Seven Days of Voice Rest Post-phonosurgery Is Not Better than 3 days: A Prospective Randomized Short-term Outcome Study.

OBJECTIVE: The aim of the study is to compare the short-term effect of 7 versus 3 days of voice rest (VR) on objective vocal (acoustic) parameters following phonosurgery. METHODS: A prospective randomized study conducted at a tertiary referral medical center. Patients with vocal fold nodules, polyps, or cysts and scheduled for phonosurgery were recruited from the Voice Clinic. They were randomized into groups of 7- or 3-day postoperative VR periods and their voices were recorded preoperatively and at 4-week postoperatively. A mixed linear model statistical analysis (MLMSA) was used to compare pre- and postoperative jitter, shimmer, harmonic-to-noise ratio, and maximum phonation time between the two groups. RESULTS: Sixty-five patients were recruited, but only 34 fully complied with the study protocol, and their data were included in the final analysis (19 males, 20 females; mean age: 40.6 years; 17 patients in the 7-day VR group and 16 in the 3-day VR group). The groups were comparable in age, sex, and type of vocal lesion distribution. The preoperative MLMSA showed no significant group differences in the tested vocal parameters. Both groups exhibited significant (p < 0.05) and comparable improvement in all vocal parameters at postoperative week 4. CONCLUSIONS: A VR duration of 7 days showed no greater benefit on the examined vocal parameters than the 3-day protocol 4-week postoperatively. Our results suggest that a 3-day VR regimen can be followed by patients who undergo phonosurgery without compromising the vocal results. Larger-scale and longer-duration studies are needed to confirm our findings. LEVEL OF EVIDENCE: 2 Laryngoscope, 2024.

"Love looks not with the eyes": supranormal processing of emotional speech in individuals with late-blindness versus preserved processing in individuals with congenital-blindness.

Processing of emotional speech in the absence of visual information relies on two auditory channels: semantics and prosody. No study to date has investigated how blindness impacts this process. Two theories, Perceptual Deficit, and Sensory Compensation, yiled different expectations about the role of visual experience (or its lack thereof) in processing emotional speech. To test the effect of vision and early visual experience on processing of emotional speech, we compared individuals with congenital blindness (CB, n = 17), individuals with late blindness (LB, n = 15), and sighted controls (SC, n = 21) on identification and selective-attention of semantic and prosodic spoken-emotions. Results showed that individuals with blindness performed at least as well as SC, supporting Sensory Compensation and the role of cortical reorganisation. Individuals with LB outperformed individuals with CB, in accordance with Perceptual Deficit, supporting the role of early visual experience. The LB advantage was moderated by executive functions (working-memory). Namely, the advantage was erased for individuals with CB who showed higher levels of executive functions. Results suggest that vision is not necessary for processing of emotional speech, but early visual experience could improve it. The findings support a combination of the two aforementioned theories and reject a dichotomous view of deficiencies/enhancements of blindness.

Positive effects of the Beatalk technique on speech characteristics of young adults with intellectual disability.

Background: The Beatalk technique is a speech therapy method, based on human beatboxing, involving intense, rapid repetitions of speech-like sounds. The goals of the current feasibility study were to test its effect in enhancing articulation accuracy and voice measures in a small group of adults with intellectual disability (ID), using a wide range of measures of verbal communication, and to refine the treatment protocol. Methods: A group pre-test-post-test experimental design was used (n = 12). Treatment consisted of ten weekly group sessions of 40 min, each followed by two self-practice sessions. Changes in speech intelligibility, voice, and communication skills were assessed. Results: The findings indicate significant improvements in speech production and intelligibility measures (Percentage of Consonant Correct, and staff-member intelligibility scores), voice measures (vocal loudness, Harmonic-Noise-Ratio, shimmer, and jitter) and staff-member communication scores. Implications: These results extend our understanding of the effects of the Beatalk technique, and suggest that it may have potential as an effective intervention for adults with ID. As the experimental design is limited in its ability to yield strong conclusions, further controlled studies are required.

There is more to cluttering than meets the eye: The prevalence of cluttering and association with psychological well-being indices in an undergraduate sample.

