Elise Baker

Optimal intervention intensity

Abstract Empirical evidence exists for many of the different interventions in speech-language pathology. However, relatively little is known about the optimal intensity of those interventions. In order for speech-language pathology services to be both effective and efficient speech-language pathologists need to know how to faithfully administer ideal doses of the active ingredients of interventions, in what forms, how often and for how long. This is the lead paper to a scientific forum on this fundamental yet under-studied issue of clinical practice. Borrowing from the work of Warren, Fey, and Yoder, the concept of intervention intensity is described. Issues involved in establishing the optimal intensity of interventions are identified, including what and how intervention goals are targeted. Given that speech-language pathology interventions can involve the delivery of therapeutic inputs (e.g., conversational recasts, questions) and/or clients carrying out an act (e.g., speech production, voice production, comprehending, naming, swallowing), a framework is proposed for measuring all potential inputs and acts that might contribute to the calculation of an intervention intensity. Client-, clinician-, condition-, and service-related variables that could influence the investigation and practical application of an optimal intervention intensity are also discussed.

Why Word Learning is not Fast.

Upon fast mapping, children rarely retain new words even over intervals as short as 5 min. In this study, we asked whether the memory process of encoding or consolidation is the bottleneck to retention. Forty-nine children, mean age 33 months, were exposed to eight 2- or-3-syllable nonce neighbors of words in their existing lexicons. Didactic training consisted of six exposures to each word in the context of its referent, an unfamiliar toy. Productions were elicited four times: immediately following the examiner’s model, and at 1-min-, 5-min-, and multiday retention intervals. At the final two intervals, the examiner said the first syllable and provided a beat gesture highlighting target word length in syllables as a cue following any erred production. The children were highly accurate at immediate posttest. Accuracy fell sharply over the 1-min retention interval and again after an additional 5 min. Performance then stabilized such that the 5-min and multiday posttests yielded comparable performance. Given this time course, we conclude that it was not the post-encoding process of consolidation but the process of encoding itself that presented the primary bottleneck to retention. Patterns of errors and responses to cueing upon error suggested that word forms were particularly vulnerable to partial decay during the time course of encoding.

Evidence-Based Management of Phonological Impairment in Children.

Evidence-based management of phonological impairment in children is a dynamic process. Speech and language therapists need to evaluate published evidence and use their professional judgement to decide on an intervention plan, evaluate the efficacy of their intervention and re-evaluate decisions. Two case studies are presented to illustrate this process of evidence-based management of phonological impairment in children. Both of the children have a phonological impairment of unknown origin with similar case histories; however, their intervention outcomes were completely different. The two case studies highlight the importance of considering individual differences in the management of phonological impairment in children. They also highlight the importance of integrating up-to-date knowledge with clinical expertise.

Speech-language pathologists' practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders.

Abstract A survey of 231 Australian speech-language pathologists (SLPs) was undertaken to describe practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders (SSD). The participants typically worked in private practice, education, or community health settings and 67.6% had a waiting list for services. For each child, most of the SLPs spent 10–40 min in pre-assessment activities, 30–60 min undertaking face-to-face assessments, and 30–60 min completing paperwork after assessments. During an assessment SLPs typically conducted a parent interview, single-word speech sampling, collected a connected speech sample, and used informal tests. They also determined children’s stimulability and estimated intelligibility. With multilingual children, informal assessment procedures and English-only tests were commonly used and SLPs relied on family members or interpreters to assist. Common analysis techniques included determination of phonological processes, substitutions–omissions–distortions–additions (SODA), and phonetic inventory. Participants placed high priority on selecting target sounds that were stimulable, early developing, and in error across all word positions and 60.3% felt very confident or confident selecting an appropriate intervention approach. Eight intervention approaches were frequently used: auditory discrimination, minimal pairs, cued articulation, phonological awareness, traditional articulation therapy, auditory bombardment, Nuffield Centre Dyspraxia Programme, and core vocabulary. Children typically received individual therapy with an SLP in a clinic setting. Parents often observed and participated in sessions and SLPs typically included siblings and grandparents in intervention sessions. Parent training and home programs were more frequently used than the group therapy. Two-thirds kept up-to-date by reading journal articles monthly or every 6 months. There were many similarities with previously reported practices for children with SSD in the US, UK, and the Netherlands, with some (but not all) practices aligning with current research evidence.

