Comparison of short-term outcomes between people with and without a pre-morbid mental health diagnosis following surgery for traumatic hand injury: a prospective longitudinal study of a multicultural cohort.

BACKGROUND: Following traumatic hand injury, few studies have compared outcomes between people with and without a pre-morbid mental health diagnosis. This study aimed to compare sub-acute outcomes in a multicultural patient cohort with surgically managed traumatic hand injury with and without a pre-morbid mental health diagnosis. METHODS: A prospective, observational cohort study of people with traumatic hand injury presenting pre- surgically to a high-volume hand injury centre in a region of cultural and language diversity was conducted. Participants were assessed face-to-face (baseline) then via telephone (3-months post-surgery) and categorized according to a pre-morbid medically diagnosed mental health diagnosis. Baseline and follow-up assessments included global mental health, and the EuroQol (EQ) 'Health Today' analogue scale (0-100) and health domains. Return-to-work status, complications/symptomatic complaints, and hand function (QuickDASH) were also collected at follow-up. Adjusted analyses-accounting for covariates including cultural identity-were conducted to determine whether 3-month outcomes were associated with a pre-morbid mental health diagnosis. RESULTS: From 405 eligible patients, 386 were enrolled (76% male, mean age 38.9 (standard deviation 15.6)); 57% self-identified as Australian and 22% had a pre-morbid mental health diagnosis. Common injuries regardless of pre-morbid mental health diagnosis were skin (40%), tendon (17%) and bone (17%) injuries. None were complex mutilating injuries. Seventy-eight per cent of the cohort was followed-up. In adjusted analyses, a pre-morbid mental health diagnosis was associated with lower odds for reporting 'good or better' global mental health (Odds Ratio (OR) 0.23 (95% Confidence Interval (CI) 0.18, 0.47), p < 0.001), 'no' anxiety or depression (OR 0.21 (0.11, 0.40), p < 0.001) and no pain (OR 0.56 (0.31, 0.98), p = 0.04)(EQ domains), and worse EQ 'Health Today' (10 points on average (95%CI -14.9, -5.1, p < 0.001). QuickDASH scores, rates of complications/symptomatic complaints and return-to-work profiles were similar. CONCLUSIONS: Despite reporting worse mental and health-related quality-of-life outcomes post-surgery, people with a pre-morbid mental health diagnosis regardless of cultural identity experienced similar clinical and return-to-work outcomes. Future research assessing the value of screening for pre-morbid mental health conditions on post-surgical outcomes is required and should include people with more complex hand injuries.

I remembered the chorm! Word learning abilities of children with and without phonological impairment.

BACKGROUND: Children with phonological impairment present with pattern-based errors in their speech production. While some children have difficulties with speech perception and/or the establishment of robust underlying phonological representations, the nature of phonological impairment in children is still not well understood. Given that phonological and lexical development are closely linked, one way to better understand the nature of the problem in phonological impairment is to examine word learning abilities in children. AIMS: To examine word learning and its relationship with speech perception, speech production and vocabulary knowledge in children aged 4-5 years. There were two variables of interest: speech production abilities ranging from phonological impairment to typical speech; and vocabulary abilities ranging from typical to above average ('lexically precocious'). METHODS & PROCEDURES: Participants were 49 Australian-English-speaking children aged 48-69 months. Children were each taught four novel non-words (out of a selection of eight) through stories, and word learning was assessed at 1 week post-initial exposure. Word learning was assessed using two measures: confrontation naming and story retell naming. Data were analysed by group using independent-samples t-tests and Mann-Whitney U-tests, and continuously using multiple linear regression. OUTCOMES & RESULTS: There was no significant difference in word learning ability of children with and without phonological impairment, but regardless of speech group, children with above average vocabulary had significantly better word learning abilities than children with average vocabulary. In multiple linear regression, vocabulary was the only significant predictor of variance in word learning ability. CONCLUSIONS & IMPLICATIONS: Children with phonological impairment can be lexically precocious and learn new words like their peers without phonological impairment. Contrary to expectations, vocabulary knowledge rather than expressive phonological ability explained variance in measures of word learning. These findings question an assumption that children with phonological impairment have underspecified phonological representations. They also highlight the heterogeneity among children with phonological impairment and the need to better understand the nature of their difficulty learning the phonological system of the ambient language. WHAT THIS PAPER ADDS: What is already known on the subject There is limited research examining the word learning abilities of children with phonological impairment. Most previous research focuses on word properties such as phonotactic probability and neighbourhood density. Within the existing literature there are different reports and conclusions regarding the word learning abilities of children with phonological impairment and whether their word learning differs from that of children with typically developing speech. What this study adds to existing knowledge This study found that vocabulary was the strongest predictor of word learning across children with and without phonological impairment. There was no significant difference in word learning ability between children with and without phonological impairment. However, children with lexically precocious vocabulary abilities were significantly better at word learning than children with average vocabulary abilities. What are the potential or actual clinical implications of this work? Findings from this study support the importance of assessing and considering measures of word learning-including vocabulary-when working with children with phonological impairment. This study indicates that it is possible to use stories coupled with measures of confrontation naming and story retell to gain deeper insight into children's word learning abilities.

