Hereditary Creutzfeldt-Jakob Disease: A Case Presentation of a Rare Stroke Mimic.

Acute ischemic cerebrovascular accident (CVA) is a time-sensitive emergent diagnosis, requiring rapid diagnosis and consideration of thrombolytic administration. However, a myriad of cerebrovascular mimics creates a diagnostic challenge. A rare CVA mimic is Creutzfeldt-Jakob disease (CJD), a rapidly progressive fatal dementia due to protein misfolding. Magnetic resonance imaging (MRI) and neurology consultation for electroencephalogram (EEG) and specialized cerebrospinal fluid (CSF) studies are diagnostic while the patient is alive. All forms are fatal within months, and diagnosis can be confirmed on postmortem brain testing. While incredibly uncommon, emergency clinicians should consider this diagnosis in the proper patient to advocate for specialized CSF testing and potential palliative care consultation.

Automated phonological analysis and treatment target selection using AutoPATT.

Automated analyses of speech samples can offer improved accuracy and timesaving advantages that streamline clinical assessment for children with a suspected speech sound disorder. In this paper, we introduce AutoPATT, an automated tool for clinical analysis of speech samples. This free, open-source tool was developed as a plug-in for Phon and follows the procedures of the Phonological Analysis and Treatment Target Selection protocol, including extraction of a phonetic inventory, phonemic inventory with corresponding minimal pairs, and initial consonant cluster inventory. AutoPATT also provides suggestions for complex treatment targets using evidence-based guidelines. Automated analyses and target suggestions were compared to manual analyses of 25 speech samples from children with phonological disorder. Results indicate that AutoPATT inventory analyses are more accurate than manual analyses. However, treatment targets generated by AutoPATT should be viewed as suggestions and not used to substitute necessary clinical judgement in the target selection process.

Complexity and cross-linguistic transfer in intervention for Spanish-English bilingual children with speech sound disorder.

With bilingual children, intervention for speech sound disorders must consider both of the child's phonological systems, which are known to interact with each other in development. Further, cross-linguistic generalization following intervention for bilingual children with speech sound disorders (i.e., the impact of treatment in one language on the other) has been documented to varying degrees in some prior studies. However, none to date have documented the cross-linguistic impact of treatment with complex targets (e.g., consonant clusters) for bilingual children. Because complex phonological targets have been shown to induce system-wide generalization within a single language, the potential for bilingual children to generalize learning across languages could impact the efficiency of intervention in this population. This pilot intervention study examines the system-wide, cross-linguistic effects of treatment targeting consonant clusters in Spanish for two Spanish-English bilingual children with phonological disorder. Treatment was provided with 45-minute sessions in Spanish via teletherapy, three times per week for six weeks. Comprehensive phonological probes were administered in English and Spanish prior to intervention and across multiple baselines. Pre-intervention data were compared to data from probes administered during and after intervention to generate qualitative and quantitative measures of treatment outcomes and cross-linguistic generalization. Results indicate a medium effect size for system-wide generalization in Spanish (the language of treatment) and English (not targeted in treatment), for both participants (mean effect size in Spanish: 3.6; English 4.3). These findings have implications for across-language transfer and system-wide generalization in treatment for bilingual children.

A Hard Case to Swallow: Crucifix Esophageal Foreign Body in a Nonverbal Patient.

Delayed presentation of esophageal foreign bodies places patients at high risk for esophageal perforation and infection. In nonverbal patients as well as children and adults with other concomitant illnesses, it is important to consider a broad differential diagnosis for presentations with upper respiratory complaints. The authors present a case of a nonverbal, elderly woman who presented after several days of mild, dry cough and was ultimately found to have a large esophageal foreign body that had been present for an unclear amount of time.

Quantifying phonological knowledge in children with phonological disorder.

