding auditory pseudonames (e.g., associating the spoken word "bouba" with a round shape; the spoken word "kiki" with a spiky shape). Thus, children with CAS demonstrated a statistically significant reduced BK effect compared with participants with TD and participants with DLD. No significant difference was found between the TD group and the DLD group.

CONCLUSIONS

The reduced BK effect in children with CAS supports the notion that cross-modal sensory integration may be altered in these children. Cross-modal sensory integration is the basis for speech production. Thus, difficulties in sensory integration may contribute to speech difficulties in CAS.

Validation of the pediatric Radboud Dysarthria Assessment

PURPOSE

The Radboud Dysarthria Assessment (RDA) was published in 2014. Adaptation into a pediatric version (p-RDA) was required because of relevant differences between children and adults. The purpose of this study was to assess the feasibility of the p-RDA and to test intra-rater and inter-rater reliability as well as the validity of the two severity scales (function and activity level).

METHODS

Video recordings were made of 35 participants with (suspected) dysarthria (age 4 to 17 years) while being assessed using the p-RDA. Intra-rater reliability was assessed by one, and inter-rater reliability by two experiments using the Intraclass Correlation Coefficient (ICC). Validity of the severity scales was tested by correlating the consensus scores with the independently rated scores on four communication scales, three mobility scales, and one self-care scale using Spearman correlation coefficients (rs).

RESULTS

The assessment was applicable for 89% of the tested sample, with good intra-rater and inter-rater reliability (ICC = 0.88-0.98 and 0.83-0.93). The p-RDA severity scales (function and activity level) correlated from substantially to strongly with the communication scales (rs = 0.69-0.82 and 0.77-0.92) and self-care scale (rs = 0.76-0.71) and correlated substantially with the mobility scales (rs = 0.49-0.60).

CONCLUSION

The feasibility, reliability and validity of the p-RDA are sufficient for clinical use.

Phonological Profile of Patients With Velopharyngeal Dysfunction and Palatal Anomalies

PURPOSE

This purpose of this study was to assess the frequency and types of phonological process errors in patients with velopharyngeal dysfunction (VPD) and the different types of palatal anomalies.

METHOD

A total of 808 nonsyndromic patients with VPD, who underwent follow-up at the Center for Cleft Palate and Craniofacial Anomalies, from 2000 to 2016 were included. Patients were stratified into four age groups and five subphenotypes of palatal anomalies: cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), and non-CP. Phonological processes were compared among groups.

RESULTS

The 808 patients ranged in age from 3 to 29 years, and 439 (54.3%) were male. Overall, 262/808 patients (32.4%) had phonological process errors; 80 (59.7%) ages 3-4 years, 98 (40, 0%) ages 4.1-6 years, 48 (24.7%) 6.1-9 years, and 36 (15.3%) 9.1-29 years. Devoicing was the most prevalent phonological process error, found in 97 patients (12%), followed by cluster reduction in 82 (10.1%), fronting in 66 (8.2%), stopping in 45 (5.6%), final consonant deletion in 43 (5.3%), backing in 30 (3.7%), and syllable deletion and onset deletion in 13 (1.6%) patients. No differences were found in devoicing errors between palatal anomalies, even with increasing age. Phonological processes were found in 61/138 (44.20%) with CP, 46/118 (38.1%) with SMCP, 61/188 (32.4%) with non-CP, 70/268 (26.1%) with OSMCP, and 25/96 (26.2%) with CLP. Phonological process errors were most frequent with CP and least with OSMCP (p = .001).

CONCLUSIONS

Phonological process errors in nonsyndromic VPD patients remained relatively high in all age groups up to adulthood, regardless of the type of palatal anomaly. Our findings regarding the phonological skills of patients with palatal anomalies can help clarify the etiology of speech and sound disorders in VPD patients, and contribute to general phonetic and phonological studies.

