Virtual Post-Intervention Speech and Language Assessment of Toddler and Preschool Participants in Babble Boot Camp.

PURPOSE: Babble Boot Camp (BBC) is a parent-implemented telepractice intervention for infants at risk for speech and language disorders. BBC uses a teach-model-coach-review approach, delivered through weekly 15-min virtual meetings with a speech-language pathologist. We discuss accommodations needed for successful virtual follow-up test administration and preliminary assessment outcomes for children with classic galactosemia (CG) and controls at age 2.5 years. METHOD: This clinical trial included 54 participants, 16 children with CG receiving BBC speech-language intervention from infancy, age 2 years, five children receiving sensorimotor intervention from infancy and changing to speech-language intervention at 15 months until 2 years of age, seven controls with CG, and 26 typically developing controls. The participants' language and articulation were assessed via telehealth at age 2.5 years. RESULTS: The Preschool Language Scale-Fifth Edition (PLS-5) was successfully administered with specific parent instruction and manipulatives assembled from the child's home. The GFTA-3 was successfully administered to all but three children who did not complete this assessment due to limited expressive vocabularies. Referrals for continued speech therapy based on PLS-5 and GFTA-3 scores were made for 16% of children who received BBC intervention from infancy as compared to 40% and 57% of children who began BBC at 15 months of age or did not receive BBC intervention, respectively. CONCLUSIONS: With extended time and accommodations from the standardized administration guidelines, virtual assessment of speech and language was possible. However, given the inherent challenges of testing very young children virtually, in-person assessment is recommended, when possible, for outcome measurements.

Translating principles of precision medicine into speech-language pathology: Clinical trial of a proactive speech and language intervention for infants with classic galactosemia.

Precision medicine is an emerging approach to managing disease by taking into consideration an individual's genetic and environmental profile toward two avenues to improved outcomes: prevention and personalized treatments. This framework is largely geared to conditions conventionally falling into the field of medical genetics. Here, we show that the same avenues to improving outcomes can be applied to conditions in the field of behavior genomics, specifically disorders of spoken language. Babble Boot Camp (BBC) is the first comprehensive and personalized program designed to proactively mitigate speech and language disorders in infants at predictable risk by fostering precursor and early communication skills via parent training. The intervention begins at child age 2 to 5 months and ends at age 24 months, with follow-up testing at 30, 42, and 54 months. To date, 44 children with a newborn diagnosis of classic galactosemia (CG) have participated in the clinical trial of BBC. CG is an inborn error of metabolism of genetic etiology that predisposes up to 85% of children to severe speech and language disorders. Of 13 children with CG who completed the intervention and all or part of the follow-up testing, only one had disordered speech and none had disordered language skills. For the treated children who completed more than one assessment, typical speech and language skills were maintained over time. This shows that knowledge of genetic risk at birth can be leveraged toward proactive and personalized management of a disorder that manifests behaviorally.

Toward Preventing Speech and Language Disorders of Known Genetic Origin: First Post-Intervention Results of Babble Boot Camp in Children With Classic Galactosemia.

Purpose Babble Boot Camp (BBC) is a package of proactive activities and routines designed to prevent speech and language disorders in infants at predictable risk. It is implemented via parent training and currently undergoing clinical trial in children with a newborn diagnosis of classic galactosemia (CG), a metabolic disease with high risk of speech and language disorders. The purpose of this study is to provide updates to a previous pilot study and to present the first set of post-intervention results. Method The intervention and data collection occurred during child ages < 6-24 months, with follow-up assessments of speech and language at ages 2.5 and 3.5 years. Treatment targets included earliest vocalization rates, babble complexity, speech production accuracy, and vocabulary and syntactic growth. The oldest 15 children with CG (including three untreated controls) completed the first set of follow-up assessments. Aggregate data up to 10 months were available for 17 treated children with CG, six untreated children with CG, and six typical controls. Results At ages 7-9 months, babbling complexity, as measured with mean babbling level, was higher in the treated children with CG than in the untreated children with CG and the typical controls. Prior to 24 months of age, the treated children with CG had greater expressive but not receptive vocabulary sizes than an untreated control. Follow-up testing showed typical language scores for all 12 treated children with CG and typical articulation scores for 11 of these, whereas one of three untreated children with CG had low articulation and expressive language scores. Conclusions The BBC appears to be a viable intervention to support the speech and expressive language development of children with GC. Future studies will evaluate the relative contributions of the earliest and later BBC components to outcomes.

Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia.

Background: Speech and language therapy is typically initiated reactively after a child shows delays. Infants with classic galactosemia (CG), a metabolic disease with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth. We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC).  Method: Five children with CG, otherwise healthy, participated in the study from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management, which typically starts at age 2-3 years. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the intervention protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were vocalization rates and developmental milestones in communication, motor, and cognition. The trial is ongoing. Results:  All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, three had higher global developmental scores, and two had higher vocalization rates, compared to the control child with CG. Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization. Trial registration: ClinicalTrials.gov NCT03838016 (12 th February 2019).

Sequential processing deficit as a shared persisting biomarker in dyslexia and childhood apraxia of speech.

The purpose of this study was to investigate the hypothesis that individuals with dyslexia and individuals with childhood apraxia of speech share an underlying persisting deficit in processing sequential information. Levels of impairment (sensory encoding, memory, retrieval, and motor planning/programming) were also investigated. Participants were 22 adults with dyslexia, 10 adults with a probable history of childhood apraxia of speech (phCAS), and 22 typical controls. All participants completed nonword repetition, multisyllabic real word repetition, and nonword decoding tasks. Using phonological process analysis, errors were classified as sequence or substitution errors. Adults with dyslexia and adults with phCAS showed evidence of persisting nonword repetition deficits. In all three tasks, the adults in the two disorder groups produced more errors of both classes than the controls, but disproportionally more sequencing than substitution errors during the nonword repetition task. During the real word repetition task, the phCAS produced the most sequencing errors, whereas during the nonword decoding task, the dyslexia group produced the most sequencing errors. Performance during multisyllabic motor speech tasks, relative to monosyllabic conditions, was correlated with the sequencing error component during nonword repetition. The results provide evidence for a shared persisting sequential processing deficit in the dyslexia and phCAS groups during linguistic and motor speech tasks. Evidence for impairments in sensory encoding, short-term memory, and motor planning/programming was found in both disorder groups. Future studies should investigate clinical applications regarding preventative and targeted interventions towards cross-modal treatment effects.

Phonological acquisition of Korean consonants in conversational speech produced by young Korean children.

This study investigates the phonological acquisition of Korean consonants using conversational speech samples collected from sixty monolingual typically developing Korean children aged two, three, and four years. Phonemic acquisition was examined for syllable-initial and syllable-final consonants. Results showed that Korean children acquired stops and nasals followed by affricates, fricatives, and the liquid. In general, Korean consonants were acquired earlier in syllable-initial position compared to syllable-final position, except for the liquid /l/. The findings are compared with previous research based on single-word assessments, and differences that appear to be associated with the unique morphological system of Korean are noted.

Using PhonBank and Phon in studies of phonological development and disorders.

The goal of this paper is to present an overview of new tools that can be used to further our understanding of phonological development and disorders. We begin with a summary of the field of child phonology with a focus on databases and methods of analysis and then move to a description of PhonBank, a shared database for the study of phonology, and Phon, a specialised software system capable of performing various types of phonological analyses based on both phonetic transcriptions and acoustic analyses of speech productions. We provide a detailed example of using PhonBank and Phon to examine the use of velar fronting using longitudinal data from one child with typical development and three children with phonological disorder. We conclude with an emphasis on data sharing and its central relevance to further advances in our field.

Using multiple measures to document change in English vowels produced by Japanese, Korean, and Spanish speakers: the case for goodness and intelligibility.

