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.

Eligibility Determinations for Speech and Language Services in U.S. Public Schools: Experiences and Tensions.

PURPOSE: The purpose of this study was to examine school speech-language pathologists' (SLPs) experiences regarding students' eligibility for services in public schools within the United States. METHOD: Fifteen school SLPs participated in online focus groups to examine the complex nature of SLPs' participation within decision-making teams and describe practice experiences in U.S. schools. SLPs worked in one to 10+ schools serving students from pre-K through 12th grade. Data were analyzed using Cultural-Historical Activity Theory (CHAT; Engeström, 2015). RESULTS: School SLPs' practice is impacted by rules, community, and division of labor in schools. Participants discussed the following: culture of the work setting, interaction between team members, desire to assist families and children, knowledge of regulations, evaluation practices, and the impact of poverty, and cultural and linguistic differences. Nine major tensions were identified: need for greater SLP empowerment and advocacy, documentation of educational impact, complexities of students learning English as an additional language, concerns about evaluation data for decision making, SLPs' concerns regarding outcomes of eligibility decision making, overuse of speech-language impairment for students who do not qualify, parents' involvement in decision making, disagreement between team members, and administrations' adherence to rules. CONCLUSIONS: Within the schools, the CHAT framework was useful to identify tensions and opportunities for change at the individual and institutional levels, impacting team decision making for eligibility, SLPs' provision of services, and student outcomes. Acknowledgment of tensions and opportunities for change regarding students' eligibility for services may guide public policy; preservice training; and individual, local, and national advocacy.

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.

Multilingual Speech Acquisition by Vietnamese-English-Speaking Children and Adult Family Members.

PURPOSE: This article presents a large-scale example of culturally responsive assessment and analysis of multilingual Vietnamese-English-speaking children and their family members using the VietSpeech Protocol involving (a) examining all spoken languages, (b) comparing ambient phonology produced by family members, (c) including dialectal variants in the definition of accuracy, and (d) clustering participants with similar language experience. METHOD: The VietSpeech participants (N = 154) comprised 69 children (2;0-8;10 [years;months]) and 85 adult family members with Vietnamese heritage living in Australia. Speech was sampled using the Vietnamese Speech Assessment (Vietnamese) and the Diagnostic Evaluation of Articulation and Phonology (English). RESULTS: Children's Vietnamese consonant accuracy was significantly higher when dialectal variants were accepted (percentage of consonants correct-dialect [PCC-D]: M = 87.76, SD = 8.18), compared to when only Standard Vietnamese was accepted as the correct production (percentage of consonants correct-standard [PCC-S]: M = 70.34, SD = 8.78), Cohen's d = 3.55 (large effect). Vietnamese voiced plosives, nasals, semivowels, vowels, and tones were more often correct than voiceless plosives and fricatives. Children's Standard Australian English consonant accuracy (PCC-S) was 82.51 (SD = 15.57). English plosives, nasals, glides, and vowels were more often correct than fricatives and affricates. Vietnamese word-initial consonants had lower accuracy than word-final consonants, whereas English consonant accuracy was rarely influenced by word position. Consonant accuracy and intelligibility were highest for children with high proficiency in both Vietnamese and English. Children's consonant productions were most similar to their mothers' than other adults or siblings' productions. Adults' Vietnamese consonants, vowels, and tones were more likely to match Vietnamese targets than their children's productions. CONCLUSIONS: Children's speech acquisition was influenced by cross-linguistic, dialectal, maturational, language experience, and environmental (ambient phonology) factors. Adults' pronunciation was influenced by dialectal and cross-linguistic factors. This study highlights the importance of including all spoken languages, adult family members, dialectal variants, and language proficiency to inform differential diagnosis of speech sound disorders and identify clinical markers in multilingual populations. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23290055.

Equitable access to speech practice for rural Australian children using the SayBananas! mobile game.