Collaboration Between Child Play Therapy and Speech-Language Pathology: Case Reports of a Novel Language and Behavior Intervention

Purpose It has been well documented that a significant number of children with developmental language disorders (DLDs) also exhibit challenging behaviors. In this study, a new intervention (Play and Language [PAL]) was developed through a research collaboration between a speech-language pathologist and a play therapist. The purpose of this clinical focus article is to describe child play therapy techniques and how these, along with early language intervention techniques, may positively impact preschool children's general communication and behavior. Method Students in a communication sciences and disorders program were trained to use a combination of child therapy techniques and language facilitation procedures in the PAL approach. Five preschool children, who displayed DLD and challenging behaviors, participated in a 2-week daily intensive intervention. Pre- and postintervention data for general communication and behavior skills were collected through parent report and language sample data. Student clinician and parent surveys were collected to assess the feasibility of conducting the new intervention and the parent-observed outcomes and satisfaction. Results A majority of the children who participated in the study increased their intelligibility and number of different words. Fewer than half increased their sentence length. These same children decreased their challenging behaviors, with 11 of 14 behaviors being reduced to normal levels. All parents reported satisfaction with their child's results. In addition, students trained to provide the intervention reported high levels of satisfaction with the training to implement PAL and that they were confident in providing the intervention techniques. Conclusion Together, our exploratory data provide preliminary and limited evidence that combining play therapy and language facilitation techniques may improve general communication skills and decrease challenging behaviors within the same intervention. Supplemental Material https://doi.org/10.23641/asha.16840459.

Phonological Measures for Bilingual Spanish-English-Speaking Preschoolers: The Language Combination Effect

Purpose The purpose of this study was to examine the diagnostic accuracy of traditional measures of phonological ability developed for monolingual English-speaking children with their bilingual peers in both English and Spanish. We predicted that a composite measure, derived from a combination of English and Spanish phonological measures, would result in higher diagnostic accuracy than examining the individual phonological measures of bilingual children separately by language. Method Sixty-six children, ages 3;3-6;3 (years;months), participated in this study: 29 typically developing bilingual Spanish-English-speaking children (x = 5;3), five bilingual Spanish-English-speaking children with speech sound disorders (x = 4;6), 26 typically developing monolingual English-speaking children (x = 4;8), and six monolingual English-speaking children with speech sound disorders (x = 4;9). Children were recorded producing single words using the Assessments of English and Spanish Phonology, and productions were phonetically transcribed and analyzed using the Logical International Phonetics Program. Overall consonants correct-revised; accuracy of early-, middle-, and late-developing sounds; and percent occurrence of phonological error patterns in both English and Spanish were calculated. Receiver operating characteristic curves and support vector machine models were applied to observe diagnostic accuracy, separately and combined, for each speaker group and each language. Results Findings indicated the combination of measures improved diagnostic accuracy within both the English and Spanish of bilingual children and significantly increased accuracy when measures from both languages of bilingual children were combined. Combining measures for the productions of monolingual English-speaking children did not increase diagnostic accuracy. Conclusion To prevent misdiagnosis of speech sound disorders in bilingual preschoolers, the composite phonological abilities of bilingual children need to be assessed across both gross and discrete measures of phonological ability. Supplemental Material https://doi.org/10.23641/asha.16632604.

Icelandic Children's Acquisition of Consonants and Consonant Clusters

Purpose This study investigated Icelandic-speaking children's acquisition of singleton consonants and consonant clusters. Method Participants were 437 typically developing children aged 2;6-7;11 (years;months) acquiring Icelandic as their first language. Single-word speech samples of the 47 single consonants and 45 consonant clusters were collected using Málhljóðapróf ÞM (ÞM's Test of Speech Sound Disorders). Results Percentage of consonants correct for children aged 2;6-2;11 was 73.12 (SD = 13.33) and increased to 98.55 (SD = 3.24) for children aged 7;0-7;11. Overall, singleton consonants were more likely to be accurate than consonant clusters. The earliest consonants to be acquired were /m, n, p, t, j, h/ in word-initial position and /f, l/ within words. The last consonants to be acquired were /x, r, r̥, s, θ, n̥/, and consonant clusters in word-initial /sv-, stl-, str-, skr-, θr-/, within-word /-ðr-, -tl-/, and word-final /-kl̥, -xt/ contexts. Within-word phonemes were more often accurate than those in word-initial position, with word-final position the least accurate. Accuracy of production was significantly related to increasing age, but not sex. Conclusions This is the first comprehensive study of consonants and consonant cluster acquisition by typically developing Icelandic-speaking children. The findings align with trends for other Germanic languages; however, there are notable language-specific differences of clinical importance.

