Alison Purcell

Nasalance Levels in the Speech of Normal Australian Children

OBJECTIVE Nasalance scores have been shown to depend on the regional dialect of English spoken. Australian cleft palate clinics are increasingly making use of the Nasometer as part of their evaluation of velopharyngeal inadequacy. There are, however, no normative data for Australian English available as reference information. The objective of this study, therefore, was to obtain comprehensive nasalance data for a large group of Australian children, aged 4 to 9 years, for two standard nasalance passages (Zoo Passage and Nasal Sentences) and to investigate any gender or age differences within that age range. PARTICIPANTS The participants were 245 children (123 female, 122 male) ranging in age from 4 years, 0 months, to 9 years, 3 months. The children were recruited from a variety of schools and preschools across the Sydney metropolitan region. The children all spoke Australian English, and their hearing, articulation skills, and speech resonance were within normal limits. METHOD Mean nasalance scores were obtained for two speech passages that are used as standards for Nasometer testing (Zoo Passage and Nasal Sentences). In addition, the nasalance data were analyzed for any gender and age dependence, using separate analyses of variance for each speech passage. Five consecutive age groups were used to examine age dependence (4-, 5-, 6-, 7-, and 8-year-old children). RESULTS A mean score of 13.1 (SD, 5.9) was obtained for the Zoo Passage, and a mean of 59.6 (SD, 8.1) for the Nasal Sentences. The analysis of variance results indicated that, at a probability level of p < 0.01, there was no statistically significant age or gender dependence for either speech passage. CONCLUSION These normative nasalance data for children who speak Australian English will provide important reference information for clinicians who assess nasality disorders in cleft palate clinics in Australia.

Communication and behavioural disorders among children with hearing loss increases risk of mental health disorders

Objective : This study examines the mental health and associated risk factors of children with hearing loss.

Expressive language skills in Chinese Singaporean preschoolers with nonsyndromic cleft lip and/or palate

OBJECTIVE The main objective of the present study was to examine THE EXPRESSIVE LANGUAGE SKILLS and obtain a prevalence estimate of expressive language IMPAIRMENT (not skills) in Chinese Singaporean preschoolers with nonsyndromic cleft lip and/or palate (CLP). METHODS A group of 43 Chinese Singaporean preschoolers aged 3 to 6 years with a diagnosis of nonsyndromic CLP was assessed using the Singapore English Action Picture Test (SEAPT). The SEAPT is an English Language screening tool standardised on typically developing English-Mandarin Chinese Singaporean preschoolers that assesses expressive vocabulary and grammatical usage. A grammar and/or information score below the 20(th) percentile on the SEAPT is indicative of an expressive language impairment. In addition, the medical records of this cohort were examined retrospectively for documentation of surgical timings, audiological history, articulation and resonance. RESULTS Based on the results of the SEAPT, 33% of the preschoolers with CLP were identified as having a-possible expressive language impairment. Hence, the likelihood that a child with CLP with normal cognitive functioning will have an expressive language impairment is between 3.9 to 12.7 times more likely than in the general population. There was no statistical significance when comparisons were made between dominant language groups or CLP groups on SEAPT measures of information and grammar content. Significantly more males than females were identified with language difficulties, relative to the sex ratio in the sample. No significance was found for the other participant variables. CONCLUSIONS The findings of this study suggest that Chinese Singaporean preschoolers with CLP have more difficulty in the expressive use of grammar and vocabulary than their peers of typical development, with significantly more males affected than females. As language performance was not related to hearing, articulation or resonance; these early results suggest that a comprehensive investigation of cognition, literacy and family aggregation of communication disorders is urgently warranted to study other possible aetiologies for language impairment in children with CLP in Singapore.

Case-based learning: One route to evidence-based practice

Discussion about the use of evidence-based practice (EBP) by speech pathologists is widespread yet little is known on how to teach EBP to student speech pathologists. This paper illustrates how a case-based approach to learning and teaching (CBL) has been used to facilitate undergraduate and masters level students’ understanding and conduct of EBP across the speech pathology curriculum at the University of Sydney. A definition of CBL is provided followed by an overview of how students learn to manage cases within a framework, known as the Client Management Process (CMP). The CMP was designed to guide students’ evidence-based clinical reasoning and decision making across the stages of contact with clients, from referral to dismissal. Preliminary evaluation and comments by both students and instructors on the value and difficulties associated with using a CBL to teach EBP are presented. Source of funding: No source of funding reported.

Factors influencing speech and language outcomes of children with early identified severe/profound hearing loss: Clinician-identified facilitators and barriers

Abstract Purpose: Early identification of severe/profound childhood hearing loss (HL) gives these children access to hearing devices and early intervention to facilitate improved speech and language outcomes. Predicting which infants will go on to achieve such outcomes remains difficult. This study describes clinician identified malleable and non-malleable factors that may influence speech and language outcomes for children with severe/profound HL. Method: Semi-structured interviews were conducted with six experienced auditory verbal clinicians. A collective case study design was implemented. The interviews were transcribed and coded into themes using constant comparative analysis. Result: Clinicians identified that, for children with severe/profound HL, early identification, early amplification and commencing auditory-verbal intervention under 6 months of age may facilitate child progress. Possible barriers were living in rural/remote areas, the clinicians’ lack of experience and confidence in providing intervention for infants under age 6-months and belonging to a family with a culturally and linguistically diverse (CALD) background. Conclusion: The results indicate that multiple factors need to be considered by clinicians working with children with HL and their families to determine how each child functions within their own environment and personal contexts, consistent with the International Classification of Functioning, Disability and Health (ICF) framework. Such an approach is likely to empower clinicians to carefully balance potential barriers to, and facilitators of, optimal speech and language outcomes for all children with HL.

