Parents' and Students' Perceptions of Telepractice Services for Speech-Language Therapy During the COVID-19 Pandemic: Survey Study.

BACKGROUND: The ongoing COVID-19 pandemic has resulted in the suspension of face-to-face classes and a considerable increase in the use of telepractice services in speech-language pathology. However, little is known about parents' and students' satisfaction with telepractice services and their preferences for different service delivery modes. These factors may affect therapy effectiveness and the future adoption of telepractice. OBJECTIVE: We evaluated students' and parents' perceptions of telepractice efficacy and their preferences for different service delivery modes (ie, on-site practice vs telepractice). We also identified factors that affect parents' and students' preferences for different service delivery modes during the COVID-19 pandemic. METHODS: A 19-question survey on telepractice satisfaction and preferences was administered to 41 Hong Kong Chinese students and 85 parents who received telepractice services from school-based speech-language pathologists during the COVID-19 class suspension period. In addition to providing demographic information and data on the implementation of telepractice services, all participants were asked to rate their perceptions of the efficacy of telepractice services and compare on-site practices to telepractice on a 5-point Likert scale (ie, 1=strongly disagree/prefer the use of on-site speech-language therapy services and 5=strongly agree/prefer the use of telepractice services). RESULTS: Despite the fact that telepractice efficacy was highly rated by parents (95% CI 3.30-3.66) and students (95% CI 3.21-3.76), both groups believed that telepractice was less effective than on-site practices (parents: 95% CI 2.14-2.52; students: 95% CI 2.08-2.65). Moreover, parents preferred on-site practices over telepractice (95% CI 2.04-2.43), whereas students did not prefer one mode of practice over the other (95% CI 2.74-3.41). A significant association between telepractice efficacy and a preference for telepractice services was found only among the students (τ=.43, P<.001), not the parents (τ=.07; P=.44). CONCLUSIONS: Although telepractice is an acceptable alternative service delivery option for providing speech and language therapy services to school-aged individuals, speech-language therapists and parents must play a more proactive role in telepractice services to facilitate effective communication between clinicians and parents.

Visual mismatch negativity elicited by semantic violations in visual words.

The remarkable rapidity and effortlessness of speech perception and word reading by skilled listeners or readers suggest implicit or automatic mechanisms underlying language processing. In speech perception, the implicit mechanisms are reflected by the auditory mismatch negativity (MMN) response, suggesting that phonemic, lexical, semantic, and syntactic information are automatically and rapidly processed in the absence of focused attention. In visual word reading, implicit orthographic and lexical processing are reflected by visual mismatch negativity (vMMN), the visual counterpart of auditory MMN. The semantic processing of spoken words is reflected by MMN. This study investigated whether semantic processing is also reflected by vMMN. For this purpose, visual Chinese words belonging to different semantic categories (color, taste, and action) were presented to participants in oddball paradigms. A set of words belonging to the same semantic category was frequently presented as standards; a word belonging to a different semantic category was presented sporadically as deviant. Participants were instructed to perform a visual cross-change detection task and ignore the words. Significant vMMN was elicited in Experiments 1 to 3, in which the deviant word carried a semantic radical that overtly indicated the word's semantic category information. The vMMNs were most prominent around 260 ms after word onset, were parieto-occipital distributed, and were significantly left-hemisphere lateralized, suggesting rapid semantic processing of the visual words' category-related information. No significant vMMN was elicited in Experiment 4, in which the deviant word did not carry any semantic radicals. Thus, the semantic radical, which has a high frequency of occurrence because it is carried by many words, may be critical for the elicitation of vMMN.

Spelling in developmental dyslexia in Chinese: Evidence of deficits in statistical learning and over-reliance on phonology.

This study employed a multi-dimensional (i.e., orthographic, phonological, and semantic) and bi-level (i.e., character and radical) approach to analyze the character writing of 120 Hong Kong Chinese children with developmental dyslexia in Grades 2-5 and 120 typically developing age-matched controls. Relative to their typically developing peers, children with dyslexia were less sensitive to the positional and functional consistencies of sublexical radicals and exhibited prolonged use of phonology at the character level as grade-level advanced. Furthermore, the children with dyslexia relatively relied more on phonology at the radical level than younger, reading level-matched children. These results indicate the effects of implicit statistical learning on the development of Chinese character writing skills and suggest that the prolonged use and overreliance on phonology in character writing by Chinese children with dyslexia may reflect their difficulties in implicit statistical learning.

Advantage in Character Recognition Among Chinese Preschool Children with Autism Spectrum Disorder.

