Efficacy of a Self-Directed Video-Based Caregiver-Implemented Language Programme.

INTRODUCTION: Caregiver-implemented language programmes are effective for alleviating early language difficulties. This study examined the efficacy of a self-directed video-based caregiver-implement language programme in Chinese families. METHOD: This study consisted of two stages. In stage 1, 31 caregiver-child dyads (typically developing children) completed the training programme (group 1) in the form of six video-based training modules. In stage 2, 28 caregiver-child dyads (children with language difficulties) receiving active speech therapy were randomly assigned to the training (group 2) and control arms (group 3). Group 2 received the same training as group 1 in addition to their regular therapy while group 3 was kept as status quo. Caregivers completed a quiz on their knowledge of language facilitation techniques (LFTs) and submitted caregiver-child interaction videos at the start and end of the training. Outcome measures included programme completion rate, quiz scores, and use of LFTs and children's communication skills in the videos. A pre-post design and a between-group design were adopted in the stage 1 and 2 studies, respectively. RESULTS: A completion rate of about 60% in both stages was noted. Significantly higher post-training knowledge scores were found in groups 1 and 2. General but nonsignificant growth in use of parallel talk and gesture, and significant gains in children's vocalization in the training arm were observed. CONCLUSION: The self-directed video-based training programme would be useful in imparting information to caregivers. However, the modest improvements in the use of LFTs suggested direct coaching appeared to still play a significant role in enhancing the actual implementation of LFTs. Further investigation on a larger scale is required to evaluate the effectiveness of the training programme for promoting the wider use of this mode as a preventive measure.

Rhythmic speech and stuttering reduction in a syllable-timed language.

Speaking rhythmically, also known as syllable-timed speech (STS), has been known for centuries to be a fluency-inducing condition for people who stutter. Cantonese is a tonal syllable-timed language and it has been shown that, of all languages, Cantonese is the most rhythmic (Mok, 2009). However, it is not known if STS reduces stuttering in Cantonese as it does in English. This is the first study to investigate the effects of STS on stuttering in a syllable-timed language. Nineteen native Cantonese-speaking adults who stutter were engaged in conversational tasks in Cantonese under two conditions: one in their usual speaking style and one using STS. The speakers' percentage syllables stuttered (%SS) and speech rhythmicity were rated. The rhythmicity ratings were used to estimate the extent to which speakers were using STS in the syllable-timed condition. Results revealed a statistically significant reduction in %SS in the STS condition; however, this reduction was not as large as in previous studies in other languages and the amount of stuttering reduction varied across speakers. The rhythmicity ratings showed that some speakers were perceived to be speaking more rhythmically than others and that the perceived rhythmicity correlated positively with reductions in stuttering. The findings were unexpected, as it was anticipated that speakers of a highly rhythmic language such as Cantonese would find STS easy to use and that the consequent reductions in stuttering would be great, even greater perhaps than in a stress-timed language such as English. The theoretical and clinical implications of the findings are discussed.

Lexical tone and stuttering in Cantonese.

Cantonese is a tone language, in which the variation of the fundamental frequency contour of a syllable can change meaning. There are six different lexical tones in Cantonese. While research with Western languages has shown an association between stuttering and syllabic stress, nothing is known about whether stuttering in Cantonese speakers is associated with one or more of the six lexical tones. Such an association has been reported in conversational speech in Mandarin, which is also a tone language, but which varies markedly from Cantonese. Twenty-four native Cantonese-speaking adults who stutter participated in this study, ranging in age from 18-33 years. There were 18 men and 6 women. Participants read aloud 13 Cantonese syllables, each of which was produced with six contrastive lexical tones. All 78 syllables were embedded in the same carrier sentence, to reduce the influence of suprasegmental or linguistic stress, and were presented in random order. No significant differences were found for stuttering moments across the six lexical tones. It is suggested that this is because lexical tones, at least in Cantonese, do not place the task demands on the speech motor system that typify varying syllabic stress in Western languages: variations not only in fundamental frequency, but also in duration and intensity. The findings of this study suggest that treatments for adults who stutter in Western languages, such as speech restructuring, can be used with Cantonese speakers without undue attention to lexical tone.

The Topography of Stuttering in Cantonese.

