Intervention studies with group design targeting expressive phonology for children with developmental speech and language disorder: A systematic review and meta-analysis.

BACKGROUND: Phonological difficulties are prevalent in children with speech and/or language disorders and may hamper their later language outcomes and academic achievements. These children often form a significant proportion of speech and language therapists' caseloads. There is a shortage of information on evidence-based interventions for improving phonological skills in children and adolescents with speech and language disorder. AIMS: The aim of this systematic literature review and meta-analysis was to systematically examine the effects of different intervention approaches on speech production accuracy and phonological representation skills in children with speech and language disorders. METHODS: A preregistered systematic review (International Prospective Register of Systematic Reviews ID: CRD42017076075) adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was completed. Seven electronic databases (PubMed, Web of Science, ERIC, PsychINFO, Cochrane Library, SCOPUS and Linguistics & Language Behavior Abstracts) were searched for studies related to oral language interventions with children with developmental speech and/or language disorder (mean age ranging from 3-18 years) published between January 2006 and August 2022. The included articles reported intervention studies with a group design in which speech production accuracy was the outcome measure. Studies were appraised using the Cochrane risk of bias tool, and individual effect sizes were calculated using standardised means differences when enough data was available. A meta-analysis was conducted obtaining the average standardised mean difference d. Heterogeneity, influence of possible moderator variables and publication bias were explored. RESULTS: The 23 studies that met the inclusion criteria presented low-medium risk of bias. Nine effect sizes were obtained from seven of these studies that presented a pre-post-test with a control group design. Medium-high average effect sizes were found in phonological accuracy. Heterogeneity was found between individual effect sizes. Significant moderator variables and publication bias were not detected. CONCLUSIONS: The results of this meta-analysis indicate positive effects on speech production accuracy. Based on this review, further improvements in the quality of reporting for intervention research are required in developing the evidence base for practice. WHAT THIS PAPER ADDS: What is already known on the subject An increasing number of interventions is available for children and adolescents with developmental speech and/or language disorders. Previous reviews suggest relatively low levels of evidence of interventions having phonology as an outcome measure. What this paper adds to the existing knowledge This review and meta-analysis summarise the intervention evidence from a substantial body of group design studies, indicating positive results from a range of interventions with phonological outcomes. It highlights the need to systematically implement and replicate different intervention procedures to understand factors that will maximise positive outcomes and to grow the evidence base for best practice. What are the potential or actual clinical implications of this study? Tentative evidence is emerging for the effectiveness of various approaches in enhancing speech production accuracy skills of children and adolescents with developmental speech and/or language disorder.

The implementation of the 'Testing of Phonological Skills (TOPS)' tool: a computer-based phonological analysis algorithm.

A computer-based algorithm was used for phonological analysis of Cypriot Greek (CG) word productions elicited from a sample of typically developing (TD) CG-speaking children. Specific focus was on (a) creating a complete CG phonetic and phonological test; (2) implementing a novel computer-based algorithm in the analysis of selected speech stimuli from CG-speaking TD children; and (3) examining independent and relational speech patterns based on the computer-based algorithm. The probe word list consisted of 182 target words and included all CG consonants in all word positions. Normative data were collected on a representative sample of 20 TD CG-speaking children aged 3;0 to 6;0 years. Productions were phonetically transcribed and inserted into the computer algorithm for automatic data reduction of measurable dependent variables including the percentage of consonants correct (PCC), phonetic inventory size (PIS), word-initial onset deletion (IOD), and Regressive Assimilation (RASS). Correlation analyses revealed significant interactions among phonetic and phonological patterns as well as predictive relationships of PCC and segmental word-position. The implementation of this specific probe word list permitted a homogeneous and inclusive sampling analysis. Participants presented specific developmental trajectories of segmental and phonological patterns as a function of age.

Predictive Risk Factors and Occupational Impact of Self-Perceived Voice Problems in Preschool-Kindergarten versus First- to Sixth-Grade Teachers.