This study examined Chinese character recognition and its cognitive and linguistic correlates in preschool children with autism spectrum disorder (ASD). Forty-seven children with ASD and 51 IQ-matched typically developing (TD) children were tested on Chinese character recognition, rapid automatized naming, inhibitory control, digit span, IQ, vocabulary, phonological awareness, morphological awareness, and listening comprehension. Chinese children with ASD showed strong character recognition skills. Unlike TD children's character recognition, which was correlated with all the measured cognitive and linguistic skills, character recognition of children with ASD was only significantly correlated with rapid automatized naming, inhibitory control, and phonological awareness. Our findings suggest that phonological awareness and rapid automatized naming may serve as important predictors for possible advantage in emergent literacy acquisition in Chinese children with ASD.

Visual statistical learning and orthographic awareness in Chinese children with and without developmental dyslexia.

This study examined the role of visual statistical learning in reading and writing and its relationship to orthographic awareness in Hong Kong Chinese children with and without developmental dyslexia. Thirty-five 7- to 8-year-old children with developmental dyslexia and 37 chronologically age-matched controls were tested on visual statistical learning, orthographic awareness, nonverbal cognitive ability, Chinese word reading, and word dictation tasks. Visual statistical learning was assessed using a triplet learning paradigm that required children to detect the temporal order of visual stimuli. Orthographic awareness was measured with a novel character invention task that required children to create pseudocharacters using untaught stroke patterns according to the rules of Chinese character orthography. Children with dyslexia performed significantly worse than their age-matched controls on both the visual statistical learning and orthographic awareness tasks. Furthermore, visual statistical learning was significantly associated with orthographic awareness and word reading. These findings suggest that Chinese children with dyslexia are impaired in visual statistical learning and that such deficits may be related to disrupted orthographic learning abilities, thereby contributing to their reading difficulties.

A lateral inhibition mechanism explains the dissociation between mismatch negativity and behavioral pitch discrimination.

Although mismatch negativity (MMN), a change-specific component of auditory event-related potential, is considered to be an index of sound discrimination accuracy, the amplitude of the MMN responses elicited by pitch height deviations in musicians and tone language speakers with superior pitch discrimination is usually not enhanced compared to that elicited in individuals with inferior pitch discrimination. We hypothesized that superior pitch discrimination is accompanied by enhanced lateral inhibition, a critical neural mechanism that sharpens the tuning curves of the auditory neurons in the tonotopy. Forty Mandarin-speaking healthy adults completed an auditory EEG experiment in which MMN was elicited by pitch height deviations in both pure and harmonic tones. Their behavioral pitch discrimination was indexed by the difference limens measured using pure and harmonic tones. Behavioral pitch discrimination correlated significantly with the MMN elicited by pure tones, but not by harmonic tones; this could be due to lateral inhibition strongly influencing the MMN elicited by harmonic tones but having less effect on the MMN elicited by pure tones. As lateral inhibition is a neural mechanism for attenuating the amplitude of MMN, our results support the notion that an enhanced lateral inhibition mechanism underlies superior pitch discrimination.

From Cantonese Lexical Tone Awareness to Second Language English Vocabulary: Cross-Language Mediation by Segmental Phonological Awareness.

Purpose Cantonese lexical tone awareness is closely associated with 1st language Cantonese vocabulary knowledge, but its role in 2nd language English vocabulary knowledge was unclear. We addressed this issue by investigating whether and, if so, how Cantonese lexical tone awareness contributes to English expressive vocabulary knowledge in Hong Kong Cantonese-English bilingual children. Method A sample of 112 Hong Kong Cantonese-English bilingual 2nd graders were tested on Cantonese lexical tone awareness, English lexical stress sensitivity, Cantonese- English segmental phonological awareness, and both Cantonese and English expressive vocabulary knowledge. Results Structural equation modeling analyses revealed that Cantonese lexical tone awareness contributed indirectly to English expressive vocabulary knowledge through English lexical stress sensitivity and Cantonese-English segmental phonological awareness. Conclusion These results demonstrate the role of Cantonese lexical tone awareness in Cantonese-English bilingual children's English vocabulary knowledge. This also underscores the importance of 1st language suprasegmental phonological awareness in 2nd language expressive vocabulary knowledge.

Bidirectional Cross-Linguistic Association of Phonological Skills and Reading Comprehension: Evidence From Hong Kong Chinese-English Bilingual Readers.