Therapist perceptions of barriers to telehealth uptake in children's occupational therapy.

INTRODUCTION: The COVID-19 pandemic resulted in a rapid shift to telehealth implementation across paediatric occupational therapy services. Although telehealth can be an appealing option, access is conditional, and the delivery of a telehealth service differs from face-to-face. If telehealth is to be a viable and equitable option for families, insight is needed into why the service might be declined. The purpose of our study was to explore barriers to paediatric occupational therapy telehealth services from client and therapist perspectives in a Greater Sydney local health district. METHOD: A mixed method approach was used, including (i) retrospective review of clinical records for 250 clients seeking occupational therapy who declined the service and (ii) a focus group with four therapists providing the service. Client demographic information was summarised using descriptive statistics. Open-text responses about reasons for declining telehealth were analysed using qualitative content analysis, whereas thematic analysis was used to explore focus group data. FINDINGS: Key findings from the mixed methods analysis identified barriers and issues to consider when working to ensure equitable access to telehealth for children and families. These issues included child engagement, family complexity, the nature of assessments, interventions, and overarching service characteristics as well as the family's digital inclusion. Digital inclusion comprises affordable access to the internet, data, and devices and the capacity of a child and/or family to engage online. CONCLUSION: Our findings suggest that telehealth is not a panacea when face-to-face services are not available. Multiple barriers confounded uptake of telehealth prompting a call to action to ensure equitable access to occupational therapy services for all children.

Realisation of grammatical morphemes by children with phonological impairment.

The aim of this research was to explore how preschool-aged children with phonological impairment (PI) realise grammatical morphemes across different phonological contexts (i.e. singleton consonant, consonant cluster, syllable), conditions of finiteness and individual morpheme types. Factors accounting for children's realisation of grammatical morphemes were also examined. Eighty-seven Australian English-speaking preschoolers (aged 4-5 years) with PI completed the Children's Assessment of Morphophonology (CHAMP)-an elicited response task-in addition to standardised tests of speech and receptive language. The most challenging grammatical morphemes were finite morphemes (particularly past tense) and grammatical morphemes realised in consonant clusters. The ability to produce consonant clusters in single words significantly accounted for children's ability to realise grammatical morphemes, regardless of whether grammatical morphemes were realised in singleton, consonant cluster or syllable contexts. Realisation of grammatical morphemes by preschoolers with PI is influenced by phonological and morphological factors. The findings have implications regarding the assessment and differential diagnosis of preschoolers with concomitant phonological and language difficulties.

Determining the scope of attacks on health in four governorates of Syria in 2016: Results of a field surveillance program.