AIM: The aim of this investigation was to complete a further analysis of existing data to compare risk factors of voice problems as well as create a hierarchical ranking of risk factors in preschool-kindergarten and 1st- to 6th-grade teachers in order to develop a voice hygiene program and prioritize its goals for each group of teachers. METHODS: An online survey was completed by 148 preschool-kindergarten and 301 1st- to 6th-grade public school teachers. Participants were divided into four groups, preschool-kindergarten and 1st- to 6th-grade teachers with no self-perceived voice disorders and preschool-kindergarten and 1st- to 6th-grade teachers with self-perceived voice disorders. A χ2 test and a multivariate logistic regression model were used to examine the differences in answers between the preschool-kindergarten teachers with and without voice disorders and the 1st- to 6th-grade teachers with and without voice disorders and to identify the most important predictors. RESULTS: The significant predictors for preschool-kindergarten teachers are frequently or sometimes continuing to talk after a breath cycle and being exposed to an excessive or a lot of noise generated in the classroom. The significant predictors for 1st- to 6th-grade teachers include having short breaks between classes and continuing to talk frequently after a breath cycle. CONCLUSIONS: Job-related risk factors in preschool-kindergarten and in 1st- to 6th-grade teachers may vary. Therefore, a preventative vocal hygiene education program specifically tailored for each population of teachers is suggested.

Promoting Speech Intelligibility in Autism Spectrum Disorder through the Implementation of Phonologically Similar Stimuli.

OBJECTIVES: The study focused on promoting expressive phonological skills in 1 Greek-speaking child with autism spectrum disorder (ASD) and comorbid speech sound disorder (SSD). Based on the phonological neighborhood density framework, it was hypothesized that the experimental manipulation through clinical implementation of phonologically overlapping stimuli would yield positive expressive phonology gains relevant to ASD. Participant and Methods: A multiple-baseline single-subject design was implemented. Three baseline sessions measured expressive phonology variables. Sixteen biweekly 30-min intervention sessions were carried out for a period of 2 months. Dependent variables included phonetic inventory size, proportion of consonants correct, occurrences of phonological processes, and percentage of whole word matches elicited via specific word probe stimuli. The Intelligibility in Context Scale was completed by the child's teacher prior to the initiation of intervention and at a follow-up session. Experimental stimuli were grouped together in phonologically dense cohorts. RESULTS: Comparison between pre-test and post-test measures revealed expressive phonology gains across all measured variables. Follow-up session results showed generalization of expressive phonology gains on untreated targets. CONCLUSIONS: Significant expressive phonology gains were achieved through the implementation of phonologically similar word stimuli within a systematic intervention protocol with the implementation of specific word-level variables. The findings supported this treatment approach for a child with ASD and SSD, while providing evidence for the phonological density advantage from a cross-linguistic perspective.

Dynamic Linguistic Interconnectedness and Variability in Toddlers.

This investigation examined the existence of interconnectedness between developing linguistic subsystems. Spontaneous speech samples were collected from 31 typically-developing Greek-speaking toddlers across two age levels, at 28 and 36 months. Correlational analyses were performed synchronically and predictively, revealing significant positive relationships among all language skills within ages. Phonetic and grammatical skills also showed predictive value for later skills. In addition, a cluster analysis on the basis of performance on each individual skill revealed variable linguistic profiles: Low performers showed multiple interactions within and across ages, while High performers showed minimal such interactions. The current results revealed complex interdependencies among the different language skills with children exhibiting variable linguistic profiles, as supported by dynamic systems theory approaches to language acquisition.

Promoting speech intelligibility through phonologically dense targets.