This study examined the roles of first-language (L1) Chinese and second-language (L2) English phonological skills in English and Chinese reading comprehension, respectively, and their association with reading comprehension difficulties among Hong Kong Chinese-English bilingual children. We tested 258 second graders on nonverbal intelligence, working memory, phonological skills, word reading, and reading comprehension, in both Chinese and English. Structural equation modeling analyses revealed that Chinese phonological skills contributed to English reading comprehension both directly and indirectly, through the mediation of English phonological skills and English word reading. In contrast, English phonological skills contributed only indirectly to Chinese reading comprehension through L1 Chinese phonological and word reading skills. Furthermore, poor Chinese readers, poor English readers, and poor readers in both Chinese and English exhibited lower levels of lexical tone awareness than average readers, even after controlling for nonverbal intelligence, word reading, and working memory. Poor Chinese readers outperformed poor English readers and poor readers in both Chinese and English on Chinese segmental phonological awareness, and their performance was comparable to average readers. These findings suggest that both suprasegmental and segmental phonological skills are critical to the development of reading comprehension across L1 Chinese and L2 English in Hong Kong Chinese-English bilingual children.

Better than native: Tone language experience enhances English lexical stress discrimination in Cantonese-English bilingual listeners.

While many second language (L2) listeners are known to struggle when discriminating non-native features absent in their first language (L1), no study has reported that L2 listeners perform better than native listeners in this regard. The present study tested whether Cantonese-English bilinguals were better in discriminating English lexical stress in individual words or pseudowords than native English listeners, even though lexical stress is absent in Cantonese. In experiments manipulating acoustic, phonotactic, and lexical cues, Cantonese-English bilingual adults exhibited superior performance in discriminating English lexical stress than native English listeners across all phonotactic/lexical conditions when the fundamental frequency (f0) cue to lexical stress was present. The findings underscore the facilitative effect of Cantonese tone language experience on English lexical stress discrimination.

Learning to read in Chinese: Evidence for reciprocal relationships between word reading and oral language skills.

This study investigates the longitudinal predictors of the development of Chinese word reading skills and potential bidirectional relationships between Chinese word reading and oral language skills. We examine, in a 2-year longitudinal study, a wide range of theoretically important predictors (phonological awareness, tone awareness, morphological awareness, visual skills, rapid automatized naming, Pinyin knowledge, and vocabulary knowledge) of reading in 143 primary-school children living in mainland China. Initial levels of reading were predicted by vocabulary knowledge, phonological awareness, and visual discrimination skills. Only initial reading levels predicted growth in reading. Initial reading also predicted growth in vocabulary knowledge and morphological construction. This pattern demonstrates that the early stages of learning to read in Chinese places demands on semantic (vocabulary) and visual skills in addition to phonological skills. Furthermore, early levels of word reading predict the growth of vocabulary knowledge and morphological awareness suggesting that the development of these oral language skills is facilitated by learning to read.

Tone language experience modulates the effect of long-term musical training on musical pitch perception.

Long-term musical training is widely reported to enhance music pitch perception. However, it remains unclear whether tone language experience influences the effect of long-term musical training on musical pitch perception. The present study addressed this question by testing 30 Cantonese and 30 non-tonal language speakers, each divided equally into musician and non-musician groups, on pitch height and pitch interval discrimination. Musicians outperformed non-musicians among non-tonal language speakers, but not among Cantonese speakers on the pitch height discrimination task. However, musicians outperformed non-musicians among Cantonese speakers, but not among non-tonal language speakers on the pitch interval discrimination task. These results suggest that the effect of long-term musical training on musical pitch perception is shaped by tone language experience and varies across different pitch perception tasks.

Toward a Graded Psycholexical Space Mapping Model: Sublexical and Lexical Representations in Chinese Character Reading Development.

Following a review of contemporary models of word-level processing for reading and their limitations, we propose a new hypothetical model of Chinese character reading, namely, the graded lexical space mapping model that characterizes how sublexical radicals and lexical information are involved in Chinese character reading development. The underlying assumption of this model is that Chinese character recognition is a process of competitive mappings of phonology, semantics, and orthography in both lexical and sublexical systems, operating as functions of statistical properties of print input based on the individual's specific level of reading. This model leads to several testable predictions concerning how the quasiregularity and continuity of Chinese-specific radicals are organized in memory for both child and adult readers at different developmental stages of reading.

Beyond Auditory Sensory Processing Deficits: Lexical Tone Perception Deficits in Chinese Children With Developmental Dyslexia.

