Application of the Challenge Point Framework During Treatment of Speech Sound Disorders.

Purpose The purpose of this article is to provide trial-by-trial practice performance data in relation to learning (outcome probe data) as collected from 18 treatment sessions provided to children with severe speech sound disorders. The data illustrate the practice-learning paradox: Specific, perfect practice performance is not required for speech production learning. Method We detailed how nine student speech-language pathologists (SSLPs) implemented and modified the motor learning practice conditions to reach a proposed challenge point during speech practice. Eleven participants diagnosed with a severe speech sound disorder received high-intensity speech therapy 3 times per week for 6 weeks. SSLPs implemented treatment procedures with the goal of achieving at least 100 practice trials while manipulating practice parameters to maintain practice at the challenge point. Specifically, child performance was monitored for accuracy in five-trial increments, and practice parameters were changed to increase functional task difficulty when the child's performance was high (four or five correct responses) or to decrease functional task difficulty when the child's performance was low (fewer than four correct responses). The practice stimulus, type and amount of feedback, structure of practice, or level of support might be changed to ensure practice at the challenge point. Results On average, the children achieved 102 practice trials per session at a level of 58% correct responses. Fast achievement of connected speech with the lowest amount of support was associated with high scores on generalization probes. Even with high levels of error during practice, the children improved percent consonants correct with maintenance of learning 3 months posttreatment. Conclusion The results of this study show that it may not be necessary to overpractice or maintain a high degree of performance accuracy during treatment sessions to achieve transfer and retention of speech production learning.

Vocal imitation between mothers and infants.

The aim of the present mixed cross-sectional and longitudinal study was to observe and describe some aspects of vocal imitation in natural mother-infant interaction. Specifically, maternal imitation of infant utterances was observed in relation to the imitative modeling, mirrored equivalence, and social guided learning models of infant speech development. Nine mother-infant dyads were audio-video recorded. Infants were recruited at different ages between 6 and 11 months and followed for 3 months, providing a quasi-longitudinal series of data from 6 through 14 months of age. It was observed that maternal imitation was more frequent than infant imitation even though vocal imitation was a rare maternal response. Importantly, mothers used a range of contingent and noncontingent vocal responses in interaction with their infants. Mothers responded to three-quarters of their infant's vocalizations, including speech-like and less mature vocalization types. The infants' phonetic repertoire expanded with age. Overall, the findings are most consistent with the social guided learning approach. Infants rarely imitated their mothers, suggests a creative self-motivated learning mechanism that requires further investigation.

Can technology help close the gender gap in literacy achievement? Evidence from boys and girls sharing eBooks.

Purpose: Digital technologies may offer new solutions to old problems or bring additional complications. In this paper, we address a longstanding and widespread issue, specifically, slower acquisition of literacy skills by boys compared to girls. Electronic books might serve to close this gender gap because it is believed that boys are generally less motivated to read but that boys are especially engaged by technology. However, interactive features in electronic books could further challenge boys' weak self-regulation skills, thus impeding their literacy achievement. Gender differences in literacy learning and the learning environment were examined in two studies conducted in French-language kindergartens.Method: Study 1 involved 56 girls and 36 boys, where the relationship between oral language precursors at school entry and literacy outcomes at the end of second grade was assessed. Study 2 included 43 girls and 44 boys, where interactions between children and an adult during shared reading exchanges with electronic books were coded to reveal gender-related differences in the learning environment.Result: In Study 1, the oral language and emergent literacy screener in first grade significantly predicted second grade spelling, with a significant gender gap in orthographic skills favouring girls in grade two despite similar oral language skills in grade one. In Study 2, adult readers were observed to re-direct boys' attention or regulate their behaviour more often during shared reading (when compared to girls).Conclusion: These findings suggest that self-regulation may mediate early reading precursors and different literacy outcomes by gender. Strategies to alleviate stress and improve the learning environment during literacy activities are suggested. Overall, it is clear that technology is neither beneficial nor harmful by itself; rather, synchronised interactions between adult, child and technological features are crucial. Furthermore, the broader social context in which teaching and learning interactions are embedded plays a role.

