Variability, accuracy, and cross-linguistic transfer in bilingual children speaking Jamaican Creole and English.

Due to the lack of normative data about bilingual speech development and limited availability of diagnostic tools optimised for this population, bilingual children under consideration for speech-language services are at an elevated risk of misdiagnosis. In the absence of validated assessment tools, speech-language pathologists may use measures of accuracy and variability of speech production to diagnose suspected speech sound disorders in bilingual children. Research in general motor development suggests that variability and accuracy may trade off in the course of maturation, whereby movement variability spikes before the transition to a more mature stage of motor control. Such variability-accuracy tradeoffs have been described in monolingual speech development but are understudied in bilingual populations, where cross-linguistic transfer occurs. This study aimed to examine variability, accuracy, and cross-linguistic transfer in the speech of 20 bilingual children speaking Jamaican Creole and English. We hypothesised that children who showed higher accuracy in their productions would also exhibit more variable speech, indicating a variability-accuracy tradeoff. The Word Inconsistency Assessment from the Diagnostic Evaluation of Articulation and Phonology was administered to measure accuracy and variability in the English context, where misdiagnosis is likely to occur. Contrary to our hypothesis, we observed that individuals with higher accuracy tended to be less variable in their productions. Future research should examine longitudinal trajectories of accuracy and variability and consider a more culturally-appropriate definition of 'accuracy' in documenting bilingual speech sound development.

Comparing metrics for quantification of children's tongue shape complexity using ultrasound imaging.

Speech sound disorders can pose a challenge to communication in children that may persist into adulthood. As some speech sounds are known to require differential control of anterior versus posterior regions of the tongue body, valid measurement of the degree of differentiation of a given tongue shape has the potential to shed light on development of motor skill in typical and disordered speakers. The current study sought to compare the success of multiple techniques in quantifying tongue shape complexity as an index of degree of lingual differentiation in child and adult speakers. Using a pre-existing data set of ultrasound images of tongue shapes from adult speakers producing a variety of phonemes, we compared the extent to which three metrics of tongue shape complexity differed across phonemes/phoneme classes that were expected to differ in articulatory complexity. We then repeated this process with ultrasound tongue shapes produced by a sample of young children. The results of these comparisons suggested that a modified curvature index and a metric representing the number of inflection points best reflected small changes in tongue shapes across individuals differing in vocal tract size. Ultimately, these metrics have the potential to reveal delays in motor skill in young children, which could inform assessment procedures and treatment decisions for children with speech delays and disorders.

Effects of Practice Variability on Second-Language Speech Production Training.

BACKGROUND: Mastering the phonetics of a second language (L2) involves a component of speech-motor skill, and it has been suggested that L2 learners aiming to achieve a more native-like pronunciation could benefit from practice structured in accordance with the principles of motor learning. PARTICIPANTS AND METHODS: This study investigated the influence one such principle, high versus low variability in practice, has on speech-motor learning for Korean adults seeking to acquire native-like production of English rhotics. Practice incorporated a commercially available intraoral placement device ("R Buddy," Speech Buddies Inc.). In a single-subject across-behaviors design, 8 participants were pseudorandomly assigned to practice rhotic targets in a low-variability (single word) or high-variability (multiple words) practice condition. RESULTS: The hypothesized advantage for high-variability over low-variability practice was observed in the short-term time frame. However, long-term learning was limited in nature for both conditions. CONCLUSION: These results suggest that future research should incorporate high-variability practice while identifying additional manipulations to maximize the magnitude of long-term generalization learning.

Treatment generalization from trained /ɹ/ to untrained /l/: a case study of persisting distortion errors.

The extent to which treatment of speech errors that are phonetic in nature (i.e., distortions) produces generalization to untrained sounds is not well understood. This case study reports a child referred for treatment of a velarized distortion of American English /ɹ/, who also demonstrated an inconsistent velarized distortion of /l/. Acoustic analysis revealed evidence of a covert contrast between /ɹ/ and /l/ prior to treatment. Ultrasound biofeedback treatment and perceptual training targeted /ɹ/ only, but progress was tracked for both /ɹ/ and /l/. Substantial improvements in perceptually rated accuracy and significant changes in acoustic features were observed for both sounds, indicating generalization. These results highlight that generalization from trained to untrained sounds is possible for children with residual speech errors characterized by phonetic distortions.

