Effects of explicit teacher-implemented phoneme awareness instruction in 4-year-olds.

The purpose of this study was to determine whether gains would be observed in an integrated group of 4-year-olds when phoneme awareness skills were explicitly taught by trained early childhood educators. In a quasi-experimental design with a delayed treatment approach, one classroom (N = 14) was randomly assigned to receive the instructional program in fall, while a second classroom (N = 10) served as a control and subsequently received the program in spring. Baseline assessment of speech and language skills indicated there were four participants with speech and/or language impairments. The teacher training involved an initial workshop and weekly hour-long mentoring meetings; the program was provided for 20 min a day, 4 d a week, for 10 weeks. Outcome measures of phoneme awareness and letter knowledge skills were obtained from non-standardized tasks administered pre-instruction and post-instruction, at mid-year and end-year points. When each classroom received the phoneme instruction, participants made gains in letter knowledge and phoneme level skills in comparison with group performance under regular instruction. These gains were statistically significant for phoneme blending and letter knowledge. Using an aggregate of all outcome measures, the gain for each classroom when under instruction was statistically significant as compared with when that same classroom was receiving the regular curriculum. Children with speech and/or language impairment responded more variably. Gains in the more difficult phoneme awareness skill of blending suggest the potential for marked change with an intensive, explicit classroom instruction and hold promise for SLPs collaborating with preschool teachers to provide time-efficient PA instruction.

Stimulability: relationships to other characteristics of children's phonological systems.

In honour of Miccio's memory, this article revisits the topic of stimulability in children with speech sound disorders (SSD). Eighteen children with SSD, aged 3;6-5;5 (M = 4;8), were tested for their system-wide stimulability, percentage consonants correct (PCC), phonetic inventory size, and oral- and speech-motor skills. Pearson Product Moment Correlations were calculated to determine the nature of relations between stimulability and each of these other variables. Results revealed marked relations between stimulability and PCC and between stimulability and inventory size. Relations between stimulability and both multisyllabic nonsense and real word repetition rates were substantial. Findings suggest that stimulability, as measured for a group of sounds typically challenging for children with SSD, reflects both underlying phonological representations (UPRs) and phonetic imitative skill. The impact of poor stimulability skills in children with severe involvement of SSD and limited phonetic inventories implicates not only the potential difficulty non-stimulable sounds pose at the word level, but the need for increasing stimulability in these children. This, in turn, is a tribute to Miccio's intervention programme and the need for including it in both efficacy and efficiency investigations.

A comparison of linguistic profiles in subgroups of children with specific language impairment.

PURPOSE: To compare morphosyntactic skills of preschoolers in different subgroups of language impairment. METHOD: Eighty-three children participated in this study. They represented 4 groups: (a) language impairment-only, (b) speech-language impairment with minimal or no final cluster reduction/consonant deletion, (c) speech-language impairment with frequent final cluster reduction/consonant deletion, and (d) a no-impairment control group. Group performance was compared for finite and nonfinite morpheme production and sentence structure. RESULTS: Children in the language impairment-only group had significantly higher performance than children in both speech-language impairment subgroups, even when errors that could be attributed to final consonant deletion/cluster reduction were taken into account. The language impairment-only and control groups' performance was similar for finite and nonfinite morpheme production, and both groups produced nonfinite plurals with significantly higher accuracy than finite third person singular forms. The language impairment-only group had significantly higher accuracy for both plural and third person singular relative to the group with speech-language impairment characterized by infrequent final cluster reduction/consonant deletion. CONCLUSIONS: Children with speech-language impairment generally had poorer morphosyntactic skills than peers who had language deficits and age-appropriate speech skills. Final consonant and final cluster production skills alone did not account for group differences. Clinically, the findings suggest that it is important to assess carefully the speech skills, including final cluster production skills, of preschoolers who have language deficits and language skills of preschoolers who have speech sound disorders.

Commentary on "treatment decisions for children with speech-sound disorders": revisiting the past in EBP.

PURPOSE: This commentary, written in response to Alan Kamhi's paper, "Treatment Decisions for Children with Speech-Sound Disorders," further considers the "what" or goal selection process of decision making with the aim of efficiency-getting the most change in the shortest time. METHOD: My comments reflect a focus on the client values piece of the evidence-based practice (EBP) triad through validating treatment decisions for individual clients using generalization data. Such data are ideal for demonstrating change according to specific benchmarks and suggesting that treatment was responsible for this change. Consideration is also given to deficit profiles and their implications for long-term outcomes when validating the effects of treatment. CONCLUSION: Although the abundance of evidence suggests that a variety of treatment approaches are effective for children with speech-sound disorders, less is known about which are most efficient as compared to one another or for which specific children. Practitioners, however, are embracing EBP when they select a treatment by matching the research evidence with a client's profile, collect systematic data, and use those data to demonstrate that change is attributable to treatment.