OBJECTIVE: This is the first study to investigate the behavioral nature (topography) of stuttering in Cantonese. Cantonese, a Sino-Tibetan language, is both tonal and syllable-timed. Previous studies of stuttering topography have mainly been in Western languages, which are mainly stress-timed. METHODS: Conversational speech samples were collected from 24 native Cantonese-speaking adults who stuttered. Six consecutive stuttering moments from each participant were analyzed using the Lidcombe behavioral data language (LBDL). A complexity analysis based on the LBDL was developed to indicate the proportion of multiple-behavior stuttering moments for each participant. RESULTS: There was no significant difference in the frequency of the 7 LBDL behaviors. Almost half the stuttering moments across participants were reported as complex, containing more than 1 stuttering behavior, and stuttering complexity correlated significantly with stuttering severity. CONCLUSIONS: These preliminary findings require replication because of their important theoretical and clinical implications. Differences in topography across languages have the potential to contribute to our understanding of the nature of stuttering. Clinically, the recognition of such differences may assist practitioners in identifying stuttering, for example when screening for early stuttering. The LBDL complexity score developed in this study has the potential to be used in other languages.

Phonetic variations and sound changes in Hong Kong Cantonese: diachronic review, synchronic study and implications for speech sound assessment.

The aim of this article was to describe phonetic variations and sound changes in Hong Kong Cantonese (HKC) to provide speech-language pathologists with information about acceptable variants of standard pronunciations for speech sound assessments. Study 1 examined the pattern of variations and changes based on past diachronic research and historical written records. Nine phonetic variations were found. Five in syllable-initial and syllabic contexts: (1) [n-] → [l-], (2) [ŋ-] → Ø-, (3) Ø- → [ŋ-], (4) [k(w)ɔ-] → [kɔ-], (5) syllabic [ŋ̍] → [mÌ©]; and four in syllable-final contexts: (6) [-ŋ] → [-n], (7) [-n] → [-ŋ], (8) [-k] → [-t], (9) [-t] → [-k]. Historical records demonstrated the pattern of variation and changes in HKC across time. In study 2, a large-scale synchronic study of speakers of differing ages was undertaken to determine acceptable phonetic variations of HKC for speech sound assessments. In the synchronic study, single-words were elicited from 138 children (10;8-12;4) and 112 adults (18-45 years) who spoke Cantonese and lived in Hong Kong. Synchronic evidence demonstrated five acceptable variants in syllable-initial and syllabic contexts: (1) [n-] → [l-], (2) [ŋ-] → Ø-, (3) Ø- → [ŋ-], (4) [k(w)ɔ-] → [kɔ-] and (5) syllabic [ŋ̍] → [mÌ©] and four incomplete sound changes in syllable-final contexts: (6) [-ŋ] → [-n], (7) [-n] → [-ŋ], (8) [-k] → [-t] and (9) [-t] → [-k]. The incomplete sound changes may still be accepted as variants in speech sound assessments unless related speech problems are indicated.

Validation of the Intelligibility in Context Scale as a screening tool for preschoolers in Hong Kong.

The Intelligibility in Context Scale (ICS) is a parent report questionnaire for assessing children's speech intelligibility. The original version was developed in English and was based on Environmental Factors identified within the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). The ICS has been translated into over 30 languages, including Traditional Chinese (ICS-TC). The aims of the current study were to examine the psychometric properties of the ICS-TC with Cantonese-speaking parent--child dyads and to identify speech measures that were more sensitive to the ICS-TC ratings. A total of 72 Cantonese-speaking preschoolers with (n = 39) and without speech sound disorders (SSD; n = 33) were recruited. Native Cantonese-speaking parents completed the ICS-TC independently. The measure showed good internal consistency and test-retest reliability. Correlations with speech performance on the Hong Kong Cantonese Articulation Test (HKCAT), and significant difference in ICS-TC mean scores between the two groups provided preliminary support for the validity of ICS-TC and suggested that ICS-TC can differentiate between children with and without SSD with a large effect size of d = 0.74. The optimal cutoff was estimated using Receiver Operative Characteristic (ROC) curve analysis, giving a sensitivity of 0.70 and specificity of 0.59. ICS-TC mean scores showed a positive correlation with the percentage of initial consonants correct and negative correlation with frequency of atypical errors, and both were moderate in strength. Given the satisfactory psychometric properties of ICS-TC, it may be a valuable clinical tool for screening Cantonese-speaking preschool children's intelligibility.

