Refining and extending measures for fricative spectra, with special attention to the high-frequency rangea).

Fricatives have noise sources that are filtered by the vocal tract and that typically possess energy over a much broader range of frequencies than observed for vowels and sonorant consonants. This paper introduces and refines fricative measurements that were designed to reflect underlying articulatory and aerodynamic conditions These show differences in the pattern of high-frequency energy for sibilants vs non-sibilants, voiced vs voiceless fricatives, and non-sibilants differing in place of articulation. The results confirm the utility of a spectral peak measure (FM) and low-mid frequency amplitude difference (AmpD) for sibilants. Using a higher-frequency range for defining FM for female voices for alveolars is justified; a still higher range was considered and rejected. High-frequency maximum amplitude (Fh) and amplitude difference between low- and higher-frequency regions (AmpRange) capture /f-θ/ differences in English and the dynamic amplitude range over the entire spectrum. For this dataset, with spectral information up to 15 kHz, a new measure, HighLevelD, was more effective than previously used LevelD and Slope in showing changes over time within the frication. Finally, isolated words and connected speech differ. This work contributes improved measures of fricative spectra and demonstrates the necessity of including high-frequency energy in those measures.

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.

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.

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.

Tongue shapes for rhotics in school-age children with and without residual speech errors.

Speakers of North American English use variable tongue shapes for rhotic sounds. However, quantifying tongue shapes for rhotics can be challenging, and little is known about how tongue shape complexity corresponds to perceptual ratings of rhotic accuracy in children with residual speech sound errors (RSE). In this study, 16 children aged 9-16 with RSE and 14 children with typical speech (TS) development made multiple productions of 'Let Robby cross Church Street'. Midsagittal ultrasound images were collected once for children with TS and twice for children in the RSE group (once after 7 h of speech therapy, then again after another 7 h of therapy). Tongue contours for the rhotics in the four words were traced and quantified using a new metric of tongue shape complexity: the number of inflections. Rhotics were also scored for accuracy by four listeners. During the first assessment, children with RSE had fewer tongue inflections than children with TS. Following 7 h of therapy, there were increases in the number of inflections for the RSE group, with the cluster items cross and Street reaching tongue complexity levels of those with TS. Ratings of rhotic accuracy were correlated with the number of inflections. Therefore, the number of inflections in the tongue, an index of tongue shape complexity, was associated with perceived accuracy of rhotic productions.

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.

Motor-based treatment with and without ultrasound feedback for residual speech-sound errors.

BACKGROUND: There is a need to develop effective interventions and to compare the efficacy of different interventions for children with residual speech-sound errors (RSSEs). Rhotics (the r-family of sounds) are frequently in error American English-speaking children with RSSEs and are commonly targeted in treatment. One treatment approach involves the use of ultrasound visual feedback of the tongue. AIMS: Although prior studies have shown that children with RSSEs acquire rhotics and generalize to untrained words with ultrasound visual feedback treatment, predictions from schema-based motor learning theory suggest that visual feedback might impede generalization. Therefore, the primary aim was to compare the generalization of rhotics treated with and without ultrasound in children with RSSEs. METHODS & PROCEDURES: Twelve children aged 10-16 years with RSSEs affecting rhotics participated in a multiple-baseline single-case design with two treatment phases. For each participant, rhotics in one syllable position were treated for 7 h-long sessions with ultrasound visual feedback and rhotics in a different syllable position were treated without ultrasound in a second treatment phase. The order of treatment conditions was counterbalanced across participants. A treatment framework incorporating the principles of motor learning through chaining procedures was implemented across both treatment phases; thus the primary distinction between conditions was the use of ultrasound visual feedback. OUTCOMES & RESULTS: On average, both treatments resulted in an approximately 30% increase in accuracy of untreated words in seven sessions. However, variability in response suggested some children showed a preferential response to one treatment over another, some responded well to both interventions, and some responded minimally to both interventions. CONCLUSIONS & IMPLICATIONS: Motor-based treatment with and without ultrasound visual feedback of the tongue may aid in speech-sound acquisition for children with RSSEs. Both approaches may be viable options for some children. Future research is necessary to determine which children are the best candidates for interventions with and without ultrasound visual feedback.

Risk and Protective Factors for Late Talking: An Epidemiologic Investigation.