Outcomes of different speech and language goal attack strategies.

The purpose of this study was to assess phonological and morphosyntactic change in children with co-occurring speech and language impairments using different goal attack strategies. Participants included 47 preschoolers, ages 3;0 (years;months) to 5;11, with impairments in both speech and language: 40 children in the experimental group and 7 in a no-treatment control group. Children in the experimental group were assigned at random to each of 4 different goal attack strategies: (a) in the phonology first condition, children received a 12-week block of phonological intervention followed by 12 weeks of work on morphosyntax; (b) the morphosyntax first condition was the same as phonology first, with the order of interventions reversed; (c) the alternating condition involved intervention on phonology and morphosyntax goals that alternated domains weekly; and (d) the simultaneous condition addressed phonological and morphosyntactic goals each session. Data were collected pretreatment, after the first intervention block, and posttreatment (after 24 weeks). For the control group, data were collected at the beginning and end of a period equivalent to 1 intervention block. Change in a finite morpheme composite and target generalization phoneme composite was assessed. Results showed that morphosyntactic change was greatest for children receiving the alternating strategy after 24 weeks of intervention. No single goal attack strategy was superior in facilitating gains in phonological performance. These results provide preliminary evidence that alternating phonological and morphosyntactic goals may be preferable when children have co-occurring deficits in these domains; further research regarding cross-domain intervention outcomes is necessary.

Predictors of phonological change following intervention.

To date, predictor variables strongly associated with phonological change as a result of intervention have not been identified. The purpose of this study was to determine the best predictor or combination of predictors of change in percentage of consonants correct (PCC; L. D. Shriberg and J. Kwiatkowski, 1982) as a result of speech-language intervention for a group of 20 participants and to replicate this procedure with a second group of 20. Participants were preschool children, ages 3;0 (years;months) to 5;11, with impairments in phonology and morphosyntax who received intervention focused on both phonology and morphosyntax in different goal attack configurations. The relationship of predictor variables chronological age, inventory size, error consistency, and expressive language to the criterion variable, change in PCC, was investigated. In both the initial study and the replication, the mean change in PCC following a 24-week intervention period was 13.1%. In the initial study, error consistency and a finite morpheme composite (FMC; L. M. Bedore and L. B. Leonard, 1998) accounted for 52% of the variance for the criterion variable. Error consistency at the first step in the regression accounted for 31.6% of the variance. In the replication, error consistency was the only variable related to PCC change, again accounting for 31% of the variance. Further research examining overall error consistency is warranted.

Speech abilities in preschool children with speech sound disorder with and without co-occurring language impairment.

PURPOSE: The authors compared preschool children with co-occurring speech sound disorder (SSD) and language impairment (LI) to children with SSD only in their numbers and types of speech sound errors. METHOD: In this post hoc quasi-experimental study, independent samples t tests were used to compare the groups in the standard score from different tests of articulation/phonology, percent consonants correct, and the number of omission, substitution, distortion, typical, and atypical error patterns used in the production of different wordlists that had similar levels of phonetic and structural complexity. RESULTS: In comparison with children with SSD only, children with SSD and LI used similar numbers but different types of errors, including more omission patterns ( p < .001, d = 1.55) and fewer distortion patterns ( p = .022, d = 1.03). There were no significant differences in substitution, typical, and atypical error pattern use. CONCLUSIONS: Frequent omission error pattern use may reflect a more compromised linguistic system characterized by absent phonological representations for target sounds (see Shriberg et al., 2005). Research is required to examine the diagnostic potential of early frequent omission error pattern use in predicting later diagnoses of co-occurring SSD and LI and/or reading problems.

Lexical and phonological variability in preschool children with speech sound disorder.

PURPOSE: The authors of this study examined relationships between measures of word and speech error variability and between these and other speech and language measures in preschool children with speech sound disorder (SSD). METHOD: In this correlational study, 18 preschool children with SSD, age-appropriate receptive vocabulary, and normal oral motor functioning and hearing were assessed across 2 sessions. Experimental measures included word and speech error variability, receptive vocabulary, nonword repetition (NWR), and expressive language. Pearson product­moment correlation coefficients were calculated among the experimental measures. RESULTS: The correlation between word and speech error variability was slight and nonsignificant. The correlation between word variability and receptive vocabulary was moderate and negative, although nonsignificant. High word variability was associated with small receptive vocabularies. The correlations between speech error variability and NWR and between speech error variability and the mean length of children's utterances were moderate and negative, although both were nonsignificant. High speech error variability was associated with poor NWR and language scores. CONCLUSION: High word variability may reflect unstable lexical representations, whereas high speech error variability may reflect indistinct phonological representations. Preschool children with SSD who show abnormally high levels of different types of speech variability may require slightly different approaches to intervention.

What works: evidence-based intervention for children with speech sound disorders.