The Challenge of Rich Vocabulary Instruction for Children With Developmental Language Disorder

Purpose The aims of the study were to explore responses of children with developmental language disorder (DLD) to rich vocabulary instruction and to identify potential factors that contribute to outcomes. Method Children with DLD participated in a language intervention embedded within a science camp. Using parent and clinician reports, standardized tests, probes, notes, and video, we derived descriptions of seven of the campers who received a vocabulary intervention that incorporated principles of rich instruction. We present them here as a case series. Results Five cases responded to the intervention with modest gains in Tier 2 science vocabulary and science knowledge. One case demonstrated no response, and another was unable to complete the intervention. The latter two cases presented with triple risks: DLD, executive function deficits, and stressors associated with poverty. In comparison, the best responder also lived in poverty and had DLD, but he had intact executive function, strengths in extant vocabulary, stronger knowledge of science, better engagement in the science and language intervention activities, and was older. Other factors that seemed to contribute to outcomes included the complexity of the word forms and dosage. Conclusions Translating research on rich instruction to clinical practice is challenging. This case series motivated hypotheses about the nature of the challenge and what to do about it, the primary one being that the modest success of rich vocabulary instruction for children with DLD is not a limitation of the approach itself but rather a reflection of the difficulty of delivering the intervention while tailoring the targets, approach, and dosage to the needs of individual children with DLD. Supplemental Material https://doi.org/10.23641/asha.13667699.

Family environmental risk factors for developmental speech delay in children in Northern China

Most reported risk factors for developmental speech delay (DSD) remain controversial, and studies on paternal influencing factors are rare. This study investigated family environmental risk factors for DSD in northern China. The medical records of 276 patients diagnosed with DSD at four centres between October 2018 and October 2019 were retrospectively analysed. A questionnaire was designed that contained items such as maternal age at the child’s birth, child sex, child age, birth order, family type and parental personality. Patients whose medical records lacked complete information for this investigation were contacted by e-mail or phone. Additionally, 339 families whose children received routine physical examinations at the four involved centres completed the survey. Data were collected, and potential risk factors were analysed using the t test or chi-square test; the obtained outcomes were subjected to multivariable logistic regression for further analysis. The multivariable regression showed that older maternal age at the child’s birth (OR = 1.312 (1.192–1.444), P < 0.001), introverted paternal personality (OR = 0.023 (0.011–0.048), P < 0.001), low average parental education level (OR = 2.771 (1.226–6.263), P = 0.014), low monthly family income (OR = 4.447 (1.934–10.222), P < 0.001), and rare parent–child communication (OR = 6.445 (3.441–12.072), P < 0.001) were independent risk factors for DSD in children in North China. The study results may provide useful data for broadening and deepening the understanding of family risk factors for DSD.

Identification of the factors associated with the severity of the speech production problems in children with comorbid speech sound disorder and developmental language disorder

It has been suggested that factors such as auditory perception, oral motor skills, phonological awareness, and working memory are all associated with speech production problems in children with speech sound disorder (SSD) and developmental language disorder (DLD). However, it remains unclear whether the severity of the speech production problems in these children can be explained by an interaction among the aforementioned factors. The aim of this study was to determine which of these four factors best explain the severity of the speech production problems in children with SSD and DLD and whether an interaction between factors occurs. Forty-one children with SSD and DLD between 5 and 5;11 years old were selected. The number of phonological process errors was used as a measure of the severity of the speech production problems. The association between the number of phonological process errors and performance in auditory perception, oral motor skills, phonological awareness, and working memory along with the severity of the DLD was explored using univariate and multivariate regression models (with and without an interaction term). The results showed that the number of phonological process errors was largely explained by working memory and phonological awareness. An interaction between these two factors was also found. This means that working memory and phonological awareness interact to have an effect on the number of phonological process errors that is more than the sum of their parts. In addition, the severity of the DLD was significantly associated with the number of phonological process errors. These findings suggest that phonological awareness and working memory should be considered when assessing and treating children with comorbid SSD and DLD.

The BioVisualSpeech Corpus of Words with Sibilants for Speech Therapy Games Development

In order to develop computer tools for speech therapy that reliably classify speech productions, there is a need for speech production corpora that characterize the target population in terms of age, gender, and native language. Apart from including correct speech productions, in order to characterize the target population, the corpora should also include samples from people with speech sound disorders. In addition, the annotation of the data should include information on the correctness of the speech productions. Following these criteria, we collected a corpus that can be used to develop computer tools for speech and language therapy of Portuguese children with sigmatism. The proposed corpus contains European Portuguese children’s word productions in which the words have sibilant consonants. The corpus has productions from 356 children from 5 to 9 years of age. Some important characteristics of this corpus, that are relevant to speech and language therapy and computer science research, are that (1) the corpus includes data from children with speech sound disorders; and (2) the productions were annotated according to the criteria of speech and language pathologists, and have information about the speech production errors. These are relevant features for the development and assessment of speech processing tools for speech therapy of Portuguese children. In addition, as an illustration on how to use the corpus, we present three speech therapy games that use a convolutional neural network sibilants classifier trained with data from this corpus and a word recognition module trained on additional children data and calibrated and evaluated with the collected corpus.