BACKGROUND: Cluttering is a fluency disorder characterized by an abnormally fast or irregular speech delivery rate along with disfluencies that are frequent but are not judged to be stuttering. Data on cluttering prevalence in the general population are scarce, as well as its association with psychological well-being indices, such as anxiety, and depressive symptoms. AIMS: To estimate cluttering prevalence among undergraduates, as well as its relationship with psychological and well-being indicators. METHODS & PROCEDURES: To address these issues, a large sample (n = 1582) of undergraduates completed a questionnaire that provided a lay definition of cluttering and were asked to identify themselves as clutterers (SI-Clut), as well as to indicate the presence of several psychological and mental well-being indices. OUTCOMES & RESULTS: A total of 276 respondents (23%) self-identified as clutterers (now or in the past), with 55.1% of those being male. Only 56 respondents (3.5% of the total sample; about 21% of SI-Clut) reported having received speech therapy for cluttering. Relative to students self-identifying as non-clutterers, self-identification of cluttering was associated with higher levels of psychosomatic symptoms, depressive symptoms and stress, indicating a tendency toward internalizing psychopathology, along with lower self-esteem, and lower subjective happiness. CONCLUSIONS & IMPLICATIONS: The current findings point to the high prevalence of students self-identifying as clutterers, along with a significant link between cluttering and mental distress. Therefore, it is important to increase public awareness of cluttering, its diagnosis and treatment. From the clinical perspective, the elevated levels of somatic complaints, anxiety and depression may represent internalizing psychopathology, associated with more covert rather than overt symptomatology. Such symptom manifestation calls for special attention from the speech-language pathologists providing cluttering therapy, using designated well-being or mental health screening tools. Although data on standard cluttering treatment are limited, it should be customized to the client's unique difficulties. Speech-language pathologists' understanding of cluttering, which includes both speech characteristics as well as psychological and social aspects of well-being, may assist them in implementing effective treatments. WHAT THIS PAPER ADDS: What is already known on the subject Cluttering is a fluency disorder characterized by an abnormally fast or irregular speech rate, along with various disfluencies and articulatory imprecision. It may co-occur with other disorders, such as learning disabilities, and attention-deficit/hyperactivity disorder. Data on cluttering prevalence and its association with psychological well-being indices, such as anxiety and depression, are limited. What this paper adds to existing knowledge A total of 276 undergraduates (23%) self-identified as clutterers, of whom 55.1% were males. A total of 56 respondents (3.5% of the total sample, and about 21% of undergraduates self-identified as clutterers) reported having received speech therapy for cluttering. Psychosomatic symptoms, depressive symptoms and stress levels were higher among these students, suggesting a tendency toward internalizing psychopathology, along with a lower sense of self-esteem and subjective happiness. What are the potential or actual clinical implications of this work? The high prevalence of students self-identifying as clutterers, along with the low percentage of respondents who received speech therapy for cluttering, emphasize the need to raise public awareness of the problem, its diagnosis and treatment (Reichel et al., 2010). The association between cluttering and mental distress requires speech-language pathologists to be aware that cluttering may have covert symptomatology, similar to stuttering, which should be addressed in therapy.

Hypervigilance or shutdown? Electrophysiological processing of trauma-unrelated aversive stimuli after traumatic life events.

Post-Traumatic Stress Disorder (PTSD) research indicates that hyper-reactivity to trauma-related stimuli reflects reduced prefrontal cortex (PFC) modulation of amygdala reactivity. However, other studies indicate a dissociative "shutdown" reaction to overwhelming aversive stimuli, possibly reflecting PFC over-modulation. To explore this, we used an Event-Related Potential (ERP) oddball paradigm to study P3 responses in the presence of the following: 1. Trauma-unrelated morbid distractors (e.g., "injured bear") related to the Rorschach inkblot test, and 2. Negative distractors (e.g., "significant failure"), among participants with high post-traumatic stress symptoms (PTS; n = 20), low PTS (n = 17), and controls (n = 15). Distractors were presented at 20% frequency amongst the more frequent (60%) neutral standard stimuli (e.g., "desk lamp") and the equally frequent (20%) neutral trauma-unrelated target stimulus ("golden fish"). P3 amplitudes were high in the presence of morbid distractors and low in the presence of negative distractors only amongst the control group. Possible mechanisms underlying the lack of P3 amplitude modulation after trauma are discussed.