Review of the Phonological System of Contemporary Urdu Spoken in Pakistan.

PURPOSE: Urdu is the lingua franca and national language of Pakistan, and is the 10th most-spoken language worldwide with over 230 million speakers. The Urdu phonological system has been examined over the past decades. However, the system has been evolving. This paper aimed to review the available studies investigating various aspects of the Urdu phonological system and to reveal the variations noted among these studies. METHOD: Twenty-one studies examining the phonological system of Urdu were located. The studies were reviewed in terms of consonants, geminates, consonant clusters, vowels, diphthongs, syllable structure, phonotactic constraints, and stress. RESULT: The findings indicated that 38 consonants, 23 vowels, and 15 diphthongs are used in contemporary Urdu. Most consonants exist as geminates word medially. There are six syllable structures. The consonant clusters are constrained to the coda position only, and short vowels cannot exist in the word-final position. Like other syllable-timed languages, stress is not prominent in Urdu. CONCLUSION: Based on this review, a contemporary Urdu phonemic and syllable structure inventory has been proposed. This will serve as a reference for use in further acquisition research and clinical practice.

Empowering Hong Kong Chinese families with autism: A preliminary study of the online Hanen More Than Words Program.

Purpose: Parent involvement is crucial for tailored early intervention programs. The Hanen More Than Words (HMTW) program is a parent-implemented language intervention for autistic children. The current study examined the effectiveness of the HMTW program delivered online among Chinese families. Methods: Using a randomized controlled trial design, 22 Chinese families of autistic children in Hong Kong completed the trial. Baseline and post-intervention assessments were conducted to measure changes in parent-child interaction, parents' use of linguistic facilitation techniques (LFTs), and children's communication skills. Additionally, the influence of parental self-efficacy and parenting stress on treatment outcomes was explored. Results: The intervention group demonstrated significant improvements in parent-child attention synchrony. Although the treatment effect on children's spontaneous communication was not significant, the intervention group showed a larger effect size compared to the controls. The treatment outcomes were mainly influenced by the parents' initial levels of self-efficacy but not by parenting stress. Conclusion: These findings provide preliminary evidence of the effectiveness of the online-delivered HMTW program for Chinese parents of autistic children. Further research involving a larger sample and focusing on long-term effects is needed.

Spontaneous Generation of Unconventional Language and Its Link with Grammatical Performance in Chinese Adults With and Without ASD.

This study investigated the generation of unconventional language in the spontaneous speech of Chinese adults with autism spectrum disorder (ASD), and how it was related to their grammatical performance, when compared to neurotypical (NT) controls. Twenty Cantonese-speaking adults with ASD and 20 NT controls completed three interview tasks in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and their spontaneous speech was recorded and transcribed. Utterances containing unconventional language (neologisms, idiosyncratic phrases, and pedantic language), morphosyntactic errors, mean length of utterance (MLU), and mazes were computed. The ASD group produced more neologisms, idiosyncratic phrases, and pedantic language than the NT group and their grammatical difficulties were shown in shorter MLU but not morphosyntactic errors. Mazes were more frequent in the ASD than the NT group. While the use of unconventional language increased with MLU in the NT group, it correlated positively with mazes in the ASD group. Generation of unconventional language, particularly pedantic language, in Cantonese-speaking NT adults is linked to more advanced grammar, while it appears to be a common speech characteristic among autistic speakers regardless of individual grammatical performance.

Brief Report: Atypical Temporal Sensitivity in Coarticulation in Autism: Evidence from Sibilant-Vowel Interaction in Cantonese.