Auditory-perceptual acuity in rhotic misarticulation: baseline characteristics and treatment response.

The rhotic sound /r/ is one of the latest-emerging sounds in English, and many children receive treatment for residual errors affecting /r/ that persist past the age of 9. Auditory-perceptual abilities of children with residual speech errors are thought to be different from their typically developing peers. This study examined auditory-perceptual acuity in children with residual speech errors affecting /r/ and the relation of these skills to production accuracy, both before and after a period of treatment incorporating visual biofeedback. Identification of items along an /r/-/w/ continuum was assessed prior to treatment. Production accuracy for /r/ was acoustically measured from standard/r/stimulability probes elicited before and after treatment. Fifty-nine children aged 9-15 with residual speech errors (RSE) affecting /r/ completed treatment, and forty-eight age-matched controls who completed the same auditory-perceptual task served as a comparison group. It was hypothesized that children with RSE would show lower auditory-perceptual acuity than typically developing speakers and that higher auditory-perceptual acuity would be associated with more accurate production before treatment. It was also hypothesized that auditory-perceptual acuity would serve as a mediator of treatment response. Results indicated that typically developing children have more acute perception of the /r/-/w/ contrast than children with RSE. Contrary to hypothesis, baseline auditory-perceptual acuity for /r/ did not predict baseline production severity. For baseline auditory-perceptual acuity in relation to biofeedback efficacy, there was an interaction between auditory-perceptual acuity and gender, such that higher auditory-perceptual acuity was associated with greater treatment response in female, but not male, participants.

Protocol for Correcting Residual Errors with Spectral, ULtrasound, Traditional Speech therapy Randomized Controlled Trial (C-RESULTS RCT).

BACKGROUND: Speech sound disorder in childhood poses a barrier to academic and social participation, with potentially lifelong consequences for educational and occupational outcomes. While most speech errors resolve by the late school-age years, between 2 and 5% of speakers exhibit residual speech errors (RSE) that persist through adolescence or even adulthood. Previous findings from small-scale studies suggest that interventions incorporating visual biofeedback can outperform traditional motor-based treatment approaches for children with RSE, but this question has not been investigated in a well-powered randomized controlled trial. METHODS/DESIGN: This project, Correcting Residual Errors with Spectral, ULtrasound, Traditional Speech therapy Randomized Controlled Trial (C-RESULTS RCT), aims to treat 110 children in a parallel randomized controlled clinical trial comparing biofeedback and non-biofeedback interventions for RSE affecting the North American English rhotic sound /ɹ/. Eligible children will be American English speakers, aged 9-15 years, who exhibit RSE affecting /ɹ/ but otherwise show typical cognitive-linguistic and hearing abilities. Participants will be randomized, with stratification by site (Syracuse University or Montclair State University) and pre-treatment speech production ability, to receive either a motor-based treatment consistent with current best practices in speech therapy (40% of participants) or treatment incorporating visual biofeedback (60% of participants). Within the biofeedback condition, participants will be assigned in equal numbers to receive biofeedback in the form of a real-time visual display of the acoustic signal of speech or ultrasound imaging of the tongue during speech. The primary outcome measure will assess changes in the acoustics of children's production of /ɹ/ during treatment, while a secondary outcome measure will use blinded listeners to evaluate changes in the perceived accuracy of /ɹ/ production after the completion of all treatment. These measures will allow the treatment conditions to be compared with respect to both efficacy and efficiency. DISCUSSION: By conducting the first well-powered randomized controlled trial comparing treatment with and without biofeedback, this study aims to provide high-quality evidence to guide treatment decisions for children with RSE. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03737318, November 9, 2018.

Can perceptual training alter the effect of visual biofeedback in speech-motor learning?

Recent work showing that a period of perceptual training can modulate the magnitude of speech-motor learning in a perturbed auditory feedback task could inform clinical interventions or second-language training strategies. The present study investigated the influence of perceptual training on a clinically and pedagogically relevant task of vocally matching a visually presented speech target using visual-acoustic biofeedback. Forty female adults aged 18-35 yr received perceptual training targeting the English /æ-ɛ/ contrast, randomly assigned to a condition that shifted the perceptual boundary toward either /æ/ or /ɛ/. Participants were then asked to produce the word head while modifying their output to match a visually presented acoustic target corresponding with a slightly higher first formant (F1, closer to /æ/). By analogy to findings from previous research, it was predicted that individuals whose boundary was shifted toward /æ/ would also show a greater magnitude of change in the visual biofeedback task. After perceptual training, the groups showed the predicted difference in perceptual boundary location, but they did not differ in their performance on the biofeedback matching task. It is proposed that the explicit versus implicit nature of the tasks used might account for the difference between this study and previous findings.