Increasing evidence suggests that children with developmental dyslexia exhibit a deficit not only at the segmental level of phonological processing but also, by extension, at the suprasegmental level. However, it remains unclear whether such a suprasegmental phonological processing deficit is due to a difficulty in processing acoustic cues of speech rhythm, such as rise time and intensity. This study set out to investigate to what extent suprasegmental phonological processing (i.e., Cantonese lexical tone perception) and rise time sensitivity could distinguish Chinese children with dyslexia from typically developing children. Sixteen children with dyslexia and 44 age-matched controls were administered a Cantonese lexical tone perception task, psychoacoustic tasks, a nonverbal reasoning ability task, and word reading and dictation tasks. Children with dyslexia performed worse than controls on Cantonese lexical tone perception, rise time, and intensity. Furthermore, Cantonese lexical tone perception appeared to be a stable indicator that distinguishes children with dyslexia from controls, even after controlling for basic auditory processing skills. These findings suggest that suprasegmental phonological processing (i.e., lexical tone perception) is a potential factor that accounts for reading difficulty in Chinese.

From Lexical Tone to Lexical Stress: A Cross-Language Mediation Model for Cantonese Children Learning English as a Second Language.

This study investigated how Cantonese lexical tone sensitivity contributed to English lexical stress sensitivity among Cantonese children who learned English as a second language (ESL). Five-hundred-and-sixteen second-to-third grade Cantonese ESL children were tested on their Cantonese lexical tone sensitivity, English lexical stress sensitivity, general auditory sensitivity, and working memory. Structural equation modeling revealed that Cantonese lexical tone sensitivity contributed to English lexical stress sensitivity both directly, and indirectly through the mediation of general auditory sensitivity, in which the direct pathway had a larger relative contribution to English lexical stress sensitivity than the indirect pathway. These results suggest that the tone-stress association might be accounted for by joint phonological and acoustic processes that underlie lexical tone and lexical stress perception.

Tone matters for Cantonese-English bilingual children's English word reading development: A unified model of phonological transfer.

Languages differ considerably in how they use prosodic features, or variations in pitch, duration, and intensity, to distinguish one word from another. Prosodic features include lexical tone in Chinese and lexical stress in English. Recent cross-sectional studies show a surprising result that Mandarin Chinese tone sensitivity is related to Mandarin-English bilingual children's English word reading. This study explores the mechanism underlying this relation by testing two explanations of these effects: the prosodic hypothesis and segmental phonological awareness transfer. We administered multiple measures of Cantonese tone sensitivity, English stress sensitivity, segmental phonological awareness in Cantonese and English, nonverbal ability, and English word reading to 123 Cantonese-English bilingual children ages 7 and 8 years. Structural equation modeling revealed a longitudinal prediction of Cantonese tone sensitivity to English word reading between 8 and 9 years of age. This relation was realized through two parallel routes. In one, Cantonese tone sensitivity predicted English stress sensitivity, and English stress sensitivity, in turn, significantly predicted English word reading, as postulated by the prosodic hypothesis. In the second, Cantonese tone sensitivity predicted English word reading through the transfer of segmental phonological awareness between Cantonese and English, as predicted by segmental phonological transfer. These results support a unified model of phonological transfer, emphasizing the role of tone in English word reading for Cantonese-English bilingual children.

Lexical prosody beyond first-language boundary: Chinese lexical tone sensitivity predicts English reading comprehension.

This 1-year longitudinal study examined the role of Cantonese lexical tone sensitivity in predicting English reading comprehension and the pathways underlying their relation. Multiple measures of Cantonese lexical tone sensitivity, English lexical stress sensitivity, Cantonese segmental phonological awareness, general auditory sensitivity, English word reading, and English reading comprehension were administered to 133 Cantonese-English unbalanced bilingual second graders. Structural equation modeling analysis identified transfer of Cantonese lexical tone sensitivity to English reading comprehension. This transfer was realized through a direct pathway via English stress sensitivity and also an indirect pathway via English word reading. These results suggest that prosodic sensitivity is an important factor influencing English reading comprehension and that it needs to be incorporated into theoretical accounts of reading comprehension across languages.

A Tale of Two Features: Perception of Cantonese Lexical Tone and English Lexical Stress in Cantonese-English Bilinguals.

