Children with speech sound disorder: comparing a non-linguistic auditory approach with a phonological intervention approach to improve phonological skills.

This study aimed to compare the effects of a non-linguistic auditory intervention approach with a phonological intervention approach on the phonological skills of children with speech sound disorder (SSD). A total of 17 children, aged 7-12 years, with SSD were randomly allocated to either the non-linguistic auditory temporal intervention group (n = 10, average age 7.7 ± 1.2) or phonological intervention group (n = 7, average age 8.6 ± 1.2). The intervention outcomes included auditory-sensory measures (auditory temporal processing skills) and cognitive measures (attention, short-term memory, speech production, and phonological awareness skills). The auditory approach focused on non-linguistic auditory training (e.g., backward masking and frequency discrimination), whereas the phonological approach focused on speech sound training (e.g., phonological organization and awareness). Both interventions consisted of 12 45-min sessions delivered twice per week, for a total of 9 h. Intra-group analysis demonstrated that the auditory intervention group showed significant gains in both auditory and cognitive measures, whereas no significant gain was observed in the phonological intervention group. No significant improvement on phonological skills was observed in any of the groups. Inter-group analysis demonstrated significant differences between the improvement following training for both groups, with a more pronounced gain for the non-linguistic auditory temporal intervention in one of the visual attention measures and both auditory measures. Therefore, both analyses suggest that although the non-linguistic auditory intervention approach appeared to be the most effective intervention approach, it was not sufficient to promote the enhancement of phonological skills.

Generalization of sensory auditory learning to top-down skills in a randomized controlled trial.

BACKGROUND: Research has shown that auditory training improves auditory sensory skills; however, it is unclear whether this improvement is transferred to top-down skills, such as memory, attention, and language, and whether it depends on group characteristics in regard to memory and attention skills. PURPOSE: The primary goal of this research was to investigate the generalization of learning from auditory sensory skills to top-down skills such as memory, attention, and language. We also aimed to compare whether this generalization process occurs in the same way among typically developing children and children with speech sound disorder. RESEARCH DESIGN: This study was a randomized controlled trial. STUDY SAMPLE: Typically developing 7- to 12-yr-old children and children with speech sound disorder were separated into four groups: a trained control group (TDT; n = 10, age 9.6 ± 2.0 yr), a nontrained control group (TDNT; n = 11, age 8.2 ± 1.6 yr), a trained study group (SSDT; n = 10, age 7.7 ± 1.2 yr), and a nontrained study group (SSDNT; n = 8, age 8.6 ± 1.2 yr). INTERVENTION: Both trained groups underwent a computerized, nonverbal auditory training that focused on frequency discrimination, ordering, and backward-masking tasks. The training consisted of twelve 45 min sessions, once a week, for a total of 9 hr of training, approximately. DATA COLLECTION AND ANALYSIS: Near-transfer (Gap-In-Noise [GIN] and Frequency Pattern Test) and far-transfer measures (auditory and visual sustained attention tests, phonological working memory and language tests) were applied before and after training. The results were analyzed using a 2 × 2 × 2 mixed-model analysis of variance with the group and training as the between-group variables and the period as the within-group variable. The significance threshold was p ≤ 0.05. RESULTS: There was a group × period × training interaction for GIN [F(1.35) = 7.18, p = 0.011], indicating a significant threshold reduction only for the TDT group (Tukey multiple comparisons). There was a significant group × period interaction [F(1.35) = 5.52, p = 0.025] and a training × period interaction for visual reaction time [F(1.35) = 4.20, p = 0.048], indicating improvement in the SSDT group and worsening in both nontrained groups. There was also a significant group × training × period interaction [F(1.35) = 4.27, p = 0.046] for the auditory false alarms, with a significant improvement after training only for the SSDT group. Analysis of variance also revealed that all groups exhibited approximately the same level of gains for all measures, except for GIN [F(3,38) = 4.261, p = 0.011] and visual response time [F(3.38) = 4.069, p = 0.014]. CONCLUSIONS: After training, the TDT group demonstrated a significant improvement for GIN and the SSDT exhibited the same for sustained attention, indicating learning generalization from an auditory sensory training to a top-down skill. For the other measures, all groups exhibited approximately the same level of gains, indicating the presence of a test-retest effect. Our findings also show that the memory span was not related to the learning generalization process given that the SSDT exhibited a more pronounced gain in attention skills after the sensory training.

Auditory and visual sustained attention in children with speech sound disorder.

Although research has demonstrated that children with specific language impairment (SLI) and reading disorder (RD) exhibit sustained attention deficits, no study has investigated sustained attention in children with speech sound disorder (SSD). Given the overlap of symptoms, such as phonological memory deficits, between these different language disorders (i.e., SLI, SSD and RD) and the relationships between working memory, attention and language processing, it is worthwhile to investigate whether deficits in sustained attention also occur in children with SSD. A total of 55 children (18 diagnosed with SSD (8.11 ± 1.231) and 37 typically developing children (8.76 ± 1.461)) were invited to participate in this study. Auditory and visual sustained-attention tasks were applied. Children with SSD performed worse on these tasks; they committed a greater number of auditory false alarms and exhibited a significant decline in performance over the course of the auditory detection task. The extent to which performance is related to auditory perceptual difficulties and probable working memory deficits is discussed. Further studies are needed to better understand the specific nature of these deficits and their clinical implications.

