Acoustic Analyses of Tone Productions in Sequencing Contexts Among Cantonese-Speaking Preschool Children With and Without Childhood Apraxia of Speech.

PURPOSE: Pitch variations (tone productions) have been reported as a measure to differentiate Cantonese-speaking children with and without childhood apraxia of speech (CAS). This study aims to examine fundamental frequency (F0) changes within syllables and the effects of syllable structure, lexical status, and syllable positions on F0 in Cantonese-speaking preschool children with and without CAS. METHOD: Six children with CAS, six children with non-CAS speech sound disorder plus language disorder (S&LD), 22 children with speech sound disorder only (SSD), and 63 children with typical speech-language development (TD) performed the tone sequencing task (TST). Growth curve analysis was employed to analyze and compare the F0 values within syllables with three Cantonese tones (high level, high rising, and low falling). The analysis considered the effects of syllable structure (vowel and consonant-vowel), lexical status (word and nonword), and syllable position (initial, medial, and final) on F0, as well as comparisons within and between groups. RESULTS: Within each group, the effects of syllable structure and position on F0 values were found with different patterns. Between-group comparisons showed that the CAS group had reduced F0 contrasts. The CAS group could be differentiated from the control groups based on interactions of F0 with syllable structure and position, but not lexical status. The dissimilarity of F0 values detected between the CAS and SSD/TD groups was more prominent than that observed between the CAS and S&LD groups. CONCLUSIONS: This study demonstrated that Cantonese-speaking children with CAS had difficulty in varying F0 within syllables as compared to those without CAS, suggesting pitch variation difficulty and language-specific impairment profiles in CAS. Future investigations of objective measures for identifying Cantonese speakers with CAS and cross-linguistic investigations using growth curve analysis and the TST are suggested.

Speech-Language Outcomes in the COVID-19 Milieu for Multilingual Jamaican Preschoolers and Considerations for Telepractice Assessments.

PURPOSE: The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children's speech-language outcomes secondary to pandemic-related social restrictions. METHOD: Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children's communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD (n = 226) Jamaican Creole-English-speaking preschoolers and those with fSSDs (n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica. RESULTS: Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate. CONCLUSIONS: Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children's speech-language outcomes in the context of acutely changing environmental circumstances. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25461505.

Development of the Digital Speech Assessment Instrument.

OBJECTIVE: This study aimed to develop a Digital Speech Assessment Instrument to evaluate the phonological and motor speech skills of Brazilian Portuguese-speaking children and adolescents through six tasks: (a) word naming, (b) word imitation, (c) pseudoword imitation, (d) word repetition, (e) pseudoword repetition, and (f) diadochokinesis. METHOD: The assessment instrument was developed and validated in a seven-step process, beginning with stimulus selection and ending with Pilot Study 1 (involving children and adolescents with typical speech development) and Pilot Study 2 (involving children and adolescents with speech sound disorders [SSDs]). Participants of the study included expert and nonexpert judges, children, and adolescents. RESULTS: The Digital Speech Assessment Instrument contains 91 real words (61 in the naming task, 51 in the imitation task, and five in the repetition task), 26 pseudowords (26 in the imitation task and four in the repetition task), and six stimuli for diadochokinesis. The test contains stimuli in the form of images as well as audio and video recordings and allows for the analysis and storage of participant data in a virtual database. CONCLUSIONS: This study described the development of the Digital Speech Assessment Instrument, available in Brazilian Portuguese for the evaluation of several aspects of speech production (including word and pseudoword naming, imitation, and repetition and diadochokinesis). The test was developed for children aged 2;0 (years;months) to 17;11 and is administered fully online. In the future, the instrument can be used to provide a timely and accurate diagnosis of SSDs.

Evaluating acoustic representations and normalization for rhoticity classification in children with speech sound disorders.

The effects of different acoustic representations and normalizations were compared for classifiers predicting perception of children's rhotic versus derhotic /ɹ/. Formant and Mel frequency cepstral coefficient (MFCC) representations for 350 speakers were z-standardized, either relative to values in the same utterance or age-and-sex data for typical /ɹ/. Statistical modeling indicated age-and-sex normalization significantly increased classifier performances. Clinically interpretable formants performed similarly to MFCCs and were endorsed for deep neural network engineering, achieving mean test-participant-specific F1-score = 0.81 after personalization and replication (σx = 0.10, med = 0.83, n = 48). Shapley additive explanations analysis indicated the third formant most influenced fully rhotic predictions.

