Treatment Of Speech Sound Disorders Research Articles

Diagnosis and Treatment of Childhood Apraxia of Speech Among Children With Autism: Narrative Review and Clinical Recommendations.

Treatment for children with autism spectrum disorder (ASD) and low verbal ability is a largely neglected area of study. Existing research focuses on language abilities; however, a subset of children with ASD also has speech sound disorders (SSDs). The purpose of this tutorial is to provide clinicians with evidence-based recommendations to guide speech assessment and treatment among children with ASD, low verbal ability, and suspected childhood apraxia of speech (CAS). Multifaceted search procedures were used to identify studies that have assessed or treated speech sound production among children with ASD. A narrative review and synthesis of the literature is followed by practical clinical recommendations based on best available evidence. It is critically important to consider all possible hindrances to the development of functional communication ability for children with ASD. Speech sound production has been identified as a key predictor of expressive language outcomes, yet there are very few studies that address assessment and treatment of SSDs among children with ASD. Less is known about the presentation of CAS among children with ASD and low verbal ability. More research is needed to determine whether existing speech assessment and treatment methods are appropriate for children with ASD, if modifications are needed, or if new methods should be designed.

The Effectiveness of an Integrated Treatment for Functional Speech Sound Disorders-A Randomized Controlled Trial.

Background: The treatment of functional speech sound disorders (SSDs) in children is often lengthy, ill-defined, and without satisfactory evidence of success; effectiveness studies on SSDs are rare. This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses on integrating phonological and phonetic processing according to the Integrated Psycholinguistic Model of Speech Processing (IPMSP). Methods: Thirty-two German-speaking children aged from 3.5 to 5.5 years (median 4.6) with functional SSD were randomly assigned to a treatment or a wait-list control group with 16 children each. All children in the treatment group and, after an average waiting period of 6 months, 12 children in the control group underwent PhonoSens treatment. Results: The treatment group showed more percent correct consonants (PCC) and a greater reduction in phonological processes after 15 therapy sessions than the wait-list control group, both with large effect sizes (Cohen’s d = 0.89 and 1.04). All 28 children treated achieved normal phonological abilities: 21 before entering school and 7 during first grade. The average number of treatment sessions was 28; the average treatment duration was 11.5 months. Conclusion: IPMSP-aligned therapy is effective in the treatment of SSD and is well adaptable for languages other than German.

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.

Quantifying changes in ultrasound tongue-shape pre- and post-intervention in speakers with submucous cleft palate: an illustrative case study

ABSTRACT Ultrasound Tongue Imaging is increasingly used during assessment and treatment of speech sound disorders. Recent literature has shown that ultrasound is also useful for the quantitative analysis of a wide range of speech errors. So far, the compensatory articulations of speakers with cleft palate have only been analysed qualitatively. This study provides a pilot quantitative ultrasound analysis, drawing on longitudinal intervention data from a child with submucous cleft palate. Two key ultrasound metrics were used: 1. articulatory t-tests were used to compare tongue-shapes for perceptually collapsed phonemes on a radial measurement grid and 2. the Mean Radial Difference was reported to quantify the extent to which the two tongue shapes differ, overall. This articulatory analysis supplemented impressionistic phonetic transcriptions and identified covert contrasts. Articulatory errors identified in this study using ultrasound were in line with errors identified in the speech of children with cleft palate in previous literature. While compensatory error patterns commonly found in speakers with cleft palate have been argued to facilitate functional phonological development, the nature of our findings suggest that the compensatory articulations uncovered are articulatory in nature.

