Diagnosing inconsistent phonological disorder: quantitative and qualitative measures.

Studies of children's consistency of word production allow identification of speech sound disorder. Inconsistent errors are reported for two groups of children: childhood apraxia of speech (CAS) due to difficulty with the motoric precision and consistency of speech movements; and inconsistent phonological disorder (IPD) attributed to impaired phonological planning. This paper describes the inconsistent productions of children with IPD in comparison to typically developing children. In two studies of suspected SSD (N = 135), 22 children pronounced ≥40% of 25 words inconsistently on three repeated trials. No participant had symptoms of CAS. They were monolingual and spoke Australian- or Irish-English. Assessment determined the proportions of words said consistently (i.e. the same across productions: all correct or with the same error) or inconsistently (i.e. differently across productions: at least one correct and one error or different errors in productions). Qualitative analyses examined error types and explored the effect of target words' characteristics on inconsistency. Children with IPD produced 52% of words with different errors. While 56% of all phoneme errors were developmental (age appropriate or delayed), atypical errors typified inconsistency: default sounds and word structure errors. Words with more phonemes, syllables and consonant clusters were vulnerable to inconsistency, but their frequency of occurrence had no effect. TD children and those with IPD had different quantitative and qualitative error profiles, confirming IPD as a diagnostic category of SSD. Qualitative analyses supported the hypothesised deficit in phonological planning of words' production for children with IPD.

Preschool children's consistency of word production.

Consistency of word production contributes to carers' ability to understand children's speech. Reports of the proportion of words produced consistently by typically developing preschool children, however, vary widely from 17% to 87%. This paper examines the quantitative (consistency count) and qualitative (e.g. phonemic analysis) characteristics of word consistency in 96 children aged 36-60 months. Children named 15 pictures twice, in separate trials, in the same assessment session. The mean consistency of the production for the whole group was 82%. Older children were more consistent than younger children. Girls were more consistent than boys. Words produced correctly in one trial and in error in another may indicate resolving error patterns. Words produced in error in two different ways provided useful evidence about the nature of inconsistent word production in typically developing children. The clinical and theoretical implications are discussed.

The exploration of speech-language pathology students' perceptions and attitudes towards written clinical reflection.

Purpose: Written clinical reflection is frequently used in speech-language pathology training programs to develop student clinical skills. The aim of this study was to explore speech-language pathology students' perceptions towards written clinical reflection.Method: Seventy-two undergraduate speech-language pathology students completed an online survey. An observational research design was undertaken. Descriptive statistics were used to analyse quantitative data. Inductive content analysis was used for qualitative data analysis.Result: Speech-language pathology students reported that written clinical reflections are useful but also wanted to explore alternative ways to reflect. Most students used written clinical reflection to focus on self-improvement of clinical skills and a small number of students used reflection to consider stakeholders' points of view. Students wanted more guidance and feedback on written clinical reflections.Conclusion: The results indicate that written clinical reflection is a useful learning tool. To facilitate the development of reflection skills in speech-language pathology students, it is important to explicitly teach clinical reflection in university curricula and to receive guidance from professional practice educators.

Benefits of a professional development course on transcription for practising speech-language pathologists.

Purpose: Transcription of speech sounds is a fundamental skill used by speech-language pathologists. Little is known about the impact of professional development courses on transcription accuracy and confidence. This study explored speech-language pathologists' use and perceptions of transcription and the effect of a professional development course on their transcription accuracy and confidence.Method: A quasi-experimental, one-group pretest-posttest design was used. Twenty-two Australian speech-language pathologists working with children with speech sound disorders participated in the course. Participants transcribed single words and completed a survey about confidence, perceptions, and the use of transcription at both time points.Result: The number of participants who reported feeling confident about using transcription significantly increased from 36.84% pre-training to 68.42% post-training. Transcription accuracy of phonemes based on point-to-point accuracy was high pre-training (88.97%) and did not significantly improve. Participants identified strategies to maintain their transcription skills.Conclusion: This study suggests speech-language pathologists transcribe single words in typical speech with high accuracy using broad transcription, and that participating in a transcription professional development course increases their transcription confidence. Further research is needed to explore different delivery methods of professional development, the impact of professional development on transcription accuracy of disordered speech, and the long-term impacts of professional development on transcription accuracy and confidence.

Is children's speech development changing? Preliminary evidence from Australian English-speaking 3-year-olds.

Purpose: Around 9% of children have difficulty acquiring intelligible speech despite typical sensory, neuro-motor and cognitive function. Speech-language pathologists (SLPs) rely on descriptions of children's speech errors to identify speech sound disorder (SSD) and determine intervention targets and goals. Existing normative data, however, need re-evaluation to reflect changes in populations and the language learning environment. This research evaluates whether developmental phonological patterns widely accepted as describing typical acquisition predict speech errors in a recent sample of pre-school children.Method: In 2015, 99 neurotypical children aged 3;0-3;8 years;months were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP). Their performance was compared to studies describing speech development by children of the same age for phone repertoire and phonological patterns.Result: There were differences for both measures. Phone repertoire differences were marginal, but changes in phonological pattern use were unexpected. Suppression of three developmental phonological patterns (stopping of fricatives, final consonant deletion and voicing contrasts) was delayed compared to previous norms. Atypical consonant cluster reduction, sometimes considered a marker for disorder, was observed in 10% of children.Conclusion: There were qualitative differences in the speech development of the 2015 cohort of children compared to previous developmental norms. Valid and current normative data are necessary for the accurate identification of children needing intervention. The differences we found reinforce the need for regular updating of assessment tools, as well as greater understanding of how children's language learning environments are changing and potentially influencing speech development.

Narrative skills of children born preterm.