Equitable access to speech practice for rural Australian children using the SayBananas! mobile game.

PURPOSE: To evaluate the effect, usage, and user-experience for SayBananas!, a Mario-style mobile game providing Australian children access to high-dose individualised speech therapy practice. METHOD: Participants were 45 rural Australian children with speech sound disorders (SSD; 4;4-10;5 years) with internet access. This mixed-methods study involved: (a) recruitment, (b) eligibility screening, (c) questionnaire, (d) online pre-assessment, (e) SayBananas! intervention using motor learning principles (4 weeks, 10-15 target words), and (f) online post-assessment and interview. Usage and performance were automatically monitored. RESULT: Most participants were highly engaged with SayBananas! completing a median of 44.71 trials/session (∼45% of the 100 trial/session target, range 7-194). After intervention, participants made significant gains on treated words and on formal assessment of percentage of consonants, vowels, and phonemes correct. There was no reliable change for parent-rated intelligibility or children's feelings about talking. The number of practice sessions was significantly correlated with percent change on treated words. On average, children rated the app as "happy/good/fun" providing detailed drawings of playing SayBananas!. Families provided high ratings of engagement, functionality, aesthetics, and quality. CONCLUSION: SayBananas! is a viable and engaging solution for rural Australian children with SSD to gain access to equitable, cost-effective speech practice. The amount of app use was associated with amount of speech production improvement over a 4-week period.

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

BACKGROUND: AIMS: To investigate the developmental trajectory of the rate and perceptual assessment of oral diadochokinesis (DDK) in typically developing children compared with adults. Also to examine the characteristics of DDK productions in children with speech sound disorders (SSD) and the relationship between DDK production and percentage of consonants correct (PCC). METHODS & PROCEDURES: Participants were 316 typically developing children and 90 children with SSD from 3 to 9 years old, as well as 20 adults with normal speech. The mono-, bi- and trisyllabic nonsense strings containing Korean tense consonants and the vowel [a] were used for DDK tasks. The number of iterations per s was measured as the DDK rate for each stimulus. The perceptual assessment of DDK productions was also performed for regularity, accuracy and rate. OUTCOMES & RESULTS: The DDK rates increased throughout childhood, but the oldest children, 9-year-olds in the current study, did not achieve adult-like rates for all mono- and trisyllabic strings. Children with SSD also did not show significant differences from typically developing children when the DDK productions were analysed using only accurate tokens. The PCC of children with SSD showed higher correlations with regularity, accuracy and rate of perceptual ratings than the timed DDK rate. CONCLUSIONS & IMPLICATIONS: This study highlighted the fact that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills. WHAT THIS PAPER ADDS: What is already known on the subject Rates of DDK reflect the motor skills of the articulatory systems independently of phonological skills; therefore, the tasks are widely used in the diagnostic evaluations of speech disorders in both children and adult populations. However, a substantial number of studies have questioned the validity and usefulness of DDK rates for evaluating speech abilities. Also, the literature suggested that the measure of DDK rate alone does not provide a clear and useful indication of children's oral motor skills. DDK tasks should be analysed in terms of accuracy and consistency as well as rate. What this paper adds to the existing knowledge The literature reporting normative DDK performance has mainly been based on English speakers. As different consonants have different temporal characteristics, the linguistic and segmental features of DDK tasks can impact the DDK rate. This study established a norm for DDK rate for Korean-speaking children and investigated the developmental trajectory of DDK performance in typically developing children compared with adults. This study suggested that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills by examining the characteristics of DDK productions in children with SSD. What are the potential or actual clinical implications of this work? This study provided normative data of young Korean-speaking children aged 3-9 years. Normative data in children under 5 years of age are valuable given that the majority of children referred for speech difficulty assessments are between 3 and 5 years of age, but only a few studies have provided the normative data in young children. This study showed that many children could not complete DDK tasks correctly and provided additional support for the notion that other aspects of DDK performance, including accuracy and regularity, may yield more useful diagnostic indications than timed DDK rates alone.

Is Articulation Assessment via Synchronous Telepractice as Reliable as In-Person Assessment?