PURPOSE: To evaluate the effect, usage, and user-experience for SayBananas!, a Mario-style mobile game providing Australian children access to high-dose individualised speech therapy practice. METHOD: Participants were 45 rural Australian children with speech sound disorders (SSD; 4;4-10;5 years) with internet access. This mixed-methods study involved: (a) recruitment, (b) eligibility screening, (c) questionnaire, (d) online pre-assessment, (e) SayBananas! intervention using motor learning principles (4 weeks, 10-15 target words), and (f) online post-assessment and interview. Usage and performance were automatically monitored. RESULT: Most participants were highly engaged with SayBananas! completing a median of 44.71 trials/session (∼45% of the 100 trial/session target, range 7-194). After intervention, participants made significant gains on treated words and on formal assessment of percentage of consonants, vowels, and phonemes correct. There was no reliable change for parent-rated intelligibility or children's feelings about talking. The number of practice sessions was significantly correlated with percent change on treated words. On average, children rated the app as "happy/good/fun" providing detailed drawings of playing SayBananas!. Families provided high ratings of engagement, functionality, aesthetics, and quality. CONCLUSION: SayBananas! is a viable and engaging solution for rural Australian children with SSD to gain access to equitable, cost-effective speech practice. The amount of app use was associated with amount of speech production improvement over a 4-week period.

Communication for all and the Sustainable Development Goals.

PURPOSE: Communication is central to the accomplishment of each of the United Nations' 17 Sustainable Development Goals (SDGs) and is a fundamental human right. METHOD: This special issue of the International Journal of Speech-Language Pathology (IJSLP, vol. 25, no. 1) is dedicated to communication, swallowing and the SDGs; particularly focussing on people with communication and/or swallowing disability and those who support them. RESULT: The papers in the special issue of IJSLP demonstrate that successful communication is necessary for realisation of all 17 SDGs at both a global and an individual level and advance the international call for SDG 18: Communication for All. The 36 papers address all 17 goals, focussing on poverty, hunger, health, education, work, innovation, climate, cities, land, oceans, justice, and partnerships. Authors worked and undertook their research in Australia, Austria, Benin, Cambodia, Cameroon, Canada, China, Columbia, Denmark, Egypt, Ethiopia, Ghana, Greece, Iceland, India, Iraq, Ireland, Italy, Jordan, Kenya, Lebanon, Maldives, Mozambique, Nepal, New Zealand, Nigeria, State of Palestine, Peru, Philippines, Rwanda, Serbia, South Africa, Uganda, UK, USA, Vietnam. CONCLUSION: Communication for all is essential for the achievement of the SDGs, "peace and prosperity for people and the planet" (United Nations, 2015a). Achievement of the SDGs is the role of all; including communication specialists, people with communication/swallowing disability, their families and communities.

Parent Perspectives of Ear Health and the Relationship with Children's Speech and Language in the Longitudinal Study of Indigenous Children.

Health and well-being are holistic concepts that are perceived to be inseparable for Aboriginal and Torres Strait Islander peoples. We examined relationships between parent-reported ear symptoms for 787 Indigenous children at two time points (age 2-3 years, age 4-5 years) and two parent-reported speech and language outcomes one year later (age 5-6 years). Most parents (80.2%) reported no concern about their child's expressive language and (93.8%) receptive language. Binary logistic regression models examined ear health as a predictor of children's expressive and receptive speech and language adjusting for sociodemographic and health covariates. For children without parent-reported ear symptoms, there were lower odds of parental concern about expressive speech and language (aOR = 0.45; 95% CI 0.21-0.99) and receptive language (aOR = 0.24; 95% CI 0.09-0.62). Parents were less likely to have concerns about the child's expressive speech and language if their child was female, lived in urban or regional areas, had excellent or very good global health, or had no disability when aged 2-5 years. Since parent-reported ear health and speech and language concerns were related, Aboriginal and Torres Strait Islander children could benefit from culturally safe, strength-based, and family-centered integrated speech, language, and ear health services.

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.

Fijian school students' Fiji English speech sound acquisition.