Individual predictors of response to biofeedback training for second-language production.

While recent research suggests that visual biofeedback can facilitate speech production training in clinical populations and second language (L2) learners, individual learners' responsiveness to biofeedback is highly variable. This study investigated the hypothesis that the type of biofeedback provided, visual-acoustic versus ultrasound, could interact with individuals' acuity in auditory and somatosensory domains. Specifically, it was hypothesized that learners with lower acuity in a sensory domain would show greater learning in response to biofeedback targeting that domain. Production variability and phonological awareness were also investigated as predictors. Sixty female native speakers of English received 30 min of training, randomly assigned to feature visual-acoustic or ultrasound biofeedback, for each of two Mandarin vowels. On average, participants showed a moderate magnitude of improvement (decrease in Euclidean distance from a native-speaker target) across both vowels and biofeedback conditions. The hypothesis of an interaction between sensory acuity and biofeedback type was not supported, but phonological awareness and production variability were predictive of learning gains, consistent with previous research. Specifically, high phonological awareness and low production variability post-training were associated with better outcomes, although these effects were mediated by vowel target. This line of research could have implications for personalized learning in both L2 pedagogy and clinical practice.

Modelling category goodness judgments in children with residual sound errors.

This study investigates category goodness judgments of /r/ in adults and children with and without residual speech errors (RSEs) using natural speech stimuli. Thirty adults, 38 children with RSE (ages 7-16) and 35 age-matched typically developing (TD) children provided category goodness judgments on whole words, recorded from 27 child speakers, with /r/ in various phonetic environments. The salient acoustic property of /r/ - the lowered third formant (F3) - was normalized in two ways. A logistic mixed-effect model quantified the relationships between listeners' responses and the third formant frequency, vowel context and clinical group status. Goodness judgments from the adult group showed a statistically significant interaction with the F3 parameter when compared to both child groups (p < 0.001) using both normalization methods. The RSE group did not differ significantly from the TD group in judgments of /r/. All listeners were significantly more likely to judge /r/ as correct in a front-vowel context. Our results suggest that normalized /r/ F3 is a statistically significant predictor of category goodness judgments for both adults and children, but children do not appear to make adult-like judgments. Category goodness judgments do not have a clear relationship with /r/ production abilities in children with RSE. These findings may have implications for clinical activities that include category goodness judgments in natural speech, especially for recorded productions.

Comparing online versus laboratory measures of speech perception in older children and adolescents.

Given the increasing prevalence of online data collection, it is important to know how behavioral data obtained online compare to samples collected in the laboratory. This study compares online and in-person measurement of speech perception in older children and adolescents. Speech perception is important for assessment and treatment planning in speech-language pathology; we focus on the American English /ɹ/ sound because of its frequency as a clinical target. Two speech perception tasks were adapted for web presentation using Gorilla: identification of items along a synthetic continuum from rake to wake, and category goodness judgment of English /ɹ/ sounds in words produced by various talkers with and without speech sound disorder. Fifty typical children aged 9-15 completed these tasks online using a standard headset. These data were compared to a previous sample of 98 typical children aged 9-15 who completed the same tasks in the lab setting. For the identification task, participants exhibited smaller boundary widths (suggestive of more acute perception) in the in-person setting relative to the online setting. For the category goodness judgment task, there was no statistically significant effect of modality. The correlation between scores on the two tasks was significant in the online setting but not in the in-person setting, but the difference in correlation strength was not statistically significant. Overall, our findings agree with previous research in suggesting that online and in-person data collection do not yield identical results, but the two contexts tend to support the same broad conclusions. In addition, these results suggest that online data collection can make it easier for researchers connect with a more representative sample of participants.

Evaluating acoustic representations and normalization for rhoticity classification in children with speech sound disorders.