Generative phonologists use contrastive minimal pairs to determine functional phonological units in a language. This technique has been extended for clinical purposes to derive phonemic inventories for children with phonological disorder, providing a qualitative analysis of a given child's phonological system that is useful for assessment, treatment, and progress monitoring. In this study, we examine the single-word productions of 275 children with phonological disorder from the Learnability Project (Gierut, 2015b) to confirm the relationship between phonemic inventory - a measure of phonological knowledge - and consonant accuracy - a quantitative, relational measure that directly compares a child's phonological productions to the target (i.e. adult-like) form. Further, we identify potential percentage accuracy cutoff scores that reliably classify sounds as in or out of a child's phonemic inventory in speech-sound probes of varying length. Our findings indicate that the phonemic function of up to 90% of English consonants can be identified from percentage accuracy for preschool-age children with phonological disorder when a sufficiently large and thorough speech sample is used.

Treatment Targets for Co-Occurring Speech-Language Impairment: A Case Study.

PURPOSE: The intersection of speech and language impairments is severely understudied. Despite repeatedly documented overlap and co-occurrence, treatment research for children with combined phonological and morphosyntactic deficits is limited. Especially little is known about optimal treatment targets for combined phonological-morphosyntactic intervention. We offer a clinically focused discussion of the existing literature pertaining to interventions for children with combined deficits and present a case study exploring the utility of a complex treatment target in word-final position for co-occurring speech and language impairment. METHOD: Within a school setting, a kindergarten child (age 5;2) with co-occurring phonological disorder and developmental language disorder received treatment targeting a complex consonant cluster in word-final position inflected with third-person singular morphology. RESULTS: For this child, training a complex consonant cluster in word-final position resulted in generalized learning to untreated consonants and clusters across word positions. However, morphological generalization was not demonstrated consistently across measures. CONCLUSION: These preliminary findings suggest that training complex phonology in word-final position can result in generalized learning to untreated phonological targets. However, limited improvement in morphology and word-final phonology highlights the need for careful monitoring of cross-domain treatment outcomes and additional research to identify the characteristics of treatment approaches, techniques, and targets that induce cross-domain generalization learning in children with co-occurring speech-language impairment.

Influences of Phonological Context on Tense Marking in Spanish-English Dual Language Learners.

Purpose: The emergence of tense-morpheme marking during language acquisition is highly variable, which confounds the use of tense marking as a diagnostic indicator of language impairment in linguistically diverse populations. In this study, we seek to better understand tense-marking patterns in young bilingual children by comparing phonological influences on marking of 2 word-final tense morphemes. Method: In spontaneous connected speech samples from 10 Spanish-English dual language learners aged 56-66 months (M = 61.7, SD = 3.4), we examined marking rates of past tense -ed and third person singular -s morphemes in different environments, using multiple measures of phonological context. Results: Both morphemes were found to exhibit notably contrastive marking patterns in some contexts. Each was most sensitive to a different combination of phonological influences in the verb stem and the following word. Conclusions: These findings extend existing evidence from monolingual speakers for the influence of word-final phonological context on morpheme production to a bilingual population. Further, novel findings not yet attested in previous research support an expanded consideration of phonological context in clinical decision making and future research related to word-final morphology.

Dialect Density in Bilingual Puerto Rican Spanish-English Speaking Children.

It is still largely unknown how the two phonological systems of bilingual children interact. In this exploratory study, we examine children's use of dialect features to determine how their speech sound systems interact. Six monolingual Puerto Rican Spanish-speaking children and 6 bilingual Puerto Rican Spanish-English speaking children, ages 5-7 years, were included in the current study. Children's single word productions were analyzed for (1) dialect density and (2) frequency of occurrence of dialect features (after Oetting & McDonald, 2002). Nonparametric statistical analyses were used to examine differences within and across language groups. Results indicated that monolinguals and bilinguals exhibited similar dialect density, but differed on the types of dialect features used. Findings are discussed within the theoretical framework of the Dual Systems Model (Paradis, 2001) of language acquisition in bilingual children.

Age of acquisition and allophony in Spanish-English bilinguals.

