Extraction of primary maxillary incisors and children's speech production: A case series.

Dental caries (tooth decay) is a disease with a significant global burden. Management may necessitate the extraction of teeth to restore oral health. The association between dental extractions and children's speech is unclear, with clinical implications for speech-language pathologists and dentists. This case series describes a prospective study reporting the impact of primary maxillary incisor teeth extraction on speech sound accuracy for three children (C1 aged 5;6 (years; months), C2 aged 4;6, C3 aged 3;10). Their speech was assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and the Intelligibility in Context Scale (ICS) before (T1) and 1 month after dental treatment (T2). Speech analysis included the percentage of consonants correct (PCC) and error-type analyses. Caregiver and child perception of the child's oral health-related quality of life (OHRQoL) were assessed pre- and post-operatively using a modified Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). At T1, all three children scored >1 standard deviation below the mean on normative data in the DEAP. There was no clinically significant change in PCC for any child (C1 T1: 89.6%, T2: 90.6%, C2 T1: 78.0%, T2: 75.9%, C3 T1: 56.1%, T2: 63.1%). OHRQoL measures were improved for C1 by the carergiver report and remained stable for C2 and C3 and all child reports. Speech sound difficulties were present before dental treatment in all participants and extraction of primary maxillary incisors did not significantly impact speech production. Dental extractions appear to be independent from speech production in this case series of preschool children.

Considerations of dialect on the identification of speech sound disorder in Vietnamese-speaking children.

BACKGROUND: The dialect spoken by children influences diagnostic decision-making regarding the identification and severity of speech sound disorder (SSD). AIMS: The primary objective was to review papers that examined the influence of dialect on the identification of SSD in Vietnamese-speaking children. METHODS & PROCEDURES: Five studies of mono- and multilingual Vietnamese-speaking children living in Vietnam and Australia were reviewed to examine the influence of dialect on the assessment and analysis children's speech. The main Vietnamese dialects (Standard, Northern, Central, Southern) differ in the production of consonants, vowels and tones. MAIN CONTRIBUTION: Most speech assessments define correct production using the standard dialect of a language. Insights from recent studies of Vietnamese provide recommendations for also considering dialect in diagnostic decision-making. First, we recommend adding column(s) to the assessment score sheet that includes the dialectal variants spoken by adults in the child's family or community. Second, we calculate the accuracy of production twice, based on the standard form and dialectal form. Third, we report the percentage of consonants correct-standard (PCC-S) and percentage of consonants correct-dialect (PCC-D). CONCLUSIONS & IMPLICATIONS: Diagnostic decision-making is influenced by dialectal variation in children's speech, so speech and language therapists need to compare standard and dialectal productions when undertaking assessments, analysis and diagnostic decision-making. WHAT THIS PAPER ADDS: What is already known on the subject Most speech assessments use the standard form of a dialect as the correct production. The standard dialect is used for diagnosis of SSD and identification of intervention targets. What this paper adds to the existing knowledge This paper examines five research studies of Vietnamese to identify ways to consider dialect in speech and language therapy assessment and analysis. Vietnamese provides a complex environment for this examination since there are numerous Vietnamese dialects and they differ according to consonants, vowels and tones. What are the potential or actual clinical implications of this work? Speech and language therapists are encouraged to add column(s) to their assessment score sheet that includes the dialectal variants spoken by adults and to report the PCC-S and PCC-D.

Transcribing multilingual children's and adults' speech.

Speech-language pathologists (SLPs) face challenges in transcription and diagnosis of speech sound disorders (SSD) in multilingual children due to ambient language influences and cross-linguistic transfer. The VietSpeech Multilingual Transcription Protocol, a 4-step process to undertake impressionistic transcription of multilingual speech was tested using data from Vietnamese-Australian children (n = 69) and adult family members (n = 85). The transcription team included an English-speaking SLP, a Vietnamese-English-speaking linguist and accredited interpreter, and two Vietnamese-English-speaking SLPs. (1) Training: The team completed training together in Vietnamese and English phonology. (2) Speech assessment: The participants were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) in English and the Vietnamese Speech Assessment (VSA). (3) Transcription comparison: Inter-rater reliability for 10 children and 12 adults was calculated using consonant-by-consonant agreement. For English the 3-way inter-rater agreement was 92.62% for children and 88.69% for adults. For Vietnamese the 4-way inter-rater agreement was 86.57% for children and 96.05% for adults. There was a significant correlation between speech accuracy and inter-rater reliability for children's consonants in English (r = 0.95) and Vietnamese (r = 0.91), and adults' consonants in English (r = 0.90), but not for Vietnamese (r = 0.49). Reliability was influenced by phoneme class and whether the target consonant was shared between languages. (4) Rule generation and consensus: Rules based on near functional equivalence were implemented to maintain consistency and reach consensus. SLPs who do not speak clients' home languages can be supported to transcribe multilingual speech by working with multilingual teams, and understanding personal limitations during multilingual speech assessments.