BACKGROUND: Violent attacks on and interferences with hospitals, ambulances, health workers, and patients during conflict destroy vital health services during a time when they are most needed and undermine the long-term capacity of the health system. In Syria, such attacks have been frequent and intense and represent grave violations of the Geneva Conventions, but the number reported has varied considerably. A systematic mechanism to document these attacks could assist in designing more protection strategies and play a critical role in influencing policy, promoting justice, and addressing the health needs of the population. METHODS AND FINDINGS: We developed a mobile data collection questionnaire to collect data on incidents of attacks on healthcare directly from the field. Data collectors from the Syrian American Medical Society (SAMS), using the tool or a text messaging system, recorded information on incidents across four of Syria's northern governorates (Aleppo, Idleb, Hama, and Homs) from January 1, 2016, to December 31, 2016. SAMS recorded a total of 200 attacks on healthcare in 2016, 102 of them using the mobile data collection tool. Direct attacks on health facilities comprised the majority of attacks recorded (88.0%; n = 176). One hundred and twelve healthcare staff and 185 patients were killed in these incidents. Thirty-five percent of the facilities were attacked more than once over the data collection period; hospitals were significantly more likely to be attacked more than once compared to clinics and other types of healthcare facilities. Aerial bombs were used in the overwhelming majority of cases (91.5%). We also compared the SAMS data to a separate database developed by Physicians for Human Rights (PHR) based on media reports and matched the incidents to compare the results from the two methods (this analysis was limited to incidents at health facilities). Among 90 relevant incidents verified by PHR and 177 by SAMS, there were 60 that could be matched to each other, highlighting the differences in results from the two methods. This study is limited by the complexities of data collection in a conflict setting, only partial use of the standardized reporting tool, and the fact that limited accessibility of some health facilities and workers and may be biased towards the reporting of attacks on larger or more visible health facilities. CONCLUSIONS: The use of field data collectors and use of consistent definitions can play an important role in the tracking incidents of attacks on health services. A mobile systematic data collection tool can complement other methods for tracking incidents of attacks on healthcare and ensure the collection of detailed information about each attack that may assist in better advocacy, programs, and accountability but can be practically challenging. Comparing attacks between SAMS and PHR suggests that there may have been significantly more attacks than previously captured by any one methodology. This scale of attacks suggests that targeting of healthcare in Syria is systematic and highlights the failure of condemnation by the international community and medical groups working in Syria of such attacks to stop them.

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.

Cultural influences on the developing semantic lexicon.

To determine whether the developing semantic lexicon varies with culture, we examined the animal and food naming of children from three communities distinguished by language, cultural heritage, and population density. The children were five- and seven-year-olds from Australia (n = 197), Taiwan (n = 456), and the US (n = 172). Naming patterns revealed hierarchical and flexible organization of the semantic lexicon. The content of the lexicon, particularly food names, varied with cultural heritage. In all three communities, wild mammals were predominant during animal naming, a likely influence of children's media. The influence of the Chinese zodiac was evident in the clustering of animal names in the Taiwanese sample. There was no apparent influence of population density and little influence of language, except that the Taiwanese children more frequently named foods at the superordinate level, a possible influence of the structure of Mandarin. Children develop their lexicons in response to culture as experienced first-hand or through media.

Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment.

AIMS: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. METHODS: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers' speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ2) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. RESULTS: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. CONCLUSION: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders.

The Monosyllable Imitation Test for Toddlers: influence of stimulus characteristics on imitation, compliance and diagnostic accuracy.

BACKGROUND: Although verbal imitation can provide a valuable window into the developing language abilities of toddlers, some toddlers find verbal imitation challenging and will not comply with tests that involve elicited verbal imitation. The characteristics of stimuli that are offered to toddlers for imitation may influence how easy or hard it is for them to imitate. This study presents a new test of elicited imitation-the Monosyllable Imitation Test for Toddlers (MITT)-comprising stimuli of varying characteristics and test features designed to optimize compliance. AIMS: To investigate whether the stimulus characteristics of neighbourhood density and consonant complexity have independent and/or convergent influences on imitation accuracy; and to examine non-compliance rates and diagnostic accuracy of the MITT and an existing test, the Test of Early Nonword Repetition (TENR) (Stokes and Klee 2009a). METHODS & PROCEDURES: Fifty-two toddlers (25-35 months) participated. Twenty-six had typically developing language (TDs) and 26 were defined as late talkers (LTs) based on parent-reported vocabulary. The MITT stimuli were created by manipulating both neighbourhood density (dense or sparse) and consonant complexity (early- or late-developing initial consonant). The MITT was designed to maximize compliance by: (1) using eight monosyllabic stimuli, (2) providing three exposures to stimuli and (3) embedding imitation in a motivating context: a computer animation with reasons for imitation. OUTCOMES & RESULTS: Stimulus characteristics influenced imitation accuracy in TDs and LTs. For TDs, neighbourhood density had an independent influence, whereas for LTs consonant complexity had an independent influence. These characteristics also had convergent influences. For TDs, stimuli were all equally easy to imitate, except those that were both sparse and contained a late-developing consonant which were harder to imitate. For LTs, stimuli that were both dense and contained an early-developing consonant were easier to imitate than any other stimuli. Two LTs and no TDs were non-compliant with the MITT. With the TENR, five LTs and two TDs were non-compliant. The MITT and TENR yielded similar levels of diagnostic sensitivity, but the TENR offered higher specificity rates. Subsets of stimuli from the MITT and the TENR also showed diagnostic promise when explored post-hoc. CONCLUSIONS & IMPLICATIONS: Stimulus characteristics converge to influence imitation accuracy in both TD and LT toddlers and therefore should be considered when designing stimuli. The MITT resulted in better compliance than the TENR, but the TENR offered higher specificity. Insights about late talking, elicited imitation and speech production capabilities are discussed.