PURPOSE: Atypicalities in the prosodic aspects of speech are commonly considered in clinical assessments of autism. While there is an increasing number of studies using objective measures to assess prosodic deficits, such studies have primarily focused on the intonational and rhythmic aspects of prosody. Little is known about prosodic deficits that are reflected at the segmental level, despite the strong connection between prosody and segmental realization. This study examines the nature of sibilant-vowel coarticulation among male adult native speakers of Cantonese with autism and those without. METHODS: Fifteen Cantonese-speaking autistic (ASD) adults (mean age = 25 years) and 23 neuro-typical (NT) adults (mean age = 20 years) participated. Each participant read aloud 42 syllables with a sibilant onset in carrier phrase. Spectral means and variance, skewness and kurtosis were measured, and regressed by vocalic rounding (rounded vs. unrounded), cohort (ASD vs. NT), sibilant duration, and articulation rate. RESULTS: While neurotypical participants exhibit sibilant-vowel coarticulation that are sensitive to variation in sibilant duration, autistic participants show no sensitivity to segmental temporal changes. CONCLUSION: These findings point to the potential for atypicalities in prosody-segment interaction as an important characteristic of autistic speech.

The impact of extrinsic demographic factors on Cantonese speech acquisition.

This study modeled the associations between extrinsic demographic factors and children's speech acquisition in Hong Kong Cantonese. The speech of 937 Cantonese-speaking children aged 2;4 to 6;7 in Hong Kong was assessed using a standardized speech test. Demographic information regarding household income, paternal education, maternal education, presence of siblings and having a domestic helper as the main caregiver was collected via parent questionnaires. After controlling for age and sex, higher maternal education and higher household income were significantly associated with better speech skills; however, these variables explained a negligible amount of variance. Paternal education, number of siblings and having a foreign domestic helper did not associate with a child's speech acquisition. Extrinsic factors only exerted minimal influence on children's speech acquisition. A large amount of unexplained variance in speech ability still warrants further research.

Role of sentence-final particles and prosody in irony comprehension in Cantonese-speaking children with and without Autism Spectrum Disorders.

English-speaking children with Autism Spectrum Disorders (ASD) are less capable of using prosodic cues such as intonation for irony comprehension. Prosodic cues, in particular intonation, in Cantonese are relatively restricted while sentence-final particles (SFPs) may be used for this pragmatic function. This study investigated the use of prosodic cues and SFPs in irony comprehension in Cantonese-speaking children with and without ASD. Thirteen children with ASD (8;3-12;9) were language-matched with 13 typically developing (TD) peers. By manipulating prosodic cues and SFPs, 16 stories with an ironic remark were constructed. Participants had to judge the speaker's belief and intention. Both groups performed similarly well in judging the speaker's belief. For the speaker's intention, the TD group relied more on SFPs. The ASD group performed significantly poorer and did not rely on either cue. SFPs may play a salient role in Cantonese irony comprehension. The differences between the two groups were discussed by considering the literature on theory of mind.

An analysis of noun definition in Cantonese.

This study investigated the noun definitions given by Cantonese speakers at different ages. Definitional responses on six concrete nouns from 1075 children aged 4;10 to 12;01 and 15 adults were analyzed with reference to the semantic content and the syntactic form. Results showed that conventional definitions produced by Cantonese adult speakers were realized with specific superordinates and more perceptual than functional attributes. The content was carried by a syntactic frame, "NP1, is NP2", where relative clause was not the predominant form of NP2 as in the English definition forms. Core attributes signifying the defining properties increased significantly with age while non-core attributes were observed relatively evenly throughout all groups. Preschoolers tended to drop the sentential-subject (i.e., NP1) and the copula is, and produce more functional than perceptual attributes. By Primary-2 (P2) (about 7;0), the taxonomic relation was coded with the frame of "NP1 is NP2". Beginning at P4 (about 9;0), children included a superordinate but the specificity of the adult-like superordinate was not achieved even by P6 (about 11;0). In general, developmental trends accorded with the trends observed in other languages, but typological features played a role in framing the development of the syntactic form.

Corrigendum: Systematic review and meta-analysis of screening tools for language disorder.

[This corrects the article DOI: 10.3389/fped.2022.801220.].

Oral Diadochokinetic Performance on Perceptual and Acoustic Measures for Typically Developing Cantonese-Speaking Preschool Children.