The effects of different acoustic representations and normalizations were compared for classifiers predicting perception of children's rhotic versus derhotic /ɹ/. Formant and Mel frequency cepstral coefficient (MFCC) representations for 350 speakers were z-standardized, either relative to values in the same utterance or age-and-sex data for typical /ɹ/. Statistical modeling indicated age-and-sex normalization significantly increased classifier performances. Clinically interpretable formants performed similarly to MFCCs and were endorsed for deep neural network engineering, achieving mean test-participant-specific F1-score = 0.81 after personalization and replication (σx = 0.10, med = 0.83, n = 48). Shapley additive explanations analysis indicated the third formant most influenced fully rhotic predictions.

Crowdsourced Perceptual Ratings of Voice Quality in People With Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial.

PURPOSE: Limited research has examined the suitability of crowdsourced ratings to measure treatment effects in speakers with Parkinson's disease (PD), particularly for constructs such as voice quality. This study obtained measures of reliability and validity for crowdsourced listeners' ratings of voice quality in speech samples from a published study. We also investigated whether aggregated listener ratings would replicate the original study's findings of treatment effects based on the Acoustic Voice Quality Index (AVQI) measure. METHOD: This study reports a secondary outcome measure of a randomized controlled trial with speakers with dysarthria associated with PD, including two active comparators (Lee Silverman Voice Treatment [LSVT LOUD] and LSVT ARTIC), an inactive comparator (untreated PD), and a healthy control group. Speech samples from three time points (pretreatment, posttreatment, and 6-month follow-up) were presented in random order for rating as "typical" or "atypical" with respect to voice quality. Untrained listeners were recruited through the Amazon Mechanical Turk crowdsourcing platform until each sample had at least 25 ratings. RESULTS: Intrarater reliability for tokens presented repeatedly was substantial (Cohen's κ = .65-.70), and interrater agreement significantly exceeded chance level. There was a significant correlation of moderate magnitude between the AVQI and the proportion of listeners classifying a given sample as "typical." Consistent with the original study, we found a significant interaction between group and time point, with the LSVT LOUD group alone showing significantly higher perceptually rated voice quality at posttreatment and follow-up relative to the pretreatment time point. CONCLUSIONS: These results suggest that crowdsourcing can be a valid means to evaluate clinical speech samples, even for less familiar constructs such as voice quality. The findings also replicate the results of the study by Moya-Galé et al. (2022) and support their functional relevance by demonstrating that the effects of treatment measured acoustically in that study are perceptually apparent to everyday listeners.

Reproducible Speech Research With the Artificial Intelligence-Ready PERCEPT Corpora.

BACKGROUND: Publicly available speech corpora facilitate reproducible research by providing open-access data for participants who have consented/assented to data sharing among different research teams. Such corpora can also support clinical education, including perceptual training and training in the use of speech analysis tools. PURPOSE: In this research note, we introduce the PERCEPT (Perceptual Error Rating for the Clinical Evaluation of Phonetic Targets) corpora, PERCEPT-R (Rhotics) and PERCEPT-GFTA (Goldman-Fristoe Test of Articulation), which together contain over 36 hr of speech audio (> 125,000 syllable, word, and phrase utterances) from children, adolescents, and young adults aged 6-24 years with speech sound disorder (primarily residual speech sound disorders impacting /ɹ/) and age-matched peers. We highlight PhonBank as the repository for the corpora and demonstrate use of the associated speech analysis software, Phon, to query PERCEPT-R. A worked example of research with PERCEPT-R, suitable for clinical education and research training, is included as an appendix. Support for end users and information/descriptive statistics for future releases of the PERCEPT corpora can be found in a dedicated Slack channel. Finally, we discuss the potential for PERCEPT corpora to support the training of artificial intelligence clinical speech technology appropriate for use with children with speech sound disorders, the development of which has historically been constrained by the limited representation of either children or individuals with speech impairments in publicly available training corpora. CONCLUSIONS: We demonstrate the use of PERCEPT corpora, PhonBank, and Phon for clinical training and research questions appropriate to child citation speech. Increased use of these tools has the potential to enhance reproducibility in the study of speech development and disorders.

Traditional and Visual-Acoustic Biofeedback Treatment via Telepractice for Residual Speech Sound Disorders Affecting /ɹ/: Pilot study.