Longitudinal changes in polysyllable maturity of preschool children with phonologically-based speech sound disorders.

Children's polysyllables were investigated for changes in (1) consonant and vowel accuracy, (2) error frequency and (3) polysyllable maturity over time. Participants were 80 children (4;0-5;4) with phonologically-based speech sound disorders who participated in the Sound Start Study and completed the Polysyllable Preschool Test (Baker, 2013) three times. Polysyllable errors were categorised using the Word-level Analysis of Polysyllables (WAP, Masso, 2016a) and the Framework of Polysyllable Maturity (Framework, Masso, 2016b), which represents five maturity levels (Levels A-E). Participants demonstrated increased polysyllable accuracy over time as measured by consonant and vowel accuracy, and error frequency. Children in Level A, the lowest level of maturity, had frequent deletion errors, alterations of phonotactics and alterations of timing. Participants in Level B were 8.62 times more likely to improve than children in Level A at Time 1. Children who present with frequent deletion errors may be less likely to improve their polysyllable accuracy.

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.

The role of elicited verbal imitation in toddlers' word learning.

This study is about the role of elicited verbal imitation in toddler word learning. Forty-eight toddlers were taught eight nonwords linked to referents. During training, they were asked to imitate the nonwords. Naming of the referents was tested at three intervals (one minute later [uncued], five minutes, and 1-7 days later [cued]) and recognition at the last two intervals. Receptive vocabulary, nonword repetition, and expressive phonology were assessed. The accuracy of elicited imitation during training predicted naming at one and five minutes, but not 1-7 days later. Neither nonword repetition nor expressive phonology was associated with naming over time but extant vocabulary predicted performance at all time intervals. We hypothesize that elicited imitation facilitates word learning in its earliest stages by supporting encoding of the word form into memory and allowing practice of the articulatory-phonological plan. At later stages, vocabulary facilitates integration of the word form into the lexical network.

Speech-language pathologists' practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders.

A survey of 231 Australian speech-language pathologists (SLPs) was undertaken to describe practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders (SSD). The participants typically worked in private practice, education, or community health settings and 67.6% had a waiting list for services. For each child, most of the SLPs spent 10-40 min in pre-assessment activities, 30-60 min undertaking face-to-face assessments, and 30-60 min completing paperwork after assessments. During an assessment SLPs typically conducted a parent interview, single-word speech sampling, collected a connected speech sample, and used informal tests. They also determined children's stimulability and estimated intelligibility. With multilingual children, informal assessment procedures and English-only tests were commonly used and SLPs relied on family members or interpreters to assist. Common analysis techniques included determination of phonological processes, substitutions-omissions-distortions-additions (SODA), and phonetic inventory. Participants placed high priority on selecting target sounds that were stimulable, early developing, and in error across all word positions and 60.3% felt very confident or confident selecting an appropriate intervention approach. Eight intervention approaches were frequently used: auditory discrimination, minimal pairs, cued articulation, phonological awareness, traditional articulation therapy, auditory bombardment, Nuffield Centre Dyspraxia Programme, and core vocabulary. Children typically received individual therapy with an SLP in a clinic setting. Parents often observed and participated in sessions and SLPs typically included siblings and grandparents in intervention sessions. Parent training and home programs were more frequently used than the group therapy. Two-thirds kept up-to-date by reading journal articles monthly or every 6 months. There were many similarities with previously reported practices for children with SSD in the US, UK, and the Netherlands, with some (but not all) practices aligning with current research evidence.

Access, Readiness and Willingness to Engage in Allied Health Telerehabilitation Services for Adults: Does Cultural and Linguistic Diversity Make a Difference?