Purpose: The aim of this study was to investigate Fijian students' acquisition of Fiji English speech sounds.Method: Participants were 72 multilingual students (5-10 years) living in Fiji who spoke the Fijian or Fiji Hindi dialects of Fiji English. The students' productions of single words from the Diagnostic Evaluation of Articulation and Phonology (DEAP) were analysed according to dialect using the Children's Independent and Relational Phonological Analysis (CHIRPA).Result: Most English consonants were acquired by 6;0. English consonants that were not in the inventories of Fijian or Fiji Hindi were the last acquired, while those that were common between English and the two languages were some of the earlier acquired consonants. Percentage of consonants correct (PCC) for Fiji English was significantly lower for Grade 1 students (M = 93.01, SD = 0.07) in comparison to Grade 4 students (M = 99.03, SD = 0.01). Plosive and nasal sounds were acquired by 90% of the students earlier than fricative, approximant and affricate sounds, though acquisition of some plosive and fricative sounds varied between Fiji English dialects. All word-initial consonant clusters were acquired by 90% of the students by 9;6, with r-clusters tending to be the latest acquired. The acquisition of word-final consonant clusters was highly variable as students often produced appropriate dialectal variants.Conclusion: Multilingual Fijian children may acquire English specific sounds later than their monolingual English-speaking peers. Consideration of the language environment and analysis of the speech sample with reference to the child's dominant English dialect is imperative for valid identification of speech sound disorder (SSD) in children who speak different dialects of English.

Predicting Which Children Will Normalize Without Intervention for Speech Sound Disorders.

PURPOSE: The speech of some children does not follow a typical normalization trajectory, and they develop speech sound disorders (SSD). This study investigated predictive correlates of speech sound normalization in children who were at risk of SSD. METHOD: A prospective population cohort study of 845 Cantonese-speaking preschoolers was conducted over 2.5 years to examine (a) children who resolved nonadult realizations of consonants (normalized) and (b) those who had persisting speech sound difficulties (did not normalize). From these 845, a sample of 82 participants characterized as having SSD (1.25 SDs below the mean in a standardized speech assessment, with a delay in initial consonant acquisition or with one or more atypical errors) was followed for 2 years at 6-month intervals or until the completion of their initial consonant inventory. Data from 43 children who did not receive speech-language pathology services were analyzed with survival analysis to model time to normalization while controlling for covariates. The target event (outcome) was the completion of their initial consonant inventory. RESULTS: Under the no-intervention condition, the estimated median time to normalization was 6.59 years of age. Children who were more likely to normalize or normalized in a shorter time were stimulable to all errors and more intelligible as rated by caregivers using the Intelligibility in Context Scale. Those who showed atypical error patterns did not necessarily take longer to normalize. Similarly, expressive language ability was not significantly associated with speech normalization. CONCLUSIONS: Stimulability and intelligibility were more useful prognostic factors of speech normalization when compared to (a)typicality of error patterns and expressive language ability. Children with low intelligibility and poor stimulability should be prioritized for speech-language pathology services given that their speech errors are less likely to resolve naturally.

SuperSpeech: Multilingual Speech and Language Maintenance Intervention for Vietnamese-Australian Children and Families via Telepractice.

PURPOSE: The aim of this pilot feasibility study was to evaluate the effectiveness of the group VietSpeech SuperSpeech program targeting speech skills and home language maintenance via telepractice. METHOD: In Stage 1, using a case-control design, 30 Vietnamese-English-speaking children were assessed in English and Vietnamese, and parents completed questionnaires about speech and language competency and practices. During Stage 2, children were allocated to intervention (n = 14) or control (n = 16) conditions. COVID-19 restrictions resulted in changes including nonrandom allocation. Online group intervention targeting speech, home language maintenance, and multilingualism as a superpower was delivered 1 hr/week for 8 weeks. For Stage 3, assessments were undertaken approximately 10 weeks after the pre-intervention assessment. RESULTS: Parents in the intervention group significantly increased encouragement of their children to speak Vietnamese. The intervention group significantly increased intelligibility in English. Growth of Vietnamese vocabulary was faster for the control group. There was a moderate effect of intervention for children's perception of being happy talking in Vietnamese and English. There was no significant mean change from pre- to post-intervention compared with the control group for measures of speech sound accuracy in Vietnamese or English, Vietnamese intelligibility, English vocabulary, or hours of Vietnamese spoken each week. CONCLUSIONS: This study presents preliminary evidence that this 8-hr online group program targeting speech skills and home language maintenance had some impact on Vietnamese-Australian children's speech and home language maintenance. Further research involving a randomized trial is warranted.

Drawing Talking: Listening to Children With Speech Sound Disorders.