Competence-based curricula for the education of speech-language pathologists and audiologists in Brazil.

OBJECTIVE: The aim of this paper is to present the academic requirements for the education of speech-language pathologists (SLPs) and to discuss some of the challenges in providing quality supervised practice and the solutions proposed by some programs in Brazil. METHODS: Brazilian proposals regarding the training of SLPs are reviewed, with guidelines provided by the International Association of Logopedics and Phoniatrics (IALP) and the Comité Permanent de Liaison des Orthophonistes-Logopèdes de l'UE (CPLOL), and descriptions of the specific experience of the oldest Brazilian program are provided. RESULTS: The bachelor's degree is the minimum level required for the independent practice of speech-language pathology and audiology in Brazil, where there are 75 undergraduate programs. In several programs, students are encouraged to enjoy the diversity at their university, enrolling in courses of different areas to broaden their experience. The basic areas of the undergraduate program are mandatory as per recommendation of the Ministry of Education and include competences related to the health system, decision making, communication, leadership and continued education. Since practice training is part of the undergraduate programs, it is incorporated into the pedagogical concept and has a major role in it. CONCLUSION: The structure of the programs allows the dissociation of theory from practice to be attenuated; both educational strategies are used together as part of the pedagogical concept.

Emerging issues concerning the education of speech and language pathologists and audiologists in Brazil and South America.

Diversity is one of the major characteristics of Brazil and all South America. This paper presents an overview of the current situation of the education of speech and language pathologists (SLP) and audiologists in Brazil and in several other countries of South America. This paper also discusses the main challenges shared by these countries. The discussion is focused on the mutual interferences between education and the areas of professional practice, cultural diversity and continued education. There are many emerging issues about the education of SLP and audiologists in South America. The suggested conclusion is that, despite the many differences, the South American SLP and audiologists' education would benefit from joint efforts and collaborative experiences.

Análise da freqüência fundamental, jitter, shimmer e intensidade vocal em crianças com transtorno fonológico / Analysis of fundamental frequency, jitter, shimmer and vocal intensity in children with phonological disorders

O transtorno fonológico é uma alteração de manifestação primária de causa indefinida que torna a fala ininteligível. A análise de parâmetros vocais torna-se importante no processo do diagnóstico deste transtorno, pois distúrbios de voz poderiam interferir na produção dos sons da fala. OBJETIVO: O objetivo deste estudo foi verificar as características vocais relacionadas à intensidade e freqüência fundamental - F0 - e seus índices de perturbação - jitter e shimmer - em crianças com transtorno fonológico. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. MATERIAL E MÉTODO: Foram sujeitos 40 crianças distribuídas em dois grupos: 20 com transtorno fonológico e 20 sem alteração de fala e linguagem. Foram aplicadas provas de fonologia do Teste de Linguagem Infantil ABFW e de fala espontânea. Utilizou-se o Computer Speech Lab, para gravação e análise acústica das vogais /a/, /e/, /i/, por meio dos parâmetros vocais: freqüência fundamental, intensidade, jitter e shimmer. RESULTADOS: F0 - vogal /e/ é menor, em média, para o Grupo com Transtorno Fonológico (126Hz) e 237Hz no Grupo Controle. Para o shimmer e jitter não há evidência de que as médias do Grupo com Transtorno Fonológico sejam diferentes das do Grupo Controle (p= 0,191, p=0,865 respectivamente). Quanto à intensidade, há evidência de que a média diferencia os dois grupos (p= 0,002). CONCLUSÃO: A freqüência da vogal /e/ é menor no Grupo com Transtorno Fonológico. Existe diferença entre grupos para as médias da intensidade das vogais /a/, /e/ e /i/, sendo estas menores no Grupo com Transtorno Fonológico. Não foram encontradas diferenças entre grupos para as médias do jitter e do shimmer.

Analysis of fundamental frequency, jitter, shimmer and vocal intensity in children with phonological disorders.

UNLABELLED: Phonological Disorder is a disturbance of primary manifestation of undefined causes that makes speech become unintelligible. The analysis of vocal parameters becomes important in the process of diagnosis of this disorder, since voice disorders could interfere in the production of speech sounds. AIM: The objective of this study was to verify vocal characteristics related to the intensity and fundamental frequency--F0--and their disturbance indexes--jitter and shimmer--in children with phonological disorders. STUDY DESIGN: Clinical prospective with transversal cohort. MATERIAL AND METHOD: There were 40 children, 20 of them with phonological disorders and 20 with no speech and language disturbances. Phonological exams with the ABFW infantile language test and spontaneous speech were applied. The Computer Speech Lab was used to record and perform acoustic analyses of the vowels /a/, /e/, /i/, through the vocal parameters: fundamental frequency, intensity, jitter and shimmer. RESULTS: F0--vowel /e/ was smaller, on average, in the Phonological Disorder Group and it was 126 Hz in the Control Group. To shimmer and jitter there was no evidence that the means of the Phonological Disorder Group were different from the ones of the Control Group (p= 0.191, p= 0.865, respectively). As for intensity, there was evidence that the average did not differ in the Phonological Disorder Group and the Control Group (p= 0.002). CONCLUSION: The frequency of the vowel /e/ was smaller in the Phonological Disorder Group. There was difference between the two groups regarding the means of intensity of vowels /a/, /e/ and /i/, smaller in the Phonological Disorder Group. No differences between the groups were found regarding the averages of jitter and shimmer.