Telerehabilitation is an appealing service delivery option for optimising recovery. Internationally, the equity of telerehabilitation services for people from culturally and linguistically diverse (CALD) backgrounds has been questioned. Using a 31-item survey, our study explored the access, readiness and willingness of 260 patients receiving allied health services from a large tertiary health service located in Sydney, Australia, to use telerehabilitation for adults. Overall, 72% patients reported having access to technology, 38% met our readiness criteria and 53% reported willingness to engage in telerehabilitation. There were no differences in access, readiness and willingness to engage in telerehabilitation between patients from CALD and non-CALD backgrounds. Age was the only factor that influenced access (OR = 0.94, 95% CI 0.90 to 0.97), readiness (OR = 0.95, 95% CI 0.92 to 0.98) and willingness (OR = 0.97, 95% CI 0.95 to 1.00) to engage in telerehabilitation. Past experience of telerehabilitation was related to willingness (OR = 2.73, 95% CI 1.55-4.79) but not access (OR = 1.79, 95% CI 0.87 to 3.68) or readiness (OR = 1.90, 95% CI 0.93 to 3.87). Our findings highlight the importance of ensuring positive patient experiences to promote ongoing willingness to use telerehabilitation. Efforts are needed to improve patients' digital health literacy, especially patients from older age groups, to ensure equitable engagement in telerehabilitation services.

Four Cases of Children With Phonological Impairment and Precocious Vocabulary: Making Sense of a Clinical Conundrum.

PURPOSE: The purpose of this study was to describe the speech production, speech perception, vocabulary, and word learning abilities of lexically precocious 4-year-old children with phonological impairment, in an effort to better understand the underlying nature of phonological impairment in children. METHOD: Using a case series approach, we identified four children with phonological impairment and precocious vocabulary abilities. Each child completed routine speech production and vocabulary assessments, as well as experimental speech perception and word learning tasks. The results from these tasks were then used to create profiles of each child's individual strengths and needs across the abilities assessed. RESULTS: Although all four children presented with phonological impairment and lexically precocious receptive and expressive vocabulary, they differed in their specific speech errors. One child presented with phonological speech errors only, while the other three children presented with an interdental lisp alongside their phonological errors. Three children presented with average speech perception abilities, and one child presented with poorer speech perception. The same three children also showed some learning of novel nonwords 1 week post-initial exposure, while the other child showed no evidence of word learning 1 week post-initial exposure. CONCLUSIONS: The clinical profiles of lexically precocious children with phonological impairment offered different insights into the nature of the problem. Although one child appeared to present with underspecified underlying representations of words, the other three children appeared to present with well-specified underlying representations. Of the three children with well-specified underlying representations, two appeared to have difficulty abstracting particular rules of the ambient phonological system. Further research is needed to improve our understanding of the underlying nature of phonological impairment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26307640.

The Relationship Between Speech Perception, Speech Production, and Vocabulary Abilities in Children: Insights From By-Group and Continuous Analyses.

PURPOSE: The purpose of this study was to explore the relationship between speech perception, speech production, and vocabulary abilities in children with and without speech sound disorders (SSDs), analyzing the data both by group and continuously. METHOD: Sixty-one Australian English-speaking children aged 48-69 months participated in this study. Children's speech production abilities ranged along the continuum from SSDs through to typical speech. Their vocabulary abilities ranged along the continuum from typical to above average ("lexically precocious"). Children completed routine speech and language assessments in addition to an experimental Australian English lexical and phonetic judgment task. RESULTS: When analyzing data by group, there was no significant difference between the speech perception ability of children with SSDs and that of children without SSDs. Children with above-average vocabularies had significantly better speech perception ability than children with average vocabularies. When analyzing data continuously, speech production and vocabulary were both significant positive predictors of variance in speech perception ability, both individually in simple linear regression and when combined in multiple linear regression. There was also a significant positive correlation between perception and production of two of the four target phonemes tested (i.e., /k/ and /ʃ/) among children in the SSD group. CONCLUSIONS: Results from this study provide further insight into the complex relationship between speech perception, speech production, and vocabulary abilities in children. While there is a clinical and important need for categorical distinctions between SSDs and typically developing speech, findings further highlight the value of investigating speech production and vocabulary abilities continuously and categorically. By capturing the heterogeneity among children's speech production and vocabulary abilities, we can advance our understanding of SSDs in children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22229674.

Harnessing automatic speech recognition to realise Sustainable Development Goals 3, 9, and 17 through interdisciplinary partnerships for children with communication disability.