Diagnosing Pain in Individuals with Intellectual and Developmental Disabilities: Current State and Novel Technological Solutions.

Pain assessment poses a challenge in several groups of clients, yet specific barriers arise when it comes to pain assessment of individuals with intellectual and developmental disabilities (IDD), due mostly to communication challenges preventing valid and reliable self-reports. Despite increased interest in pain assessment of those diagnosed with IDD within recent years, little is known about pain behavior in this group. The present article overviews the current state of pain diagnosis for individuals with IDD, focusing on existing pain assessment scales. In addition, it suggests technological developments offering new ways to diagnose existence of pain in this population, such as a Smartphone App for caregivers based on unique acoustic characteristics of pain-related vocal responses, or the use of smart wearable shirts that enable continuous surveillance of vital physiological signs. Such novel technological solutions may improve diagnosis of pain in the IDD population, as well as in other individuals with complex communication needs, to provide better pain treatment and enhance overall quality of life.

Response to McKenzie et al. 2021: Keep It Simple; Young Adults With Autism Spectrum Disorder Without Intellectual Disability Can Process Basic Emotions.

We recently read the interesting and informative paper entitled "Empathic accuracy and cognitive and affective empathy in young adults with and without autism spectrum disorder" (McKenzie et al. in Journal of Autism and Developmental Disorders 52: 1-15, 2021). This paper expands recent findings from our lab (Ben-David in Journal of Autism and Developmental Disorders 50: 741-756, 2020a; International Journal of Audiology 60: 319-321, 2020b) and a recent theoretical framework (Icht et al. in Autism Research 14: 1948-1964, 2021) that may suggest a new purview for McKenzie et al.'s results. Namely, these papers suggest that young adults with autism spectrum disorder without intellectual disability can successfully recruit their cognitive abilities to distinguish between different simple spoken emotions, but may still face difficulties processing complex, subtle emotions. McKenzie et al. (Journal of Autism and Developmental Disorders 52: 1-15, 2021) extended these findings to the processing of emotions in video clips, with both visual and auditory information.

Validation and cross-linguistic adaptation of the Frenchay Dysarthria Assessment (FDA-2) speech intelligibility tests: Hebrew version.

'Dysarthria' is a group of motor speech disorders resulting from a disturbance in neuromuscular control. Most individuals with dysarthria cope with communicative restrictions due to speech impairments and reduced intelligibility. Thus, language-sensitive measurements of intelligibility are important in dysarthria neurological assessment. The Frenchay Dysarthria Assessment, 2nd edition (FDA-2), is a validated tool for the identification of the nature and patterns of oro-motor movements associated with different types of dysarthria. The current study conducted a careful culture- and linguistic-sensitive adaption of the two intelligibility subtests of the FDA-2 to Hebrew (words and sentences) and performed a preliminary validation with relevant clinical populations. First, sets of Hebrew words and sentences were constructed, based on the criteria defined in FDA-2, as well as on several other factors that may affect performance: emotional valence, arousal and familiarity. Second, the new subtests were validated in healthy older adults (n = 20), and in two clinical groups (acquired dysarthria, n = 15; and developmental dysarthria, n = 19). Analysis indicated that the new subtests were found to be specific and sensitive, valid and reliable, as scores significantly differ between healthy older adults and adults with dysarthria, correlated with other subjective measures of intelligibility, and showed high test-retest reliability. The words and sentences intelligibility subtests can be used to evaluate speech disorders in various populations of Hebrew speakers, thus may be an important addition to the speech-language pathologist's toolbox, for clinical work as well as for research purposes. WHAT THIS PAPER ADDS: What is already known on the subject 'Dysarthria' is a group of disorders reflecting impairments in the strength, speed and precision of movements required for adequate control of the various speech subsystems. Reduced speech intelligibility is one of the main consequences of all dysarthria subtypes, irrespective of their underlying cause. Indeed, most individuals with dysarthria cope with communicative restrictions due to speech impairments. Thus, language-sensitive measurements of intelligibility are important in dysarthria assessment. The FDA-2's words and sentences subtests present standardized and validated tools for the identification of the nature and patterns of oro-motor movements associated with different types of dysarthria. What this paper adds to existing knowledge The lack of assessment tools in Hebrew poses challenges to clinical evaluation as well as research purposes. The current study conducted a careful culture- and linguistic-sensitive adaption of the FDA-2 intelligibility subtests to Hebrew and performed a preliminary validation with relevant clinical populations. First, sets of Hebrew words and sentences were constructed, based on the criteria defined in FDA-2, as well as on several other factors that may affect performance: emotional valence, arousal and familiarity. Second, the new subtests were validated in healthy older adults (n = 20), and in two clinical groups (adults with acquired dysarthria, n = 15; and young adults with developmental dysarthria, n = 19). What are the potential or actual clinical implications of this work? Analyses indicated that the new word and sentence subtests are specific, sensitive, valid and reliable. Namely, (1) they successfully differentiate between healthy individuals and individuals with dysarthria; (2) they correlate with other subjective measures of intelligibility; and (3) they show high test-retest reliability. The words and sentences intelligibility subtests can be used to evaluate speech disorders in various populations of Hebrew speakers. Thus, they may be an important addition to the speech-language pathologist's toolbox, for clinical and research purposes. The methods described here can be emulated for the adaptation of speech assessment tools to other languages.

Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk.

BACKGROUND: Individuals with developmental dysarthria typically demonstrate reduced functioning of one or more of the speech subsystems, which negatively impacts speech intelligibility and communication within social contexts. A few treatment approaches are available for improving speech production and intelligibility among individuals with developmental dysarthria. However, these approaches have only limited application and research findings among adolescents and young adults. AIMS: To determine and compare the effectiveness of two treatment approaches, the modified Speech Intelligibility Treatment (mSIT) and the Beatalk technique, on speech production and intelligibility among Hebrew-speaking adolescents and young adults with developmental dysarthria. METHODS & PROCEDURES: Two matched groups of adolescents and young adults with developmental dysarthria participated in the study. Each received one of the two treatments, mSIT or Beatalk, over the course of 9 weeks. Measures of speech intelligibility, articulatory accuracy, voice and vowel acoustics were assessed both pre- and post-treatment. OUTCOMES & RESULTS: Both the mSIT and Beatalk groups demonstrated gains in at least some of the outcome measures. Participants in the mSIT group exhibited improvement in speech intelligibility and voice measures, while participants in the Beatalk group demonstrated increased articulatory accuracy and gains in voice measures from pre- to post-treatment. Significant increases were noted post-treatment for first formant values for select vowels. CONCLUSIONS & IMPLICATIONS: Results of this preliminary study are promising for both treatment approaches. The differentiated results indicate their distinct application to speech intelligibility deficits. The current findings also hold clinical significance for treatment among adolescents and young adults with motor speech disorders and application for a language other than English. WHAT THIS PAPER ADDS: What is already known on the subject Developmental dysarthria (e.g., secondary to cerebral palsy) is a motor speech disorder that negatively impacts speech intelligibility, and thus communication participation. Select treatment approaches are available with the aim of improving speech intelligibility in individuals with developmental dysarthria; however, these approaches are limited in number and have only seldomly been applied specifically to adolescents and young adults. What this paper adds to existing knowledge The current study presents preliminary data regarding two treatment approaches, the mSIT and Beatalk technique, administered to Hebrew-speaking adolescents and young adults with developmental dysarthria in a group setting. Results demonstrate the initial effectiveness of the treatment approaches, with different gains noted for each approach across speech and voice domains. What are the potential or actual clinical implications of this work? The findings add to the existing literature on potential treatment approaches aiming to improve speech production and intelligibility among individuals with developmental dysarthria. The presented approaches also show promise for group-based treatments as well as the potential for improvement among adolescents and young adults with motor speech disorders.

Processing of Spoken Emotions in Schizophrenia: Forensic and Non-forensic Patients Differ in Emotional Identification and Integration but Not in Selective Attention.