OBJECTIVE: To identify risk and protective factors for late talking in toddlers between 24 and 30 months of age in a large community-based cohort. STUDY DESIGN: A prospective, longitudinal pregnancy cohort of 1023 mother-infant pairs in metropolitan Calgary, Canada, were followed across 5 time points: before 25 weeks gestation, between 34-36 weeks gestation, and at 4, 12, and 24 months postpartum. Toddlers who scored ≤10th percentile on The MacArthur-Bates Communicative Development Inventories: Words and Sentences between 24 and 30 months of age were identified as late talkers. Thirty-four candidate characteristics theoretically and/or empirically linked to language development and/or language impairment were collected using survey methodology. RESULTS: The prevalence of late talking was 12.6%. Risk factors for late talking in the multivariable model included: male sex (P = .017) and a family history of late talking and/or diagnosed speech or language delay (P = .002). Toddlers were significantly less likely to be late talkers if they engaged in informal play opportunities (P = .013), were read to or shown picture books daily (P < .001), or cared for primarily in child care centers (P = .001). CONCLUSIONS: Both biological and environmental factors were associated with the development of late talking. Biological factors placed toddlers at risk for late talking, and facets of the environment played a protective role. Enveloping infants and toddlers in language-rich milieus that promote opportunities for playing, reading, and sharing books daily may decrease risk for delayed early vocabulary.

Print-Speech Convergence Predicts Future Reading Outcomes in Early Readers.

Becoming a skilled reader requires building a functional neurocircuitry for printed-language processing that integrates with spoken-language-processing networks. In this longitudinal study, functional MRI (fMRI) was used to examine convergent activation for printed and spoken language (print-speech coactivation) in selected regions implicated in printed-language processing (the reading network). We found that print-speech coactivation across the left-hemisphere reading network in beginning readers predicted reading achievement 2 years later beyond the effects of brain activity for either modality alone; moreover, coactivation effects accounted for variance in later reading after controlling for initial reading performance. Within the reading network, effects of coactivation were significant in bilateral inferior frontal gyrus (IFG) and left inferior parietal cortex and fusiform gyrus. The contribution of left and right IFG differed, with more coactivation in left IFG predicting better achievement but more coactivation in right IFG predicting poorer achievement. Findings point to the centrality of print-speech convergence in building an efficient reading circuitry in children.

Using ultrasound visual feedback to remediate velar fronting in preschool children: A pilot study.

Anecdotally, velar fronting can be difficult to remediate in some children. This pilot study examined the use of ultrasound visual feedback in remediating velar fronting in typically developing children. A single-case, multiple-baseline across-subjects experimental design was used to examine acquisition, retention and generalisation of velar treatment targets. Two otherwise typically developing children (P1, aged 4;0; P3, aged 4;11) completed the study. The productions of /k/ and /É¡/ at syllable level were targeted during treatment. P1 improved her productions of /k/ and /É¡/ at syllable level during the treatment period and achieved correct production at word level during follow-up. P3 made no improvements in his productions of velar targets. This study suggests that ultrasound visual feedback may be an option for remediating velar fronting in some preschoolers. Further study is required.

Limited acquisition and generalisation of rhotics with ultrasound visual feedback in childhood apraxia.

Ultrasound visual feedback of the tongue is one treatment option for individuals with persisting speech sound errors. This study evaluated children's performance during acquisition and generalisation of American English rhotics using ultrasound feedback. Three children aged 10-13 with persisting speech sound errors associated with childhood apraxia of speech (CAS) were treated for 14 one-hour sessions. Two of the participants increased the accuracy of their rhotic production during practise trials within treatment sessions, but none demonstrated generalisation to untreated words. Lack of generalisation may be due to a failure to acquire the target with sufficient accuracy during treatment, or to co-existing linguistic weaknesses that are not addressed in a motor-based treatment. Results suggest a need to refine the intervention procedures for CAS and/or a need to identify appropriate candidates for intervention to optimise learning.

Glutamate and choline levels predict individual differences in reading ability in emergent readers.