An N-of-1 Randomized Controlled Trial of Interventions for Children With Inconsistent Speech Sound Errors.

Purpose The aim of this study was to test the hypothesis that children with inconsistent speech errors would respond differentially to 1 of 3 specific interventions depending on their primary underlying impairment: Children with deficient motor planning were expected to respond best to an auditory-motor integration (AMI) intervention, and children with deficient phonological planning were expected to respond best to a phonological memory and planning (PMP) intervention. Method Twelve participants were diagnosed with a motor planning (n = 7) or phonological planning (n = 5) deficit based on a comprehensive assessment, which included the Syllable Repetition Task as an important source of diagnostic evidence. An N-of-1 randomized controlled trial was used. Each child experienced all 3 interventions: AMI, PMP, and control (CTL); however, these interventions were randomly allocated to sessions within weeks (3 sessions per week × 6 weeks for 18 sessions). The AMI intervention procedures targeted knowledge of the acoustic-phonetic target and integration of auditory and somatosensory feedback during speech practice. The PMP intervention procedures targeted segmenting and recompiling the phonological plan for each word. The CTL intervention was standard drill practice. The child was taught 5 pseudowords in a meaningful context in each intervention condition. Results Same-day (SD) probes assessed transfer from taught pseudowords to untaught real words, and next-day (ND) probes assessed retention of that learning. Nonparametric resampling tests with pooling of p values across children with the same diagnosis were used to assess the results. Pooled p values indicated a significant benefit of AMI over PMP for the group with a motor planning deficit (p = 2.01E-04 for SD probes and 2.97E-03 for ND probes) and a significant benefit of PMP over AMI for the group with a phonological planning deficit (p = 1.22E-02 for SD probes and 1.32E-02 for ND probes). Response to the CTL intervention was variable within groups. Conclusion In this study, the child's underlying psycholinguistic deficit helped to predict response to intervention.

Speech therapy in adolescents with Down syndrome: In pursuit of communication as a fundamental human right.

PURPOSE: The achievement of speech intelligibility by persons with Down syndrome facilitates their participation in society. Denial of speech therapy services by virtue of low cognitive skills is a violation of their fundamental human rights as proclaimed in the Universal Declaration of Human Rights in general and in Article 19 in particular. Here, we describe the differential response of an adolescent with Down syndrome to three speech therapy interventions and demonstrate the use of a single subject randomisation design to identify effective treatments for children with complex communication disorders. METHOD: Over six weeks, 18 speech therapy sessions were provided with treatment conditions randomly assigned to targets and sessions within weeks, specifically comparing auditory-motor integration prepractice and phonological planning prepractice to a control condition that included no prepractice. All treatments involved high intensity practice of nonsense word targets paired with tangible referents. RESULT: A measure of generalisation from taught words to untaught real words in phrases revealed superior learning in the auditory-motor integration condition. CONCLUSION: The intervention outcomes may serve to justify the provision of appropriate supports to persons with Down syndrome so that they may achieve their full potential to receive information and express themselves.

Demonstrating treatment efficacy using the single subject randomization design: A tutorial and demonstration.

Single case research refers to the broader category of research designs in which each case serves as his or her own control. A single subject randomization design is a specific form in which sessions are randomly allocated to treatment conditions within subjects. Two tutorials on the application of these designs are provided. In the single subject randomized phase design, baseline probes are administered repeatedly during a no-treatment or usual care phase; subsequently probes are administered repeatedly during the treatment phase of the experiment; the starting point for the treatment phase is determined by random selection. In the single subject randomized alternation design, any session can be randomly allocated to any treatment condition. In either case, the test statistic can be the mean of probe performance during the treatment sessions after subtracting the baseline mean. The significance of the obtained test statistic is determined by resampling test. Specifically, the obtained test statistic is interpreted relative to a distribution of test statistics generated by all possible random allocations. This distribution yields a P value which represents the probability of obtaining a test statistic as large as that obtained by the selected allocation. In addition to the tutorials, two experiments using these designs with a single 8-year-old participant with Childhood Apraxia of Speech are presented to demonstrate the utility of these designs and the application of the associated statistical analysis procedures.

