Evaluation of Parent- and Speech-Language Pathologist-Delivered Multiple Oppositions Intervention for Children With Phonological Impairment: A Multiple-Baseline Design Study.

Purpose Evidence for the multiple oppositions intervention approach indicates it should be delivered 3 times weekly; however, this high dose frequency is not provided by many speech-language pathologists worldwide. This study investigated whether parents could be involved in delivering phonological intervention to fulfill this intensity shortfall. Method Five children with moderate-to-severe phonological impairment aged 3;3-5;11 (years;months) and 1 of their parents participated in this study using a multiple-baseline across participants design. Participants attended one 60-min clinic-based session per week for 8 weeks, and parents completed home practice 2 times per week over this period after receiving training. Parents also attended a 60-min training session prior to commencing intervention. Results All children showed a treatment effect to treated words. Three of the 5 children demonstrated a large effect size for generalization to nontreatment words, with 1 child demonstrating a moderate effect and 1 child demonstrating no effect. However, all children showed qualitative changes to their speech system. Three of the 5 children experienced significant changes to communicative participation. Measures of treatment fidelity indicated that parents were able to competently deliver the intervention both within the clinic and at home. Conclusions Combined parent- and speech-language pathologist-delivered multiple oppositions intervention is effective for some children with moderate-to-severe phonological impairment. The findings indicate that parents can be trained to competently and confidently deliver phonological intervention. Further evidence is needed to identify optimal child and parent characteristics most suited to this modified service delivery approach. Supplemental Material https://doi.org/10.23641/asha.10565885.

Service delivery and intervention intensity for phonology-based speech sound disorders.

BACKGROUND: When planning evidence-based intervention services for children with phonology-based speech sound disorders (SSD), speech and language therapists (SLTs) need to integrate research evidence regarding service delivery and intervention intensity within their clinical practice. However, relatively little is known about the optimal intensity of phonological interventions and whether SLTs' services align with the research evidence. AIMS: The aims are twofold. First, to review external evidence (i.e., empirical research evidence external to day-to-day clinical practice) regarding service delivery and intervention intensity for phonological interventions. Second, to investigate SLTs' clinical practice with children with phonology-based SSD in Australia, focusing on service delivery and intensity. By considering these complementary sources of evidence, SLTs and researchers will be better placed to understand the state of the external evidence regarding the delivery of phonological interventions and appreciate the challenges facing SLTs in providing evidence-based services. METHODS & PROCEDURES: Two studies are presented. The first is a review of phonological intervention research published between 1979 and 2016. Details regarding service delivery and intervention intensity were extracted from the 199 papers that met inclusion criteria identified through a systematic search. The second study was an online survey of 288 SLTs working in Australia, focused on the service delivery and intensity of intervention provided in clinical practice. MAIN CONTRIBUTIONS: There is a gap between the external evidence regarding service delivery and intervention intensity and the internal evidence from clinical practice. Most published intervention research has reported to provide intervention two to three times per week in individual sessions delivered by an SLT in a university clinic, in sessions lasting 30-60 min comprising 100 production trials. SLTs reported providing services at intensities below that found in the literature. Further, they reported workplace, client and clinician factors that influenced the intensity of intervention they were able to provide to children with phonology-based SSD. CONCLUSIONS & IMPLICATIONS: Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice.

Elements of Phonological Interventions for Children With Speech Sound Disorders: The Development of a Taxonomy.

Purpose: Our aim was to develop a taxonomy of elements comprising phonological interventions for children with speech sound disorders. Method: We conducted a content analysis of 15 empirically supported phonological interventions to identify and describe intervention elements. Measures of element concentration, flexibility, and distinctiveness were used to compare and contrast interventions. Results: Seventy-two intervention elements were identified using a content analysis of intervention descriptions then arranged to form the Phonological Intervention Taxonomy: a hierarchical framework comprising 4 domains, 15 categories, and 9 subcategories. Across interventions, mean element concentration (number of required or optional elements) was 45, with a range of 27 to 59 elements. Mean flexibility of interventions (percentage of elements considered optional out of all elements included in the intervention) was 44%, with a range of 29% to 62%. Distinctiveness of interventions (percentage of an intervention's rare elements and omitted common elements out of all elements included in the intervention [both optional and required]) ranged from 0% to 30%. Conclusions: An understanding of the elements that comprise interventions and a taxonomy that describes their structural relationships can provide insight into similarities and differences between interventions, help in the identification of elements that drive treatment effects, and facilitate faithful implementation or intervention modification. Research is needed to distil active elements and identify strategies that best facilitate replication and implementation.

An Australian survey of parent involvement in intervention for childhood speech sound disorders.

PURPOSE: To investigate how speech-language pathologists (SLPs) report involving parents in intervention for phonology-based speech sound disorders (SSDs), and to describe the home practice that they recommend. Further aims were to describe the training SLPs report providing to parents, to explore SLPs' beliefs and motivations for involving parents in intervention, and to determine whether SLPs' characteristics are associated with their self-reported practice. METHOD: An online survey of 288 SLPs working with SSD in Australia was conducted. RESULT: The majority of SLPs (96.4%) reported involving parents in intervention, most commonly in providing home practice. On average, these tasks were recommended to be completed five times per week for 10 min. SLPs reported training parents using a range of training methods, most commonly providing opportunities for parents to observe the SLP conduct the intervention. SLPs' place of work and years of experience were associated with how they involved and trained parents in intervention. Most (95.8%) SLPs agreed or strongly agreed that family involvement is essential for intervention to be effective. CONCLUSION: Parent involvement and home practice appear to be intricately linked within intervention for phonology-based SSDs in Australia. More high-quality research is needed to understand how to best involve parents within clinical practice.