Speech acquisition within a 3-generation Vietnamese-English family: the influence of maturation and ambient phonology.

The emergence approach to speech acquisition theorises the influence of intrinsic capabilities (e.g., maturation), interactional capabilities, and extrinsic contexts (e.g., ambient phonology). Intrinsic and extrinsic influences were examined via a case study of a 3-generation Vietnamese-English family with two brothers (C1 aged 5;6 and C2 aged 3;10), their mother (M), grandfather (GF) and grandmother (GM). Their speech was assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and the Vietnamese Speech Assessment (VSA). Standard Australian English/Standard Vietnamese productions were defined as 'correct', even though the adults spoke different Vietnamese dialects. Their percentage of standard consonants correct (PSCC) was: C1 (English:92.27%, Vietnamese:89.05%), C2 (E:86.47%, VN:86.13%), M (E:90.34%, VN:96.35%), GF (E:82.61%, VN:97.81%), GM (VN:99.27%). Percentages were higher when dialectal variants were included. C1 and C2 had more pronunciation matches with English (86.96%) than Vietnamese (79.56%). C1's pronunciation matched: M (E:85.02%, VN:83.94%), GF (E:79.23%, VN:77.37%), GM (VN:73.72%) and C2's pronunciation matched: M (E:79.23%, VN:73.72%), GF (E:73.91%, VN:75.18%), GM (VN:72.26%). There was evidence of ambient phonology influences and cross-linguistic transfer. For example, in Vietnamese 'r' is produced as /ʐ/ or /r/ , but was produced by C1 as [ɹ] (English approximant) and by C2 [w] (age-appropriate/ɹ/substitution). The children demonstrated maturation influences for late-occurring English consonants (e.g., English /θ/ →[f]). This study found evidence for the emergence approach and recommends knowledge of the ambient phonology augments traditional child-focused understandings of children's speech acquisition.

Intelligibility in 3-Year-Olds With Cleft Lip and/or Palate Using the Intelligibility in Context Scale: Findings from the Cleft Collective Cohort Study.

OBJECTIVE: To provide comparison data on the Intelligibility in Context Scale (ICS) for a sample of 3-year-old English-speaking children born with any cleft type. DESIGN: Questionnaire data from the Cleft Collective Cohort Study were used. Descriptive and inferential statistics were carried out to determine difference according to children's cleft type and syndromic status. PARTICIPANTS: A total of 412 children born with cleft lip and/or palate whose mothers had completed the ICS when their child was 3 years old. MAIN OUTCOME MEASURE(S): Mothers' rating of their children's intelligibility using the ICS. RESULTS: The average ICS score for the total sample was 3.75 (sometimes-usually intelligible; standard deviation [SD] = 0.76, 95% CIs = 3.68-3.83) of a possible score of 5 (always intelligible). Children's speech was reported to be most intelligible to their mothers (mean = 4.33, SD = 0.61, 95% CIs = 4.27-4.39) and least intelligible to strangers (mean = 3.36, SD = 1.00, 95% CIs = 3.26-3.45). There was strong evidence (P < .001) for a difference in intelligibility between children with cleft lip only (n = 104, mean = 4.13, SD = 0.62, 95% CIs = 4.01-4.25) and children with any form of cleft palate (n = 308, mean = 3.63, SD = 0.76, 95% CIs = 3.52-3.71). Children born with cleft palate with or without cleft lip and an identified syndrome were rated as less intelligible (n = 63, mean = 3.28, SD = 0.85, 95% CIs = 3.06-3.49) compared to children who did not have a syndrome (n = 245, mean = 3.72, SD = 0.71, 95% CIs = 3.63-3.81). CONCLUSIONS: These results provide preliminary comparative data for clinical services using the outcome measures recommended by the International Consortium for Health Outcomes Measurement.