Underlying manifestations of developmental phonological disorders in French-speaking pre-schoolers.

This study examined the psycholinguistic profiles of Quebec French-speaking children with developmental phonological disorders (DPD). The purpose was to determine whether the endophenotypes that have been identified in English-speaking children with DPD are similarly associated with speech impairment in French-speaking children. Seventy-two children with DPD and ten children with normally developing speech, aged four to six years, received a comprehensive assessment battery that included measures at the phenotype level (i.e. measures of overt speech production skills) and endophenotype level (i.e. measures of potential underlying core deficits such as phonological processing or oral motor impairments). The majority of the children with DPD presented with a psycholinguistic profile indicative of difficulties with phonological processing. Phonological processing skills also explained unique variance in speech production accuracy, indicating that French-speaking children with DPD, who produce different surface speech errors than English-speaking children with DPD, are nonetheless very similar with regards to their underlying psycholinguistic profile.

A Randomized Trial of 12-Week Interventions for the Treatment of Developmental Phonological Disorder in Francophone Children.

PURPOSE: This study was designed to test the relative efficacy of different combinations of intervention approaches when targeting speech production accuracy and phonological awareness skills. All children received individual speech therapy, a home program, and a small-group phonological awareness intervention. METHOD: Sixty-five 4-year-olds with a developmental phonological disorder received these intervention components in different combinations over 12 weeks, resulting in 4 groups: output-oriented individual intervention and articulation practice home program, output-oriented individual intervention and dialogic reading home program, input-oriented individual intervention and articulation practice home program, and input-oriented individual intervention and dialogic reading home program. RESULTS: A significant interaction of the individual treatment condition and the home program condition was observed for 2 outcome measures: targeted feature match (which reflected changes in speech production accuracy for features and word shape structures that were targeted in therapy) and explicit phonological awareness skills. CONCLUSION: In this context, in which the children received a brief period of direct therapy and a home program component provided sequentially, the most effective strategy was to teach the parents to use treatment procedures at home that were congruent with the direct therapy component.

Monolingual or bilingual intervention for primary language impairment? A randomized control trial.

PURPOSE: This study investigated the clinical effectiveness of monolingual versus bilingual language intervention, the latter involving speech-language pathologist-parent collaboration. The study focuses on methods that are currently being recommended and that are feasible within current clinical contexts. METHOD: Bilingual children with primary language impairment who speak a minority language as their home language and French as their second (n=29, mean age=5 years) were randomly assigned to monolingual treatment, bilingual treatment, and no-treatment (delayed-treatment) conditions. Sixteen sessions of individual language intervention were offered, targeting vocabulary and syntactic skills in French only or bilingually, through parent collaboration during the clinical sessions. Language evaluations were conducted before and after treatment by blinded examiners; these evaluations targeted French as well as the home languages. An additional evaluation was conducted 2 months after completion of treatment to assess maintenance of gains. Both monolingual and bilingual treatment followed a focused stimulation approach. RESULTS: Results in French showed a significant treatment effect for vocabulary but no difference between treatment conditions. Gains were made in syntax, but these gains could not be attributed to treatment given that treatment groups did not improve more than the control group. Home language probes did not suggest that the therapy had resulted in gains in the home language. CONCLUSIONS: The intervention used in this study is in line with current recommendations of major speech-language pathology organizations. However, the findings indicate that the bilingual treatment created through collaboration with parents was not effective in creating a sufficiently intense bilingual context to make it significantly different from the monolingual treatment. Further studies are needed to assess the gains associated with clinical modifications made for bilingual children and to search for effective ways to accommodate their unique needs.

Cross-linguistic comparison of speech errors produced by English- and French-speaking preschool-age children with developmental phonological disorders.