This study examines age of acquisition (AoA) in Spanish-English bilinguals' phonetic and phonological knowledge of /l/ in English and Spanish. In English, the lateral approximant /l/ varies in darkness by context [based on the second formant (F2) and the difference between F2 and the first formant (F1)], but the Spanish /l/ does not. Further, English /l/ is overall darker than Spanish /l/. Thirty-eight college-aged adults participated: 11 Early Spanish-English bilinguals who learned English before the age of 5 years, 14 Late Spanish-English bilinguals who learned English after the age of 6 years, and 13 English monolinguals. Participants' /l/ productions were acoustically analyzed by language and context. The results revealed a Spanish-to-English phonetic influence on /l/ productions for both Early and Late bilinguals, as well as an English-to-Spanish phonological influence on the patterning of /l/ for the Late Bilinguals. These findings are discussed in terms of the Speech Learning Model and the effect of AoA on the interaction between a bilingual speaker's two languages.

Effects of Neighborhood Density on Adult Word Repetition.

Presumable lexical competition has been found to result in higher perceptual accuracy for words with few versus many neighbors. Previous studies have typically only analyzed the lexical-semantic level, however. In order to also explore the possibility of phonological effects, a word repetition task was administered to 46 typical adults in which 80 stimuli differed only in neighborhood density. In contrast to previous studies, verbal responses were elicited in order to analyze productions holistically and segmentally at the phonological level. An additional error analysis examined differences in neighborhood density between target words and substitutions. Findings revealed that words with more neighbors facilitated recognition, and were more accurately repeated than those with fewer neighbors. When a target word was misperceived, its substitution tended to be higher in neighborhood density, unrelated to word frequency. In order to interpret these results, an account of lexical competition is re-visited with consideration of characteristics of the lexicon discovered using graph theory (Vitevitch, 2008).

A comparison of word lexicality in the treatment of speech sound disorders.

The goal of this research programme was to evaluate the role of word lexicality in effecting phonological change in children's sound systems. Four children with functional speech sound disorders (SSDs) were enrolled in an across-subjects multiple baseline single-subject design; two were treated using high-frequency real words (RWs) and two were treated using (low-frequency) non-words (NWs). Dependent variables were learning during treatment, generalization of treated and untreated sounds post-treatment and error consistency indices. The oldest child in the NW group demonstrated slightly greater increases in learning during treatment, and both children demonstrated increases in generalization as well as large decreases in sound error variability. In comparison, one child in the RW group demonstrated untreated sound generalization, as well as decreases in sound error variability. These results suggest that NWs may be useful in helping children learn the sound structure of words containing treated sounds. These findings are interpreted within an established connectionist model accounting for phonological and lexical representations.

A retrospective study of phonetic inventory complexity in acquisition of Spanish: implications for phonological universals.

This study evaluates 39 different phonetic inventories of 16 Spanish-speaking children (ages 0;11 to 5;1) in terms of hierarchical complexity. Phonetic featural differences are considered in order to evaluate the proposed implicational hierarchy of Dinnsen et al.'s phonetic inventory typology for English. The children's phonetic inventories are examined independently and in relation to one another. Five hierarchical complexity levels are proposed, similar to those of English and other languages, although with some language-specific differences. These findings have implications for theoretical assumptions about the universality of phonetic inventory development, and for remediation of Spanish-speaking children with phonological impairments.

Age-related changes in acoustic characteristics of adult speech.

UNLABELLED: This paper addresses effects of age and sex on certain acoustic properties of speech, given conflicting findings on such effects reported in prior research. The speech of 27 younger adults (15 women, 12 men; mean age 25.5 years) and 59 older adults (32 women, 27 men; mean age 75.2 years) was evaluated for identification of differences for sex and age group across measures of fundamental and formant frequencies (F0, F1, F2 and F3) and voice onset time (VOT). There were significant sex-by-age group interactions for F0, F1, and VOT, some of which were specific to individual speech sounds. The findings suggest that further research on aging speech should focus on sex differences and the potential influence such changes may have on communication abilities of older adults with hearing loss. LEARNING OUTCOMES: The reader will be able to understand and describe (1) possible changes in specific acoustic properties with age, (2) how these changes may differ for women and men, and (3) the potential impact these changes may have on the speech understanding of older individuals with hearing loss.