Patients with schizophrenia (PwS) typically demonstrate deficits in visual processing of emotions. Less is known about auditory processing of spoken-emotions, as conveyed by the prosodic (tone) and semantics (words) channels. In a previous study, forensic PwS (who committed violent offenses) identified spoken-emotions and integrated the emotional information from both channels similarly to controls. However, their performance indicated larger failures of selective-attention, and lower discrimination between spoken-emotions, than controls. Given that forensic schizophrenia represents a special subgroup, the current study compared forensic and non-forensic PwS. Forty-five PwS listened to sentences conveying four basic emotions presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Their performance was compared to that of 21 forensic PwS (previous study). The two groups did not differ in selective-attention. However, better emotional identification and discrimination, as well as better channel integration were found for the forensic PwS. Results have several clinical implications: difficulties in spoken-emotions processing might not necessarily relate to schizophrenia; attentional deficits might not be a risk factor for aggression in schizophrenia; and forensic schizophrenia might have unique characteristics as related to spoken-emotions processing (motivation, stimulation).

A Cross-Linguistic Validation of the Test for Rating Emotions in Speech: Acoustic Analyses of Emotional Sentences in English, German, and Hebrew.

PURPOSE: The Test for Rating Emotions in Speech (T-RES) has been developed in order to assess the processing of emotions in spoken language. In this tool, spoken sentences, which are composed of emotional content (anger, happiness, sadness, and neutral) in both semantics and prosody in different combinations, are rated by listeners. To date, English, German, and Hebrew versions have been developed, as well as online versions, iT-RES, to adapt to COVID-19 social restrictions. Since the perception of spoken emotions may be affected by linguistic (and cultural) variables, it is important to compare the acoustic characteristics of the stimuli within and between languages. The goal of the current report was to provide cross-linguistic acoustic validation of the T-RES. METHOD: T-RES sentences in the aforementioned languages were acoustically analyzed in terms of mean F0, F0 range, and speech rate to obtain profiles of acoustic parameters for different emotions. RESULTS: Significant within-language discriminability of prosodic emotions was found, for both mean F0 and speech rate. Similarly, these measures were associated with comparable patterns of prosodic emotions for each of the tested languages and emotional ratings. CONCLUSIONS: The results demonstrate the lack of dependence of prosody and semantics within the T-RES stimuli. These findings illustrate the listeners' ability to clearly distinguish between the different prosodic emotions in each language, providing a cross-linguistic validation of the T-RES and iT-RES.

More Than Words: the Relative Roles of Prosody and Semantics in the Perception of Emotions in Spoken Language by Postlingual Cochlear Implant Users.

OBJECTIVES: The processing of emotional speech calls for the perception and integration of semantic and prosodic cues. Although cochlear implants allow for significant auditory improvements, they are limited in the transmission of spectro-temporal fine-structure information that may not support the processing of voice pitch cues. The goal of the current study is to compare the performance of postlingual cochlear implant (CI) users and a matched control group on perception, selective attention, and integration of emotional semantics and prosody. DESIGN: Fifteen CI users and 15 normal hearing (NH) peers (age range, 18-65 years) 1istened to spoken sentences composed of different combinations of four discrete emotions (anger, happiness, sadness, and neutrality) presented in prosodic and semantic channels-T-RES: Test for Rating Emotions in Speech. In three separate tasks, listeners were asked to attend to the sentence as a whole, thus integrating both speech channels (integration), or to focus on one channel only (rating of target emotion) and ignore the other (selective attention). Their task was to rate how much they agreed that the sentence conveyed each of the predefined emotions. In addition, all participants performed standard tests of speech perception. RESULTS: When asked to focus on one channel, semantics or prosody, both groups rated emotions similarly with comparable levels of selective attention. When the task was called for channel integration, group differences were found. CI users appeared to use semantic emotional information more than did their NH peers. CI users assigned higher ratings than did their NH peers to sentences that did not present the target emotion, indicating some degree of confusion. In addition, for CI users, individual differences in speech comprehension over the phone and identification of intonation were significantly related to emotional semantic and prosodic ratings, respectively. CONCLUSIONS: CI users and NH controls did not differ in perception of prosodic and semantic emotions and in auditory selective attention. However, when the task called for integration of prosody and semantics, CI users overused the semantic information (as compared with NH). We suggest that as CI users adopt diverse cue weighting strategies with device experience, their weighting of prosody and semantics differs from those used by NH. Finally, CI users may benefit from rehabilitation strategies that strengthen perception of prosodic information to better understand emotional speech.