Purpose: This study aimed to examine the feasibility of telepractice delivery of a treatment package including visual-acoustic biofeedback and motor-based treatment for residual speech sound disorder affecting /ɹ/ in school-age children. The overall study used a single-case randomization design; however, this preliminary report will simply quantify changes in accuracy before and after completion of the treatment package. The present analysis did not differentiate between the relative contributions of biofeedback and motor-based treatments. Method: Seven children aged 9-14 received speech therapy for /ɹ/ distortions via telepractice. The study design consisted of three phases: baseline (four sessions), treatment (20 sessions), and post-treatment (three sessions). Treatment included two sessions weekly for a duration of 10 weeks. The participants received one motor-based/non-biofeedback session and one visual-acoustic biofeedback session per week. The order of treatment within each week was randomly determined prior to the start of therapy. Overall progress was assessed using untrained listeners' ratings of word probes administered in the baseline and posttreatment phases. Results: Findings revealed that six of the seven participants showed a clinically significant response to the overall treatment package, although the magnitude of individual responses varied across speech contexts (consonantal and vocalic) and participants. Conclusion: The present results suggest that a treatment combining visual-acoustic biofeedback and motor-based treatment for residual /ɹ/ errors treatment can be effectively delivered via telepractice. Considerations for technology setup and treatment protocols are provided.

Tutorial: Using Visual-Acoustic Biofeedback for Speech Sound Training.

PURPOSE: This tutorial summarizes current practices using visual-acoustic biofeedback (VAB) treatment to improve speech outcomes for individuals with speech sound difficulties. Clinical strategies will focus on residual distortions of /ɹ/. METHOD: Summary evidence related to the characteristics of VAB and the populations that may benefit from this treatment are reviewed. Guidelines are provided for clinicians on how to use VAB with clients to identify and modify their productions to match an acoustic representation. The clinical application of a linear predictive coding spectrum is emphasized. RESULTS: Successful use of VAB requires several key factors including clinician and client comprehension of the acoustic representation, appropriate acoustic target and template selection, as well as appropriate selection of articulatory strategies, practice schedules, and feedback models to scaffold acquisition of new speech sounds. CONCLUSION: Integrating a VAB component in clinical practice offers additional intervention options for individuals with speech sound difficulties and often facilitates improved speech sound acquisition and generalization outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21817722.

Auditory and Somatosensory Development for Speech in Later Childhood.

PURPOSE: This study collected measures of auditory-perceptual and oral somatosensory acuity in typically developing children and adolescents aged 9-15 years. We aimed to establish reference data that can be used as a point of comparison for individuals with residual speech sound disorder (RSSD), especially for RSSD affecting American English rhotics. We examined concurrent validity between tasks and hypothesized that performance on at least some tasks would show a significant association with age, reflecting ongoing refinement of sensory function in later childhood. We also tested for an inverse relationship between performance on auditory and somatosensory tasks, which would support the hypothesis of a trade-off between sensory domains. METHOD: Ninety-eight children completed three auditory-perceptual tasks (identification and discrimination of stimuli from a "rake"-"wake" continuum and category goodness judgment for naturally produced words containing rhotics) and three oral somatosensory tasks (bite block with auditory masking, oral stereognosis, and articulatory awareness, which involved explicit judgments of relative tongue position for different speech sounds). Pairwise associations were examined between tasks within each domain and between task performance and age. Composite measures of auditory-perceptual and somatosensory functions were used to investigate the possibility of a sensory trade-off. RESULTS: Statistically significant associations were observed between the identification and discrimination tasks and the bite block and articulatory awareness tasks. In addition, significant associations with age were found for the category goodness and bite block tasks. There was no statistically significant evidence of a trade-off between auditory-perceptual and somatosensory domains. CONCLUSIONS: This study provided a multidimensional characterization of speech-related sensory function in older children/adolescents. Complete materials to administer all experimental tasks have been shared, along with measures of central tendency and dispersion for scores in two subgroups of age. Ultimately, we hope to apply this information to make customized treatment recommendations for children with RSSD based on sensory profiles.

Neural Changes in Children With Residual Speech Sound Disorder After Ultrasound Biofeedback Speech Therapy.

