Jane McCormack

A systematic review of the association between childhood speech impairment and participation across the lifespan

Speech impairment of unknown origin is one of the most common communication impairments in childhood. The purpose of this systematic review was to identify limitations in life activities that may be associated with speech impairment, through analysing the findings of papers published in the past 10 years. Domains from the Activities and Participation component of the International Classification of Functioning, Disability and Health were used as search terms, and resulted in 57 papers being identified. Findings from each paper were reviewed in terms of the association between speech impairment and Activity Limitations and/or Participation Restrictions as defined by the ICF. The systematic review revealed that speech impairment in childhood may be associated with the following Activity Limitations and/or Participation Restrictions: learning to read/reading, learning to write/writing, focusing attention and thinking, calculating, communication, mobility, self-care, relating to persons in authority, informal relationships with friends/peers, parent-child relationships, sibling relationships, school education, and acquiring, keeping and terminating a job.

The impact of speech impairment in early childhood: Investigating parents' and speech-language pathologists' perspectives using the ICF-CY

PURPOSE To explore the application of the Activities and Participation component of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY, World Health Organization, 2007) as a framework for investigating the perceived impact of speech impairment in childhood. METHOD A 32-item questionnaire based on six ICF-CY domains was distributed to (a) a national sample of speech-language pathologists (SLPs; n=205), and (b) parents (n=86) of preschool children identified with speech impairment. RESULTS Factor analysis of the SLP data revealed six coherent factors with moderate-high internal reliability: Verbal communication (e.g., Conversation, Speaking), Advanced learning (e.g., Learning to read/write), Interpersonal interactions (e.g., Relating with strangers, Informal social relationships), Basic learning (e.g., Copying, Rehearsing), Applied learning and general tasks (e.g., Focussing attention, Handling stress), and Non-verbal communication. The first five factors were also confirmed by the parent data. Both SLPs and parents rated the first two factors, Verbal communication and Interpersonal interactions, as the most difficult activities for children with speech impairment. CONCLUSION The ICF-CY Activities and Participation component is a useful framework for considering the breadth of activities that may be impacted by speech impairment in childhood. LEARNING OUTCOMES (1) Discuss the potential use of the ICF-CY in speech-language pathology; (2) Describe the breadth of activities that may be difficult for children as a result of speech impairment; and (3) Recognize that SLPs and parents may have different perspectives regarding the impact of speech impairment on childrens activities and participation.

Effect of dialect on identification and severity of speech impairment in Indigenous Australian children

This study investigated the effect of dialectal difference on identification and rating of severity of speech impairment in children from Indigenous Australian backgrounds. The speech of 15 Indigenous Australian children identified by their parents/caregivers and teachers as having ‘difficulty talking and making speech sounds’ was assessed using the Diagnostic Evaluation of Articulation and Phonology. Fourteen children were identified with speech impairment on the Diagnostic Evaluation of Articulation and Phonology using Standard Australian English (AusE) as the target pronunciation; whereas 13 were identified using Australian Aboriginal English (AAE) as the target. There was a statistically significant decrease in seven children’s severity classification and a statistically significant increase in all children’s percentage of consonants, vowels and phonemes correct when comparing AAE with AusE. Features of AAE used by the children included /h/ insertion and deletion, primary stress on the first syllable and diphthongs alternating with short clear vowels. It is important that speech-language pathologists consider children’s dialect as one component of culturally and linguistically appropriate services.

The ICF Body Functions and Structures related to speech-language pathology

Body Functions and Body Structures form one component of the International Classification of Functioning, Disability and Health (ICF). Coding of items within these ICF chapters can be useful in speech-language pathology to provide a holistic overview of an individuals condition, but only if this component is considered alongside the other components that make up the ICF. This paper outlines the Body Functions and Body Structures codes that are most relevant to speech-language pathology and discusses the overlap that occurs with the Activities and Participation component. A review of the strengths and limitations of the ICF Body Structures and Body Functions components is also presented.