Production Improves Visual and Auditory Text Memory in Younger and Older Adults.

INTRODUCTION: The production effect refers to memory benefits for materials that were produced (e.g., read aloud) relative to not produced (e.g., read silently) at study. Previous works have found a production benefit for younger and older adults studying written words and for young adults studying written text. The present study aimed to extend these findings by examining the effect of production on text memory in younger and older adults, in the visual, and in the auditory modalities. METHODS: A group of young adults (n = 30) and a group of older adults (n = 30) learned informational texts, presented either visually or aurally. In each text, half of the sentences were learned by production (reading aloud or writing) and half by no production (reading silently or listening), followed by fill-in-the-blank tests. RESULTS: An overall memory performance was found to be similar for both groups, with an advantage for the auditory modality. For both groups, more test items were filled in correctly when the relevant information appeared in the produced than in nonproduced sentences, showing the learners' ability to use distinctiveness information. The production effects were larger for older than younger adults, in both modalities. DISCUSSION: Since older adults are increasingly engage in learning, it is important to develop high-quality structured learning programs for this population. The current results demonstrate the preserved ability of older adults to successfully memorize texts and may guide planning of such programs. Specifically, since learning via the auditory modality yields superior performance for learners across age-groups, it may be recommended for text learning. Because older adults showed larger benefits from active production of the study material, it may be used to better remember educationally relevant material.

Improving speech characteristics of young adults with congenital dysarthria: An exploratory study comparing articulation training and the Beatalk method.

INTRODUCTION: This exploratory study compared the effects of two speech therapy approaches on speech characteristics of young adults with congenital dysarthria resulting from various etiologies: a) articulation training focusing on consonant articulation exercises at various levels (isolation, syllables, and words), and b) the Beatalk method, based on human beatboxing, i.e., producing various instrumental sounds in an a-cappella musical context. Both interventions were designed to increase participants' speech intelligibility. METHODS: Twelve adults with congenital dysarthria and reduced speech intelligibility participated in treatment groups for eight weeks. Six participants were assigned to the articulation training group, and six to the Beatalk group. Intelligibility of single words and continuous speech, voice measures, and oral-diadochokinesis rates were measured before and after the treatment. RESULTS: The results showed that the Beatalk intervention yielded a significant overall pre- to post-treatment effect. Specifically, it resulted in gains in articulatory accuracy and intelligibility for single words. Improvements were not noted following articulation training. CONCLUSIONS: The results present initial evidence of the positive effect of the Beatalk method as an intervention tool for adults with congenital dysarthria. This relatively easy-to-learn technique shows promise, as it involves intense and repetitive production of speech sounds while controlling rhythm and breathing in an enjoyable context.

Can the Vocal Expression of Intellectually Disabled Individuals Be Used as a Pain Indicator? Initial Findings Supporting a Possible Novice Assessment Method.

Pain is difficult to assess in non-verbal populations such as individuals with intellectual and developmental disability (IDD). Due to scarce research in this area, pain assessment for individuals with IDD is still lacking, leading to maltreatment. To improve medical care for individuals with IDD, immediate, reliable, easy to use pain detection methods should be developed. The goal of this preliminary study was to examine the sensitivity of acoustic features of vocal expressions in identifying pain for adults with IDD, assessing their feasibility as a pain detection indicator for those individuals. Such unique pain related vocal characteristics may be used to develop objective pain detection means. Adults with severe-profound IDD level (N = 9) were recorded in daily activities associated with pain (during diaper changes), or without pain (at rest). Spontaneous vocal expressions were acoustically analyzed to assess several voice characteristics. Analyzing the data revealed that pain related vocal expressions were characterized by significantly higher number of pulses and higher shimmer values relative to no-pain vocal expressions. Pain related productions were also characterized by longer duration, higher jitter and Cepstral Peak Prominence values, lower Harmonic-Noise Ratio, lower difference between the amplitude of the 1st and 2nd harmonic (corrected for vocal tract influence; H1H2c), and higher mean and standard deviation of voice fundamental frequency relative to no-pain related vocal productions, yet these findings were not statistically significant, possibly due to the small and heterogeneous sample. These initial results may prompt further research to explore the possibility to use pain related vocal output as an objective and easily identifiable indicator of pain in this population.