This multiple baseline single-case study focused on the implementation of two theoretically motivated models relevant to speech sound disorders (SSD): (1) complexity approach and (2) phonological density neighborhood variable. The complexity approach perspective predicted that complex intervention target stimuli would yield greater phonological gains on more complex targets after systematic phonological intervention. Furthermore, phonologically dense targets would promote speech intelligibility as these stimuli 'tax' productive outputs demand on par with complexity approach. A 4; 6 year-old Greek-speaking male diagnosed with a SSD received phonological intervention for 6 months. Therapy goals included: (1) the reduction of phonological process use and (2) the improvement of output intelligibility. Phonological gains were revealed in cluster reduction leading in increases in the proportion of consonant correct use and improvements in the use of correct whole word matches. Phonological gains were observed for untreated word stimuli. Our findings support the synergistic relationship of Complexity Approach and Phonological Density variable in promoting positive speech outcomes and effectiveness of phonological intervention in the child examined.

Morphophonology and compensation in Specific Language Impairment: Evidence from Standard Modern Greek and Cypriot Greek.

The current study investigates the role of the morphophonological realisation of grammatical features as a compensatory mechanism for morphosyntactic deficits in specific language impairment (SLI). The phenomenon examined is past tense formation in Standard Modern Greek (SMG) and Cypriot Greek (CG) as it manifests a distinction in morphophonological salience realisation in the two linguistic varieties via differential use of a stress shift and stressed syllabic augment [é] required for past tense rule formation. Participants were pre-schoolers with typical language development (TD) and children with SLI. Subjects produced real verb (RV) and pseudo-verb stimuli (PV) in sentence completion tasks. Results indicated that morphophonological properties of past tense formation affected SLI but not TD performance. We attribute the results to the difference in the status of the augment in each variety and the effects it has on its realisation at the phonetic interface. Furthermore, verb contractibility appeared to pose particular difficulties in the performance of all groups.

Neurobiological Bases of Autism Spectrum Disorders and Implications for Early Intervention: A Brief Overview.

OBJECTIVES: To better understand the pathogenesis of autism spectrum disorder (ASD) and implications for intervention, the current paper reports on research related to the neurobiological underpinnings of ASD and the implication for early intervention with a focus on the importance of joint attention and eye gaze behaviors. PARTICIPANTS AND METHODS: An overview is provided on the available research findings from the fields of social neuroscience and experimental psychology specific to brain development, brain pathology, eye gaze, and joint attention behaviors. RESULTS: The results of the review converge towards the existence of aberrant brain connections and atypical brain morphology areas, which in complex and dynamic ways hinder the prioritization of social information. Consequently, the atypical social interaction skills exhibited by infants at risk for developing ASD are traced in the malformation of respective brain connections. CONCLUSIONS: Given the importance of neurobiological findings and their mapping onto early social pragmatic skills, early intervention goals need to focus on increasing appropriate eye gaze skills and joint attention. Such goals could potentially improve intervention outcomes in terms of improving social communication skills in youngsters with ASD.

International Survey of Speech-Language Pathologists' Practices in Working with Children with Autism Spectrum Disorder.

OBJECTIVE: Autism spectrum disorder (ASD) is a complex neurodevelopmental impairment. To better understand the role of speech-language pathologists (SLPs) in different countries in supporting children with ASD, the International Association of Logopedics and Phoniatrics (IALP) Child Language Committee developed a survey for SLPs working with children or adolescents with ASD. Method and Participants: The survey comprised 58 questions about background information of respondents, characteristics of children with ASD, and the role of SLPs in diagnosis, assessment, and intervention practices. The survey was available in English, French, Russian, and Portuguese, and distributed online. RESULTS: This paper provides a descriptive summary of the main findings from the quantitative data from the 1,114 SLPs (representing 35 countries) who were supporting children with ASD. Most of the respondents (91%) were experienced in working with children with ASD, and the majority (75%) worked in schools or early childhood settings. SLPs reported that the children's typical age at diagnosis of ASD on their caseload was 3-4 years, completed mostly by a professional team. CONCLUSIONS: The results support positive global trends for SLPs using effective practices in assessment and intervention for children with ASD. Two areas where SLPs may need further support are involving parents in assessment practices, and supporting literacy development in children with ASD.

