Monolingual or bilingual intervention for primary language impairment? A randomized control trial.

PURPOSE: This study investigated the clinical effectiveness of monolingual versus bilingual language intervention, the latter involving speech-language pathologist-parent collaboration. The study focuses on methods that are currently being recommended and that are feasible within current clinical contexts. METHOD: Bilingual children with primary language impairment who speak a minority language as their home language and French as their second (n=29, mean age=5 years) were randomly assigned to monolingual treatment, bilingual treatment, and no-treatment (delayed-treatment) conditions. Sixteen sessions of individual language intervention were offered, targeting vocabulary and syntactic skills in French only or bilingually, through parent collaboration during the clinical sessions. Language evaluations were conducted before and after treatment by blinded examiners; these evaluations targeted French as well as the home languages. An additional evaluation was conducted 2 months after completion of treatment to assess maintenance of gains. Both monolingual and bilingual treatment followed a focused stimulation approach. RESULTS: Results in French showed a significant treatment effect for vocabulary but no difference between treatment conditions. Gains were made in syntax, but these gains could not be attributed to treatment given that treatment groups did not improve more than the control group. Home language probes did not suggest that the therapy had resulted in gains in the home language. CONCLUSIONS: The intervention used in this study is in line with current recommendations of major speech-language pathology organizations. However, the findings indicate that the bilingual treatment created through collaboration with parents was not effective in creating a sufficiently intense bilingual context to make it significantly different from the monolingual treatment. Further studies are needed to assess the gains associated with clinical modifications made for bilingual children and to search for effective ways to accommodate their unique needs.

Computer-assisted voice analysis: establishing a pediatric database.

OBJECTIVES: To establish and characterize the first pediatric normative database for the Multi-Dimensional Voice Program, a computerized voice analysis system, and to compare the normative data with the vocal profiles of patients with vocal fold nodules. DESIGN: A cross-sectional, observational design was used to establish the normative database. The comparative study was completed using a case-control design. SETTING: University-based outpatient pediatric otolaryngology clinic. PARTICIPANTS: One hundred control subjects (50 boys and 50 girls) aged 4 to 18 years contributed to the normative database. The voices of 26 patients (19 boys and 7 girls) with bilateral vocal fold nodules were also analyzed. MAIN OUTCOME MEASURES: Demographic data, including sex, age, height, weight, body mass index, and cigarette smoke exposure, were obtained. The Multi-Dimensional Voice Program extracted up to 33 acoustic variables from each voice analysis. RESULTS: The mean (SEM) values of each of the acoustic variables are presented. At age 12 years, boys experience a dramatic decrease in fundamental frequency measurements. The voices of patients with vocal fold nodules had significantly elevated frequency perturbation measurements compared with control subjects (P<.001). CONCLUSIONS: The vocal profile of children is uniform across all girls and prepubescent boys. Patients with vocal fold nodules demonstrated a consistent acoustic profile characterized by an elevation in frequency perturbation measurements. Normal acoustic reference ranges may be used to detect various vocal fold pathologic abnormalities and to monitor the effects of voice therapy.