Adaptation to a physical alteration of the vocal apparatus: The effect of visual self-perception on speech motor plasticity

Adapting speech movements to novel or perturbed conditions relies critically on the processing of self-produced sensory information. In the context of a physical alteration of the vocal apparatus (e.g., palatal prosthesis), talkers have been shown to adapt following 10–15 min of practice to produce improved acoustic output. It is possible that additional information, such as ultrasound imaging of the tongue, may help talkers adapt even more effectively to such perturbations. Providing visual feedback of the tongue surface in real-time has shown promise in the treatment of speech-sound disorders. However, it remains unclear whether the addition of such visual information will influence speech plasticity on the timescale examined in experimental studies of speech adaptation. Here, we examine how neurotypical talkers adapt to a palatal prosthesis, relying on auditory and somatosensory feedback alone (n = 15), or with the addition of ultrasound feedback of the tongue, either in the mid-sagittal (n = 15) or coronal plane (n = 15). Differences in adaptation performance between the three feedback conditions were observed, both in the patterns of speech adaptation and the learning after-effects. The results indicate that talkers will rapidly integrate visual articulatory information into their control of oral speech movements in order to guide productions towards improved acoustic outcomes.Adapting speech movements to novel or perturbed conditions relies critically on the processing of self-produced sensory information. In the context of a physical alteration of the vocal apparatus (e.g., palatal prosthesis), talkers have been shown to adapt following 10–15 min of practice to produce improved acoustic output. It is possible that additional information, such as ultrasound imaging of the tongue, may help talkers adapt even more effectively to such perturbations. Providing visual feedback of the tongue surface in real-time has shown promise in the treatment of speech-sound disorders. However, it remains unclear whether the addition of such visual information will influence speech plasticity on the timescale examined in experimental studies of speech adaptation. Here, we examine how neurotypical talkers adapt to a palatal prosthesis, relying on auditory and somatosensory feedback alone (n = 15), or with the addition of ultrasound feedback of the tongue, either in the mid-sagittal (n = 15) or co...

Treatment of speech sound disorders in children: Nonspeech oral exercises.

BackgroundChildren with speech disorders need to receive effective services to improve their speech intelligibility. A variety of treatments are available, and one of the most commonly used techniques is oral-motor training, which includes nonspeech oral exercises.MethodsThis paper conducted a review of the literature on using nonspeech oral exercises to treat children with developmental speech sound disorders.ResultsDespite the popularity of this treatment, the nonspeech oral techniques lack supporting evidence in existing literature. Also, the justification of the proposed rationales for this treatment is being questioned. Many other speech-based approaches that are supported by research are available for speech-language pathologists. Some have suggested that any oral training and activity should be performed in the context of speech. The appropriate role of nonspeech oral exercises is that they should be ultimately practiced within the context of speech.ConclusionGenerally, oral training that does not involve speech production should be considered carefully with respect to a client's speech needs. Thus, further research is needed to examine the clinical value of using nonspeech oral exercises to treat speech sound disorders in children.

Impact of the speech sound disorders: family and child perception

ABSTRACT Objective: to verify both the family’s and the children’s perception of the impact of the phonological type of speech sound disorders. Methods: this is an exploratory qualitative-quantitative prospective research of a Speech-Language Pathology Service of a Higher Education Institution. Sixty-four persons took part in the study, thirty-two being children (nineteen boys and thirteen girls), their age ranging from four years and one month to eight years and nine months, diagnosed with the phonological type of Speech Sound Disorder. Besides them, thirty-two adults, either their parents or guardians, participated in the study. The results were organized by degree of association - strong association, average association and average association with aspects of speech. Results: regarding the parents’ perception, the impact of Speech Sound Disorder on their children is related to interpersonal relationships and to emotional behavior, besides school issues. As for the children’s perception, the results demonstrated that the biggest impact of irregular speech takes place in unfamiliar environments. In addition to that, they have shown that isolation and the development of feelings such as frustration, shyness and low self-esteem are common among these children, making their relationship with other people difficult. Conclusion: the perception of parents and children regarding speech-related difficulties should be studied in order to reach both a better understanding and a more adequate treatment of Speech Sound Disorders.