Phonological Process Occurrence in Typically Developing Toddlers.

BACKGROUND/AIMS: The study examined the phonological development in Cypriot Greek (CG)-speaking, typically developing (TD) toddlers for the purpose of observing occurrences of initial consonant deletion (ICD), regressive assimilation (RAS), and their interactive relationship as a function of time. PARTICIPANTS AND METHODS: Subjects were 8 CG-speaking TD toddlers assessed longitudinally at ages 24-28 and 32-36 months. Word targets from spontaneously produced utterances via language sample collection were analyzed for the percentage of occurrence of ICD and RAS. RESULTS: Results revealed a significant change of phonological process occurrence as a function of time as well as an antagonistic relationship between ICD and correct onset production. Comparisons between measures showed that trisyllabic (three-syllable) words exhibited higher rates of ICD than disyllabic words. CONCLUSIONS: Early patterns of phonological development and phonological assessment should include a hierarchical account of phonological behavior in the form of word structure shapes and a possible interaction among phonological process occurrence.

Early phonetic development in typically developing children: A longitudinal investigation from Cypriot-Greek child data.

The current longitudinal study examined the acquisition of consonantal singleton segments in Cypriot-Greek. The study's aims were: (a) to determine the acquisition of segments for manner and place of articulation as a function of age and word position, (b) to provide preliminary normative data, and (c) to further support the cross-linguistic data pool regarding developmental phonology patterns. Participants were 14 Cypriot-Greek speaking typically developing toddlers, examined at ages 24, 28, 32 and 36 months. Spontaneously produced and elicited glossable utterances were used in constructing each child's inventory. Findings revealed an increase of segmental acquisition across all age levels. Group trend analysis for manner and place of articulation indicated bilabial and alveolar stops and nasals to be among the earlier segments to develop. A word medial position advantage was also evident. The findings are discussed in terms of phonological universals and language-specific factors. Implications for early evidence-based phonetic assessment are discussed.

Early language delay phenotypes and correlation with later linguistic abilities.

OBJECTIVES: The present study focused on examining the continuity and directionality of language skills in late talkers (LTs) and identifying factors which might contribute to language outcomes at the age of 3 years. METHODS: Subjects were 23 Cypriot-Greek-speaking toddlers classified as LTs and 24 age-matched typically developing peers (TDs). Participants were assessed at 28, 32 and 36 months, using various linguistic measures such as size of receptive and expressive vocabulary, mean length of utterance (MLU) of words and number of consonants produced. Data on otitis media familial history were also analyzed. RESULTS: The ANOVA results indicated parallel developmental profiles between the two groups, with a language lag characterizing LTs. Concurrent correlations between measures showed that poor phonetic inventories in the LT group at 28 months predicted poor MLU at the ages of 32 and 36 months. Significant cross-lagged correlations supported the finding that poor phonetic inventories at 28 months served as a good predictor for MLU and expressive vocabulary at the age of 32 and for MLU at 36 months. CONCLUSIONS: The results highlight the negative effect of early language delay on language skills up to the age of 3 years and lend support to the current literature regarding the universal linguistic picture of early and persistent language delay. Based on the current results, poor phonetic inventories at the age of intake might serve as a predictive factor for language outcomes at the age of 36 months. Finally, the findings are discussed in view of the need for further research with a focus on more language-sensitive tools in testing later language outcomes.

Correction: Global TALES feasibility study: Personal narratives in 10-year-old children around the world.

[This corrects the article DOI: 10.1371/journal.pone.0273114.].

Correlation Between a Self-Voice Assessment and Objective-Voice Evaluation Outcomes in Speech Language Pathology Students.