Designs and decisions: The creation of informal measures for assessing speech production in children

Abstract Speech-language pathologists (SLPs) frequently assess childrens speech to diagnose and identify areas of difficulty, then determine appropriate intervention goals. Formal measures are available for assessment; however, many SLPs use informal measures within clinical practice. The purpose of this two-part mixed methods study was to describe informal measures created to assess childrens speech. Study 1 involved a systematic review of 39 informal measures identified via journal database and internet searches, scanning of reference lists, and submission by SLPs and researchers. The measures were reviewed in terms of their conceptualization (content and format) and operationalization (evaluation and validation). Common conceptual features included assessment of consonant singletons, single words, computer format, and picture-naming. Few measures provided information addressing operational criteria; in particular, they lacked evaluation of their effectiveness. Study 2 involved an inductive thematic analysis of journal entries from eight creators of informal measures that explored key considerations in the development process. Informal measures were created due to the absence of measures which were sufficiently comprehensive and culturally appropriate, plus a desire to incorporate technology. Considerations in the creation of informal measures included sourcing research and existing measures to inform the measures’ development, maximizing childrens engagement, and utility. SLPs must be cautious when using informal measures due to their lack of operationalization. However, these measures often address SLPs’ needs and so operationalization of informal measures would be beneficial for the profession.

Knowing, having, doing: The battles of childhood speech impairment

This study describes the experience of childhood speech impairment (speech sound disorder) from the perspective of two young men and their mothers. Semi-structured interviews were conducted with the four participants, with questions framed around the International classification of functioning, disability and health (ICF; WHO, 2001) to gain a holistic understanding of life with speech impairment. Phenomenological analysis of the interviews revealed that the experience of speech impairment was associated with three key themes: (1) knowing, (2) having, and (3) doing. A core theme of ‘battles’ was common to all three themes (i.e. the battle for knowledge, the battle of having speech and associated difficulties, and the battle to do something to minimize the impact of the difficulties); however, the nature of the battles was different for participants, and was related to other life factors. This qualitative research provides valuable insights into the experiences of those living with speech impairment, and shows the importance of considering such information alongside quantitative research when making decisions in clinical practice.

Polysyllable productions in preschool children with speech sound disorders: Error categories and the Framework of Polysyllable Maturity

Abstract Purpose: Children with speech sound disorders (SSD) find polysyllables difficult; however, routine sampling and measurement of speech accuracy are insufficient to describe polysyllable accuracy and maturity. This study had two aims: (1) compare two speech production tasks and (2) describe polysyllable errors within the Framework of Polysyllable Maturity. Method: Ninety-three preschool children with SSD from the Sound Start Study (4;0–5;5 years) completed the Polysyllable Preschool Test (POP) and the Diagnostic Evaluation of Articulation and Phonology (DEAP-Phonology). Result: Vowel accuracy was significantly different between the POP and the DEAP-Phonology. Polysyllables were analysed using the seven Word-level Analysis of Polysyllables (WAP) error categories: (1) substitution of consonants or vowels (97.8% of children demonstrated common use), (2) deletion of syllables, consonants or vowels (65.6%), (3) distortion of consonants or vowels (0.0%), (4) addition of consonants or vowels (0.0%), (5) alteration of phonotactics (77.4%), (6) alteration of timing (63.4%) and (7) assimilation or alteration of sequence (0.0%). The Framework of Polysyllable Maturity described five levels of maturity based on children’s errors. Conclusions: Polysyllable productions of preschool children with SSD can be analysed and categorised using the WAP and interpreted using the Framework of Polysyllable Maturity.

