Speech sound disorder or DLD (phonology)? Towards a consensus agreement on terminology.

BACKGROUND: The publication of phase 2 of the CATALISE project in 2017 clarified terminology for children with developmental language disorder (DLD) or delay but unintentionally muddied the water for children with unintelligible speech. A diagnostic label of DLD (phonology) indicates poor prognosis and phonological disorder that persists into middle childhood. However, in contrast to other diagnostic labels that fall under the overarching term of speech sound disorder (SSD), DLD (phonology) does not elucidate the characteristics of the child's speech nor does it point us in the direction of appropriate intervention. AIMS: The aim of this paper is to discuss terminology in SSD leading to an evidence-based model which builds on the model of DLD developed in CATALISE, supports descriptive diagnosis and signposts intervention. METHODS: Following a focused review of literature proposing or describing terminology for SSD, an expert group of researchers in developmental SSD proposed a revised model of existing terminology. Groups of UK speech and language therapists (SLTs) who provide services for children with SSD were asked to comment on its acceptability and feasibility. DISCUSSION: A three-level terminology model was developed. This comprised an overarching Level 1 term; Level 2 terms that differentiated SSD of unknown origin from SSD with associated or underlying conditions; and specific diagnostic terms at Level 3 to support further assessment and intervention decisions. Consulted SLTs generally expressed agreement with the proposed terminology and a willingness to adopt it in practice. CONCLUSIONS: Existing terminology for childhood SSD provides a good basis for clinical decision-making. A modified version of Dodd's (2005) terminology was found to be acceptable to UK SLTs. There is an evident overlap of SSD with CATALISE terminology. However more detailed and specialist terminology than 'DLD (phonology)' is required to support clinical decision-making. It is proposed that endorsement by the UK Royal College of Speech and Language Therapists would obviate the need for a Delphi process. WHAT THIS PAPER ADDS: What is already known on this subject Over nearly a hundred years, as our knowledge and understanding of speech sound disorder (SSD) has increased, so has the terminology that is used to describe those disorders. Current terminology not only describes subtypes of SSD but can also signpost us to effective interventions. With the publication, in 2017, of phase 2 of CATALISE a new term of 'developmental language disorder (DLD) (phonology)' was introduced with the unintentional consequence of challenging more specific descriptive terms for SSD. What this paper adds In the context of CATALISE and DLD (phonology), the history and nature of SSD terminology are reappraised. Building on the model of DLD developed in CATALISE, a tiered model that supports descriptive diagnosis and signposts intervention is proposed for discussion. Clinical implications of this study The proposed model of terminology for SSD provides descriptive and detailed labels that will support accuracy in differential diagnosis of developmental SSD by speech and language therapists. Furthermore, a decision-making tree for SSD demonstrates the pathway from diagnostic use of the terminology to the selection of evidence-based, effective interventions.

Hypomagnesaemia: diagnosis and management in the emergency department.

Magnesium is an intracellular electrolyte and is a vital element in human physiological functioning. A deficiency in magnesium, termed hypomagnesaemia, can affect the neuromuscular, cardiovascular and renal systems. Hypomagnesaemia may be more prevalent in patients with cancer than in the general population. The increasing numbers of cancer diagnoses in the UK means that emergency department (ED) nurses are likely to be involved in care of this population, including those with suspected hypomagnesaemia. This article describes some of the causes and signs and symptoms of hypomagnesaemia and outlines the diagnosis and clinical management of patients with the condition. The article includes a case study of a patient with cancer who was admitted to an ED with hypomagnesaemia.

Interventions for pre-school children with co-occurring phonological speech sound disorder and expressive language difficulties: A scoping review.

BACKGROUND: Recent evidence suggests that pre-school children with co-occurring phonological speech sound disorder (SSD) and expressive language difficulties are at a higher risk of ongoing communication and literacy needs in comparison with children with these difficulties in isolation. However, to date there has been no systematic or scoping review of the literature specific to interventions for children with this dual profile. AIMS: To explore the evidence regarding interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties, including the content/delivery of such interventions, areas of speech and language targeted, and a broad overview of study quality. METHODS & PROCEDURES: A scoping review methodology was used in accordance with the guidance from the Joanna Briggs Institute. Following a systematic search of Ovid Medline, Ovid Emcare, OVID Embase, CINAHL, Psychinfo and ERIC, 11 studies were included in the review. A researcher-developed data extraction form was used to extract specific information about each intervention, with the JBI appraisal tools used to provide a broad overview of the quality of each study. MAIN CONTRIBUTION: Included papers consisted of six randomized controlled trials (RCTs), two cohort studies, two case studies and one case series. Interventions fell into two main categories: (1) integrated interventions that combined content for both speech and language targets and/or explicitly used the same type of technique to improve both domains; and (2) single-domain interventions that explicitly included content to target speech or language only, but also aimed to improve the other domain indirectly. Study quality varied, with detail on the content, context and delivery of interventions often underspecified, hampering the replication and clinical applicability of findings. CONCLUSIONS & IMPLICATIONS: Early emerging evidence was identified to support both integrated speech and language interventions as well as single-domain interventions. However, caution should be exercised due to the variation in the quality and level of detail reported for the interventions. Future intervention studies may seek to address this by reporting in accordance with Template for Intervention Description and Replication (TIDieR) reporting guidelines. This approach would enable clinicians to consider the applicability of the intervention to individual children within differing settings. WHAT THIS PAPER ADDS: What is already known on the subject Pre-school children with co-occurring phonological SSD and expressive language difficulties frequently present within speech and language therapy services. These children are at a higher risk of long-term communication and literacy difficulties compared with children with these needs in isolation. Some emerging evidence suggests that interventions for children with this co-occurring profile may exist within the literature; however, this evidence may not be known to clinicians in everyday practice. What this paper adds to existing knowledge This review is the first to systematically examine evidence of interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties. The review identified a small number of intervention studies that varied in research quality and level of detail provided regarding the content and delivery of interventions. What are the potential or actual clinical implications of this work? The findings of this study highlight published evidence for interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties. These may take the form of integrating techniques for speech/language into a single intervention, or the explicit targeting of one domain with the aim of also influencing the other. However, there is a need for further high-quality research in this area. Such studies should provide sufficient detail to enable replication. This would enable clinicians to understand the relevance and applicability of such intervention findings to the individual children they see within their clinical practice.