PURPOSE: This study aimed to determine whether articulation assessment via telepractice is as reliable as in-person assessment. METHOD: Thirty-four children aged 4-11 years with speech sound disorder (SSD) participated in the study. The Articulation Subtest (SET) of the Turkish Articulation and Phonology Test (SST) was used to assess the children's articulation skills. The study's procedures comprised two stages. First, in the Baseline Pilot Stage, five speech-language pathologists (SLPs; four graduate SLPs and one SLP with a PhD degree) conducted in-person assessments on seven children, and their agreement was examined (α for five SLPs = .950; p < .0001). In the Main Assessment Stage, four SLPs assessed 27 children synchronously on four separate days through either online (two SLPs) or in-person (the other two SLPs) clinician roles, which changed daily. Online evaluators did not use microphones and headphones to avoid any advantage. The agreement among the four raters was examined by calculating the intraclass correlation coefficient. RESULTS: The results revealed an excellent level of agreement regarding overall assessment between online and in-person clinicians (p < .0001). All articulation manners were acceptable, good, or excellent. However, some sounds' (α < .7 for /d/, /É£/, /b/; α < .8 for /p/, /ʃ/, /t/, /l/, /v/) reliability levels were relatively low compared with others. CONCLUSIONS: There may be certain restrictiveness regarding discriminating visual or auditory clues related to certain phonemes in a telepractice environment. This restrictiveness may be related with sonority and with differentiation between minimal pairs where visual clues are limited.

[Analysis of neuropsychological development characteristics and influencing factors in children with speech sound disorder].

Objective: Exploring the neuropsychological developmental characteristics and influencing factors of children with speech disorder. Methods: A case-control study was conducted. A total of 395 children diagnosed with speech disorders were selected as speech sound disorder (SSD) group from January 2019 to September 2021 in the speech-speech outpatient department of the Children's Hospital Affiliated to Capital Institute of Pediatrics, and 1 179 healthy children who underwent physical examination in the health department during the same period were selected as the control group. All the children were examined by the "Children's Neuropsychological Behavior Scale 2016 Edition" (Children's Mind Scale 2016 edition). Independent sample t test was used to compare the developmental levels of the two groups of children, including total developmental quotient, gross motor, fine motor, adaptive ability, language and social behavior ability. The influential factors of children's speech disorders were analyzed by univariate Chi-square analysis and multivariate logistic regression. Results: There were 395 SSD children, including 296 males and 99 females, 4≤ age ≤6, (4.71±0.76) years. There were 1 179 children in the control group, including 864 males and 315 females, 4≤ age ≤6, (4.64±0.78) years. The mean value of total developmental factors in SSD group was lower than that in control group [(86.45±11.57)/(91.24±8.0), t=-7.78, P<0.01], and the mean values of total developmental markers in both boys and girls in SSD group were lower than those in control group [(86.00±11.40)/(90.78±7.86), t=-6.70, P<0.01; (87.82±12.03)/(92.87±8.49), t=-3.88, P<0.01]. The mean values of gross motor, fine motor, adaptive ability, language ability and social behavior in SSD group were lower than those in control group [(89.76±12.47)/(92.01±10.69), t=-3.21, P<0.01; (80.62±13.64)/(84.49±11.55), t=-5.06, P<0.01; (87.92±15.25)/(92.98±12.06), t=-6.00, P<0.01; (86.48±16.30)/(94.55±12.08), t=-9.04, P<0.01; (87.02±15.18)/(92.63±12.57), t=-6.62, P<0.01]; The mean value of fine motor in boys was lower than that in girls in SSD group [(79.80±13.42)/(83.08±14.05), t=-2.08, P<0.05]. Independent mealtimes. 2 years old (OR=1.527, 95%CI: 1.180-1.977, P=0.001), delay in adding supplemental food (OR=1.510, 95%CI: 1.123-2.029, P=0.006), dialect in the home language environment (OR=1.351, 95%CI: 1.060-1.723, P=0.015) were risk factors for children with speech disorders. Conclusion: Children with speech disorders are more common in boys. The overall development level of SSD children is lower than that of normal children, and the fine motor of SSD boys is lower than that of girls. The incidence of children's speech disorders is related to the addition time of supplementary food, independent meal time and family language environment.

Tutorial: Using Visual-Acoustic Biofeedback for Speech Sound Training.