Randomised Controlled Trial Evaluating Active versus Passive Waiting for Speech-Language Pathology.

INTRODUCTION: High demand for speech-language pathology means children sometimes wait over 12 months for services, missing out on timely support. Waiting can be a time of stress, concern, and powerlessness for caregivers. Provision of information via a website may support families and encourage active waiting. OBJECTIVE: The aim of this study was to compare children's speech, intelligibility, language, and literacy outcomes, and caregivers' satisfaction and empowerment in active versus passive waiting conditions. METHODS: Ninety-seven preschool-aged children referred to a community health speech-language pathology service in Australia were screened for eligibility. Eligible children (n =42) with speech/language difficulties were randomly allocated to: (a) active waiting (provision of a purpose-built website; n = 20), or (b) passive waiting (control group; n = 22). Pre- and post-assessments (after 6 months on a waiting list) were completed with children and caregivers by a speech-language pathologist blinded to group allocations. RESULTS: Intention to treat (n =36) and per-protocol analyses (n =30) were conducted to measure group differences in child and caregiver outcomes at post-assessment using one-way ANCOVA, controlling for baseline scores. There were no statistically significant differences between groups for children's speech, intelligibility, language, and literacy, or caregivers' empowerment and satisfaction. Children in both groups made minimal gains over 6 months. CONCLUSIONS: Provision of an active waiting website did not lead to statistically significant change in child or caregiver outcomes, and children in both groups made little progress over a 6-month period. Early speech-language pathology intervention delivered with appropriate dosage is needed to optimise children's outcomes. Until timely and effective speech-language pathology intervention can be provided for all who need it, provision of early assessments may be beneficial. There remains a need for effective ways to support children and families on waiting lists.

Applying the ICF-CY to Specialist Speech-Language Pathologists' Practice With Toddlers With Cleft Palate Speech.

OBJECTIVE: To evaluate how the practice of specialist speech-language pathologists (SLPs) working with young children with cleft palate ± cleft lip (CP±L) maps onto the International Classification of Functioning, Disability, and Health - Children and Youth version (ICF-CY) and consider the functionality of the categories of the ICF-CY for this specialist area of practice. DESIGN: Cross-sectional, qualitative study. SETTING: Semistructured face-to-face interviews were conducted with SLPs working in tertiary-level hospitals, universities, and public clinics. PARTICIPANTS: Six specialist SLPs with 17 to 39 years of experience working with young children with CP±L as researchers and clinicians in Australia, Brazil, Denmark, Ireland, New Zealand, and the United States. MAIN OUTCOME MEASURE(S): Specialists' practices were captured using in-depth, semistructured interviews. Data collected were analyzed by directed content analysis applying the ICF-CY as a coding schema. RESULTS: In total, 4077 data points were coded. Most mapped onto Body Structures (684, 16.8%), Body Functions (906, 22.2%), and Environmental Factors (1626, 39.9%) with less emphasis on Activities and Participation (560, 13.7%). A "best fit" approach was taken to topics that did not map exactly onto categories of the ICF-CY (eg, velopharyngeal insufficiency [VPI]); however, there was not always an ideally suitable category available. CONCLUSIONS: The current study revealed strengths and challenges in categorizing practice within the ICF-CY for children with CP±L, including collaboration with parents and significant others, specificity around speech, language, and articulation, and the different types of VPI. Therefore, future discussion around how best to use the framework with children with CP±L is needed.

Transcription of Vietnamese Adults' and Children's Consonants by English-Speaking Speech-Language Pathologists.