Involvement of parents in intervention for childhood speech sound disorders: a review of the evidence.

BACKGROUND: Internationally, speech and language therapists (SLTs) are involving parents and providing home tasks in intervention for phonology-based speech sound disorder (SSD). To ensure that SLTs' involvement of parents is guided by empirical research, a review of peer-reviewed published evidence is needed. AIMS: To provide SLTs and researchers with a comprehensive appraisal and analysis of peer-reviewed published intervention research reporting parent involvement and the provision of home tasks in intervention studies for children with phonology-based SSD. METHODS & PROCEDURES: A systematic search and review was conducted. Academic databases were searched for peer-reviewed research papers published between 1979 and 2013 reporting on phonological intervention for SSD. Of the 176 papers that met the criteria, 61 were identified that reported on the involvement of parents and/or home tasks within the intervention. These papers were analysed using a quality appraisal tool. Details regarding the involvement of parents and home tasks were extracted and analysed to provide a summary of these practices within the evidence base. MAIN CONTRIBUTION: Parents have been involved in intervention research for phonology-based SSD. However, most of the peer-reviewed published papers reporting this research have provided limited details regarding what this involved. This paucity of information presents challenges for SLTs wishing to integrate external evidence into their clinical services and clinical decision-making. It also raises issues regarding treatment fidelity for researchers wishing to replicate published intervention research. CONCLUSIONS & IMPLICATIONS: The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.

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.

Intensity in phonological intervention: is there a prescribed amount?

Despite a number of studies that have demonstrated positive outcomes for inducing clinical change in children with speech sound disorders (SSD), there is a need to address the question of whether resources are being applied in an optimal manner. As a consequence, there has been a call to look within interventions to examine parameters that may contribute to intervention outcomes; specifically the intensity of intervention (dose, frequency, duration, and cumulative intervention intensity). In this paper, empirical evidence from three intervention studies using multiple oppositions primarily, and a second contrastive approach, minimal pairs, is reported with regard to the parameters of intervention intensity. The findings indicated that greater intensity yields greater treatment outcomes. Further, quantitative and qualitative changes in intensity occur as intervention progresses, and there were differences in intensity based on severity of the SSD. Based on these data, suggestions were made toward establishing some prescribed amounts of intensity to affect treatment outcomes for children with SSD.

Early and later vocalization skills in children with and without cleft palate.

OBJECTIVE: The purpose of this study was to describe the early vocalization skills in children with cleft lip and palate (CLP) at 6 and 12 months of age and compare these early vocalization measures to later speech and vocabulary development at 30 months of age. METHODS: The participants in the study included 13 children without cleft lip or palate (NCLP) who were typically developing and 13 children with CLP matched for age, gender and socioeconomic status. Standardized measures of cognition, language, hearing, and prelinguistic vocalization measures were administered at 6 and 12 months and speech production, and vocabulary measures were collected at 30 months of age. RESULTS: Group differences were observed in both receptive and expressive language development at 12 and 30 months of age. Group differences were observed in the frequency of babbling and Mean Babbling Level at 12 months and speech sound accuracy and vocabulary production at 30 months of age. Significant correlation coefficients were observed between babbling frequency at 6 months and consonant inventory size, vocabulary at 30 months for the children with clefts and PCC-R for noncleft children. CONCLUSIONS: This study documented that young children with clefts have persistent vocalization and vocabulary deficits well beyond palate closure. Measures of babbling frequency, Mean Babbling Level and consonant inventories provide clinically effective means of identifying these early deficits. Additionally, these measures may provide a tool for monitoring the effects of early intervention programs that promote facilitation of sound and vocabulary development.

A Prospective Longitudinal Study of Phonological Development in Late Talkers.

PURPOSE: This study involved prospective longitudinal data on 5 late talkers to provide information about the course of phonological development in order to identify possible predictors of delayed versus deviant development. METHOD: Five children (3 boys, 2 girls) were identified as late talkers and divided into a younger group and an older group. Each child was followed monthly for 10 to 12 months (22-33 months for the younger group and 30-42 months for the older group). Two types of monthly language samples (free play and elicited) were obtained to describe the individual courses of phonological development for each child. Independent and relational analyses were completed at each age to describe word-initial and word-final phonetic inventories, syllable structure, syllable diversity, percentage of consonants correct (PCC), sound variability, and error patterns. RESULTS: The results indicated that 3 of the children resolved their late onset of speech by 33 to 35 months of age. In addition to quantitative factors, (e.g., limited phonetic inventory, lower PCC, and more sound errors), qualitative variables (e.g., atypical error patterns, greater sound variability, and slower rate of resolution) also were identified as potential markers of long-term phonological delay. CLINICAL IMPLICATIONS: This study provides information to clinicians so they can identify those children who are less likely to resolve their late onset of phonological development without direct intervention. Procedures are described for assessing early linguistic behaviors that incorporate independent and relational analyses on more extensive speech samples (elicited and free play). From these analyses, clinicians can examine quantitative and qualitative variables to differentiate phonological delay from deviance.