Effect of dialect on phonological analysis

ABSTRACTIt is important to understand a child’s language background, to ensure appropriate assessment, diagnosis and treatment of speech sound disorders. Singapore is home to various cultures and languages, and local speech norms are needed to provide an accurate reference for assessing phonological disorders in the local population. This study aims to establish normative data and better understand the English phonological development of English–Mandarin bilingual preschoolers in Singapore, aged 3; 6–4; 5 years. The Articulation and Phonology subtests of the Diagnostic Evaluation of Articulation and Phonology – UK were used to collect speech data from 146 preschoolers. Responses were scored against two standards – British Standard English (BSE) and Singapore English (SGE), in terms of speech sound accuracy, and the frequency and type of error patterns present. The effect of language dominance on the children’s English phonological abilities was explored. Results showed that the preschoolers’ speech sound accuracy increased significantly when scored against SGE versus BSE targets. The number of children identified to be using several error patterns was reduced when SGE targets were used instead of BSE targets. English-dominant children scored significantly higher than their Mandarin-dominant peers on measures of speech sound accuracy. The identification of error patterns also differed between the two groups. These results show that it is important to take dialectal variation and language dominance into account in assessment, to determine if speech characteristics are due to a speech sound disorder or just normal dialectal variations.

An intensive boot camp approach to the remediation of speech sound disorders: a case report

ABSTRACTBackground: Understanding treatment dose is essential to optimizing therapeutic frequency and intensity for speech sound disorders. Intensive therapies, known as boot camp approaches, have proven efficacious in certain speech therapy contexts such as voice disorder treatment. However, few data exist regarding intervention intensity for developmental speech sound disorders.Method: This investigation examined the effects of an intensive boot camp speech therapy approach to remediate interdental /s/ production over two consecutive days. Treatment occurred in morning and afternoon blocks for a total of 5.5 h per day. Auditory-perceptual ratings were used to evaluate /s/ productions pre-treatment, immediately post-treatment, and one week following treatment.Results: Interdental /s/ production improved significantly immediately following the boot camp treatment; improvements were sustained at one week post-treatment (p < .05). Improvement was more pronounced for /s/ productions in medial and final word position versus initial word position.Conclusion: The findings of this study indicate that an intensive boot camp speech therapy approach might be useful to stimulate or accelerate treatment of speech sound disorders in certain populations. Future research should explore dose–response relationships among treatment frequency, intensity, and duration in children with a variety of speech sound disorders.

Target Selection Practices of Speech and Language Therapists Working with Children with Speech Sound Disorders in Ireland

Objective: To investigate speech and language therapists’ current practice in the selection of intervention targets for children with speech sound disorders. Method: Questionnaires were used to elicit information from 88 speech and language therapists working in the Republic of Ireland about their selection of intervention targets in the treatment of speech sound disorders. Main results: The majority (73%) of therapists placed a high priority on selecting stimulable sounds as intervention targets. Around half (52%) placed a high priority on earlier developing sounds with a minority prioritizing later developing sounds (10%) and non-stimulable sounds (14%). Speech and language therapists’ years of experience did not have a significant impact on their selection practices. However, the amount of continuing professional development a speech and language therapist had in the area of speech sound disorders did have a significant effect on target selection. Conclusion: The speech and language therapists in this study used clinical experience and traditional practices, such as stimulability, to select intervention targets in the treatment of speech sound disorders. However, there is research evidence to show that the selection of non-traditional intervention targets, such as non-stimulable and later developing sounds, can result in more system-wide generalisation. Speech and language therapists may benefit from increasing their knowledge about current theories and intervention research relevant to target selection.

Lexical Considerations in the Treatment of Speech Sound Disorders in Children

The interaction between lexical and phonological development has been the focus of a growing body of research. Findings suggest that phonological ability influences word learning and that certain characteristics of words influence how words are produced by children. This article summarizes research findings regarding the effects of word frequency, phonological neighborhood density (PND), and phonotactic probability (PP) on phonological development, and describes how these factors have been manipulated to influence phonological learning in the treatment of speech sound disorder in children. Clinical applications and ideas for considering lexical factors in the selection of target words for treatment are provided.

How To Get Started With Ultrasound Technology for Treatment of Speech Sound Disorders

Although providing visual feedback with ultrasound is becoming more and more popular among speech-language pathologists, it is still not widely used, perhaps because many speech-language pathologists are unfamiliar with its application to treatment of speech sound disorders. This report introduces basic information on ultrasound for new users and summarizes existing studies conducted with ultrasound to provide clinical evidence for speech treatment. This report also presents a clinical case using ultrasound and discusses a treatment protocol for establishing postvocalic /r/ to illustrate an example of how ultrasound was used in a clinical setting.