Spelling Processes of Children With Nonsyndromic Cleft Lip and/or Palate: A Preliminary Study.

Objective To compare the cognitive-linguistic processes underlying spelling performance of children with cleft lip and/or palate with those of typically developing children. Design An assessment battery including tests of hearing, articulation, verbal short-term and working memory, and phonological awareness, as well as word and nonword spelling, was administered to both groups. Participants A total of 15 children with nonsyndromic cleft lip and/or palate were case-matched by age and sex to 15 typically developing children. The children were aged between 6 and 8 years and were bilingual, with English the dominant language. Results Wilcoxon signed-rank tests revealed that the performance of children with cleft lip and/or palate was significantly poorer on phoneme deletion and nonword spelling (P < .05) compared with typically developing children. Spearman correlation analyses revealed different relationships between the cognitive-linguistic and spelling measures for the cleft lip and/or palate and typically developing groups. Conclusions Children with cleft lip and/or palate underachieve in phonological awareness and spelling skills. To facilitate early intervention for literacy problems, speech-language pathologists should routinely assess the cognitive-linguistic processing of children with cleft lip and/or palate, especially phonological awareness, as part of their case management protocols.

Typical consonant cluster acquisition in auditory-verbal children with early-identified severe/profound hearing loss

Abstract Early-identified severe/profound hearing loss (HL) following universal newborn hearing screening (UNHS) has been associated with improved speech and language outcomes. However, speech outcome reports have typically been based on broad measures of speech intelligibility and/or singleton consonant accuracy, with little known about production of consonant clusters. Using a prospective design, the range and accuracy of consonant clusters produced by a homogenous cohort of 12 children early-identified with severe/profound HL aged 3- and 4-years were examined. All children demonstrated bilateral aided thresholds within a range of 15–25 dB HL across all frequencies, were optimally amplified with cochlear implants (11/12) or hearing aids (1/12), and attended auditory-verbal (AV) early intervention. Standardized speech and language assessments were administered. Consonant clusters were strategically sampled in single-word and conversational speech contexts. All standard scores for speech, receptive, and expressive language were within normal limits. All children produced consonant clusters commensurate with expectations for typically-developing hearing peers at 3- and 4- years-of-age. Childrens production of phonetically complex morphophonemes (final consonant clusters marking grammatical morphemes) was also in keeping with developmental expectations. Factors which contributed to these encouraging outcomes require further investigation.

Evidence-based practice in speech language pathologist training of early childhood professionals

With more children attending formal child care and limited speech language pathology resources, there is a need to consider alternate service delivery models. One such approach is clinician training of early childhood professionals (ECPs). To be appropriately targeted and efficient, training programs should be based on research evidence. This systematic review focuses on studies into which ECP skills improve child language and literacy. Databases searched were PsychINFO, Scopus, Web of Science, CINAHL, ERIC, LLBA, and Medline from 1990 onwards. Papers were included if they were (a) studies reporting the efficacy of professional development programs in terms of positive outcomes for both child and ECP, or (b) longitudinal or cross-sectional experimental investigations that examined the relation between ECP skills and child language/literacy outcomes. The initial search identified 212 potential studies with 34 studies meeting the inclusion criteria. These 34 studies included 2 longitudinal, 1 descriptive, and 31 cross-sectional experiments (16 randomized controlled trials, RCTs; 15 non-RCTs). The review identified four key skill categories: (a) quality adult–child interactions; (b) explicit literacy instruction; (c) storytelling skills; and (d) supporting peer-to-peer interactions. The inclusion of these skills by clinicians in training of ECPs is supported by research evidence. Source of funding: Department of Community Services, Western Sydney area assistance Scheme, NSW, Australia.

Parental perceptions of posterior pharyngeal wall augmentation using autologous fat for treating velopharyngeal dysfunction

Abstract Posterior pharyngeal wall augmentation using autologous fat to treat velopharyngeal dysfunction (VPD) is an alternative surgical procedure to more commonly used invasive procedures such as the pharyngeal flap. However, limited research exists on this technique. The aim of this study was to qualitatively investigate parental perceptions of posterior pharyngeal wall augmentation using autologous fat when treating velopharyngeal dysfunction. Furthermore, this research aimed to examine parents perspectives of their childs speech and quality-of-life following this procedure. A qualitative collective case study methodology was used in the form of semi-structured interviews with seven participants. These were then analysed using constant comparative analysis. Four distinct themes emerged: post-surgical outcomes; speech-language pathology, not just medicine; factors for successful post-operative speech and resonance; and long-term sustainability and worthiness of the procedure. Six out of seven participants expressed positive post-operative speech and resonance results. Five further expressed long-term satisfaction up to 6 years post-operatively. Overall the majority of participants were satisfied that this procedure provided their child with long-term successful speech outcomes. The participants also discussed the importance of receiving speech-language pathology services alongside surgery and the positive impact of the procedure on their childs quality-of-life including social interactions, confidence, friendships, as well as eating and drinking.

A systematic review of assessment and intervention strategies for effective clinical communication in culturally and linguistically diverse students

Culturally and linguistically diverse (CALD) students often experience difficulties with the clinical communication skills that are essential for successful interactions in the workplace. However, there is little evidence on the effectiveness of assessment and intervention strategies for this population. The two aims of this study were: to evaluate the effectiveness of assessment tools in identifying and describing the clinical communication difficulties of CALD health care students; and to determine whether communication programmes improved their clinical communication skills.