PURPOSE: This tutorial summarizes current practices using visual-acoustic biofeedback (VAB) treatment to improve speech outcomes for individuals with speech sound difficulties. Clinical strategies will focus on residual distortions of /ɹ/. METHOD: Summary evidence related to the characteristics of VAB and the populations that may benefit from this treatment are reviewed. Guidelines are provided for clinicians on how to use VAB with clients to identify and modify their productions to match an acoustic representation. The clinical application of a linear predictive coding spectrum is emphasized. RESULTS: Successful use of VAB requires several key factors including clinician and client comprehension of the acoustic representation, appropriate acoustic target and template selection, as well as appropriate selection of articulatory strategies, practice schedules, and feedback models to scaffold acquisition of new speech sounds. CONCLUSION: Integrating a VAB component in clinical practice offers additional intervention options for individuals with speech sound difficulties and often facilitates improved speech sound acquisition and generalization outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21817722.

A survey of interventions used by speech-language pathologists for children with speech sound disorders in the Middle East.

PURPOSE: While many examples of speech pathology intervention approaches for children with speech sound disorders (SSDs) exist in English and some other European languages, approaches with children in other languages are largely unknown. The aim was to determine current speech-language pathologists (SLPs) intervention practices with children with SSDs in the ME, and to then compare these with international practices. METHODS: Data were collected by online questionnaire using Qualtrics. One hundred and eighty-nine SLPs completed the survey. Participants were required to be Arabic first language speaking SLPs practicing in the ME (e.g. Kuwait, Saudi Arabia, UAE, and Egypt), working with children with SSDs. RESULTS: The respondents reported a frequent use of phonological awareness, traditional articulation therapy, auditory discrimination, minimal pairs, and whole language therapy approaches in the treatment of children with SSDs, like their counterparts in Australia, the USA, UK, and Portugal. Gaps between research recommendations for evidence-based practice and actual clinical practice are identified, and discussed. CONCLUSIONS: Future research should investigate the efficacy of speech-therapy approaches to improve service delivery for Arabic-speaking children with SSDs in the ME.

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.

A survey of Swedish speech-language pathologists' practices regarding assessment of speech sound disorders.

PURPOSE: To explore Swedish clinical practice regarding assessment of suspected Speech Sound Disorders (SSD) in children. METHODS: A web-based questionnaire, regarding assessment of SSD in children 4;6-6;11 (years; months), was distributed to Swedish speech-language pathologists (SLPs) through social media and online forums. The questions concerned the frequency and manner of assessment for seven assessment components, chosen based on a review of international recommendations for SSD assessment. RESULTS: A total of 131 SLPs responded to the questionnaire. The results show that Swedish SSD assessment practices vary with regards to the frequency and manner of assessment for many components. Speech output is frequently assessed while speech perception, phonological awareness and oral-motor function are assessed less frequently. A variety of manners of assessment, for example, standardised tests, non-standardised material, and informal assessment procedures, such as observation, are utilized by respondents. CONCLUSIONS: Swedish SSD assessment practices are variable. The present paper reveals areas for development within SLP practice and education programmes, and provides a new perspective on present praxis with regards to the assessment of suspected SSD in Sweden.

Speech Error Variability and Phonological Awareness in Preschoolers.

PURPOSE: The purpose of this article was to investigate the relationship between speech error variability and phonological awareness. METHOD: This article begins with a narrative review of the theoretical interpretation of speech error variability. The post hoc exploratory analysis of the relationship between speech error variability and phonological awareness included 40 children: 20 with typical speech and language and 20 with speech sound disorder and typical language. Groups were matched on gender, age, maternal education, receptive and expressive vocabulary, nonverbal intelligence, and expressive morphosyntax. Multiple regression was used to identify the best fit model for the relationship between vocabulary, speech errors, and phonological awareness. RESULTS: Segmental variability was associated with poor phonological awareness in preschool-aged children. CONCLUSION: Children with high levels of segmental variability have poor phonological awareness, likely due to unstable phonological representations.

Phonological processing skills in children with speech sound disorder: A multiple case study approach.