Auditory Perception and Ultrasound Biofeedback Treatment Outcomes for Children With Residual /ɹ/ Distortions: A Randomized Controlled Trial

Purpose This study evaluated whether outcomes from treatment, which includes ultrasound visual feedback (UVF), would be more or less effective when combined with auditory perception training for children with residual /ɹ/ errors. Method Children ages 8-16 years with /ɹ/ distortions participated in speech therapy that included real-time UVF of the tongue. Thirty-eight participants were randomized to speech therapy conditions that included a primary focus on articulation using UVF or a condition that included auditory perceptual training plus UVF (incorporating category goodness judgments and self-monitoring). Generalization of /ɹ/ production accuracy to untrained words was assessed before and after 14 hr of therapy. Additionally, the role of auditory perceptual acuity was explored using a synthetic /ɹ/-/w/ continuum. Results There was no difference between the treatment groups in rate of improvement of /ɹ/ accuracy (increase of 34% for each group; p = .95, η_p² = .00). However, pretreatment auditory acuity was associated with treatment progress in both groups, with finer perceptual acuity corresponding to greater progress (p = .015, η_p² = .182). Conclusion Similar gains in speech sound accuracy can be made with treatment that includes UVF with or without auditory perceptual training. Fine-grained perceptual acuity may be a prognostic indicator with treatment. Supplemental Material https://doi.org/10.23641/asha.11886219.

Performance of Children With Hearing Loss on an Audiovisual Version of a Nonword Repetition Task

Purpose The aims of this study were to (a) determine if a high-quality adaptation of an audiovisual nonword repetition task can be completed by children with wide-ranging hearing abilities and to (b) examine whether performance on that task is sensitive to child demographics, hearing status, language, working memory, and executive function abilities. Method An audiovisual version of a nonword repetition task was adapted and administered to 100 school-aged children grouped by hearing status: 35 with normal hearing, 22 with mild bilateral hearing loss, 17 with unilateral hearing loss, and 26 cochlear implant users. Participants also completed measures of vocabulary, working memory, and executive function. A generalized linear mixed-effects model was used to analyze performance on the nonword repetition task. Results All children were able to complete the nonword repetition task. Children with unilateral hearing loss and children with cochlear implants repeated nonwords with less accuracy than normal-hearing peers. After adjusting for the influence of vocabulary and working memory, main effects were found for syllable length and hearing status, but no interaction effect was observed. Conclusions The audiovisual nonword repetition task captured individual differences in the performance of children with wide-ranging hearing abilities. The task could act as a useful tool to aid in identifying children with unilateral or mild bilateral hearing loss who have language impairments beyond those imposed by the hearing loss.

Sexual Dimorphism Within Brain Regions Controlling Speech Production

Neural processing of speech production has been traditionally attributed to the left hemisphere. However, it remains unclear if there are structural bases for speech functional lateralization and if these may be partially explained by sexual dimorphism of cortical morphology. We used a combination of high-resolution MRI and speech-production functional MRI to examine cortical thickness of brain regions involved in speech control in healthy males and females. We identified greater cortical thickness of the left Heschl's gyrus in females compared to males. Additionally, rightward asymmetry of the supramarginal gyrus and leftward asymmetry of the precentral gyrus were found within both male and female groups. Sexual dimorphism of the Heschl's gyrus may underlie known differences in auditory processing for speech production between males and females, whereas findings of asymmetries within cortical areas involved in speech motor execution and planning may contribute to the hemispheric localization of functional activity and connectivity of these regions within the speech production network. Our findings highlight the importance of consideration of sex as a biological variable in studies on neural correlates of speech control.