PURPOSE: This study examined the effectiveness of using goodness ratings and intelligibility scores to document changes in vowel production following pronunciation training. The relationship between listener perceptions of goodness and intelligibility was also examined. METHOD: Fifteen English language learner speakers (5 Japanese, 5 Korean, and 5 Spanish) participated in 16 sessions of vowel-focused pronunciation training. Pre- and posttraining judgments of 10 English vowels in /hVt/ context were conducted by 25 monolingual English speakers who served as listeners. Listeners judged vowel intelligibility using a 10-alternative forced-choice task and rated goodness using a 5-point Likert scale. RESULTS: Goodness ratings and intelligibility scores captured improvement in the accuracy of several vowels following training. However, some vowels that received better mean intelligibility scores received poorer mean goodness ratings following training. The relationship between goodness ratings and intelligibility scores revealed that vowels such as /æ/ and /ʌ/ were more dependent on goodness for intelligibility than vowels such as /i/ and /e/, which were highly intelligible even when they received poor goodness ratings. CONCLUSION: English vowels differ with respect to the importance of goodness for accurate identification by listeners. As such, clinicians should examine both goodness and intelligibility when measuring change following pronunciation training.

Early phonological development: creating an assessment test.

This paper describes a new protocol for assessing the phonological systems of two-year-olds with typical development and older children with delays in vocabulary acquisition. The test (Profiles of Early Expressive Phonological Skills (PEEPS), Williams & Stoel-Gammon, in preparation ) differs from currently available assessments in that age of acquisition, based on lexical norms from the MacArthur-Bates Communicative Developmental Inventories, served as the primary criterion for creating a word list. Phonetic and semantic properties of the words were also considered in selecting items for the test. Productions of words using the PEEPS protocol have been gathered from a group of children with typical development and another group with cleft lip and/or palate. By 24 months of age, the children with typical development produced more than 90% of the target words and the children with atypical development produced 73% of the words. Regarding administration, the time needed for administering the protocol decreased with age.

Associations among measures of sequential processing in motor and linguistics tasks in adults with and without a family history of childhood apraxia of speech: a replication study.

The purpose of this study was to address the hypothesis that childhood apraxia of speech (CAS) is influenced by an underlying deficit in sequential processing that is also expressed in other modalities. In a sample of 21 adults from five multigenerational families, 11 with histories of various familial speech sound disorders, 3 biologically related adults from a family with familial CAS showed motor sequencing deficits in an alternating motor speech task. Compared with the other adults, these three participants showed deficits in tasks requiring high loads of sequential processing, including nonword imitation, nonword reading and spelling. Qualitative error analyses in real word and nonword imitations revealed group differences in phoneme sequencing errors. Motor sequencing ability was correlated with phoneme sequencing errors during real word and nonword imitation, reading and spelling. Correlations were characterized by extremely high scores in one family and extremely low scores in another. Results are consistent with a central deficit in sequential processing in CAS of familial origin.

Deficits in sequential processing manifest in motor and linguistic tasks in a multigenerational family with childhood apraxia of speech.

The purpose of this study was to evaluate a global deficit in sequential processing as candidate endophenotypein a family with familial childhood apraxia of speech (CAS). Of 10 adults and 13 children in a three-generational family with speech sound disorder (SSD) consistent with CAS, 3 adults and 6 children had past or present SSD diagnoses. Two preschoolers with unremediated CAS showed a high number of sequencing errors during single-word production. Performance on tasks with high sequential processing loads differentiated between the affected and unaffected family members, whereas there were no group differences in tasks with low processing loads. Adults with a history of SSD produced more sequencing errors during nonword and multisyllabic real word imitation, compared to those without such a history. Results are consistent with a global deficit in sequential processing that influences speech development as well as cognitive and linguistic processing.

Assessment of Single-Word Production for Children under Three Years of Age: Comparison of Children with and without Cleft Palate.