PURPOSE: Listening to children using age-appropriate techniques supports evidence-based clinical decision-making. In this article, we test the Sound Effects Study Drawing Protocol, an arts-based technique, to support children with speech sound disorder (SSD) to express their views about talking. METHOD: Participants were 124 Australian children aged 4-5 years in the Sound Effects Study. Their parents and teachers were concerned about their talking, and they were assessed as having SSD on the Diagnostic Evaluation of Articulation and Phonology. Drawings and children's interpretations were elicited then analyzed using the (a) Who Am I? Draw-a-Person Scale and (b) Sound Effects Study Focal Points. RESULTS: Drawings were developmentally typical for 4- to 5-year-olds. The six Sound Effects Study Focal Points were identified across the 124 drawings: body parts and facial expressions, talking and listening, relationships and connection, positivity, negativity, and no talking. Participants portrayed talking and listening as an action requiring mouths and ears represented by symbols (letters, speech bubbles) or as an activity with a variety of people. Children typically portrayed themselves as happy when talking; however, some portrayed negativity and some chose not to draw talking. CONCLUSIONS: In keeping with Articles 12 and 13 of the Convention on the Rights of the Child, this research demonstrated that 4- to 5-year-old children with SSD can express their views about talking via drawing. Professionals may use the Sound Effects Study Drawing Protocol as a child-friendly technique to support children to express views to guide holistic, evidence-based, child-centered speech-language pathology practice.

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.

Advancing Workplace Diversity Through the Culturally Responsive Teamwork Framework.

Purpose Diversification of the profession is an important element of combating racism, bias, and prejudice in the speech-language pathology workforce at national and systemic levels. However, national and systemic change needs to be combined with equipping individual speech-language pathologists to adapt to the challenges that they face to engaging in culturally responsive practice. This paper presents four interacting levels of practice within the Culturally Responsive Teamwork Framework (CRTF): (a) intrapersonal practices, (b) interpersonal practices, (c) intraprofessional practices, and (d) the interprofessional practices. Conclusion CRTF is a practical, strengths-based framework that draws on international research and expertise to expand personal and professional practice and describe critical behaviors within the workplace that can be used to promote principles of evidence-based practice and social justice, especially when working with people from nondominant cultural or linguistic groups.

Profiles of Linguistic Multicompetence in Vietnamese-English Speakers.

Purpose Speech-language pathologists work with increasing numbers of multilingual speakers; however, even when the same languages are spoken, multilingual speakers are not homogeneous. Linguistic multicompetence (aka multi-competence) considers competency across all languages and is associated with multiple demographic, migration, linguistic, and cultural factors. Method This article examines the linguistic multicompetence of adults with Vietnamese heritage living in Australia (n = 271) and factors associated with varying profiles of multilingualism. Participants completed a self-report questionnaire (available in English and Vietnamese) regarding their language proficiency and associated factors. Results Participants were largely (76.6%) first-generation migrants to Australia. Three distinct profiles of linguistic multicompetence were statistically identified using a cluster analysis: (a) Vietnamese proficient (n = 81, 31%), (b) similar proficiency (n = 135, 52%), and (c) English proficient (n = 43, 17%); that is, half were proficient in both languages. Multinomial logistic regression analyses compared participants profiled as having similar proficiency with those who were more dominant in one language. Factors associated with the Vietnamese proficient group (compared with the similar proficiency group) were that the participants used Vietnamese much more than English with different people across different situations, were more likely to believe that maintaining Vietnamese helped them communicate in English, and earned less. Participants in the English proficient group used English more than Vietnamese with different people across different situations, were more likely to have lived in English-speaking countries longer, were younger in age, and were less likely to believe that maintaining Vietnamese helped improve academic study than those with similar proficiency. Conclusion Undertaking a comprehensive language profile is an important component of any multilingual assessment to enable speech-language pathologists to develop an understanding of different presentations of linguistic multicompetence, engage in culturally responsive practice, and acknowledge that high levels of competence can be achieved across multiple languages. Supplemental Material https://doi.org/10.23641/asha.14781984.

Waiting lists and prioritization of children for services: Speech-language pathologists' perspectives.