This study investigated the similarities and differences in perception of Cantonese tones and English stress patterns by Cantonese-English bilingual children, adults, and English monolingual adults. All three groups were asked to discriminate pairs of syllables that minimally differed in either Cantonese tone or in English stress. Bilingual children's performance on tone perception was comparable to their performance on stress perception. By contrast, bilingual adults' performance on tone perception was lower than their performance on stress perception, and there was a similar pattern in English monolingual adults. Bilingual adults tended to perform better than English monolingual adults on both the tone and stress perception tests. A significant correlation between tone perception and stress perception performance was found in bilingual children but not in bilingual adults. All three groups showed lower accuracy in the high rising-low rising contrast than any of the other 14 Cantonese tone contrasts. The acoustic analyses revealed that average F0, F0 onset, and F0 major slope were the critical acoustic correlates of Cantonese tones, whereas multiple acoustic correlates were salient in English stress, including average F0, spectral balance, duration and intensity. We argue that participants' difficulty in perceiving high rising-low rising contrasts originated from the contrasts' similarities in F0 onset and average F0; indeed the difference between their major slopes was the only cue with which to distinguish them. Acoustic-perceptual correlation analyses showed that although the average F0 and F0 onset were associated with tone perception performance in all three groups, F0 major slope was only associated with tone perception in the bilingual adult group. These results support a dynamic interactive account of suprasegmental speech perception by emphasizing the positive prosodic transfer between Cantonese tone and English stress, and the role that level of bilingual language experience and age play in shaping suprasegmental speech perception.

Tune in to the Tone: Lexical Tone Identification is Associated with Vocabulary and Word Recognition Abilities in Young Chinese Children.

Lexical tone is one of the most prominent features in the phonological representation of words in Chinese. However, little, if any, research to date has directly evaluated how young Chinese children's lexical tone identification skills contribute to vocabulary acquisition and character recognition. The present study distinguished lexical tones from segmental phonological awareness and morphological awareness in order to estimate the unique contribution of lexical tone in early vocabulary acquisition and character recognition. A sample of 199 Cantonese children aged 5-6 years was assessed on measures of lexical tone identification, segmental phonological awareness, morphological awareness, nonverbal ability, vocabulary knowledge, and Chinese character recognition. It was found that lexical tone awareness and morphological awareness were both associated with vocabulary knowledge and character recognition. However, there was a significant relationship between lexical tone awareness and both vocabulary knowledge and character recognition, even after controlling for the effects of age, nonverbal ability, segmental phonological awareness and morphological awareness. These findings suggest that lexical tone is a key factor accounting for individual variance in young children's lexical acquisition in Chinese, and that lexical tone should be considered in understanding how children learn new Chinese vocabulary words, in either oral or written forms.

A tale of two writing systems: double dissociation and metalinguistic transfer between Chinese and English word reading among Hong Kong children.

This study investigated the rate of school-aged Chinese-English language learners at risk for reading difficulties in either Chinese or English only, or both, among second and fifth graders in Hong Kong. In addition, we examined the metalinguistic skills that distinguished those who were poor in reading Chinese from those who were poor in reading English. The prevalence of poor English readers among children identified to be poor in Chinese word recognition across the five participating schools was approximately 42% at Grade 2 and 57% at Grade 5. Across grades, children who were poor readers of both languages tended to have difficulties in phonological and morphological awareness. Poor readers of English only were found to manifest significantly poorer phonological awareness, compared to those who were poor readers of Chinese only; their average tone awareness score was also lower relative to normally developing controls. Apart from indicating possible dissociations between Chinese first language (L1) word reading and English second language (L2) word reading, these findings suggested that the degree to which different metalinguistic skills are important for reading in different writing systems may depend on the linguistic features of the particular writing system.

Neural correlates of acoustic cues of English lexical stress in Cantonese-speaking children.

The present study investigated the temporal course of neural discriminations of acoustic cues of English lexical stress (i.e., pitch, intensity and duration) in Cantonese-speaking children. We used an event-related potential (ERP) measure with a multiple-deviant oddball paradigm to record auditory mismatch responses to four deviants, namely, a change in pitch, intensity, or duration, or a change in all three acoustic dimensions, of English lexical stress in familiar words. In the time window of 170-270 ms, we found that the pitch deviant elicited significant positive mismatch responses (p-MMRs) and that the duration deviant elicited a mismatch negativity (MMN) response as compared with the standard. In the time window of 270-400 ms, the intensity deviant elicited a significant p-MMR, whereas both the duration and the three-dimension changed deviants elicited significant MMNs. These results suggest that Cantonese-speaking children are sensitive to either single or convergent acoustic cues of English words, and that the relative weighting of pitch, intensity and duration in stress processing may correlate with different ERP components at different time windows in Cantonese second graders.