Background. This study reports comparative phonological assessment results for children with cleft lip and/or palate (CLP) to typically developing peers using an evaluation tool for early phonological skills. Methods. Children without clefts (NC = noncleft) and 24 children with CLP, ages of 18-36 months, were evaluated using the Profile of Early Expressive Phonological Skills (PEEPSs) [1]. Children interacted with toy manipulatives to elicit a representative sample of target English consonants and syllable structures that are typically acquired by children between 18 and 27 months of age. Results. Results revealed significant differences between the two groups with regard to measures of consonant inventory, place of articulation, manner of production, accuracy, and error patterns. Syllable structure did not indicate differences, with the exception of initial consonant clusters. Conclusions. findings provide support for PEEPS as a viable option for single-word assessment of children with CLP prior to 3 years of age.

Lexical and phonological effects in early word production.

PURPOSE: This study examines the influence of word frequency, phonological neighborhood density (PND), age of acquisition (AoA), and phonotactic probability on production variability and accuracy of known words by toddlers with no history of speech, hearing, or language disorders. METHOD: Fifteen toddlers between 2;0 (years;months) and 2;5 produced monosyllabic target words varying in word frequency, PND, AoA, and phonotactic probability. Phonetic transcription was used to determine (a) whole-word variability and (b) proportion of whole-word proximity (PWP; Ingram, 2002) of each target word produced. RESULTS: Results show a significant effect of PND on PWP and variability (words from dense neighborhoods had higher PWP and lower variability than those from sparse neighborhoods), a significant effect of word frequency on variability (high-frequency words were less variable) but not proximity, and a significant effect of AoA on proximity (earlier acquired words had lower PWP) but not variability. CONCLUSIONS: Results provide new information regarding the role that lexical and phonological factors play in the speech of young children; specifically, several factors are identified that influence variability of production. Additionally, by examining lexical and phonological factors simultaneously, the current study isolates differential effects of the individual factors. Implications for our understanding of emerging phonological representations are discussed.

Phonological development of word-initial Korean obstruents in young Korean children.

This study investigates the acquisition of word-initial Korean obstruents (i.e. stops, affricates and fricatives). Korean obstruents are characterized by a three-way contrast among stops and affricates (i.e. fortis, aspirated and lenis) and a two-way fricative contrast (i.e. fortis and lenis). All these obstruents are voiceless word-initially. Cross-sectional data were collected from forty Korean children aged 2 ; 6 (year;month), 3 ; 0, 3 ; 6 and 4 ; 0, and the acquisition patterns of Korean obstruents were explored based on productions of mono- and multisyllabic words. Results confirm the universal patterns: stops were acquired before affricates and fricatives. In terms of order of acquisition across different laryngeal types, lenis stops were the last to be acquired. For Korean fricatives, in contrast, the lenis category appears to be acquired earlier than the fortis category. This study proposes that this order of acquisition may be explained by articulatory complexity associated with language-specific phonetic properties.

Relationships between lexical and phonological development in young children.

Our understanding of the relationships between lexical and phonological development has been enhanced in recent years by increased interest in this area from language scientists, psychologists and phonologists. This review article provides a summary of research, highlighting similarities and differences across studies. It is suggested that the research falls into two categories with different goals and different methodological approaches: (1) child-centered studies that examine the influences active in the prelinguistic and early-word period, emphasizing individual developmental patterns and the active role played by the child; and (2) studies inspired by research on word processing in adults; these focus on the effects of the phonological and lexical characteristics of the ambient language on underlying representations and word learning in children. The article concludes with suggestions for integrating the findings from the two approaches and for future research.

Segmental timing of young children and adults.

Young children's speech is compared to (a) adult-to-adult (A-A) normal speech, and (b) adult-to-adult (A-A) slow speech, and (c) adult-to-child (A-C) speech by measuring durations and variability of each segment in consonant-vowel-consonant CVC (CVC consonant-vowel-consonant) words. The results demonstrate that child speech is more similar to A-C speech than A-A slow speech in that it exhibits a large portion of long vowel duration in a word. However, child speech but differs from A-C speech by more noticeable lengthening of consonants. In addition, child speech exhibits an inconsistent timing relationship across segments within a word whereas durational variation in consonants and vowels was correlated in A-A speech and A-C speech. The results suggest that temporal patterns of young children are quite different from those of adults, and provide some evidence for lack of motor control capability and great variance in articulatory coordination.