AIM: The aims of this study is to explore the correlation between the Voice Disorder Index (VDI) score and acoustic and phonatory respiratory voice parameters in speech language pathology (SLP) students with and without self-perceived voice disorders. METHODS: The Voice Disorder Index (VDI) and the Lingwaves 3 "Voice Protocol" were administered to each participant in order to assess his/her self-perceived severity of his/her voice problem, as well as, acoustic and phonatory respiratory measurements. The correlation coefficients were used to evaluate and quantify the degree of a linear relationship between VDI scores and acoustic and phonatory respiratory voice measures in students with and without self-perceived voice disorders. RESULTS: Relatively strong, strong and strong positive correlations were revealed when comparing the VDI physical subscale with the Dysphonia Severity Index (r(11) = 0.56, P = 0.048), mean loudness when reading in English (r(11) = 0.70, P = 0.008) and mean loudness when reading in Greek (r(11) =0.69, P = 0.009) respectively. CONCLUSIONS: SLP students may be more aware of the impact of their laryngeal discomfort and voice output characteristics on their daily activities that can predict certain acoustic parameters than the emotional and functional impact on their daily activities.

Recent Advances of Telepractice for Autism Spectrum Disorders in Speech and Language Pathology.

Telepractice or teletherapy is defined as the means of service delivery via technology-based platforms that allow long-distance interventions across populations, age spans, and geographical locations. Specifically, telepractice capitalizes on communication technologies such as online modules, videoconferencing, and computerized software programs, in servicing populations with communication challenges. Notably, telepractice has emerged as a potentially effective, low-cost, and promising means of conducting and completing online assessment, diagnosis, and intervention sessions for individuals with autism spectrum disorders (ASD). Moreover, telepractice allows the inclusion of parents, caregivers, and educators as potential facilitators in supporting treatment delivery in populations with ASD. This thematic review article aims to highlight and acquaint practitioners and other stakeholders with relatively recent information regarding the advantages and disadvantages of the telepractice service delivery model in ASD. Furthermore, the emergence of the COVID-19 pandemic has impacted service delivery in the field of Health Sciences including speech and language pathology (SLP). Consequently, the need to avoid face-to-face therapy sessions, recommended to SLPs as to all health practitioners, resulted in the call for adaptation and adjustment of service telepractice. This paper attempts to answer this call by suggesting supplementing traditional diagnostic and therapy resources with training modules consisting of online materials and use of animated and specially designed programs in SLP intervention with individuals with ASD. Lastly, the paper includes a discussion of research findings in the field, a conclusion, and a take-home message.

Risk Factors for Voice Disorders in Undergraduate Speech Language Pathology Students.

OBJECTIVES: The aim of this research study is to determine the risk factors for voice disorders in SLP students in order to help us develop specific goals for a vocal hygiene education program specifically for SLP students. METHODS: An online questionnaire was completed by 121 undergraduate SLP students. Participants were divided into two groups, students with no self-perceived voice disorders (NVD group) and students with self-perceived voice disorders (VD group). The Fisher Exact test (FET) was used to explore the differences in responses for each voice risk factor and the academic and occupational consequences between students with and without self-perceived voice disorders. RESULTS: Students in the VD group were more likely to experience vocal fold problems, hearing problems and throat clearing than in the NVD group. More students in the VD group reported to "sometimes' and "often" take medications that impact their voice, hear a "moderate" amount of noise generated from the passage of planes and the road and hear a "moderate" and "large" amount of noise generated within and outside the building than in the NVD group. Moreover, students in the VD group were more likely to limit their ability to perform certain tasks at school (eg, participating in lectures) and clinical practicum (eg, administering therapy sessions) and reduce their interactions annually due to voice problems. CONCLUSIONS: Health, voice use, lifestyle, and environmental factors are risk factors for voice disorders that were presented more frequently in SLP students with self-perceived voice disorders.

Psychometric Properties of the Cyprus Lexical List in the Greek Language for Infants and Preschool Children and Preliminary Results.