Profiling Speech Sound Disorders for Clinical Validation of the Computer Articulation Instrument

Purpose The current article presents data from 2 studies on clinical groups of children referred for speech assessment. The aims of these studies are to validate the Computer Articulation Instrument (CAI) with the known-group validation method and to determine the differential diagnostic power of the resulting speech profiles. Method Study 1 examined known-group validity by comparing the scores of 93 children diagnosed with speech-language difficulties on the picture naming (PN) task of the CAI with intelligibility judgments given by speech-language pathologists. In Study 2, the speech profiles of 41 children diagnosed with speech sound disorders (SSDs), consisting of 4-6 factor scores extracted from the 4 tasks of the CAI, namely, PN, nonword imitation (NWI), word and nonword repetition, and maximum repetition rate (MRR), were validated against clinical judgments of severity of the SSD given by speech-language pathologists. Results In Study 1, a repeated-measures analysis of variance revealed a significant effect of intelligibility level on the PN performance of the CAI and there were highly significant correlations between intelligibility and PN performance in the expected direction. Neither intelligibility level nor PN performance was related to nonverbal intelligence and language scores. The analysis of variance and a series of t tests in Study 2 revealed significant differences between the moderate and severe groups for the CAI factors based on PN and NWI and the bisyllabic and trisyllabic sequences of MRR, but not for the factor word and nonword proportion of whole-word variability based on word and nonword repetition, and the monosyllabic sequences of MRR. These results suggest that, especially, the tasks PN, NWI, and the bisyllabic and trisyllabic sequences of MRR are most sensitive for diagnosing SSDs. Conclusions The findings of these 2 studies support the known-group validity of the CAI. Together with the results of a previous study of our group on reliability and validity ( van Haaften et al., 2019 ), we can conclude that the CAI is a reliable and valid tool for assessment of children with SSDs.

Nonword Repetition Across Two Dialects of English: Effects of Specific Language Impairment and Nonmainstream Form Density

Purpose Nonword repetition (NWR) has been proposed as a culturally and linguistically fair measure of children's language abilities that is useful for the identification of specific language impairment (SLI). However, Moyle, Heilmann, and Finneran (2014) suggested that the density of a child's nonmainstream forms also influences NWR in ways that could complicate its use. Using speakers of either African American English (AAE) or Southern White English (SWE), we asked if NWR performance differed in children with SLI and same dialect-speaking typically developing (TD) children and if nonmainstream form density impacted their scores. Method The participants were 106 kindergartners (AAE: SLI n = 35; TD n = 35; SWE: SLI n = 18; TD n = 18; groups matched for age and IQ) who performed the NWR task of Dollaghan and Campbell (1998) . Nonmainstream form density measures were gathered from listener judgments of conversational samples. Results NWR performance differed between those with and without SLI, but the difference was smaller in AAE than in SWE, especially at the longest syllable length. Nonmainstream form density was found to further explain NWR performance beyond the children's SLI status for AAE speakers; density and SLI status were confounded for the SWE speakers, making it harder to disentangle the effects of each in that dialect. Conclusions Results indicate the NWR may differ in diagnostic utility between speakers of different dialects. Results also support Moyle et al.'s (2014) finding that density affects NWR. Thus, NWR is more sensitive to dialectal differences than originally assumed.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Standardized Tests and the Diagnosis of Speech Sound Disorders

Purpose

The purpose of this tutorial is to provide speech-language pathologists with the knowledge and tools to (a) evaluate standardized tests of articulation and phonology and (b) utilize criterion-referenced approaches to assessment in the absence of psychometrically strong standardized tests.

Method

Relevant literature on psychometrics of standardized tests used to diagnose speech sound disorders in children is discussed. Norm-referenced and criterion-referenced approaches to assessment are reviewed, and a step-by-step guide to a criterion-referenced assessment is provided. Published criterion references are provided as a quick and easy resource guide for professionals.

Results

Few psychometrically strong standardized tests exist for the evaluation of speech sound disorders for monolingual and bilingual populations. The use of criterion-referenced testing is encouraged to avoid diagnostic pitfalls.

Discussion

Speech-language pathologists who increase their use of criterion-referenced measures and decrease their use of standardized tests will arrive at more accurate diagnoses of speech sound disorders.

Estimates of the prevalence of speech and motor speech disorders in adolescents with Down syndrome