The Word Complexity Measure: description and application to developmental phonology and disorders.

Miccio's work included a number of articles on the assessment of phonology in children with phonological disorders, typically using measures of correct articulation, using the PCC, or analyses of errors, using the framework of phonological processes. This paper introduces an approach to assessing phonology by examining the phonetic complexity of children's productions. Unlike most current measures of phonological development and disorders, this approach does not assess accuracy, but focuses exclusively on the complexity of segments, syllables, and words. Using independent analyses, the Word Complexity Measure is based on the phonetic complexity of a child's productions, with later acquired sound classes, syllable shapes, and word patterns coded as more complex. The Word Complexity Measure allows researchers and clinicians to compare the phonetic and phonological aspects of productions across children and over time. The measure can also be used to compare the complexity of a child's productions with that of the target words.

Octave-shifted pitch matching in nonword imitations: the effects of lexical stress and speech sound disorder.

Perceptual similarities of musical tones separated by octave intervals are known as octave equivalence (OE). Peter et al. [(2008). Proceedings of the Fourth Conference on Speech Prosody, edited S. Maduerira, C. Reis, and P. Barbosa, Luso-Brazilian Association of Speech Sciences, Campinas, pp. 731-734] found evidence of octave-shifted pitch matching (OSPM) in children during verbal imitation tasks, implying OE in speech tokens. This study evaluated the role of lexical stress and speech sound disorder (SSD) in OSPM. Eleven children with SSD and 11 controls imitated low-pitched nonwords. Stimulus/response f(0) ratios were computed. OSPM was expressed preferentially in stressed vowels. SSD was associated with reduced expression of OSPM in unstressed vowels only. Results are consistent with the psycholinguistic prominence of lexical stress and prosodic deficits in SSD.

The acquisition of Korean word-initial stops.

A number of studies have investigated acquisition of stop voicing contrast in various languages by voice onset time measurement. Korean stops, however, are all voiceless word-initially and are differentiated by multiple acoustic-phonetic parameters resulting in a three-way contrast (fortis, aspirated, and lenis). The present study examines developmental patterns of Korean word-initial stops produced by 40 Korean children aged 2;6 (year; month), 3;0, 3;6, and 4;0 years, and compare the children's productions to those of 10 female adults. Voice onset time, fundamental frequency, and amplitude difference between the first and second harmonics of the post-stop vowel are obtained from monosyllabic near-minimal triplets at three places of articulation (labial, alveolar, and velar). Acoustic measures of children's productions reveal both universal phonetic patterns and phonetic variation associated with articulatory complexity specific to Korean. Language-specific fundamental frequency variation begins to emerge as early as 2;6, but appears to be mastered later than the voice onset time distinction. In comparison to the adults, young Korean children exhibit greater overlap across stop categories, and the acoustic overlap decreases over age. Results suggest that language-specific phonetic details as well as universal patterns should be examined to provide a better understanding of the speech sound development of a given language.

Defining spoken language benchmarks and selecting measures of expressive language development for young children with autism spectrum disorders.

PURPOSE: The aims of this article are twofold: (a) to offer a set of recommended measures that can be used for evaluating the efficacy of interventions that target spoken language acquisition as part of treatment research studies or for use in applied settings and (b) to propose and define a common terminology for describing levels of spoken language ability in the expressive modality and to set benchmarks for determining a child's language level in order to establish a framework for comparing outcomes across intervention studies. METHOD: The National Institute on Deafness and Other Communication Disorders assembled a group of researchers with interests and experience in the study of language development and disorders in young children with autism spectrum disorders. The group worked for 18 months through a series of conference calls and correspondence, culminating in a meeting held in December 2007 to achieve consensus on these aims. RESULTS: The authors recommend moving away from using the term functional speech, replacing it with a developmental framework. Rather, they recommend multiple sources of information to define language phases, including natural language samples, parent report, and standardized measures. They also provide guidelines and objective criteria for defining children's spoken language expression in three major phases that correspond to developmental levels between 12 and 48 months of age.