Childhood Speech Sound Disorders Research Articles

Bilingual Myth-Busters Series Language Confusion in Bilingual Children

This article is the first in a series that will attempt to deconstruct myths about bilingualism. Language confusion is the popularly held belief (or myth) that children are incapable of becoming bi...

Phonological and articulation treatment approaches in Portuguese children with speech and language impairments: a randomized controlled intervention study

In Portugal, the routine clinical practice of speech and language therapists (SLTs) in treating children with all types of speech sound disorder (SSD) continues to be articulation therapy (AT). There is limited use of phonological therapy (PT) or phonological awareness training in Portugal. Additionally, at an international level there is a focus on collecting information on and differentiating between the effectiveness of PT and AT for children with different types of phonologically based SSD, as well as on the role of phonological awareness in remediating SSD. It is important to collect more evidence for the most effective and efficient type of intervention approach for different SSDs and for these data to be collected from diverse linguistic and cultural perspectives. To evaluate the effectiveness of a PT and AT approach for treatment of 14 Portuguese children, aged 4.0-6.7 years, with a phonologically based SSD. The children were randomly assigned to one of the two treatment approaches (seven children in each group). All children were treated by the same SLT, blind to the aims of the study, over three blocks of a total of 25 weekly sessions of intervention. Outcome measures of phonological ability (percentage of consonants correct (PCC), percentage occurrence of different phonological processes and phonetic inventory) were taken before and after intervention. A qualitative assessment of intervention effectiveness from the perspective of the parents of participants was included. Both treatments were effective in improving the participants' speech, with the children receiving PT showing a more significant improvement in PCC score than those receiving the AT. Children in the PT group also showed greater generalization to untreated words than those receiving AT. Parents reported both intervention approaches to be as effective in improving their children's speech. The PT (combination of expressive phonological tasks, phonological awareness, listening and discrimination activities) proved to be an effective integrated method of improving phonological SSD in children. These findings provide some evidence for Portuguese SLTs to employ PT with children with phonologically based SSD.

How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems

Children with speech sound disorders (SSD) form a heterogeneous group who differ in terms of the severity of their condition, underlying cause, speech errors, involvement of other aspects of the linguistic system and treatment response. To date there is no universal and agreed-upon classification system. Instead, a number of theoretically differing classification systems have been proposed based on either an aetiological (medical) approach, a descriptive-linguistic approach or a processing approach. To describe and review the supporting evidence, and to provide a critical evaluation of the current childhood SSD classification systems. Descriptions of the major specific approaches to classification are reviewed and research papers supporting the reliability and validity of the systems are evaluated. Three specific paediatric SSD classification systems; the aetiologic-based Speech Disorders Classification System, the descriptive-linguistic Differential Diagnosis system, and the processing-based Psycholinguistic Framework are identified as potentially useful in classifying children with SSD into homogeneous subgroups. The Differential Diagnosis system has a growing body of empirical support from clinical population studies, across language error pattern studies and treatment efficacy studies. The Speech Disorders Classification System is currently a research tool with eight proposed subgroups. The Psycholinguistic Framework is a potential bridge to linking cause and surface level speech errors. There is a need for a universally agreed-upon classification system that is useful to clinicians and researchers. The resulting classification system needs to be robust, reliable and valid. A universal classification system would allow for improved tailoring of treatments to subgroups of SSD which may, in turn, lead to improved treatment efficacy.

Multilingual Aspects of Speech Sound Disorders in Children edited by Sharynne McLeod and Brian Goldstein

<i>Multilingual Aspects of Speech Sound Disorders in Children</i> edited by <scp>Sharynne McLeod</scp> and <scp>Brian Goldstein</scp>

Optimal intervention intensity in speech-language pathology: Discoveries, challenges, and unchartered territories

This article is the final response in a scientific forum on the optimal intensity of intervention in speech-language pathology. It is a reflection on the state of knowledge offered by the 13 commentaries in this issue, addressing the areas of early communication and language impairment, speech sound disorders in children, emergent literacy, reading, aphasia, dysphagia, stuttering, motor speech disorders, voice disorders, and traumatic brain injury. Although more intense intervention can lead to better outcomes, the relationship between intensity and outcome is not always linear. More is not always better. Non-intense and intense schedules can yield similar outcomes. Intensity can also reach a point of diminishing return. The insights offered by the authors illustrate the challenges involved in studying this complex issue. To establish the optimal intensity of interventions in speech-language pathology our field needs to: identify active ingredients of interventions; better understand how principles of motor learning and neural plasticity facilitate learning; appreciate the contribution of individuals characteristics, values, and preferences; discover the effect of specific combinations of intensity (including dose, dose form, dose frequency, session duration, and total intervention duration) on treatment outcomes, and find practical solutions when disparities exist between research recommendations and workplace limitations.