Phonological processes in Portuguese children with speech sound disorders

AbstractThis study investigates the nature of phonological impairment in 20 pre- and early school Portuguese children with phonologically based Speech Sound Disorders (SSD). The phonological profile of these children was compared with the performance of 232 younger typically developing (TD) controls. Results showed differences in phonological acquisition of children with phonologically based SSD, namely a low percentage of correct consonants score and a higher percentage of occurrences of typical phonological processes. Children with phonologically based SSD also used phonological processes (e.g., backing and initial consonant deletion) that are considered unusual in normally developing children and were not observed in the TD group. Results for SSD children also showed that early acquisition consonants were substituted by later acquisitions. Children with SSD presented differences in phonological acquisition, unusual phonological processes, and replaced early acquisition consonants by later acquisition consonants. This knowledge is useful for speech and language therapists in the diagnosis and treatment of SSD.

Cross-linguistic generalization in the treatment of two sequential Spanish–English bilingual children with speech sound disorders

Purpose. The effect of bilingual service delivery on treatment of speech sound disorders (SSDs) in bilingual children is largely unknown. Bilingual children with SSDs are typically provided intervention in only one language, although research suggests dual-language instruction for language disorders is best practice for bilinguals. This study examined cross-linguistic generalization of bilingual intervention in treatment of two 5-year-old sequential bilingual boys with SSDs (one with Childhood Apraxia of Speech), hypothesizing that selecting and treating targets in both languages would result in significant overall change in their English and Spanish speech systems.Method. A multiple baseline across behaviours design was used to measure treatment effectiveness for two targets per child. Children received treatment 2–3 times per week for 8 weeks and in Spanish for at least 2 of every 3 days. Ongoing treatment performance was measured in probes in both languages; overall speech skills were compared pre- and post-treatment.Result. Both children's speech improved in both languages with similar magnitude; there was improvement in some non-treated errors.Conclusion. Treating both languages had an overall positive effect on these bilingual children's speech. Future bilingual intervention research should explore alternating treatments designs, efficiency of monolingual vs bilingual treatment, different language and bilingual backgrounds, and between-group comparisons.

Introduction: Toward a Second Revolution in the Assessment and Treatment of Speech Sound Disorders

Introduction: Toward a Second Revolution in the Assessment and Treatment of Speech Sound Disorders

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

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

Characteristics of Korean phonology: Review, tutorial, and case studies of Korean children speaking English

A significant number of bilinguals in English-speaking countries speak Korean as their first language. One such country is the United States (U.S.). As the U.S. becomes increasingly diverse, providing more effective services for culturally and linguistically diverse children is a critical issue and growing challenge for speech-language pathologists. The U.S. Census Bureau reports that the number of Korean immigrants in the U.S. has steadily increased over the past decade. As a result, a greater number of children who speak Korean as a first or second language may need speech, language, and hearing services. This paper provides a review of the literature on (1) phonological characteristics of the Korean language and (2) speech sound acquisition and developmental patterns for phonological processes in Korean children. We illustrate how language knowledge of Korean might impact the learning of English based on case studies of three Korean children speaking English in the U.S. We describe considerations for more appropriate evaluation and treatment of speech sound disorders in Korean-English-speaking children. Learning outcomes: Readers will be able to: (1) understand phonological characteristics of the Korean language and speech sound acquisition and developmental patterns for phonological process in Korean children, (2) describe characteristics of English speech sound acquisition in successive bilingual English-Korean learners and interference patterns that result from the influence of two independent phonological and phonetic systems, and (3) describe considerations and clinical implications for the more appropriate evaluation and treatment of speech sound disorders in Korean-English speaking children.

Evidence-Based Practice and Treatment of Speech Sound Disorders in Bilingual Children

Evidence-Based Practice and Treatment of Speech Sound Disorders in Bilingual Children

Evidence-Based Practice and Treatment of Speech Sound Disorders in Bilingual Children

Evidence-Based Practice and Treatment of Speech Sound Disorders in Bilingual Children