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.

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

Abstract 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.

Building vocabulary knowledge and phonological awareness skills in children with specific language impairment through hybrid language intervention: a feasibility study

BACKGROUND & AIMS Preschool and early school-aged children with specific language impairment not only have spoken language difficulties, but also are at risk of future literacy problems. Effective interventions targeting both spoken language and emergent literacy skills for this population are limited. This paper reports a feasibility study of a hybrid language intervention approach that targets vocabulary knowledge and phonological awareness skills within the context of oral narrative, storybook reading, and drill-based games. This study also reports on two novel, experimental assessments that were developed to expand options for measuring changes in lexical skills in children. METHODS & PROCEDURES Seventeen children with specific language impairment participated in a pilot within-group evaluation of a hybrid intervention programme. The childrens performance at pre- and post-intervention was compared on a range of clinical and experimental assessment measures targeting both spoken language and phonological awareness skills. Each child received intervention for six one-hour sessions scheduled on a weekly basis. Intervention sessions focused on training phonological awareness skills as well as lexical-semantic features of words within the context of oral and storybook narrative and drill-based games. OUTCOMES & RESULTS The children significantly improved on clinical measures of phonological awareness, spoken vocabulary and oral narrative. Lexical-semantic and sublexical vocabulary knowledge also significantly improved on the experimental measures used in the study. CONCLUSIONS The results of this feasibility study suggest that a larger scale experimental trial of an integrated spoken language and emergent literacy intervention approach for preschool and early school-aged children with specific language impairment is warranted.

From hindsight to foresight: working around barriers to success in phonological intervention

A major goal of phonological intervention is to help bring a childs speech development to within normal range for his or her developmental stage. Reaching that goal may take longer than anticipatedfor some children. This paper illustrates an in–depth retrospective evaluation of assessment data from one child with a phonological impairment, who progressed slowly during intervention (Baker and McLeod, 2004). An alternative intervention plan is suggested that takes key factors from the assessment data into account, and utilizes a nonlinear phonologicalframework to set up the goal sequence. The insights gained from hindsight in this case may lead to foresight for other children s intervention programmes.

The experience of discharging children from phonological intervention

The ultimate goal of phonological intervention is to make unintelligible speech intelligible. Discharging children who have achieved this goal can be a rewarding experience. However, given the constraints of everyday clinical practice, not all discharge experiences can be happy ones. In this paper I compare and contrast the issues raised by Hersh (2010) about the impact of ending therapy on speech-language pathologists (SLPs) who work with adults who have aphasia, with SLPs who work with children who have unintelligible speech. Using the scaffold provided by Hersh (2010), I consider how ideal endings for children with phonological impairment are possible, reflect on the disheartening experience of having to discharge children before realization of the ultimate goal, examine the paradox of building authentic relationships with children and their families predestined to be broken, and, explore the dilemma of promoting client involvement in decisions while retaining professional control over the discharge process. The need to better understand the clinical expertise required to discharge children from phonological intervention in ideal and less than ideal situations is discussed. Finally, the need to determine ideal intervention intensity is addressed given the potential for children with a phonological impairment to be discharged with intelligible speech.

Management of speech impairment in children: The journey so far and the road ahead

The management of speech impairment of unknown origin in children requires speech-language pathologists (SLPs) to make a number of important clinical decisions. These decisions resolve around assessment, analysis, diagnosis and intervention. Ideally, clinicians should be guided in their clinical decision making by the best available published evidence. Over 30 years ago, this was a relatively straightforward task. Most childrens speech problems were assessed and analysed from an articulation perspective, and children were provided with articulation-based intervention. Since the paradigm shift from articulation to phonology, it could be argued that clinical decision making has become challenging. This challenge is not due to a limitation of options for children with unintelligible speech, but due to a plethora of knowledge and approaches for assessment, analysis, diagnosis and intervention. This paper summarizes the current state of knowledge in the management of speech impairment in children. The benefits as well as the difficulties associated with having such a plethora of knowledge are explored, followed by a discussion of possible pathways for both clinicians and researchers. It is proposed that more comparative research is needed to make sense of the increasing diversity in the field.