Interventions for Speech Sound Disorders in Children edited by A. Lynn Williams, Sharynne Mccleod and Rebecca Mccauley

<i>Interventions for Speech Sound Disorders in Children</i> edited by A. <scp>Lynn Williams</scp>, <scp>Sharynne Mccleod</scp> and <scp>Rebecca Mccauley</scp>

Literacy outcomes of children with early childhood speech sound disorders: impact of endophenotypes.

To demonstrate that early childhood speech sound disorders (SSD) and later school-age reading, written expression, and spelling skills are influenced by shared endophenotypes that may be in part genetic. Children with SSD and their siblings were assessed at early childhood (ages 4-6 years) and followed at school age (7-12 years). The relationship of shared endophenotypes with early childhood SSD and school-age outcomes and the shared genetic influences on these outcomes were examined. Structural equation modeling demonstrated that oral motor skills, phonological awareness, phonological memory, vocabulary, and speeded naming have varying influences on reading decoding, spelling, spoken language, and written expression at school age. Genetic linkage studies demonstrated linkage for reading, spelling, and written expression measures to regions on chromosomes 1, 3, 6, and 15 that were previously linked to oral motor skills, articulation, phonological memory, and vocabulary at early childhood testing. Endophenotypes predict school-age literacy outcomes over and above that predicted by clinical diagnoses of SSD or language impairment. Findings suggest that these shared endophenotypes and common genetic influences affect early childhood SSD and later school-age reading, spelling, spoken language, and written expression skills.

Enhancing Phonological Patterns of Young Children With Highly Unintelligible Speech

Enhancing Phonological Patterns of Young Children With Highly Unintelligible Speech

Speech Sound Disorders in Children

Speech Sound Disorders in Children

Neural correlates of phonological processing in speech sound disorder: A functional magnetic resonance imaging study

Speech sound disorders (SSD) are the largest group of communication disorders observed in children. One explanation for these disorders is that children with SSD fail to form stable phonological representations when acquiring the speech sound system of their language due to poor phonological memory (PM). The goal of this study was to examine PM in individuals with histories of SSD employing functional MR imaging (fMRI). Participants were six right-handed adolescents with a history of early childhood SSD and seven right-handed matched controls with no history of speech and language disorders. We performed an fMRI study using an overt non-word repetition (NWR). Right lateralized hypoactivation in the inferior frontal gyrus and middle temporal gyrus was observed. The former suggests a deficit in the phonological processing loop supporting PM, while the later may indicate a deficit in speech perception. Both are cognitive processes involved in speech production. Bilateral hyperactivation observed in the pre and supplementary motor cortex, inferior parietal, supramarginal gyrus and cerebellum raised the possibility of compensatory increases in cognitive effort or reliance on the other components of the articulatory rehearsal network and phonologic store. These findings may be interpreted to support the hypothesis that individuals with SSD may have a deficit in PM and to suggest the involvement of compensatory mechanisms to counteract dysfunction of the normal network.

Evidence-Based Practice for Children With Speech Sound Disorders: Part 2 Application to Clinical Practice

This article provides both a tutorial and a clinical example of how speech-language pathologists (SLPs) can conduct evidence-based practice (EBP) when working with children with speech sound disorders (SSDs). It is a companion paper to the narrative review of 134 intervention studies for children who have an SSD (Baker & McLeod, 2011). A seven-step EBP decision-making process is presented for managing SSDs in children (drawing on the work of Dollaghan, 2007, and Gillam & Gillam, 2006). We describe how SLPs can integrate externally published evidence with evidence from clinical practice as well as client factors, values, and preferences, to make clinical decisions. An organized EBP network is described as a clinical example of the application of the EBP decision-making process. Compared with a matched and national sample, SLPs in the EBP network were more likely to read relevant articles and tended to have more confidence in research evidence and in their own ability to select intervention targets based on published research. SLPs need to use their clinical expertise to integrate research findings with the constraints and complexities of everyday clinical practice and client factors, values, and preferences in their management of SSDs in children.