Keep it simple: Identification of basic versus complex emotions in spoken language in individuals with autism spectrum disorder without intellectual disability: A meta-analysis study.

Daily functioning involves identifying emotions in spoken language, a fundamental aspect of social interactions. To date, there is inconsistent evidence in the literature on whether individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) experience difficulties in identification of spoken emotions. We conducted a meta-analysis (literature search following the PRISMA guidelines), with 26 data sets (taken from 23 peer-reviewed journal articles) comparing individuals with ASD-without-ID (N = 614) and typically-developed (TD) controls (N = 640), from nine countries and in seven languages (published until February 2020). In our analyses there was no sufficient evidence to suggest that individuals with HF-ASD differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, individuals with ASD-without-ID were found to perform significantly worse than controls in identification of complex prosodic emotions (e.g., envy and boredom). The level of the semantic content of the stimuli presented (e.g., sentences vs. strings of digits) was not found to have an impact on the results. In conclusion, the difference in findings between simple and complex emotions calls for a new-look on emotion processing in ASD-without-ID. Intervention programs may rely on the intact abilities of individuals with ASD-without-ID to process simple emotions and target improved performance with complex emotions. LAY SUMMARY: Individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) do not differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, they were found to perform significantly worse than controls in the identification of complex prosodic emotions (e.g., envy, boredom). This was found in a meta-analysis of 26 data sets with 1254 participants from nine countries and in seven languages. Intervention programs may rely on the intact abilities of individuals with ASD-without-ID to process simple emotions.

Evaluating rate and accuracy of real word vs. non-word diadochokinetic productions from childhood to early adulthood in Hebrew speakers.

BACKGROUND: Oral-Diadochokinesis (oral-DDK) tasks measure how quickly and accurately one can repeat a series of target sounds. Thus, they are a popular tool for evaluating oral-motor skills for individuals with various speech disorders. Typically, oral-DDK tasks involve rapid repetition of non-words. For several populations (e.g., young children, older adults), it has been suggested that repetitions of real words may be more suitable, commonly resulting in faster rates. Yet, the literature is either silent or inconsistent regarding this real-word repetition advantage for other age groups, from preschoolers to young adults. It is not clear whether performance accuracy is affected as well. Specifically, for Hebrew speakers, this data is missing. AIMS: The goal of this study was to compare rate and accuracy for non-word and real-word repetition, in four groups of Hebrew-speaking individuals; preschoolers (5 years old), younger elementary school children (7 years old), adolescents (15 years old) and young adults (25 years old). Secondary goals were to provide a developmental pattern for oral-DDK rates for Hebrew speakers, and to compare it to the English norms. METHODS & PROCEDURES: All participants (n=150) had typical speech and language development. They were asked to repeat "pataka" (non-word) and "bodeket" (Hebrew real word) as quickly and accurately as possible for 10 sec. Production rates (syllables per second) and accuracy (on a 5-point scale) were measured. OUTCOMES & RESULTS: As expected, oral-DDK rates gradually increased with age, with similar rates for both real- and non-words. Accuracy scores were higher for real- than non-word repetition, across all age groups. For the group of school-age children, the Hebrew rates differed from the English ones. CONCLUSIONS & IMPLICATIONS: A real-word repetition advantage was documented only for repetition accuracy, but not for rate. These findings can be explained as each stimulus involves different demands on an individual's neuro-motor and linguistic processing abilities. Further research using real- and non-word tasks should be conducted with clinical populations to assess whether both procedures could assist in differential diagnosis between various speech disorders. Finally, the large differences between children of different ages, as well as the apparent rate differences between Hebrew and English, highlight the need to create age- and language-sensitive norms.