OBJECTIVE: To examine English-speaking speech-language pathologists' (SLPs) transcription of consonants in Vietnamese words and identification of correct/incorrect productions of Vietnamese children's speech. PARTICIPANTS AND METHODS: Twenty English-speaking SLPs completed three tasks. Task 1: transcription of 22 English words using the International Phonetic Alphabet. Task 2: transcription of 47 words spoken by Vietnamese adults. Task 3: transcription of 94 Vietnamese words spoken by Vietnamese children and identification of correct/incorrect productions. Participants completed questionnaires exploring language proficiency, transcription skill, musicality and confidence with multilingual clients. RESULTS: Task 1: participants demonstrated good accuracy transcribing English words (M = 97.2%). Task 2: an average of 52.9% consonants were transcribed correctly (89.4% when Vietnamese-English common transcription errors were considered). Common transcription errors included voicing of plosives, place and syllable-final omission. Accuracy was higher on shared English and Vietnamese consonantal articulations (e.g., /b/ and /m/). Task 3: on average, SLPs correctly identified accuracy of 73.8% of Vietnamese children's productions and transcribed 69.2% consonants correctly (83.8% when Vietnamese-English common transcription errors were considered). Musicality was correlated with SLPs' accuracy of transcription. CONCLUSION: English-speaking SLPs have some skills transcribing Vietnamese adults and transcribing and identifying correct/incorrect productions of children's speech. SLPs may use knowledge of common transcription errors to support understanding of their transcription of speech.

Intelligibility Enhancement Assessment and Intervention: a single-case experimental design with two multilingual university students.

Speech-language pathologists (SLPs) may be approached by multilingual speakers wishing to improve their intelligibility in English. Intelligibility is an essential element of spoken language proficiency and is particularly important for multilingual international students given their need to express complex ideas in an additional language. Intelligibility Enhancement aims to improve the intelligibility and acceptability of consonants, vowels and prosody with multilingual speakers who are learning to speak English. This study aimed to describe the Intelligibility Enhancement Assessment and Intervention Protocols and determine whether the intervention changed multilingual university students' English intelligibility. A multiple-baseline single-case experimental design was applied with direct inter-subject replication across two female participants whose home languages were Vietnamese and Putonghua (Mandarin). English intelligibility was assessed at multiple intervals pre, post and during intervention. The intervention protocol consisted of 11 weekly 1-h sessions with an SLP targeting English consonants, vowels and prosody. Following intervention, both participants displayed increased performance across most measures. For example, the Vietnamese participant's percentage of consonants correct (PCC) increased from 62.5% to 85.0% in probe keywords. Effect sizes, when comparing baseline and withdrawal phases, were 5.5 for PCC, 4.6 for final consonants, 2.3 for consonant clusters and 1.6 for syllables indicating improvements in all variables measured. Her speech rate reduced, word stress increased in accuracy and she perceived less difficulty communicating in English. These promising results suggest further testing of the Intelligibility Enhancement Protocols is warranted to determine effectiveness as an intervention for multilingual speakers.

What Do Children with Speech Sound Disorders Think about Their Talking?

Investigating children's feelings and attitudes toward talking assists speech-language pathologists (SLPs) to understand experiences of communication and the impact of speech sound disorders (SSD). This, in turn, can assist SLPs in identifying appropriate intervention for children with SSD that addresses the needs of children, and their communication partners. This paper draws on data from the Sound Start Study in Australia to explore the attitudes toward talking of 132 preschool-aged children with SSD and the relationship between children's attitudes, speech accuracy, and parent-reported intelligibility and participation. The study revealed most of the children with SSD had a positive attitude toward talking. There was a significant relationship between children's attitudes toward talking and speech accuracy. Furthermore, there was a significant relationship between speech accuracy and parents' perceptions of intelligibility and participation. However, there was no significant relationship between children's attitudes and parents' perceptions. These results highlight similarities and differences between attitudes and experiences of preschool-aged children, their performance on clinical measures, and their parents' perceptions, indicating the need for SLPs to consider each of these areas during assessment and intervention.

Measuring intelligibility in signed languages.

Intelligibility of spoken languages is a widely discussed construct; however, intelligibility, as it pertains to signed languages, has rarely been considered. This study provides an initial investigation of the construct of intelligibility in American Sign Language (ASL) and evaluates potential measures for self-report and expert ratings of sign intelligibility that examined the frequency of understanding, amount of understanding, and ease of understanding. Participants were 66 college students (42 Deaf, 24 hearing) who had self-rated ASL skills ranging from poor to excellent. Participants rated their own intelligibility in ASL and then provided a signed language sample through a picture description task. Language samples were reviewed by an expert rater and measures of intelligibility were completed. Results indicated that expert ratings of sign intelligibility across all measures were significantly and positively correlated. Understanding of the signer was predicted by the amount of understanding, frequency of understanding, and ASL production skills, while understanding the picture being described was predicted by ease of understanding and ASL grammar skills. Self- and expert ratings of sign intelligibility using the ASL version of the Intelligibility in Context Scale were not significantly different. Self-report of sign intelligibility for viewers of different familiarity using the ICS-ASL was found not to be feasible due to many participants not being in contact with ASL users in the relationships defined by the measure. In conclusion, this preliminary investigation suggests that sign intelligibility is a construct worthy of further investigation.