To provide alternatives to the widespread use of nonspeech oral motor exercises for childhood speech sound disorders, speech intervention approaches that have received the highest level of experimental scrutiny are reviewed. Efficacy research over the past decade is critically evaluated according to hierarchical systems for quality and credibility. High standards for adherence to experimental methods are applied and reveal strong evidence for a variety of interventions that are effective. These approaches are organized according to whether their focus is directly on speech or indirectly on speech through language. Answers to the question, "What works?" with respect to features such as target selection strategies and teaching procedures are provided. Recommendations for selecting an evidence-based intervention are developed with consideration of developmental level and differential diagnostic evidence of speech sound disorder subtypes.

Error consistency and the evaluation of treatment outcomes.

The consistency/variability of error substitution patterns may hold important implications for subgrouping children with speech disorders, as well as for relationships between learning and generalization patterns. There is a need to quantify and examine the range of consistency/variability within the speech disordered population as it relates to system-wide change. This investigation compared two groups of preschool children (N = 10 each) differing in the consistency/variability of errors on a variety of pre-treatment and treatment outcome measures. The Error Consistency Index (ECI), a measure of error variability across the entire phonological system, was used to identify groups at the extreme ends of the ECI distribution from a larger participant pool. Each participant was treated on three target singletons from among obstruents /s, z, f, integral, tintegral, k, g/ and liquids /l, r/ and change on these targets, as well as their generalization to untrained positions was assessed. Although there were significant differences between the variable and consistent groups on all pre-treatment measures, there were no significant group differences in target and generalization learning or in per cent consonants correct (PCC) change. These findings provide evidence to suggest that relationships observed between error variability for individual phonemes and learning of those targets may differ from those observed when consistency/variability is quantified for the entire system and change across a number of phonemes, and the system as a whole, is examined.

Language-based intervention for phonological disorders.

Children with phonological disorders often display difficulty in other domains of language. Language-based approaches focus on all aspects of language; therefore, little attention may be drawn to sound errors and these may not be specific targets of intervention. These approaches involve a variety of naturalistic, conversationally based techniques such as focused stimulation in the form of expansions and recasts, scaffolding narratives, and elicited production devices such as forced choice questions, cloze tasks, and preparatory sets. Results from well-controlled group studies are inconclusive regarding the cross-domain effects of morphosyntax approaches on phonology. There are, however, individual children whose phonology improves with a language-based approach. Preliminary evidence suggests that such an approach may be an appropriate choice for children with both speech and language impairments whose phonological systems are highly inconsistent. One advantage of a language-based approach is that it may lead to simultaneous improvements in both speech and language for children with difficulty in both these domains. It is also a viable option when service delivery dictates classroom and collaborative settings. When a language-based approach is chosen for children with phonological disorders, it is imperative that the practitioner monitor phonological progress closely to ensure its effectiveness.

Efficacy and Cross-Domain Effects of a Morphosyntax and a Phonology Intervention.

PURPOSE: The purpose of this study was three-fold: (a) to determine the efficacy of a morphosyntax and a phonology intervention against a no-treatment control group, (b) to assess the effects of those interventions on the non-targeted domain, and (c) to evaluate sequence effects when children receive both interventions. METHOD: Twenty preschoolers with impairments in both morphosyntax and phonology were assigned randomly to an intervention of two 12-week blocks beginning with either a block of phonology first (n = 10) or a block of morphosyntax first (n = 10). Data were collected at pretreatment, after the first intervention block, and posttreatment. For a control group of 7 children, data were collected at the beginning and end of a time period equivalent to one intervention block. Changes in a finite morpheme composite and target/generalization phoneme composite were assessed. RESULTS: In comparison to the control group, both interventions were effective at a statistically significant level in facilitating improvement in the target domain after 12 weeks. The morphosyntax intervention led to cross-domain change in phonology that was similar to that achieved by the phonology intervention. The morphosyntax first sequence also led to slightly better overall morphosyntactic performance. CLINICAL IMPLICATIONS: Clinically, results suggest targeting morphosyntax first, followed by phonology, if using a block intervention sequence for children with concomitant morphosyntactic and phonological impairments.

Effects of a cycled morphological intervention on selected suppletive BE forms.

The purpose of this study was to demonstrate the efficacy of a cycled morphological intervention involving copula is, by comparison to a control group, and to examine the effectiveness of this intervention in producing change in untreated auxiliary is and am. Twenty-two preschool children, who produced copula is but no other suppletive forms of BE as targets, received six sessions of naturalistic intervention cycled over 24 weeks. Production accuracy levels for treated copula and untreated auxiliary is and am were obtained from spontaneous language samples elicited after 12 and 24 weeks of intervention. The cycled intervention resulted in significant improvement in copula is in comparison to the no-treatment control group at the 12 week sampling point; similar gains were observed for the untreated auxiliary is, but not am. After 24 weeks, however, gains in untreated am were significantly greater than for copula is, providing new data to suggest that generalization may also be observed for the suppletive am.