PURPOSE: This study investigated native Cantonese-speaking preschool children's diadochokinetic performance, including rate, accuracy, and regularity. The second aim of this study was to examine whether language-specific patterns exist by comparing diadochokinetic rates with the average DKK rate for native English speakers. METHOD: Sixty-four typically developing preschool children who were native Cantonese speakers participated. The diadochokinetic task administered to the children involved repetitions of monosyllabic, disyllabic, and trisyllabic words and nonsense words. The maximum performance of the children was compared by diadochokinetic rate (number of syllables per second), accuracy (percentage of matched production), and regularity (pairwise variability indexes, known as PVIs). RESULTS: Monosyllabic units were produced faster, more accurately, and more regularly than multisyllabic units. Word repetition showed higher accuracy and generally lower regularity than nonsense words but similar rates. Older children were faster and more regular (higher raw PVI of initial consonants) than younger children, but younger children performed as accurately as them. When compared with data from English speakers, the diadochokinetic rates of Cantonese children were generally lower. CONCLUSIONS: Developmental progression was evident in terms of rate and regularity. The distinctive accuracy and regularity patterns between word and nonsense word repetition suggest a clinical value for both stimulus types. Language typology plays a role in diadochokinetic rate, supporting the use of language-specific reference data in practice. The typical diadochokinetic profile obtained in this study could serve as a clinical reference for speech motor assessments.

Influence of additional language learning on first language learning in children with language disorders.

BACKGROUND: Multilingualism can bring about various positive outcomes to typically developing children. Its effect on children with language difficulties is not yet clear. AIM: The aim of this study was to examine the effects of multilingual learning as a medium of instruction (MOI) on first language (L1) acquisition of children with language disorders (LD). METHODS & PROCEDURES: Nineteen Cantonese-speaking students aged 5;8-6;8 who were diagnosed with LD were recruited from a school that used Putonghua (an alternative Chinese dialect) as the MOI when learning Chinese language and were compared with 18 age-and-gender-matched Cantonese-speaking students with LD from a school that used Cantonese as the MOI when learning Chinese language. All the students also learned English (L2) as a subject at school. Proficiency in Cantonese was tested at the beginning and the end of the semester in Grade One in terms of: (1) grammar, (2) expressive vocabulary, (3) auditory textual comprehension, (4) word definition and (5) narration. OUTCOMES & RESULTS: Mixed-model ANOVAs revealed an effect of time on language proficiency indicating positive gains in both groups. Interaction effects between time and group were not significant. There was a trend that children learning Putonghua showed slightly more improvement in auditory textual comprehension. CONCLUSIONS & IMPLICATIONS: Proficiency gains were similar across groups. The study found no evidence that a multilingual learning environment hinders the language proficiency in L1 in students who have LD.

Systematic Review and Meta-Analysis of Screening Tools for Language Disorder.

Language disorder is one of the most prevalent developmental disorders and is associated with long-term sequelae. However, routine screening is still controversial and is not universally part of early childhood health surveillance. Evidence concerning the detection accuracy, benefits, and harms of screening for language disorders remains inadequate, as shown in a previous review. In October 2020, a systematic review was conducted to investigate the accuracy of available screening tools and the potential sources of variability. A literature search was conducted using CINAHL Plus, ComDisCome, PsycInfo, PsycArticles, ERIC, PubMed, Web of Science, and Scopus. Studies describing, developing, or validating screening tools for language disorder under the age of 6 were included. QUADAS-2 was used to evaluate risk of bias in individual studies. Meta-analyses were performed on the reported accuracy of the screening tools examined. The performance of the screening tools was explored by plotting hierarchical summary receiver operating characteristic (HSROC) curves. The effects of the proxy used in defining language disorders, the test administrators, the screening-diagnosis interval and age of screening on screening accuracy were investigated by meta-regression. Of the 2,366 articles located, 47 studies involving 67 screening tools were included. About one-third of the tests (35.4%) achieved at least fair accuracy, while only a small proportion (13.8%) achieved good accuracy. HSROC curves revealed a remarkable variation in sensitivity and specificity for the three major types of screening, which used the child's actual language ability, clinical markers, and both as the proxy, respectively. None of these three types of screening tools achieved good accuracy. Meta-regression showed that tools using the child's actual language as the proxy demonstrated better sensitivity than that of clinical markers. Tools using long screening-diagnosis intervals had a lower sensitivity than those using short screening-diagnosis intervals. Parent report showed a level of accuracy comparable to that of those administered by trained examiners. Screening tools used under and above 4yo appeared to have similar sensitivity and specificity. In conclusion, there are still gaps between the available screening tools for language disorders and the adoption of these tools in population screening. Future tool development can focus on maximizing accuracy and identifying metrics that are sensitive to the dynamic nature of language development. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=210505, PROSPERO: CRD42020210505.