Twenty-four French-speaking children with developmental phonological disorders (DPD) were matched on percentage of consonants correct (PCC)-conversation, age, and receptive vocabulary measures to English-speaking children with DPD in order to describe how speech errors are manifested differently in these two languages. The participants' productions of consonants on a single-word test of articulation were compared in terms of feature-match ratios for the production of target consonants, and type of errors produced. Results revealed that the French-speaking children had significantly lower match ratios for the major sound class features [+ consonantal] and [+ sonorant]. The French-speaking children also obtained significantly lower match ratios for [+ voice]. The most frequent type of errors produced by the French-speaking children was syllable structure errors, followed by segment errors, and a few distortion errors. On the other hand, the English-speaking children made more segment than syllable structure and distortion errors. The results of the study highlight the need to use test instruments with French-speaking children that reflect the phonological characteristics of French at multiple levels of the phonological hierarchy.

Speech articulation performance of francophone children in the early school years: norming of the Test de Dépistage Francophone de Phonologie.

Good quality normative data are essential for clinical practice in speech-language pathology but are largely lacking for French-speaking children. We investigated speech production accuracy by French-speaking children attending kindergarten (maternelle) and first grade (première année). The study aimed to provide normative data for a new screening test - the Test de Dépistage Francophone de Phonologie. Sixty-one children named 30 pictures depicting words selected to be representative of the distribution of phonemes, syllable shapes and word lengths characteristic of Québec French. Percent consonants' correct was approximately 90% and did not change significantly with age although younger children produced significantly more syllable structure errors than older children. Given that the word set reflects the segmental and prosodic characteristics of spoken Québec French, and that ceiling effects were not observed, these results further indicate that phonological development is not complete by the age of seven years in French-speaking children.

The impact of bilingual language learning on whole-word complexity and segmental accuracy among children aged 18 and 36 months.

This study investigates the phonological acquisition of 19 monolingual English children and 21 English?French bilingual children at 18 and 36 months. It contributes to the understanding of age-related changes to phonological complexity and to differences due to bilingual language development. In addition, preliminary normative data is presented for English children and English?French bilingual children. Five measures were targeted to represent a range of indices of phonological development: the phonological mean length of utterance (pMLU) of the adult target, the pMLU produced by the child, the proportion of whole-word proximity (PWP), proportion of consonants correct (PCC), and proportion of whole words correct (PWC). The measures of children's productions showed improvements from 18 to 36 months; however, the rate of change varied across the measures, with PWP improving faster, then PCC, and finally PWC. The results indicated that bilingual children can keep pace with their monolingual peers at both 18 months and 36 months of age, at least in their dominant language. Based on these findings, discrepancies with monolingual phonological development that one might observe in a bilingual child's non-dominant language could be explained by reduced exposure to the language rather than a general slower acquisition of phonology.

Auditory-motor learning during speech production in 9-11-year-old children.

BACKGROUND: Hearing ability is essential for normal speech development, however the precise mechanisms linking auditory input and the improvement of speaking ability remain poorly understood. Auditory feedback during speech production is believed to play a critical role by providing the nervous system with information about speech outcomes that is used to learn and subsequently fine-tune speech motor output. Surprisingly, few studies have directly investigated such auditory-motor learning in the speech production of typically developing children. METHODOLOGY/PRINCIPAL FINDINGS: In the present study, we manipulated auditory feedback during speech production in a group of 9-11-year old children, as well as in adults. Following a period of speech practice under conditions of altered auditory feedback, compensatory changes in speech production and perception were examined. Consistent with prior studies, the adults exhibited compensatory changes in both their speech motor output and their perceptual representations of speech sound categories. The children exhibited compensatory changes in the motor domain, with a change in speech output that was similar in magnitude to that of the adults, however the children showed no reliable compensatory effect on their perceptual representations. CONCLUSIONS: The results indicate that 9-11-year-old children, whose speech motor and perceptual abilities are still not fully developed, are nonetheless capable of auditory-feedback-based sensorimotor adaptation, supporting a role for such learning processes in speech motor development. Auditory feedback may play a more limited role, however, in the fine-tuning of children's perceptual representations of speech sound categories.

The first steps in word learning are easier when the shoes fit: comparing monolingual and bilingual infants.