Realisation of grammatical morphemes by children with phonological impairment.

The aim of this research was to explore how preschool-aged children with phonological impairment (PI) realise grammatical morphemes across different phonological contexts (i.e. singleton consonant, consonant cluster, syllable), conditions of finiteness and individual morpheme types. Factors accounting for children's realisation of grammatical morphemes were also examined. Eighty-seven Australian English-speaking preschoolers (aged 4-5 years) with PI completed the Children's Assessment of Morphophonology (CHAMP)-an elicited response task-in addition to standardised tests of speech and receptive language. The most challenging grammatical morphemes were finite morphemes (particularly past tense) and grammatical morphemes realised in consonant clusters. The ability to produce consonant clusters in single words significantly accounted for children's ability to realise grammatical morphemes, regardless of whether grammatical morphemes were realised in singleton, consonant cluster or syllable contexts. Realisation of grammatical morphemes by preschoolers with PI is influenced by phonological and morphological factors. The findings have implications regarding the assessment and differential diagnosis of preschoolers with concomitant phonological and language difficulties.

Intervention for children with phonological impairment: Knowledge, practices and intervention intensity in the UK.

BACKGROUND: Across the world, research has shown that intervention for children with phonological impairment can be both effective and efficient. However, it has also raised concerns about the translation of this evidence to practice, highlighting questions around clinician knowledge and the understanding of approaches, and the intensity of intervention provided within real-life clinical contexts. AIMS: To investigate the clinical management of phonological impairment by speech and language therapists (SLTs) in the United Kingdom (UK). METHODS & PROCEDURES: An anonymous, UK-wide, online survey was developed using Qualtrics. The target audience were UK-based SLTs who worked with children with phonological impairment. The following topics were explored: (1) SLTs' understanding of intervention approaches; (2) SLTs' use of intervention approaches to treat phonological impairment; and (3) SLTs' provision of intervention intensity for children with phonological impairment. OUTCOMES & RESULTS: A total of 166 responses were analyzed. To remediate phonological impairment, SLTs most commonly used speech discrimination (79.5%), conventional minimal pairs (77.3%), phonological awareness therapy (75.6%) and traditional articulation therapy (48.4%). Participants least frequently used the complexity approaches targeting the empty set (82.9%) and two- to three-element clusters (75%) as well as the cycles approach (75.6%). Results also showed that some SLTs were uncertain of what the empty set and two- to three-element clusters approaches entailed. In terms of intervention intensity, participants predominantly provided intervention once per week (69%) for a total of 9-12 sessions (ranging from five to 30 sessions, 71.5%) and elicited targets 10-30 times in single words per session (59.4%) in sessions lasting 21-30 min (41.4%). CONCLUSIONS & IMPLICATIONS: The most commonly used intervention approaches identified in the current survey (i.e., speech discrimination, conventional minimal pairs and phonological awareness therapy) may be used eclectically by SLTs, which could impact upon the effectiveness and efficiency of treatment for phonological impairment. The current study also highlighted that almost half the participants always/often used traditional articulation therapy to remediate phonological impairment, even though this approach has been found to be less effective for this difficulty. Additionally, it appears that the currently provided intervention intensity for phonological impairment in the UK is significantly lower than what is indicated in the literature. Therefore, a research-practice gap exists for SLTs in the UK working with children with phonological impairment.

Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment.

AIMS: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. METHODS: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers' speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ2) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. RESULTS: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. CONCLUSION: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders.

Validation and norming of the Intelligibility in Context Scale in Northern Viet Nam.