Although there is substantial rationale for a motor component in the speech of persons with Down syndrome (DS), there presently are no published estimates of the prevalence of subtypes of motor speech disorders in DS. The goal of this research is to provide initial estimates of the prevalence of types of speech disorders and motor speech disorders in adolescents with DS. Conversational speech samples from a convenience sample of 45 adolescents with DS, ages 10 to 20 years old, were analysed using perceptual and acoustic methods and measures in the Speech Disorders Classification System (SDCS). The SDCS cross-classified participants into five mutually exclusive speech classifications and five mutually exclusive motor speech classifications. For participants meeting criteria for Childhood Dysarthria or for Childhood Dysarthria concurrent with Childhood Apraxia of Speech, the SDCS provided information on participants' percentile status on five subtypes of dysarthria. A total of 97.8% of participants met SDCS criteria for Speech Disorders and 97.8% met criteria for Motor Speech Disorders, including Childhood Dysarthria (37.8%), Speech Motor Delay (26.7%), Childhood Dysarthria and Childhood Apraxia of Speech (22.2%), and Childhood Apraxia of Speech (11.1%). Ataxia was the most prevalent dysarthria subtype. Nearly all participants with DS in the present sample had some type of speech and motor speech disorder, with implications for theory, assessment, prediction, and treatment. Specific to treatment, the present findings are interpreted as support for motor speech disorders as a primary explanatory construct to guide the selection and sequencing of treatment targets for persons with DS. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; DS: Down syndrome; NSA: Normal(ized) Speech Acquisition; PSD: Persistent Speech Delay; PSE: Persistent Speech Errors; SD: Speech Delay; SDCS: Speech Disorders Classification System; SE: Speech Errors; SMD: Speech Motor Delay.

Prosody perception and production by children with cochlear implants

The perception and production of emotional and linguistic (focus) prosody were compared in children with cochlear implants (CI) and normally hearing (NH) peers. Thirteen CI and thirteen hearing-age-matched school-aged NH children were tested, as baseline, on non-verbal emotion understanding, non-word repetition, and stimulus identification and naming. Main tests were verbal emotion discrimination, verbal focus position discrimination, acted emotion production, and focus production. Productions were evaluated by NH adult Dutch listeners. All scores between groups were comparable, except a lower score for the CI group for non-word repetition. Emotional prosody perception and production scores correlated weakly for CI children but were uncorrelated for NH children. In general, hearing age weakly predicted emotion production but not perception. Non-verbal emotional (but not linguistic) understanding predicted CI children's (but not controls') emotion perception and production. In conclusion, increasing time in sound might facilitate vocal emotional expression, possibly requiring independently maturing emotion perception skills.

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.

An Application of Network Science to Phonological Sequence Learning in Children With Developmental Language Disorder

PURPOSE

Network science has been a valuable tool in language research for investigating relationships between complex linguistic elements but has not yet been applied to sound sequencing in production. In the present work, we used standard error-based accuracy and articulatory kinematic approaches as well as novel measures from network science to evaluate variability and sequencing errors in speech production in children with developmental language disorder (DLD; aka specific language impairment).

METHOD

Twelve preschoolers with DLD and 12 age-matched controls participated in a 3-day novel word learning study. Transcription and articulatory movement data were collected to measure accuracy and variability of productions, and networks of speech productions were generated to analyze syllable co-occurrence patterns.

RESULTS

Results indicated that children with DLD were less accurate than children with typical language at the segmental level. Crucially, these findings did not align with performance at the articulatory level, where there were no differences in movement variability between children with DLD and those with typical language. Network analyses revealed characteristics that were not captured by standard measures of phonetic accuracy, including a larger inventory of syllable forms, more connections between the forms, and less consistent production patterns.

CONCLUSIONS

Network science provides significant insights into phonological learning trajectories in children with DLD and their typically developing peers. Importantly, errors in word production by children with DLD do not surface as a result of weakness in articulatory control. Instead, results suggest that speech errors in DLD may relate to deficits in sound sequencing.

Realisation of grammatical morphemes by children with phonological impairment

The aim of this research was to explore how preschool-aged children with phonological impairment (PI) realise grammatical morphemes across different phonological contexts (i.e. singleton consonant, consonant cluster, syllable), conditions of finiteness and individual morpheme types. Factors accounting for children's realisation of grammatical morphemes were also examined. Eighty-seven Australian English-speaking preschoolers (aged 4-5 years) with PI completed the Children's Assessment of Morphophonology (CHAMP)-an elicited response task-in addition to standardised tests of speech and receptive language. The most challenging grammatical morphemes were finite morphemes (particularly past tense) and grammatical morphemes realised in consonant clusters. The ability to produce consonant clusters in single words significantly accounted for children's ability to realise grammatical morphemes, regardless of whether grammatical morphemes were realised in singleton, consonant cluster or syllable contexts. Realisation of grammatical morphemes by preschoolers with PI is influenced by phonological and morphological factors. The findings have implications regarding the assessment and differential diagnosis of preschoolers with concomitant phonological and language difficulties.