BACKGROUND: Waiting lists occur when the availability of speech-language pathology services does not meet the demand. Speech-language pathologists (SLPs) commonly manage waiting lists and their consequences using prioritization. AIMS: The aims of this study were to: (1) describe speech-language pathology waiting lists for children and factors associated with their presence in workplaces throughout the world, and (2) describe factors considered in and influencing SLPs' prioritization of children for services. METHODS: A questionnaire about pediatric waiting lists and prioritization was completed by 267 SLPs from 10 countries working in health, disability, education, and private sectors. Valid responses to closed questions from 264 SLPs were analyzed quantitatively. RESULTS: Most (73.6 %) SLPs reported having a waiting list in their workplace. Waiting lists were most common in community health centres (97.4 %). Waiting times ranged from 0 to 42 months (M = 8.09, SD = 5.84). High priority was assigned to infants (77.4 %), toddlers (65.3 %), children with feeding difficulties (88.5 %), and children who stutter (47.4 %). Prioritization parameters ranked as most important were: severity (M = 4.34), availability of resources (M = 4.11), diagnosis (M = 4.04), and age (M = 3.91). CONCLUSIONS: Many workplaces have long waiting lists for speech-language pathology services. Young children, feeding, and stuttering were most often considered high priority; however, prioritization can be complex, implicit, and influenced by external factors. Collaborative development of explicit, transparent waiting list and prioritization guidelines within workplaces, and the development and evaluation of active waiting strategies for children and families are recommended.

Persistence, strength, isolation, and trauma: An ethnographic exploration of raising children with cleft palate.

BACKGROUND: The lives of families of young children with cleft palate (±lip) are complex. Multiple interventions are required as part of the long-term multidisciplinary treatment for children with CP±L, with an impairment-focused approach prevailing. Research with young children with CP±L has focused on treatment and intervention, and previous qualitative research has been collected predominantly via interviews, so little is understood about the day-to-day lives of families of young children with CP±L. AIMS: (1) To increase understanding of the lives of children with CP±L and their families by applying an ethnographic lens to improve clinical practice (2) to identify key interactions and encounters that shape the experiences of children with CP±L and their families (3) to examine how family-centered practice can enhance practitioner-family relationships in providing effective and evidence-based care for children with CP±L. METHOD: Ethnographic observations of seven families of children with CP±L and their families and educators including parents, siblings, aunts, grandparents, and teachers involved multiple site visits. Rich data were collected to gather information about different aspects of their lives (such as their strengths, routines, preferences, challenges and experiences). There were 84 artefacts collected: 18 interviews, 29 videos, one extended audio recording of a mealtime, seven photos contributed by families, seven case history questionnaires, and 22 field notes. These data were analyzed inductively using thematic analysis. RESULTS: Three overarching themes and 11 subthemes were identified: (1) the whole child (persistence, communication, activities, mealtimes), (2) family strength and support (strong families, external support, attitudes, advocacy, positive medical experiences) and (3) family isolation and trauma (negative medical experiences, traumatic and challenging experiences). CONCLUSION: This is the first study to use ethnographic methodology to facilitate the collection of unique insights into the lives of young children with CP±L and their families to improve clinical practice for SLPs. The unique application of family-centered practice with these families promoted trust and highlighted their challenges and strengths which could be considered by SLPs to provide holistic intervention.

Icelandic Children's Acquisition of Consonants and Consonant Clusters.

Purpose This study investigated Icelandic-speaking children's acquisition of singleton consonants and consonant clusters. Method Participants were 437 typically developing children aged 2;6-7;11 (years;months) acquiring Icelandic as their first language. Single-word speech samples of the 47 single consonants and 45 consonant clusters were collected using Málhljóðapróf ÞM (ÞM's Test of Speech Sound Disorders). Results Percentage of consonants correct for children aged 2;6-2;11 was 73.12 (SD = 13.33) and increased to 98.55 (SD = 3.24) for children aged 7;0-7;11. Overall, singleton consonants were more likely to be accurate than consonant clusters. The earliest consonants to be acquired were /m, n, p, t, j, h/ in word-initial position and /f, l/ within words. The last consonants to be acquired were /x, r, rÌ¥, s, θ, nÌ¥/, and consonant clusters in word-initial /sv-, stl-, str-, skr-, θr-/, within-word /-ðr-, -tl-/, and word-final /-klÌ¥, -xt/ contexts. Within-word phonemes were more often accurate than those in word-initial position, with word-final position the least accurate. Accuracy of production was significantly related to increasing age, but not sex. Conclusions This is the first comprehensive study of consonants and consonant cluster acquisition by typically developing Icelandic-speaking children. The findings align with trends for other Germanic languages; however, there are notable language-specific differences of clinical importance.

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.