English, French, and bilingual English-French 17-month-old infants were compared for their performance on a word learning task using the Switch task. Object names presented a /b/ vs. /g/ contrast that is phonemic in both English and French, and auditory strings comprised English and French pronunciations by an adult bilingual. Infants were habituated to two novel objects labeled 'bowce' or 'gowce' and were then presented with a switch trial where a familiar word and familiar object were paired in a novel combination, and a same trial with a familiar word-object pairing. Bilingual infants looked significantly longer to switch vs. same trials, but English and French monolinguals did not, suggesting that bilingual infants can learn word-object associations when the phonetic conditions favor their input. Monolingual infants likely failed because the bilingual mode of presentation increased phonetic variability and did not match their real-world input. Experiment 2 tested this hypothesis by presenting monolingual infants with nonce word tokens restricted to native language pronunciations. Monolinguals succeeded in this case. Experiment 3 revealed that the presence of unfamiliar pronunciations in Experiment 2, rather than a reduction in overall phonetic variability was the key factor to success, as French infants failed when tested with English pronunciations of the nonce words. Thus phonetic variability impacts how infants perform in the switch task in ways that contribute to differences in monolingual and bilingual performance. Moreover, both monolinguals and bilinguals are developing adaptive speech processing skills that are specific to the language(s) they are learning.

Clinical implications of dynamic systems theory for phonological development.

PURPOSE: To examine treatment outcomes in relation to the complexity of treatment goals for children with speech sound disorders. METHOD: The clinical implications of dynamic systems theory in contrast with learnability theory are discussed, especially in the context of target selection decisions for children with speech sound disorders. Detailed phonological analyses of pre-and posttreatment speech samples are provided for 6 children who received treatment in a previously published randomized controlled trial of contrasting approaches to target selection (Rvachew & Nowak, 2001). Three children received treatment for simple target phonemes that did not introduce any new feature contrasts into the children's phonological systems. Three children received treatment for complex targets that represented feature contrasts that were absent from the children's phonological systems. RESULTS: Children who received treatment for simple targets made more progress toward the acquisition of the target sounds and demonstrated emergence of complex untreated segments and feature contrasts. Children who received treatment for complex targets made little measurable gain in phonological development. CONCLUSIONS: Treatment outcomes will be enhanced if the clinician selects treatment targets at the segmental and prosodic levels of the phonological system in such a way as to stabilize the child's knowledge of subcomponents that form the foundation for the emergence of more complex phoneme contrasts.

A longitudinal investigation of morpho-syntax in children with Speech Sound Disorders.

PURPOSE: The intent of this study was to examine the longitudinal morpho-syntactic progression of children with Speech Sound Disorders (SSD) grouped according to Mean Length of Utterance (MLU) scores. METHODS: Thirty-seven children separated into four clusters were assessed in their pre-kindergarten and Grade 1 years. Cluster 1 were children with typical development; the other clusters were children with SSD. Cluster 2 had good pre-kindergarten MLU; Clusters 3 and 4 had low MLU scores in pre-kindergarten, and (respectively) good and poor MLU outcomes. RESULTS: Children with SSD in pre-kindergarten had lower Developmental Sentence Scores (DSS) and made fewer attempts at finite embedded clauses than children with typical development. All children with SSD, especially Cluster 4, had difficulty with finite verb morphology. CONCLUSIONS: Children with SSD and typical MLU may be weak in some areas of syntax. Children with SSD who have low MLU scores and poor finite verb morphology skills in pre-kindergarten may be at risk for poor expressive language outcomes. However, these results need to be replicated with larger groups. LEARNING OUTCOMES: The reader should (1) have a general understanding of findings from studies on morpho-syntax and SSD conducted over the last half century (2) be aware of some potential areas of morpho-syntactic weakness in young children with SSD who nonetheless have typical MLU, and (3) be aware of some potential longitudinal predictors of continued language difficulty in young children with SSD and poor MLU.

Morphosyntax and phonological awareness in children with speech sound disorders.