Integrating Pediatric Hypnosis with Complementary Modalities: Clinical Perspectives on Personalized Treatment

While pediatric integrative medicine (PIM) emphasizes an "evidence-based practice using multiple therapeutic modalities"; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind⁻body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches in children and youth are scarce. Nevertheless, integrative practitioners in clinical practice routinely mix approaches to meet the individual needs of each patient. Best practices are flexible, and include blending and augmenting services within the same session, and/or connecting modalities sequentially for an incremental effect, and/or referring to outside resources for additional interventions. Resonating with integrative medicine's definition, this article's goal is to demonstrate paradigms that "bring together complementary approaches in a coordinated way within clinical practice" by linking clinical hypnosis, the trail-blazer modality in PIM's history, with mindfulness, biofeedback, acupuncture, and yoga. Following the consideration of the overlap of guided imagery with hypnosis and an abridged literature report, this clinical perspective considers the selection of modalities within a collaborative relationship with the child/teen and parents, emphasizing goodness-of-fit with patients' contexts, e.g., symptoms, resources, interests, goals, and developmental stage. Case vignettes illustrate practical strategies for mixing approaches.

The impact of brief restriction to articulation on children's subsequent speech production

This project explored whether disruption of articulation during listening impacts subsequent speech production in 4-yr-olds with and without speech sound disorder (SSD). During novel word learning, typically-developing children showed effects of articulatory disruption as revealed by larger differences between two acoustic cues to a sound contrast, but children with SSD were unaffected by articulatory disruption. Findings suggest that, when typically developing 4-yr-olds experience an articulatory disruption during a listening task, the children's subsequent production is affected. Children with SSD show less influence of articulatory experience during perception, which could be the result of impaired or attenuated ties between perception and articulation.

Comparison of anxiety and child-care education characteristics of mothers who have children with or without speech delays

Introduction

Speech delay in a child could be the cause and/or result of the emotional disorder. The child rearing attitude that the parents have accepted could have both positive and negative effects on the personality of the child.

Objective

The current study aimed to investigate the sociodemographic features and the mothers’ anxiety of children with speech delay.

Methods

One hundred five mothers with children aged between 3 and 6 years with speech delays were included in the patient group, and 105 mothers who have children aged between 3 and 6 years with normal speech and language development were included in the control group. An information form questionnaire including demographic characteristics, the Family Life and Childrearing Attitude Scale (PARI – Parental Attitude Research Instrument) and Beck anxiety scale were requested from all mothers in the patient and the control groups.

Results

In the current study, there was a significant difference between the groups in terms of gender (p = 0.001). According to Parental Attitude Research Instrument, the mean of mothers of the children with speech delays was higher than the mean of mothers of normal children in terms of the answers to overprotective mother aspect (p < 0.01). The mothers of children with speech delays had more overprotective motherhood attitudes; however, the difference in terms of the answers to the aspects of democratic attitude and provision of equality, refusal to be a housewife, husband-wife conflict, and suppression and discipline were not statistically significant. The Beck anxiety scale, a significant difference was detected between the two groups (p < 0.01). It was found that the mothers of children with speech delays had more severe levels of anxiety.

Conclusion

The social structure of the family, the attitudes and the behaviors of the mother, and the anxiety levels of the mothers have important effects on child development. Thus, it is necessary to perform further studies related to speech delays, in which many factors play a role in the etiology.

Diagnostic Accuracy of Traditional Measures of Phonological Ability for Bilingual Preschoolers and Kindergarteners

Purpose

Bilingual children whose phonological skills are evaluated using measures designed for monolingual English speakers are at risk for misdiagnosis of speech sound disorders (De Lamo White & Jin, 2011).

Method

Forty-four children participated in this study: 15 typically developing monolingual English speakers, 7 monolingual English speakers with phonological disorders, 14 typically developing bilingual Spanish-English speakers, and 8 bilingual children with phonological disorders. Children's single-word speech productions were examined on Percentage Consonants Correct-Revised (Shriberg, Austin, Lewis, McSweeny, & Wilson, 1997a) and accuracy of early-, middle-, and late-developing sounds (Shriberg, 1993) in English. Consonant accuracy in English was compared between monolinguals and bilinguals with and without speech sound disorders. Logistic regression and receiver operating characteristic curves were used to observe diagnostic accuracy of the measures examined.

Results

Percentage Consonants Correct-Revised was found to be a good indicator of phonological ability in both monolingual and bilingual English-speaking children at the age of 5;0. No significant differences were found between language groups on any of the measures examined.