PURPOSE: To showcase how applications of automatic speech recognition (ASR) technology could help solve challenges in speech-language pathology practice with children with communication disability, and contribute to the realisation of the Sustainable Development Goals (SDGs). RESULT: ASR technologies have been developed to address the need for equitable, efficient, and accurate assessment and diagnosis of communication disability in children by automating the transcription and analysis of speech and language samples and supporting dual-language assessment of bilingual children. ASR tools can automate the measurement of and help optimise intervention fidelity. ASR tools can also be used by children to engage in independent speech production practice without relying on feedback from speech-language pathologists (SLPs), thus bridging the long-standing gap between recommended and received intervention intensity. These innovative technologies and tools have been generated from interdisciplinary partnerships between SLPs, engineers, data scientists, and linguists. CONCLUSION: To advance equitable, efficient, and effective speech-language pathology services for children with communication disability, SLPs would benefit from integrating ASR solutions into their clinical practice. Ongoing interdisciplinary research is needed to further advance ASR technologies to optimise children's outcomes. This commentary paper focusses on industry, innovation and infrastructure (SDG 9) and partnerships for the goals (SDG 17). It also addresses SDG 1, SDG 3, SDG 4, SDG 8, SDG 10, SDG 11, and SDG 16.

Optimizing Outcomes for Children With Phonological Impairment: A Systematic Search and Review of Outcome and Experience Measures Reported in Intervention Research.

PURPOSE: Reporting of outcome and experience measures is critical to our understanding of the effect of intervention for speech sound disorders (SSD) in children. There is currently no agreed-upon set of measures for reporting intervention outcomes and experiences. In this article, we introduce the Speech Outcome Reporting Taxonomy (SORT), a tool designed to assist with the classification of outcome and experience measures. In a systematic search and review using the SORT, we explore the type and frequency of these measures reported in intervention research addressing phonological impairment in children. Given the integral relationship between intervention fidelity and intervention outcomes, reporting of fidelity is also examined. METHOD: Five literature databases were searched to identify articles written or translated into English published between 1975 and 2020. Using the SORT, outcome and experience measures were extracted and categorized. The number of intervention studies reporting fidelity was determined. RESULTS: A total of 220 articles met inclusion criteria. The most frequently reported outcome domain was broad generalization measures (n = 142, 64.5%), followed by specific measures of generalization of an intervention target (n = 133, 60.5%). Eleven (5.0%) articles reported measures of the impact of the phonological impairment on children's activity, participation, quality of life, or others. Twenty articles (9.1%) reported on parent, child, or clinician experience or child engagement. Fidelity data were reported for 13.4% of studies of interventions. CONCLUSIONS: The measurement of intervention outcomes is challenging yet important. No single type of measure was reported across all articles. Through using tailored measures closely related to intervention targets in combination with a universal set of measures of intelligibility, the impact of phonological impairment on children's lives, and the experience of receiving and providing intervention, researchers and clinicians could work together to progress insights and innovations in science and practice for children with SSD. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19497803.

A Systematic Review of Interventions for Late Talkers: Intervention Approaches, Elements, and Vocabulary Outcomes.

PURPOSE: The aim of this systematic review was to examine the empirical evidence on interventions for late talkers between 18 and 42 months according to type of intervention approach (direct, indirect, and hybrid), reporting of intervention elements, and outcomes for receptive and expressive vocabulary. METHOD: This review was registered with PROSPERO and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eleven databases were systematically searched with 34 intervention studies involving 1,207 participants meeting criteria. Studies were categorized as using a direct, indirect, or hybrid intervention approach, then examined according to intervention elements, vocabulary outcomes, as well as reported tools and type of score used to evaluate outcomes. RESULTS: Across 34 studies, nine used a direct intervention approach, 10 an indirect intervention approach, and 14 a hybrid intervention approach. One study compared direct and hybrid intervention approaches. All indirect and hybrid approaches included parent training; direct approaches did not. The type and degree of reporting of other intervention elements, as well as the tools and type of score used to evaluate outcomes, varied within and across approaches. Overall, improvements in expressive vocabulary were reported by 93% of studies, with variable results for the nine studies reporting receptive vocabulary outcomes. CONCLUSIONS: The direct, indirect, and hybrid intervention approaches were typified by specific intervention elements; however, there was diversity in how other elements comprising the approaches were arranged. When making decisions about which intervention approach to use, clinicians need to be mindful of the differences among approaches, how they discuss those differences with parents, and which approaches and elements might be best suited to individual children and their families. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21291405.