Mapping speech pathology services to developmentally vulnerable and at-risk communities using the Australian Early Development Census

Abstract Purpose: The Australian Early Development Census (AEDC) is a population-based measure of childrens development across five domains in the first year of formal schooling. In this study, the AEDC data from two domains (Language and Cognitive Skills and Communication Skills and General Knowledge) were used to explore the extent and distribution of vulnerability in communication skills among children in Australian communities. Speech Pathology Australia (SPA) membership data were then used to explore the accessibility of services within those communities. Method: The 2012 AEDC data were accessed for 289,973 children, living in 577 communities across Australia. The number of children identified as “at risk” (10–25th percentile) or developmentally “vulnerable” (< 10th percentile) in each of the domains was calculated, then the location of communities with high proportions (> 20%) of these children was determined. These data were mapped against the location of paediatric speech-language pathologists (SLPs) to identify the number of communities with little to no access to speech-language pathology services. Result: Across Australia, there were 47,636 children (17.4%) identified as developmentally vulnerable/at risk in Language and Cognitive Skills and 69,153 children (25.3%) in Communication Skills and General Knowledge. There were 27 communities with > 20% of children identified as developmentally vulnerable/at risk in Language and Cognition in their first year of formal schooling. Of those, none had access to speech-language pathology services, according to current SPA membership data. There were also 27 local government areas with > 20% of children identified as developmentally vulnerable/at risk in the Communication Skills and General Knowledge domain. Of these, three had access to SLP(s) and these were in regional/metropolitan areas. Conclusion: The AEDC provides a means of identifying communities where children are performing well and communities which may benefit from population-based prevention or intervention. Given the number of communities within Australia without access to SLPs, there is a need to reconsider how such population-based services could be delivered, particularly in the communities with higher levels of vulnerability in communication development.

Cluster-randomized controlled trial evaluating the effectiveness of computer-assisted intervention delivered by educators for children with speech sound disorders

Purpose The aim was to evaluate the effectiveness of computer-assisted input-based intervention for children with speech sound disorders (SSD). Method The Sound Start Study was a cluster-randomized controlled trial. Seventy-nine early childhood centers were invited to participate, 45 were recruited, and 1,205 parents and educators of 4- and 5-year-old children returned questionnaires. Children whose parents and educators had concerns about speech were assessed (n = 275); 132 children who were identified with phonological pattern-based errors underwent additional assessment. Children with SSD and no difficulties with receptive language or hearing, typical nonverbal intelligence, and English as their primary language were eligible; 123 were randomized into two groups (intervention n = 65; control n = 58), and 3 withdrew. The intervention group involved Phoneme Factory Sound Sorter software (Wren & Roulstone, 2013) administered by educators over 9 weeks; the control group involved typical classroom practices. Participants were reassessed twice by a speech-language pathologist who was unaware of the initial assessment and intervention conditions. Results For the primary outcome variable (percentage of consonants correct), the significant mean change from pre- to postintervention for the intervention group (mean change = +6.15, p < .001) was comparable in magnitude to the significant change for the control group (mean change = +5.43, p < .001) with a small between-groups effect size for change (Cohens d = 0.08). Similar results occurred for measures of emergent literacy, phonological processing, participation, and well-being. Conclusion Computer-assisted input-based intervention administered by educators did not result in greater improvement than typical classroom practices.

The current practices of speech-language pathologists in providing information to clients with traumatic brain injury

Abstract The provision of information about cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) is important given the impact these communication impairments can have on the rehabilitation of people with TBI. This study describes the results of an online survey which investigated the current practices of 74 Australian speech-language pathologists (SLPs) working with adults with TBI. Thirty-seven SLPs outlined their practices in information provision. SLPs reported they provide information to adults with TBI about CCDs, the impact of CCDs on participation in life activities, and rehabilitation from CCDs. In addition, SLPs identified barriers and facilitators to information provision. Barriers identified included time, impairments resulting from TBI, and personal characteristics of the client. Facilitators included family functioning and support and the multidisciplinary team. Findings of this research indicate a need for some changes in the format and content of information that SLPs provide to adults with TBI, to ensure they can achieve fundamental levels of health literacy and better health outcomes.