The nature and causes of children's grammatical difficulties: Evidence from an intervention to improve past tense marking in children with Down syndrome.

Children with language learning difficulties frequently display problems learning grammar. One such group is children with Down syndrome. This study evaluates the effectiveness of an intervention to teach the use of the regular simple past tense to children with Down syndrome. Trained teaching assistants delivered the intervention for 20 min per day for 10 weeks. We conducted a Randomised Controlled Trial, with a waiting list control design in which the Intervention group (N = 26) received the intervention immediately, while the delayed intervention group (N = 26) received the intervention later. Immediately following the intervention, the intervention group showed significantly larger gains in the use of regular simple past tense forms (d = 1.63 on a composite measure of simple past tense formation) as well as generalisation to verbs not explicitly taught. In addition, following the intervention children made overregularisation errors by incorrectly using regular simple past tense marking for irregular verbs; such errors support the claim that children had acquired generative knowledge underlying past tense marking. The delayed intervention control group showed identical benefits from the intervention when they received it, and the gains shown by the intervention group were maintained at follow up testing. This study shows that children with Down syndrome, who display severe language difficulties, can be taught to use simple past tense marking. The theoretical and applied implications of these findings for understanding the nature, causes and treatments of children's language difficulties are discussed.

Computerized Speechreading Training for Deaf Children: A Randomized Controlled Trial.

Purpose We developed and evaluated in a randomized controlled trial a computerized speechreading training program to determine (a) whether it is possible to train speechreading in deaf children and (b) whether speechreading training results in improvements in phonological and reading skills. Previous studies indicate a relationship between speechreading and reading skill and further suggest this relationship may be mediated by improved phonological representations. This is important since many deaf children find learning to read to be very challenging. Method Sixty-six deaf 5- to 7-year-olds were randomized into speechreading and maths training arms. Each training program was composed of a 10-min sessions a day, 4 days a week for 12 weeks. Children were assessed on a battery of language and literacy measures before training, immediately after training, and 3 months and 11 months after training. Results We found no significant benefits for participants who completed the speechreading training, compared to those who completed the maths training, on the speechreading primary outcome measure. However, significantly greater gains were observed in the speechreading training group on one of the secondary measures of speechreading. There was also some evidence of beneficial effects of the speechreading training on phonological representations; however, these effects were weaker. No benefits were seen to word reading. Conclusions Speechreading skill is trainable in deaf children. However, to support early reading, training may need to be longer or embedded in a broader literacy program. Nevertheless, a training tool that can improve speechreading is likely to be of great interest to professionals working with deaf children. Supplemental Material https://doi.org/10.23641/asha.8856356.

Feline-transmitted sporotrichosis: A case study from California.

We report a case of cat-associated sporotrichosis in an adult female in California. A retrospectively diagnosed cutaneous sporotrichosis infection in the patient's cat and the unusual site of the primary lesion in the patient contributed to delayed diagnosis and treatment. Here, we also review the English literature regarding the epidemiology of Sporothrix schenkii as a cat-associated zoonosis.

Single tube identification and strain typing of Brucella melitensis by multiplex PCR.

We report the development of a single-tube, multi-locus variable number tandem repeat analysis (MLVA) assay for simultaneous speciation and strain typing of Brucella, the etiologic agent of brucellosis. Our MLVA assay consists of eight loci, two of which are species-specific markers that allow for definitive identification of Brucella melitensis, B. abortus, and Brucella species while ruling out related pathogenic bacterial genera. The remaining six loci are moderately variable loci capable of discriminating between Brucella strains originating within our study area. We applied the assay to a collection of 110 B. melitensis isolates of primarily Mexican origin and to smaller sample sizes of four other Brucella species for a total of 161 isolates. Simpson's index of diversity was 0.985 for B. melitensis and 0.938 for B. abortus. The assay accurately distinguished seven epidemiologically-linked clusters of B. melitensis infections and ascertained the source of infection in several laboratory-acquired cases. This assay is accessible to limited-resource settings due to its technological and economical feasibility. The timely and accurate information provided by this assay will potentially aid brucellosis control efforts, improve patient outcomes, and reduce the occurrence of laboratory-acquired infections.

From phonological therapy to phonological awareness.

Children with speech difficulties often have delayed phonological awareness development and associated literacy problems. Speech-language pathologists (S-LPs) typically use phonological and articulatory approaches in their treatment of such children. However, it is unclear to what extent phonological awareness training, originally designed to promote literacy skills, might also improve children's speech output. This article adopts a psycholinguistic approach to examine the nature and development of phonological awareness and to explore the relationship between phonological awareness training and phonological therapy. The role of phonological awareness in predicting literacy development in children is discussed, and principles for analyzing the psycholinguistic properties of therapy tasks are presented. Phonological awareness cannot be dealt with independently as it is an integral part of articulation and phonological intervention. Further, phonological awareness is a necessary "on-line" skill in the dynamic communication process between therapist and child. Failure to take this into account will result in inappropriately targeted therapy and pragmatic breakdown between the child and S-LP.