BACKGROUND: Children with speech sound disorder (SSD) are at increased risk of reading difficulties due to poor phonological processing skills. However, the extent to which children with SSD demonstrate weaknesses on specific or all phonological processing tasks is not well understood. AIMS: To examine the phonological processing abilities of a clinically identified sample of children with SSD, with and without reading difficulties. To determine the extent to which the proportion of children with concomitant SSD and reading difficulties exhibited weaknesses in specific areas of phonological processing, or a more general phonological deficit. METHODS & PROCEDURES: Data were obtained from 157 school-aged children (Mage = 77 months, SD = 7.01) in receipt of school-based speech therapy. Approximately 25% of the sample was identified as poor readers, based on a standardized measure of word decoding. We compared the proportion of children who scored at or below 1 SD below the mean, or the bottom 16th percentile, on measures of phonological awareness, rapid automatized naming and verbal short-term memory among those identified as poor readers and good readers. OUTCOMES & RESULTS: Children with SSD demonstrated a range of phonological processing difficulties, particularly on the measure of verbal short-term memory. No specific skill differentiated groups of children with SSD with and without reading difficulties; however, those classified as poor readers on the word-decoding measure exhibited more widespread difficulties, even after controlling for language ability. CONCLUSIONS & IMPLICATIONS: Results support a cumulative risk model such that children with SSD and reading difficulties are likely to demonstrate generally poor phonological processing abilities. WHAT THIS PAPER ADDS: What is already known on the subject Children with SSD are at heightened risk of reading difficulties, particularly if their SSD persists into school age. However, not all children with SSD experience reading problems. Research aimed at determining which children are at the highest risk is mixed as to how best to identify which children with SSD are most likely to experience reading difficulties. What this paper adds to existing knowledge The study used a multiple case study approach to determine if performance on phonological processing skills might differentiate children with SSD who were poor readers from those who were good readers. As a group, children with SSD exhibited poor verbal short-term memory but relatively intact rapid automatized naming skills. No one phonological processing skill differentiated children who were poor readers from good readers. However, children with reading difficulties appeared to experience more general difficulties across phonological processing tasks, even after controlling for language abilities. What are the potential or actual clinical implications of this work? A single deficit (i.e., speech sound production) is not sufficient data to make a complete diagnosis or treatment decisions. Multiple sources of data, including several aspects of phonological processing, should be obtained to understand reading risk in children with SSD.

Working memory span and receptive vocabulary assessment in Urdu speaking children with speech sound disorder.

Emerging evidence suggests that impaired speech may be related to reduced working memory (WM). The current study aimed to validate and compare the influence of articulation, short-term memory (STM), WM, and receptive vocabulary abilities of Pakistani children with speech sound disorder (SSD; N = 50) versus typically developing (TD; N = 30) children aged 7-13 years. Assessments included the Test for Assessment of Articulation and Phonology in Urdu (TAAPU), Peabody Picture Vocabulary Test-4, translated to Urdu (U-PPVT-4), and Digit Memory Test (DMT) used to determine speech articulation, receptive vocabulary, and memory abilities respectively. The percentage correct consonants (PCC) score was used to divide the SSD group further into SSD severity groups. The TD and SSD groups significantly differed in performance on all tasks (p < 0.05). Moreover, the SSD severity groups showed significant differences (p < 0.0001) in performance on different components of TAAPU (total errors and substitution errors) and DMT tasks. However, the SSD severity groups did not show significant differences in performance on the U-PPVT-4. Correlational analyses indicate statistically significant correlations of PCC with STM, WM, and receptive vocabulary. Regression analyses suggested that both WM and STM contribute to speech intelligibility in children with SSD. Our findings in Urdu-speaking children support previous results in English-speaking children suggesting the articulation skills, receptive vocabulary, STM, and WM were less developed in children with SSD than in TD children.

Treating Concomitant Language and/or Phonology Impairment in Children Who Stutter.

Stuttering can co-occur with phonological and/or language impairment in a nontrivial number of children. This article provides a framework for addressing concomitant phonology/language impairment and stuttering through the application of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Described is a multifactorial approach to understanding stuttering, the application of the ICF to treating children who stutter with concomitant disorders, and models for structuring-related therapy. A case study is explored to illustrate this process and includes a sample treatment plan with goals, short-term objectives, and sample activities.

Support-Vector Machine-Based Classifier of Cross-Correlated Phoneme Segments for Speech Sound Disorder Screening.

This paper presents a Support-Vector Machine (SVM) based method of classification of cross-correlated phoneme segments as part of the development of an automated Speech Sound Disorder (SSD) Screening tool. The pre-processing stage of the algorithm uses cross-correlation to segment the target phoneme and extracts data from the new homogeneously trimmed audio samples. Such data is then fed into the SVM-based classification script which currently achieves an accuracy of 97.5% on a dataset of 132 rows. Given the global context of an increasing trend in the incidence of Speech Sound Disorders (SSDs) amongst early-school aged children (5-6 years old), the constraints imposed by the new Corona virus pandemic, and the (consequent) shortage of professionally trained specialists, an automated screening tool would be of much assistance to Speech-Language Pathologists (SLPs).