Phonological change and the representation of consonant clusters in Spanish: a case study.

This single-subject case study evaluates effects of treatment of a complex onset on the sound system of a monolingual Spanish-speaking child (female, aged 3;9) with phonological delay. Pre-treatment, the child excluded all consonant+liquid clusters, as well as tap /[symbol: see text]/ and trill /r/. Immediately following training on /f[symbol: see text]-/ in non-words, the child generalized across consonant+liquid clusters and the tap singleton. These improvements continued to 2 months post-treatment follow-up, with the ultimate addition of the trill at that point in time. Consonant+glide sequences, whose structural status as complex onsets is debated in the Spanish phonology literature, patterned differently from consonant+liquid sequences. Specific findings are viewed in light of linguistic markedness, syllable structure, sonority sequencing, and the representation of consonant clusters.

Constraint conflict in cluster reduction.

When children reduce onset clusters to singletons, a common pattern is for the least sonorous member of the adult cluster to be produced. Within optimality theory (Prince & Smolensky, 1993), this pattern has been accounted for in terms of a fixed ranking of onset constraints that evaluate a segment's degree of sonority, whereby onset glides violate the highest ranked constraint, and onset stops the lowest. Not all children follow the sonority pattern, however. In this paper, we apply two fundamental principles of optimality theory to yield predictions about other children's cluster reduction patterns. The first principle is that of factorial typology, according to which all rankings of constraints should yield possible languages. To produce the sonority pattern, all conflicting constraints must rank beneath the onset sonority constraints. If they rank above the onset sonority constraints, these other constraints will force deviations from the sonority pattern. In this paper, we show how divergences from the sonority pattern are caused by three well-motivated conflicting constraints: *Fricative, *Dorsal, and Max-Labial. This is documented in the speech of two normally developing children (about 1;6-2;3) and a child with a phonological delay (3;8). The second principle we appeal to is that of emergent constraint activity, according to which the effects of violated constraints can be observed when higher ranked conflicting constraints are not at issue. We show that even when the onset sonority constraints are outranked by the conflicting constraints, under the right circumstances the sonority pattern does emerge in the forms produced by these children.

Minimal pair approaches to phonological remediation.

This article considers linguistic approaches to phonological remediation that emphasize the role of the phoneme in language. We discuss the structure and function of the phoneme by outlining procedures for determining contrastive properties of sound systems through evaluation of minimal word pairs. We then illustrate how these may be applied to a case study of a child with phonological delay. The relative effectiveness of treatment approaches that facilitate phonemic acquisition by contrasting pairs of sounds in minimal pairs is described. A hierarchy of minimal pair treatment efficacy emerges, as based on the number of new sounds, the number of featural differences, and the type of featural differences being introduced. These variables are further applied to the case study, yielding a range of possible treatment recommendations that are predicted to vary in their effectiveness.

Prologue: Recent Advances in Phonological Theory and Treatment: Part II.

Each of the articles in this forum considers how phonology interacts with other aspects of language and language learning. The contributors show that this interaction plays a major role in a child's learning of language, whether through typical routes, as evidenced by the normally developing child, or through clinical intervention. These interactions are apparent in both typical and atypical language learning, with the development of the lexicon being closely tied to the development of phonological representations (or URs). The correctness of these URs, as determined from morphophonemic alternations, plays a major role in accounting for children's production patterns and determining what a child "knows" about the target sound system. Finally, the interaction between morphosyntax and phonology can be observed in language learning even when it occurs as a result of clinical intervention. It is hoped that this clinical forum will be informative and enlightening for researchers and clinical professionals.

Prologue: Recent Advances in Phonological Theory and Treatment.

With the introduction, development, and application of new theoretical frameworks, both assessment and treatment methods for phonological disorders may continue to be evaluated and improved on. It is hoped that this clinical forum will be of practical use to researchers and professionals alike in shaping their understanding of how phonological systems work generally, and in guiding the development of treatment programs.