Reading disability is a brain-based difficulty in acquiring fluent reading skills that affects significant numbers of children. Although neuroanatomical and neurofunctional networks involved in typical and atypical reading are increasingly well characterized, the underlying neurochemical bases of individual differences in reading development are virtually unknown. The current study is the first to examine neurochemistry in children during the critical period in which the neurocircuits that support skilled reading are still developing. In a longitudinal pediatric sample of emergent readers whose reading indicators range on a continuum from impaired to superior, we examined the relationship between individual differences in reading and reading-related skills and concentrations of neurometabolites measured using magnetic resonance spectroscopy. Both continuous and group analyses revealed that choline and glutamate concentrations were negatively correlated with reading and related linguistic measures in phonology and vocabulary (such that higher concentrations were associated with poorer performance). Correlations with behavioral scores obtained 24 months later reveal stability for the relationship between glutamate and reading performance. Implications for neurodevelopmental models of reading and reading disability are discussed, including possible links of choline and glutamate to white matter anomalies and hyperexcitability. These findings point to new directions for research on gene-brain-behavior pathways in human studies of reading disability.

Perception of Speech Sounds in School-Aged Children with Speech Sound Disorders.

Children with speech sound disorders may perceive speech differently than children with typical speech development. The nature of these speech differences is reviewed with an emphasis on assessing phoneme-specific perception for speech sounds that are produced in error. Category goodness judgment, or the ability to judge accurate and inaccurate tokens of speech sounds, plays an important role in phonological development. The software Speech Assessment and Interactive Learning System, which has been effectively used to assess preschoolers' ability to perform goodness judgments, is explored for school-aged children with residual speech errors (RSEs). However, data suggest that this particular task may not be sensitive to perceptual differences in school-aged children. The need for the development of clinical tools for assessment of speech perception in school-aged children with RSE is highlighted, and clinical suggestions are provided.

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.

Caregiver and child perspectives of wellbeing in school-age children with childhood apraxia of speech.

PURPOSE: Childhood apraxia of speech (CAS) is a communication deficit that impacts a child's overall quality of life, including their academic and social interactions, yet few studies have investigated the impact from the child's perspective. Using The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework, we examined the children's and caregivers' perspectives on the impact of CAS on their overall wellbeing. METHOD: Survey data were collected from 32 child-caregiver dyads for children ages 9-17 years with CAS. Items elicited responses along a 5-point scale to examine the perceived impact of children's speech impairments using the framework, including impact on communication, interpersonal interactions/relationships, and major life events. RESULT: Results from non-parametric statistical analyses revealed: (a) caregivers reported a significantly greater impact than children across individual ICF domains; (b) child responses were not significantly correlated with their caregiver's responses or with the child's age, gender, or severity indicators; and (c) both caregivers and children indicated the domain of communication was impacted more than other domains. CONCLUSION: Results suggest a potential disconnect in the perceived impact of CAS between the caregiver and child. Recommendations include facilitating a dialogue between the child-caregiver dyad and considering treatment goals that address wellbeing.

Will you read how I will read? Naturalistic fMRI predictors of emergent reading.

Despite reading being an essential and almost universal skill in the developed world, reading proficiency varies substantially from person to person. To study why, the fMRI field is beginning to turn from single-word or nonword reading tasks to naturalistic stimuli like connected text and listening to stories. To study reading development in children just beginning to read, listening to stories is an appropriate paradigm because speech perception and phonological processing are important for, and are predictors of, reading proficiency. Our study examined the relationship between behavioral reading-related skills and the neural response to listening to stories in the fMRI environment. Functional MRI were gathered in a 3T TIM-Trio scanner. During the fMRI scan, children aged approximately 7 years listened to professionally narrated common short stories and answered comprehension questions following the narration. Analyses of the data used inter-subject correlation (ISC), and representational similarity analysis (RSA). Our primary finding is that ISC reveals areas of increased synchrony in both high- and low-performing emergent readers previously implicated in reading ability/disability. Of particular interest are that several previously identified brain regions (medial temporal gyrus (MTG), inferior frontal gyrus (IFG), inferior temporal gyrus (ITG)) were found to "synchronize" across higher reading ability participants, while lower reading ability participants had idiosyncratic activation patterns in these regions. Additionally, two regions (superior frontal gyrus (SFG) and another portion of ITG) were recruited by all participants, but their specific timecourse of activation depended on reading performance. These analyses support the idea that different brain regions involved in reading follow different developmental trajectories that correlate with reading proficiency on a spectrum rather than the usual dichotomy of poor readers versus strong readers.

The COMT Val/Met polymorphism is associated with reading-related skills and consistent patterns of functional neural activation.