BACKGROUND: The majority of children born preterm are considered neurologically normal and free of disability. However, follow-up studies at school age report that preterm children born without major impairment have more subtle impairments, including language difficulties, which influence their ability to function. These findings indicate a need to examine specific language-processing skills in children born preterm across the school years. AIMS: To compare oral narrative skills of children born preterm with their peers born at full term. METHODS & PROCEDURES: The research used an independent groups design to examine the narrative ability of 30 children aged between 9 years; 8 months and 10 years; 11 months: 15 children born before 33 weeks' gestation (preterm group) and 15 children matched for chronological age born at full gestation (greater than 38 weeks). Seven measures assessed productivity, structure, complexity, and formulation abilities. The research used univariate analysis to examine variations in outcomes based on group status (preterm versus full term). OUTCOMES & RESULTS: The results showed group effects on the formulation measures but not the productivity, complexity or quality measures. Children born preterm produced more utterances with mazes and had more disruptions than children born at full term. The children born preterm demonstrated difficulties formulating a narrative even though they produced a similar amount and used similar structural aspects to their peers born full term. CONCLUSIONS & IMPLICATIONS: Children born preterm show subtle and specific linguistic deficits that continue to affect their ability to formulate a narrative in the upper primary school years.

The impact of selecting different contrasts in phonological therapy.

Previous research indicates that the extent of progress made by children with phonological disorders depends upon the nature of the word pairs contrasted in therapy. For example, phonemes that differ maximally in terms of place, manner, voicing and sound class (e.g., fan - man) in comparison to therapy where the word pairs presented differ minimally (e.g., fan - van). To investigate the implications of target selection within a typical clinical context (as opposed to a rigorous research setting) eight speech-language pathologists implemented intervention with appropriate children from their caseloads. Nineteen children each received 6 hours of therapy over one school term. They were randomly allocated to two groups. One group (of nine children) received intervention based on a traditional minimal pair approach, targeting homonymy as well as distinctive feature contrast. The other group (ten children) received intervention targeting contrasts differing across a range of distinctive features. Children made considerable progress in therapy in terms of speech accuracy and number of error patterns suppressed. However, there was no difference between the progress of the two groups. Follow-up assessment of 14 of the 19 children indicated maintenance of progress by both groups. Reasons for the lack of difference between the groups in the current study are considered and clinical implications are drawn.

Differentiating normal variability from inconsistency in children's speech: normative data.

BACKGROUND: In young, typically developing children, some word production variability is expected, but highly inconsistent speech is considered a clinical marker for disorder. Speech-language pathologists need to identify variability versus inconsistency, yet these terms are not clearly differentiated. Not only is it important to identify inconsistency, but also it needs to be defined and measured so that clinical decisions are evidence based. In order to understand inconsistent speech production, typical variability must be described. AIMS: This paper differentiates between variability and inconsistent productions. Variability is defined as productions that differ, but can be attributed to factors described in normal acquisition and use of speech. Inconsistency is speech characterized by a high proportion of differing repeated productions with multiple error types, both segmental (phoneme) and structural errors (consonant-vowel sequence within a syllable). The study describes and quantifies the consistency of word production in typically developing children aged between 3;0 and 6;11 years. METHODS AND PROCEDURES: This paper reports a large cross-sectional study (n = 409) of the consistency of children's production of words within the same linguistic context. OUTCOMES AND RESULTS: The study found that the speech of typically developing children is highly consistent. Children in the youngest age group demonstrated the highest levels of variability, but it remained below 13% with 10% reflecting maturational influences. CONCLUSIONS: Inconsistent production cannot be considered a typical feature of speech development. The results inform differential diagnosis of speech disorder.

Intervention for children with severe speech disorder: a comparison of two approaches.

BACKGROUND: Children with speech disorder are a heterogeneous group (e.g. in terms of severity, types of errors and underlying causal factors). Much research has ignored this heterogeneity, giving rise to contradictory intervention study findings. This situation provides clinical motivation to identify the deficits in the speech-processing chain that underlie different subgroups of developmental speech disorder. Intervention targeting different deficits should result in a differential response to intervention across these subgroups. AIMS: To evaluate the effect of two different types of therapy on speech accuracy and consistency of word production of children with consistent and inconsistent speech disorder. METHODS & PROCEDURES: Eighteen children (aged 4;08-6;05 years) with severe speech disorder participated in an intervention study comparing phonological contrast and core vocabulary therapy. All children received two 8-week blocks of each intervention. Changes in consistency of production and accuracy (per cent consonants correct) were used to measure the effect of each intervention. OUTCOMES & RESULTS: All of the children increased their consonant accuracy during intervention. Core vocabulary therapy resulted in greater change in children with inconsistent speech disorder and phonological contrast therapy resulted in greater change in children with consistent speech disorder. CONCLUSIONS: The results provide evidence that treatment targeting the speech-processing deficit underlying a child's speech disorder will result in efficient system-wide change. Differential response to intervention across subgroups provides evidence supporting theoretical perspectives regarding the nature of speech disorders: it reinforces the concept of different underlying deficits resulting in different types of speech disorder.

Phonological development: a normative study of British English-speaking children.

This paper reports a normative study on the phonological development of British English-speaking children. Speech samples of 684 children, aged between 3;0 and 6;11 years, randomly selected from nurseries and schools in eight different areas throughout the UK, were collected and analysed to obtain normative data. This paper reports on two aspects of speech development: the age of acquisition of sounds (phonetic acquisition) and the age that error patterns were suppressed (phonemic acquisition). It discusses the effects of age, gender and socio-economic status on speech sound development. The study found that older children had more accurate production and fewer error patterns in their speech. It found no gender differences in the younger age groups. However, in the oldest age group, it found the phonological accuracy measures of girls' better than boys. It found no significant effects of socio-economic status on any of the phonological accuracy measures.