The aim of this study was to evaluate the psychometric properties of the adapted Cyprus Greek Lexical List a-CYLEX (GR) in a sample of 194 Greek toddlers from the island of Crete with Standard Modern Greek (SMG) as their primary language. The a-CYLEX (GR) is a parental report checklist for assessing the receptive and expressive vocabulary skills of children aged 12 months to 3:6 years. Concurrent validity of the instrument was tested via correlations with the adapted Greek version of the Receptive One-Word Picture Vocabulary Test-II (ROWPVT-II), which was administered to 124 SMG-speaking children between the ages of 2 and 3:6 years. Test-retest reliability was tested by administering the instrument two times within a 2-week interval to 59 parents (30.41% of the total sample). Statistical analyses provided strong evidence for the high internal consistency and test-retest reliability of the a-CYLEX (GR). The role of the demographic variables in vocabulary performance and the frequency of each a-CYLEX (GR) word category by age were also investigated. In conclusion, the a-CYLEX (GR) is a parental report checklist that can be used by clinicians who are interested in assessing receptive and expressive vocabulary of children during toddlerhood.

Global TALES feasibility study: Personal narratives in 10-year-old children around the world.

Personal narratives make up more than half of children's conversations. The ability to share personal narratives helps build and maintain friendships, promotes physical and emotional wellbeing, supports classroom participation, and underpins academic success and vocational outcomes. Although personal narratives are a universal discourse genre, cross-cultural and cross-linguistic research into children's ability to share personal narratives is in its infancy. The current study addresses this gap in the research by developing the Global TALES protocol, a protocol comprising six scripted prompts for eliciting personal narratives in school-age children (excited, worried, annoyed, proud, problem situation, something important). We evaluated its feasibility with 249 ten-year-old children from 10 different countries, speaking 8 different languages, and analyzed researchers' views on the process of adapting the protocol for use in their own country/language. At group-level, the protocol elicited discourse samples from all children, although individual variability was evident, with most children providing responses to all six prompts. When investigating the topics of children's personal narratives in response to the prompts, we found that children from around the world share many commonalities regarding topics of conversation. Once again individual variability was high, indicating the protocol is effective in prompting children to share their past personal experiences without forcing them to focus on one particular topic. Feedback from the participating researchers on the use of the protocol in their own countries was generally positive, although several translation issues were noted. Based on our results, we now invite clinical researchers from around the world to join us in conducting further research into this important area of practice to obtain a better understanding of the development of personal narratives from children across different languages and cultures and to begin to establish local benchmarks of performance.

Development of voice onset time in standard-Greek and Cypriot-Greek-speaking preschoolers.

The current investigation examined the development of voice onset time (VOT) in Standard-Greek (SG) and Cypriot-Greek (CG)-speaking children at age levels 2;0-2;5, 2;6-2;11, 3;0-3;5, and 3;6-4;0 years. SG presents with a two-way voicing contrast (voiced and voiceless unaspirated stops) whereas CG is a three-way contrast dialect containing voiceless unaspirated, voiceless aspirated, and pre-voiced stops. A cross-sectional design was used. The main goals were: (1) to determine the age at which Greek and Cypriot Greek children acquire voicing contrasts, and (2) to examine the mechanism used during the process of acquisition. Stimuli included pseudo words in minimal pair contrasts differing in stop voicing (e.g. ['gaga] vs ['kaka]). Children were taught the target words using fast mapping procedures. Each member within a word pair referred to an unfamiliar object. Audio-recorded samples were analysed from wide-band spectrograms. Results indicated a greater overall variation of voicing patterns for children than adults, in both Greek and Cypriot VOT contrasts. Greek children acquired consistent pre-voicing and short lag aspiration patterns very early on, achieving adult values for VOT contrasts for alveolar and for velar places of articulation as early as 2;0-2;5 years old. On the contrary, a developmental lag in the acquisition of voicing contrasts was noted for Cypriot children as compared to the Greek counterparts. Accounts about the developmental differences among Greek and Cypriot children with respect to the adult VOT contrasts are discussed.