Speech Sound Disorder Treatment Approaches Used by School-Based Clinicians: An Application of the Experience Sampling Method.

PURPOSE: Children with speech sound disorders (SSDs) comprise a large portion of caseloads for school-based speech-language pathologists (SLPs). Despite the existence of several evidence-based SSD intervention approaches, the translation from research to practice is often limited by ecological validity because of various factors unique to school settings (e.g., scheduling constraints, caseload size, child availability). The purpose of this study was to use the experience sampling method (ESM) to examine the current practices of school-based SLPs when treating children with SSDs on their caseloads. METHOD: SLPs (N = 106) from 42 different states working full-time in school-based K-12 settings participated in this study. At the beginning of the study, each SLP completed a one-time demographic survey about treatment practices for children with SSDs. The SLPs then participated in a series of brief surveys every day for one workweek using a specialized ESM phone application that randomly alerted participants to report on their treatment practices for children with SSDs. RESULTS: Findings revealed that although most SLPs reported using a variety of SSD intervention approaches in a one-time survey, the majority of SLPs reported using one of three approaches in situ: the traditional articulation therapy approach, cycles, and minimal pairs. We also report a significant negative relationship between the years of experience of an SLP and the number of different approaches used. CONCLUSIONS: This study is the first to use the ESM to determine which approaches school-based SLPs use to treat children with SSDs. Findings demonstrate that SLPs have knowledge of many different SSD approaches but tend to utilize only a few in school-based settings.

Clinical Considerations for Speech Perception in School-Age Children With Speech Sound Disorders: A Review of the Current Literature.

PURPOSE: The purpose of this study was to synthesize the methodological variability in the speech perception literature for school-age children with residual speech sound disorder (RSSD), with the primary intention of using the existing knowledge to inform clinical decisions and optimize treatment outcomes for children. METHOD: Ten electronic databases were systematically searched to identify articles examining the speech perception skills of school-age children with RSSD. A total of 11 articles met inclusion criteria, reporting of methodological characteristics was rated and compared across studies, and findings were summarized. RESULTS: The majority of studies reviewed here confirmed the presence of a perceptual deficit for a subset of children with RSSD. However, marked variability across study methodologies limits clinical interpretation and application of the findings. CONCLUSIONS: Despite limited research in children with RSSD and wide variability across study procedures, stimulus type, perception type, and task type emerged as potential key factors that provide critical insight into a child's perceptual skill. The current evidence suggests that deficits in speech perception may significantly impact acquisition of accurate phoneme production for children with RSSD. Furthermore, these findings suggest that assessment and treatment of speech perception may be a critical component of an intervention program for school-age children, although further research is needed to determine effective clinical procedures.

Predicting Which Children Will Normalize Without Intervention for Speech Sound Disorders.

PURPOSE: The speech of some children does not follow a typical normalization trajectory, and they develop speech sound disorders (SSD). This study investigated predictive correlates of speech sound normalization in children who were at risk of SSD. METHOD: A prospective population cohort study of 845 Cantonese-speaking preschoolers was conducted over 2.5 years to examine (a) children who resolved nonadult realizations of consonants (normalized) and (b) those who had persisting speech sound difficulties (did not normalize). From these 845, a sample of 82 participants characterized as having SSD (1.25 SDs below the mean in a standardized speech assessment, with a delay in initial consonant acquisition or with one or more atypical errors) was followed for 2 years at 6-month intervals or until the completion of their initial consonant inventory. Data from 43 children who did not receive speech-language pathology services were analyzed with survival analysis to model time to normalization while controlling for covariates. The target event (outcome) was the completion of their initial consonant inventory. RESULTS: Under the no-intervention condition, the estimated median time to normalization was 6.59 years of age. Children who were more likely to normalize or normalized in a shorter time were stimulable to all errors and more intelligible as rated by caregivers using the Intelligibility in Context Scale. Those who showed atypical error patterns did not necessarily take longer to normalize. Similarly, expressive language ability was not significantly associated with speech normalization. CONCLUSIONS: Stimulability and intelligibility were more useful prognostic factors of speech normalization when compared to (a)typicality of error patterns and expressive language ability. Children with low intelligibility and poor stimulability should be prioritized for speech-language pathology services given that their speech errors are less likely to resolve naturally.