PURPOSE: Children with residual speech sound disorders (RSSD) have shown differences in neural function for speech production, as compared to their typical peers; however, information about how these differences may change over time and relative to speech therapy is needed. To address this gap, we used functional magnetic resonance imaging (fMRI) to examine functional activation and connectivity on adaptations of the syllable repetition task (SRT-Early Sounds and SRT-Late Sounds) in children with RSSD before and after a speech therapy program. METHOD: Sixteen children with RSSD completed an fMRI experiment before (Time 1) and after (Time 2) a speech therapy program with ultrasound visual feedback for /ɹ/ misarticulation. Progress in therapy was measured via perceptual ratings of productions of untreated /ɹ/ word probes. To control for practice effects and developmental change in patterns of activation and connectivity, 17 children with typical speech development (TD) completed the fMRI at Time 1 and Time 2. Functional activation was analyzed using a region-of-interest approach and functional connectivity was analyzed using a seed-to-voxel approach. RESULTS: Children with RSSD showed a range of responses to therapy. After correcting for multiple comparisons, we did not observe any statistically significant cross-sectional differences or longitudinal changes in functional activation. A negative relationship between therapy effect size and functional activation in the left visual association cortex was on the SRT-Late Sounds after therapy, but it did not survive correction for multiple comparisons. Significant longitudinal changes in functional connectivity were observed for the RSSD group on SRT-Early Sounds and SRT-Late Sounds, as well as for the TD group on the SRT-Early Sounds. RSSD and TD groups showed connectivity differences near the left insula on the SRT-Late Sounds at Time 2. CONCLUSION: RSSD and treatment with ultrasound visual feedback may thus be associated with neural differences in speech motor and visual association processes recruited for speech production.

Sweat Equity: Student Scholarships in Aotearoa New Zealand's Universities.

This paper responds to calls from past and present students to increase the value of postgraduate scholarships in Aotearoa New Zealand. Here we provide context for understanding the scholarship landscape in Aotearoa, including how scholarships are understood in relation to dominant neoliberal framings of higher education and persistent inequities within the sector. We present data which provides insight into the current inequities in Summer, Masters and PhD scholarship values. The average value of PhD scholarships has remained stagnant between 2011 and 2019 resulting in the average being $11,238 less than the Living Wage in 2019. We show that the average length of time full-time PhD students take to complete their doctorates exceeds the three-year tenure of scholarships. We argue the status-quo of low scholarships, supplemented by postgraduate 'sweat', excludes people from participating in postgraduate education, preventing them and their communities from realising the public benefits that such an education can produce. We suggest that these inadequacies could be addressed through (1) raising Summer, Masters and PhD scholarships to the living wage; (2) extending tenure of PhD scholarships; and (3) reinstating the postgraduate student allowance. Supplementary Information: The online version contains supplementary material available at 10.1007/s40841-022-00244-5.

Characterizing sensorimotor profiles in children with residual speech sound disorder: a pilot study.

PURPOSE: Children with speech errors who have reduced motor skill may be more likely to develop residual errors associated with lifelong challenges. Drawing on models of speech production that highlight the role of somatosensory acuity in updating motor plans, this pilot study explored the relationship between motor skill and speech accuracy, and between somatosensory acuity and motor skill in children. Understanding the connections among sensorimotor measures and speech outcomes may offer insight into how somatosensation and motor skill cooperate during speech production, which could inform treatment decisions for this population. METHOD: Twenty-five children (ages 9-14) produced syllables in an /ɹ/ stimulability task before and after an ultrasound biofeedback treatment program targeting rhotics. We first tested whether motor skill (as measured by two ultrasound-based metrics of tongue shape complexity) predicted acoustically measured accuracy (the normalized difference between the second and third formant frequencies). We then tested whether somatosensory acuity (as measured by an oral stereognosis task) predicted motor skill, while controlling for auditory acuity. RESULTS: One measure of tongue shape complexity was a significant predictor of accuracy, such that higher tongue shape complexity was associated with lower accuracy at pre-treatment but higher accuracy at post-treatment. Based on the same measure, children with better somatosensory acuity produced /ɹ/ tongue shapes that were more complex, but this relationship was only present at post-treatment. CONCLUSION: The predicted relationships among somatosensory acuity, motor skill, and acoustically measured /ɹ/ production accuracy were observed after treatment, but unexpectedly did not hold before treatment. The surprising finding that greater tongue shape complexity was associated with lower accuracy at pre-treatment highlights the importance of evaluating tongue shape patterns (e.g., using ultrasound) prior to treatment, and has the potential to suggest that children with high tongue shape complexity at pre-treatment may be good candidates for ultrasound-based treatment.