In both children and adults there is large variability in reading skill, with approximately 5-10% of individuals characterized as having reading disability; these individuals struggle to learn to read despite adequate intelligence and opportunity. Although it is well established that a substantial portion of this variability is attributed to the genetic differences between individuals, specifics of the connections between reading and the genome are not understood. This article presents data that suggest that variation in the COMT gene, which has previously been associated with variation in higher-order cognition, is associated with reading and reading-related skills, at the level of both brain and behavior. In particular, we found that the COMT Val/Met polymorphism at rs4680, which results in the substitution of the ancestral Valine (Val) by Methionine (Met), was associated with better performance on a number of critical reading measures and with patterns of functional neural activation that have been linked to better readers. We argue that this polymorphism, known for its broad effects on cognition, may modulate (likely through frontal lobe function) reading skill.

Identification of conductive hearing loss in young infants using tympanometry and wideband reflectance.

OBJECTIVE: The goal of the study was to evaluate the effectiveness of tympanometry and wideband reflectance (WBR) in detecting conductive hearing loss (CHL) in young infants. METHODS: Type of hearing loss was determined using auditory brainstem response using air- and bone-conducted tone bursts in 84 ears from 70 infants (median age = 10 weeks). Of these 84 ears, 60 are included in the current analysis: 43 with normal hearing (NH) and 17 with CHL. Tympanometry was measured using probe tone frequencies of 226, 678, and 1000 Hz. Tympanograms were evaluated in two ways: (1) Acoustic middle ear admittance (Ya, in millimhos); and (2) two-category classification (normal/abnormal), as described by Baldwin (2006). Measures of Ya were evaluated in two ways: by admittance-magnitude tympanograms and calculated admittance magnitude from subcomponents (conductance and susceptance). WBR was measured in response to a chirp stimulus after probe calibration. WBR was analyzed into thirteen 1/3 octave bands. Tests for statistical differences for two-category classification were analyzed using Chi-squared and Ya, and WBR were analyzed using repeated-measures analyses of variances. Cohen's d and likelihood ratios were computed for comparison with statistically significant differences. RESULTS: Ya measured with 678- and 1000 Hz probe tones was significantly different between ears with CHL and NH. Two-category classification of tympanograms using a 1000 Hz probe tone was significantly different between ears with CHL and NH. Neither two-category classification nor Ya was significantly different between ears identified with CHL and NH using a 226 Hz probe tone. WBR was significantly higher in the frequency bands 800 to 2500 Hz and in the frequency band centered at 6300 Hz in infants with CHL. Effect sizes (Cohen's d) were greater than 2 for several WBR frequency bands and Ya measured with 1000 Hz probe tones. The results were similar for calculations of Ya from admittance-magnitude and subcomponent tympanograms. Positive likelihood ratios for WBR ranged between 8.1 and 38, and those for Ya using 1000 Hz ranged between 12.5 and 32. CONCLUSIONS: CHL in young infants can be detected well with WBR or tympanometry using probe frequencies of 678 and 1000 Hz.

A Pilot Randomized Control Trial of Motor-Based Treatments for Childhood Apraxia of Speech: Rapid Syllable Transition Treatment and Ultrasound Biofeedback.

PURPOSE: Both Rapid Syllable Transition Treatment (ReST) and ultrasound biofeedback are effective approaches to treating childhood apraxia of speech (CAS). The purpose of the study was to compare outcomes from these two motor-based treatment approaches for school-age children with CAS. METHOD: In a single site, single blind randomized control trial, 14 children with CAS ages 6-13 years were randomly assigned to 12 sessions over 6 weeks of either of ultrasound biofeedback treatment (with a speech motor chaining practice structure) or ReST. Treatment was delivered at The University of Sydney by students trained and supervised by certified speech-language pathologists. Transcriptions from blinded assessors were used to compare the two groups on speech sound accuracy (percent phonemes correct) and prosodic severity (lexical stress errors and syllable segregation) in untreated words and sentences at three time points: pretreatment, immediately posttreatment, and 1-month posttreatment (i.e., retention). RESULTS: Both groups showed significant improvement on treated items indicating a treatment effect. At no time was there a difference between groups. Both groups showed a significant improvement in speech sound accuracy on untreated words and sentences from pre to post and neither group showed an improvement in prosody pre-post. Changes to speech sound accuracy were retained by both groups at 1-month follow-up. Significant improvement in prosodic accuracy was reported at the 1-month follow-up. CONCLUSIONS: ReST and ultrasound biofeedback were equally effective. Either ReST or ultrasound biofeedback may be viable treatment options for school-age children with CAS. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22114661.