Vietnamese is one of the 20 most commonly spoken languages in the world; however, there are no standardised tools to assess Vietnamese children's speech. This study aimed to validate and norm the Vietnamese version of the Intelligibility in Context Scale (ICS-VN). Data were collected from parents of 181 children (aged 2;0-5;11) living in Ha Noi, Northern Viet Nam. The mean ICS-VN score was 4.43 (out of a maximum of 5), indicating that children were 'usually' to 'always' intelligible; however, item-level scores demonstrated significant differences between communication partners. Children with parental concerns about speech and language had significantly lower mean scores than children without parental concerns. Scores also differed by children's age, parents' occupation and mothers' education level but not by sex of child or fathers' education level. The ICS-VN had good psychometric properties indicating it to be a valid tool for use with Vietnamese-speaking children in Northern Viet Nam.

Validation of the Intelligibility in Context Scale for school students in Fiji.

Fiji is a multilingual nation with few assessment tools addressing children's communication. This article describes the validation of the Intelligibility in Context Scale for Fiji English, Standard Fijian, and Fiji Hindi. Informants were caregivers of 65 typically developing multilingual children (aged 5;3-10;5) attending a Fiji primary school. The students spoke an average of 2.9 languages (range = 1-5). Their main language was Standard Fijian (41.5%), Fiji Hindi (23.1%), Fiji English (20.0%), or Fijian dialect (15.4%). An ICS mean score of 4.6 was obtained for main language (ICS-ML) and 4.4 for Fiji English (ICS-FE) indicating that students were usually to always intelligible. There were no significant differences between main language, number of languages spoken, gender, age, or socio-economic status. Both scales had good internal consistency, but were not correlated with speech accuracy measures possibly due to ceiling effects. Further validation with younger children is recommended. The ICS may be a useful tool for Fiji with comparative results to other international studies.

Longitudinal changes in polysyllable maturity of preschool children with phonologically-based speech sound disorders.

Children's polysyllables were investigated for changes in (1) consonant and vowel accuracy, (2) error frequency and (3) polysyllable maturity over time. Participants were 80 children (4;0-5;4) with phonologically-based speech sound disorders who participated in the Sound Start Study and completed the Polysyllable Preschool Test (Baker, 2013) three times. Polysyllable errors were categorised using the Word-level Analysis of Polysyllables (WAP, Masso, 2016a) and the Framework of Polysyllable Maturity (Framework, Masso, 2016b), which represents five maturity levels (Levels A-E). Participants demonstrated increased polysyllable accuracy over time as measured by consonant and vowel accuracy, and error frequency. Children in Level A, the lowest level of maturity, had frequent deletion errors, alterations of phonotactics and alterations of timing. Participants in Level B were 8.62 times more likely to improve than children in Level A at Time 1. Children who present with frequent deletion errors may be less likely to improve their polysyllable accuracy.

Reconceptualizing practice with multilingual children with speech sound disorders: people, practicalities and policy.

BACKGROUND: The speech and language therapy profession is required to provide services to increasingly multilingual caseloads. Much international research has focused on the challenges of speech and language therapists' (SLTs) practice with multilingual children. AIMS: To draw on the experience and knowledge of experts in the field to: (1) identify aspirations for practice, (2) propose recommendations for working effectively with multilingual children with speech sound disorders, and (3) reconceptualize understandings of and approaches to practice. METHODS & PROCEDURES: Fourteen members of the International Expert Panel on Multilingual Children's Speech met in Cork, Ireland, to discuss SLTs' practice with multilingual children with speech sound disorders. Panel members had worked in 18 countries and spoke nine languages. Transcripts of the 6-h discussion were analysed using Cultural-Historical Activity Theory (CHAT) as a heuristic framework to make visible the reality and complexities of SLTs' practice with multilingual children. OUTCOMES & RESULTS: Aspirations and recommendations for reconceptualizing approaches to practice with multilingual children with speech sound disorders included: (1) increased training for working with multilingual children, their families, and interpreters, (2) increased training for transcribing speech in many languages, (3) increased time and resources for SLTs working with multilingual children and (4) use of the International Classification of Functioning, Disability and Health (ICF-CY). CONCLUSIONS & IMPLICATIONS: The reality and complexities of practice identified in this paper highlight that it is not possible to formulate and implement one 'gold standard' method of assessment and intervention for all multilingual children with speech sound disorders. It is possible, however, to underpin practice with a framework that ensures comprehensive assessment, accurate diagnosis and effective intervention. This paper proposes that by working towards the aspirations of the Expert Panel, SLTs can be empowered to facilitate appropriate services for multilingual children regardless of the context in which they live and the languages they speak.

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.