Conclusions

Our results suggest that traditional measures of phonological ability for monolinguals could provide good diagnostic accuracy for bilingual children at the age of 5;0 years. These findings are preliminary, and children younger than 5;0 years should be examined for risk of misdiagnosis.

Speech and Linguistic Features of Children With Articulation Disorder

Objective

To analyze speech and linguistic features in children with articulation disorder characterized by consonant and vowel phonological errors.

Methods

Between February 2007 and June 2015, 117 children who showed articulation disorder were selected for the study. Based on comprehensive speech and language assessments, the subjects were classified into articulation dysfunction (AD), or AD overlapping with language delay. Detailed information of articulation, including percentage of consonants correct (PCC) and normal percentage of variable consonants derived from the Assessment of Phonology and Articulation for Children test, were compared between the two groups.

Results

Totally, 55 children were diagnosed as AD and 62 as AD with language delay. Mean PCC was not significantly different between the two groups. In both groups, the acquisition order of consonants followed the universal developmental sequence. However, differences were observed in the nasal & plosive consonants abnormality between the two groups. When adjusted to their delayed language level in AD with language delay group, 53% of children had appropriate articulation function for their expressive language level.

Conclusion

Speech and linguistic characteristics in children with articulation disorder were variable. Therefore, comprehensive assessment is required in children with inaccurate pronunciation, and a proper treatment plan based on the results of assessment should be followed.

Consonant Age-of-Acquisition Effects in Nonword Repetition Are Not Articulatory in Nature

PURPOSE

Most research examining long-term-memory effects on nonword repetition (NWR) has focused on lexical-level variables. Phoneme-level variables have received little attention, although there are reasons to expect significant sublexical effects in NWR. To further understand the underlying processes of NWR, this study examined effects of sublexical long-term phonological knowledge by testing whether performance differs when the stimuli comprise consonants acquired later versus earlier in speech development.

METHOD

Thirty (Experiment 1) and 20 (Experiment 2) college students completed tasks that investigated whether an experimental phoneme-level variable (consonant age of acquisition) similarly affects NWR and lexical-access tasks designed to vary in articulatory, auditory-perceptual, and phonological short-term-memory demands. The lexical-access tasks were performed in silence or with concurrent articulation to explore whether consonant age-of-acquisition effects arise before or after articulatory planning.

RESULTS

NWR accuracy decreased on items comprising later- versus earlier-acquired phonemes. Similar consonant age-of-acquisition effects were observed in accuracy measures of nonword reading and lexical decision performed in silence or with concurrent articulation.

CONCLUSION

Results indicate that NWR performance is sensitive to phoneme-level phonological knowledge in long-term memory. NWR, accordingly, should not be regarded as a diagnostic tool for pure impairment of phonological short-term memory.

SUPPLEMENTAL MATERIALS

https://doi.org/10.23641/asha.5435137.

Stimulus Characteristics of Single-Word Tests of Children's Speech Sound Production

Purpose

This clinical focus article provides readers with a description of the stimulus characteristics of 12 popular tests of speech sound production.

Method

Using significance testing and descriptive analyses, stimulus items were compared in terms of the number of opportunities for production of all consonant singletons, clusters, and rhotic and nonrhotic vowels of Standard American English; phonetic/phonological and structural complexity; and the presence of bound morphemes.

Results

The tests varied widely in terms of the number of opportunities for production of consonant singletons, clusters, and rhotic and nonrhotic vowels. Most of the tests included only 1 opportunity, scored or unscored, to produce a majority of the consonant singletons in each word position. Only 3 of the tests included stimulus items with 3-element clusters. The majority contained limited opportunities to produce 3- or 4-syllable stimulus items. The tests provided sufficient opportunities for production of most vowels, although most did not score vowels. The tests differed significantly in the complexity of their stimulus items. Most, however, contained a negligible number of items that, with the addition of a bound morpheme, resulted in a word-final cluster.

Conclusion

Most of the tests elicit an inadequate sample with which to conduct a comprehensive phonological analysis.

Transcribing rhotics in normal and disordered speech

The IPA's comparative lack of dedicated symbols for sonorant consonants as compared to obstruents presents some difficulties for clinical phoneticians. Among these are the ways of transcribing apical versus bunched approximant-/r/, the bilabial approximant realisation of target approximant-/r/, and fricative rhotic realisations of approximant-/r/ in normal and disordered speech. This note reports some developments in transcription that would allow clinical phoneticians to avoid the use of difficult-to-read diacritics when transcribing these sounds.

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

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