The goals of the current study were to examine concurrent and longitudinal relationships of expressive morphosyntax and phonological awareness in a group of children with speech sound disorders. Tests of phonological awareness were administered to 38 children at the end of their prekindergarten and kindergarten years. Speech samples were elicited and analyzed to obtain a set of expressive morphosyntax variables. Finite verb morphology and inflectional suffix use by prekindergarten children were found to predict significant unique variance in change in phonological awareness a year later. These results are consistent with previous research showing finite verb morphology to be a sensitive indicator of language impairment in English.

Phonological processing and reading in children with speech sound disorders.

PURPOSE: To examine the relationship between phonological processing skills prior to kindergarten entry and reading skills at the end of 1st grade, in children with speech sound disorders (SSD). METHOD: The participants were 17 children with SSD and poor phonological processing skills (SSD-low PP), 16 children with SSD and good phonological processing skills (SSD-high PP), and 35 children with typical speech who were first assessed during their prekindergarten year using measures of phonological processing (i.e., speech perception, rime awareness, and onset awareness tests), speech production, receptive and expressive language, and phonological awareness skills. This assessment was repeated when the children were completing 1st grade. The Test of Word Reading Efficiency was also conducted at that time. First-grade sight word and nonword reading performance was compared across these groups. RESULTS: At the end of 1st grade, the SSD-low PP group achieved significantly lower nonword decoding scores than the SSD-high PP and typical speech groups. The 2 SSD groups demonstrated similarly good receptive language skills and similarly poor articulation skills at that time, however. No between-group differences in sight word reading were observed. All but 1 child (in the SSD-low PP group) obtained reading scores that were within normal limits. CONCLUSION: Weaknesses in phonological processing were stable for the SSD-low PP subgroup over a 2-year period.

Characteristics of speech errors produced by children with and without delayed phonological awareness skills.

PURPOSE: The purpose of this study was to examine the relationship between the types of speech errors that are produced by children with speech-sound disorders and the children's phonological awareness skills during their prekindergarten and kindergarten years. METHOD: Fifty-eight children with speech-sound disorders were assessed during the spring of their prekindergarten year and then again at the end of their kindergarten year. The children's responses on the Goldman-Fristoe Test of Articulation (R. Goldman & M. Fristoe, 2000) were described in terms of match ratios for the features of each target sound and the type of error produced. Match ratios and error type frequencies were then examined as a function of the child's performance on a test of phonological awareness. RESULTS: Lower match ratios for +distributed and higher frequencies of typical syllable structure errors and atypical segment errors were associated with poorer phonological awareness test performance. However, no aspect of the children's error patterns proved to be a reliable indicator of which individual child would pass or fail the test. The best predictor of test performance at the end of the kindergarten year was test performance 1 year earlier. Children who achieved age-appropriate articulation skills by the end of kindergarten also achieved age-appropriate phonological awareness skills. CONCLUSION: Children who enter kindergarten with delayed articulation skills should be monitored to ensure age-appropriate acquisition of phonological awareness and literacy skills.

Developmental and cross-linguistic variation in the infant vowel space: the case of Canadian English and Canadian French.

This article describes the results of two experiments. Experiment 1 was a cross-sectional study designed to explore developmental and cross-linguistic variation in the vowel space of 10- to 18-month-old infants, exposed to either Canadian English or Canadian French. Acoustic parameters of the infant vowel space were described (specifically the mean and standard deviation of the first and second formant frequencies) and then used to derive the grave, acute, compact, and diffuse features of the vowel space across age. A decline in mean F1 with age for French-learning infants and a decline in mean F2 with age for English-learning infants was observed. A developmental expansion of the vowel space into the high-front and high-back regions was also evident. In experiment 2, the Variable Linear Articulatory Model was used to model the infant vowel space taking into consideration vocal tract size and morphology. Two simulations were performed, one with full range of movement for all articulatory paramenters, and the other for movement of jaw and lip parameters only. These simulated vowel spaces were used to aid in the interpretation of the developmental changes and cross-linguistic influences on vowel production in experiment 1.