Predicting Which Children Will Normalize Without Intervention for Speech Sound Disorders.

PURPOSE: The speech of some children does not follow a typical normalization trajectory, and they develop speech sound disorders (SSD). This study investigated predictive correlates of speech sound normalization in children who were at risk of SSD. METHOD: A prospective population cohort study of 845 Cantonese-speaking preschoolers was conducted over 2.5 years to examine (a) children who resolved nonadult realizations of consonants (normalized) and (b) those who had persisting speech sound difficulties (did not normalize). From these 845, a sample of 82 participants characterized as having SSD (1.25 SDs below the mean in a standardized speech assessment, with a delay in initial consonant acquisition or with one or more atypical errors) was followed for 2 years at 6-month intervals or until the completion of their initial consonant inventory. Data from 43 children who did not receive speech-language pathology services were analyzed with survival analysis to model time to normalization while controlling for covariates. The target event (outcome) was the completion of their initial consonant inventory. RESULTS: Under the no-intervention condition, the estimated median time to normalization was 6.59 years of age. Children who were more likely to normalize or normalized in a shorter time were stimulable to all errors and more intelligible as rated by caregivers using the Intelligibility in Context Scale. Those who showed atypical error patterns did not necessarily take longer to normalize. Similarly, expressive language ability was not significantly associated with speech normalization. CONCLUSIONS: Stimulability and intelligibility were more useful prognostic factors of speech normalization when compared to (a)typicality of error patterns and expressive language ability. Children with low intelligibility and poor stimulability should be prioritized for speech-language pathology services given that their speech errors are less likely to resolve naturally.

Phonological Development in Urdu-Speaking Children: A Systematic Review.

Background Speech and language researchers study phonological acquisition and evaluate the errors that children make to understand this complex process. This information provides clinicians with a scientific reference for better assessment and intervention services to children with articulation/phonological disorders. Urdu is a language spoken by more than 200 million speakers worldwide. However, research on Urdu phonological development is in its infancy. Purpose This systematic review aimed to identify relevant studies and provide a comprehensive review of which aspects of Urdu phonological development have been targeted, along with the reported findings. Method Five phases of the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed. All retrieved studies published between January 1980 and March 2020 and focusing on Urdu speech sound acquisition and/or phonological processes in typically developing native Urdu speakers aged up to 8 years were included in the review. The final search was conducted on May 4, 2020. Results A total of 873 records were identified from five databases and a manual search. Nine studies fulfilling the inclusion criteria were included in the final review. All studies were published in the English language, five of which were unpublished master's theses and four were peer-reviewed journal articles. Four of these studies focused on consonant acquisition, whereas five explored phonological processes. No study focused on the acquisition of Urdu vowels, diphthongs, or consonant clusters. These shortlisted studies were reviewed in detail to determine participants' demographic characteristics, focused areas of phonological acquisition, data elicitation methods and contexts, transcription systems, and major findings. Conclusion This study provides a comprehensive review of the available literature on Urdu phonological development and highlights areas for future research.

Temporal Coordination and Prosodic Structure in Autism Spectrum Disorder: Timing Across Speech and Non-speech Motor Domains.

Individuals with autism spectrum disorder (ASD) often exhibit disordered speech prosody, but sources of disordered prosody remain poorly understood. We explored patterns of temporal alignment and prosodic grouping in a speech-based metronome repetition task as well as manual coordination in a drum tapping task among Cantonese speakers with ASD and normal nonverbal IQ and matched controls. Results indicate similar group results for prosodic grouping patterns, but significant differences in relative timing and longer syllable durations at phrase ends for the ASD group. Variability on the speech task was significantly correlated with variability on the drumming task, consistent with the view that impairment in both speech and non-speech motor domains can be linked with deficits in temporal processing.