Stability and composition of functional synergies for speech movements in children with developmental speech disorders

The aim of this study was to investigate the consistency and composition of functional synergies for speech movements in children with developmental speech disorders. Kinematic data were collected on the reiterated productions of syllables spa (/spaː/) and paas (/paːs/) by 10 6- to 9-year-olds with developmental speech disorders (five with speech sound disorder [SSD] and five with subtype childhood apraxia of speech [CAS]) and six normally speaking children using electro-magnetic midsagittal articulography (EMMA). Results showed a higher variability of tongue tip movement trajectories and a larger contribution of the lower lip relative to the jaw in oral closures for the five children with CAS compared to normally developing controls, indicating that functional synergies for speech movements in children with CAS may be both delayed and less stable. Furthermore, the SSD group showed a composition of tongue tip movements that is different from both CAS and controls. These results suggest that the differences in speech motor characteristics between SSD and subtype CAS are qualitative rather than quantitative. At the same time, the results suggest that both SSD and subtype CAS increase movement amplitude as an adaptive strategy to increase articulatory stability. Although in direct comparison no exclusive characteristics were found to differentiate subtype CAS from the group of children with SSD and from normally developing children, these preliminary results are promising for quantifying the role of speech motor processes in childhood speech sound disorders. Learning outcomes: The reader will be able to: (1) describe the development of speech motor control and explain the role of functional synergies/coordinative structures; (2) explain the measurement of the stability and composition of speech movements; (3) identify the difficulties in studying disordered speech motor development; (4) describe the differences in speech motor characteristics between SSD and subtype CAS; (5) describe the potential role of motor control strategies in developmental speech disorders.

What Works: Evidence-Based Intervention for Children with Speech Sound Disorders

To provide alternatives to the widespread use of nonspeech oral motor exercises for childhood speech sound disorders, speech intervention approaches that have received the highest level of experimental scrutiny are reviewed. Efficacy research over the past decade is critically evaluated according to hierarchical systems for quality and credibility. High standards for adherence to experimental methods are applied and reveal strong evidence for a variety of interventions that are effective. These approaches are organized according to whether their focus is directly on speech or indirectly on speech through language. Answers to the question, "What works?" with respect to features such as target selection strategies and teaching procedures are provided. Recommendations for selecting an evidence-based intervention are developed with consideration of developmental level and differential diagnostic evidence of speech sound disorder subtypes.

An Integrated Evaluation of Nonspeech Oral Motor Treatments

This article functions as an epilogue to the clinical forum examining the use of nonspeech oral motor treatments (NSOMTs) to remediate speech sound disorders in children. Conclusions to eight clinical questions are formed based on the findings that were reported in the clinical forum. Theoretical and clinical challenges are also identified. NSOMTs have serious theoretical and empirical shortcomings. At present, there is insufficient evidence to support the routine clinical application of these procedures to remediate developmental speech sound disorders.

Speech and Language Skills of Parents of Children With Speech Sound Disorders

This study compared parents with histories of speech sound disorders (SSD) to parents without known histories on measures of speech sound production, phonological processing, language, reading, and spelling. Familial aggregation for speech and language disorders was also examined. The participants were 147 parents of children with SSD (58 fathers and 89 mothers) who were directly tested and interviewed for family history of disorders. Thirty-six parents (18 mothers and 18 fathers) reported enrollment in speech therapy as children for SSD. Parents with a history of speech therapy obtained lower scores on the Multisyllabic Word Repetition, Nonword Repetition, and Tongue Twister tasks than parents without such histories. These parents also had poorer reading, spelling, and receptive language skills. Parents with histories of SSD and additional language impairments (LI) performed worse than parents with isolated SSD on all measures except Pig Latin and oral motor skills. Familial aggregation for SSD and LI was supported. In addition, the likelihood of SSD in a family member increased by a factor of 1.9 over rates of SSD found in individuals without additional family members with SSD, and the odds of LI increased by a factor of 4.1 over rates of LI found in individuals without additional family members with LI for each additional family member with SSD or LI, respectively. The results documented both residual effects in adulthood of childhood SSD and familial aggregation for SSD. These residual difficulties do not appear to affect educational and occupational outcomes.

Transitioning from analog to digital audio recording in childhood speech sound disorders

Few empirical findings or technical guidelines are available on the current transition from analog to digital audio recording in childhood speech sound disorders. Of particular concern in the present context was whether a transition from analog‐ to digital‐based transcription and coding of prosody and voice features might require re‐standardizing a reference database for research in childhood speech sound disorders. Two research transcribers with different levels of experience glossed, transcribed, and prosody‐voice coded conversational speech samples from eight children with mild to severe speech disorders of unknown origin. The samples were recorded, stored, and played back using representative analog and digital audio systems. Effect sizes calculated for an array of analog versus digital comparisons ranged from negligible to medium, with a trend for participants' speech competency scores to be slightly lower for samples obtained and transcribed using the digital system. We discuss the implications of these and other findings for research and clinical practise.