Acoustic vowel analysis and speech intelligibility in young adult Hebrew speakers: Developmental dysarthria versus typical development.

BACKGROUND: Developmental dysarthria is a motor speech impairment commonly characterized by varying levels of reduced speech intelligibility. The relationship between intelligibility deficits and acoustic vowel space among these individuals has long been noted in the literature, with evidence of vowel centralization (e.g., in English and Mandarin). However, the degree to which this centralization occurs and the intelligibility-acoustic relationship is maintained in different vowel systems has yet to be studied thoroughly. In comparison with American English, the Hebrew vowel system is significantly smaller, with a potentially smaller vowel space area, a factor that may impact upon the comparisons of the acoustic vowel space and its correlation with speech intelligibility. Data on vowel space and speech intelligibility are particularly limited for Hebrew speakers with motor speech disorders. AIMS: To determine the nature and degree of vowel space centralization in Hebrew-speaking adolescents and young adults with dysarthria, in comparison with typically developing (TD) peers, and to correlate these findings with speech intelligibility scores. METHODS & PROCEDURES: Adolescents and young adults with developmental dysarthria (secondary to cerebral palsy (CP) and other motor deficits, n = 17) and their TD peers (n = 17) were recorded producing Hebrew corner vowels within single words. For intelligibility assessments, naïve listeners transcribed those words produced by speakers with CP, and intelligibility scores were calculated. OUTCOMES & RESULTS: Acoustic analysis of vowel formants (F1, F2) revealed a centralization of vowel space among speakers with CP for all acoustic metrics of vowel formants, and mainly for the formant centralization ratio (FCR), in comparison with TD peers. Intelligibility scores were correlated strongly with the FCR metric for speakers with CP. CONCLUSIONS & IMPLICATIONS: The main results, vowel space centralization for speakers with CP in comparison with TD peers, echo previous cross-linguistic results. The correlation of acoustic results with speech intelligibility carries clinical implications. Taken together, the results contribute to better characterization of the speech production deficit in Hebrew speakers with motor speech disorders. Furthermore, they may guide clinical decision-making and intervention planning to improve speech intelligibility. What this paper adds What is already known on the subject Speech production and intelligibility deficits among individuals with developmental dysarthria (e.g., secondary to CP) are well documented. These deficits have also been correlated with centralization of the acoustic vowel space, although primarily in English speakers. Little is known about the acoustic characteristics of vowels in Hebrew speakers with motor speech disorders, and whether correlations with speech intelligibility are maintained. What this paper adds to existing knowledge This study is the first to describe the acoustic characteristics of vowel space in Hebrew-speaking adolescents and young adults with developmental dysarthria. The results demonstrate a centralization of the acoustic vowel space in comparison with TD peers for all measures, as found in other languages. Correlation between acoustic measures and speech intelligibility scores were also documented. We discuss these results within the context of cross-linguistic comparisons. What are the potential or actual clinical implications of this work? The results confirm the use of objective acoustic measures in the assessment of individuals with motor speech disorders, providing such data for Hebrew-speaking adolescents and young adults. These measures can be used to determine the nature and severity of the speech deficit across languages, may guide intervention planning, as well as measure the effectiveness of intelligibility-based treatment programmes.

Using Vocal Production to Improve Long-Term Verbal Memory in Adults with Intellectual Disability.

Individuals with intellectual disability (ID) typically show weak long-term memory (LTM) skills. Understanding verbal LTM processes and searching for effective mnemonics in this population is important, to improve intervention programs. The current study aimed to assess verbal LTM abilities of adults with mild ID of mixed etiologies, and to offer a simple memorization technique based on vocal production. Participants (n = 55) learned lists of different study materials (images of familiar and unfamiliar objects, written words, and sentences) by vocal production (saying or reading aloud) or by no-production (looking, listening, or reading silently). Memory tests followed. Better memory was found for vocally produced images of familiar objects, written words, and sentences. The results show that adults with mild ID can benefit from the relative distinctiveness of items at study. Hence, vocalization may be used in educational and therapeutic contexts for this population, improving memory performance.