Joanne Cleland

Relationship between speech, oromotor, language and cognitive abilities in children with Down's syndrome

BACKGROUND Children and young people with Downs syndrome present with deficits in expressive speech and language, accompanied by strengths in vocabulary comprehension compared with non-verbal mental age. Intelligibility is particularly low, but whether speech is delayed or disordered is a controversial topic. Most studies suggest a delay, but no studies explore the relationship between cognitive or language skills and intelligibility. AIMS This study sought to determine whether severity of speech disorder correlates with language and cognitive level and to classify the types of errors, developmental or non-developmental, that occur in the speech of children and adolescents with Downs syndrome. METHODS & PROCEDURES Fifteen children and adolescents with Downs syndrome (aged 9-18 years) were recruited. Participants completed a battery of standardized speech, language and cognitive assessments. The phonology assessment was subject to phonological and phonetic analyses. Results from each test were correlated to determine relationships. OUTCOME & RESULTS Individuals with Downs syndrome present with deficits in receptive and expressive language that are not wholly accounted for by their cognitive delay. Receptive vocabulary is a strength in comparison with expressive and receptive language skills, but it was unclear from the findings whether it is more advanced compared with non-verbal cognitive skills. The majority of speech errors were developmental in nature, but all of the children with Downs syndrome showed at least one atypical or non-developmental speech error. CONCLUSIONS & IMPLICATIONS Children with Downs syndrome present with speech disorders characterized by atypical, and often unusual, errors alongside many developmental errors. A lack of correlation between speech and cognition or language measures suggests that the speech disorder in Downs syndrome is not simply due to cognitive delay. Better differential diagnosis of speech disorders in Downs syndrome is required, allowing interventions to target the specific disorder in each individual.

Phonetic and phonological errors in children with high functioning autism and Asperger syndrome

This study involved a qualitative analysis of speech errors in children with autism spectrum disorders (ASDs). Participants were 69 children aged 5–13 years; 30 had high functioning autism and 39 had Asperger syndrome. On a standardized test of articulation, the minority (12%) of participants presented with standard scores below the normal range, indicating a speech delay/disorder. Although all the other children had standard scores within the normal range, a sizeable proportion (33% of those with normal standard scores) presented with a small number of errors. Overall 41% of the group produced at least some speech errors. The speech of children with ASD was characterized by mainly developmental phonological processes (gliding, cluster reduction and final consonant deletion most frequently), but non-developmental error types (such as phoneme specific nasal emission and initial consonant deletion) were found both in children identified as performing below the normal range in the standardized speech test and in those who performed within the normal range. Non-developmental distortions occurred relatively frequently in the children with ASD and previous studies of adolescents and adults with ASDs shows similar errors, suggesting that they do not resolve over time. Whether or not speech disorders are related specifically to ASD, their presence adds an additional communication and social barrier and should be diagnosed and treated as early as possible in individual children.

Using ultrasound visual biofeedback to treat persistent primary speech sound disorders

Abstract Growing evidence suggests that speech intervention using visual biofeedback may benefit people for whom visual skills are stronger than auditory skills (for example, the hearing-impaired population), especially when the target articulation is hard to describe or see. Diagnostic ultrasound can be used to image the tongue and has recently become more compact and affordable leading to renewed interest in it as a practical, non-invasive visual biofeedback tool. In this study, we evaluate its effectiveness in treating children with persistent speech sound disorders that have been unresponsive to traditional therapy approaches. A case series of seven different children (aged 6–11) with persistent speech sound disorders were evaluated. For each child, high-speed ultrasound (121 fps), audio and lip video recordings were made while probing each child’s specific errors at five different time points (before, during and after intervention). After intervention, all the children made significant progress on targeted segments, evidenced by both perceptual measures and changes in tongue-shape.

Electropalatographic therapy for children and young people with Down's syndrome

Articulation disorders in Downs syndrome (DS) are prevalent and often intractable. Individuals with DS generally prefer visual to auditory methods of learning and may therefore find it beneficial to be given a visual model during speech intervention, such as that provided by electropalatography (EPG). In this study, participants with Downs syndrome, aged 10:1 to 18:9, received 24 individualized therapy sessions using EPG. Simultaneous acoustic and EPG recordings were made pre- and post-intervention during 10 repetitions of a word list containing lingua-palatal consonants. Participants also completed the DEAP phonology sub-test at both time points. Post-treatment, all participants showed qualitative and quantifiable differences in EPG patterns and improvements in DEAP percentage consonants correct. EPG assessment and therapy appears a positive approach for identifying and improving articulatory patterns in children with DS.

Emotional recognition in autism spectrum conditions from voices and faces

The present study reports on a new vocal emotion recognition task and assesses whether people with autism spectrum conditions (ASC) perform differently from typically developed individuals on tests of emotional identification from both the face and the voice. The new test of vocal emotion contained trials in which the vocal emotion of the sentence were congruent, incongruent, or neutral with respect to the semantic content. We also included a condition in which there was no semantic content (an ‘mmm’ was uttered using an emotional tone). Performance was compared between 11 adults with ASC and 14 typically developed adults. Identification of emotion from sentences in which the vocal emotion and the meaning of sentence were congruent was similar in people with ASC and a typically developed comparison group. However, the comparison group was more accurate at identifying the emotion in the voice from incongruent and neutral trials, and also from trials with no semantic content. The results of the vocal emotion task were correlated with performance on a face emotion recognition task. In decoding emotion from spoken utterances, individuals with ASC relied more on verbal semantics than did typically developed individuals, presumably as a strategy to compensate for their difficulties in using prosodic cues to recognize emotions.

The use of electropalatography (EPG) in the assessment and treatment of motor speech disorders in children with Down's syndrome: Evidence from two case studies

Background: Many children experience significant difficulties in developing key aspects of speech. For some, these communication difficulties are compounded by co-occurring intellectual disabilities. Method: This paper presents two case studies from a larger on-going longitudinal study of the effectiveness of using electropalatography (EPG) to address the intelligibility problems experienced by many children and young people with Downs syndrome (DS). EPG, an innovative computer-based tool for assessing and treating speech motor difficulties, enables the speaker to ‘see’ the placement of his or her tongue during speech and to attempt to correct any lingual palatal errors. Results: This visual supplementation of auditory feedback offers potential therapeutic benefits for children with intellectual disabilities, many of whom show relative strengths in visual vs. auditory and simultaneous vs. sequential processing. EPG also provides therapists with an objective measure of articulatory ability. Conclusions: Findings from these two case studies demonstrate the potential utility of EPG in both the assessment and treatment of speech motor disorders in DS.

An EPG analysis of /t/ in young people with Down's syndrome

Many studies have pointed to impaired speech intelligibility in young people with Down’s syndrome (DS). Some have attributed these problems to delayed phonological development, while others have identified disordered speech patterns, which could be related to a dyspraxic element in their speech. This study uses electropalatography (EPG) to examine the speech of 25 young people with DS, focusing on their production of the obstruent /t/. For the EPG analysis, participants produced the target obstruent in the word ‘toe’, repeated 10 times. An investigative analysis was carried out. A new descriptive taxonomy of EPG error patterns was developed and these errors were related to perceptually based transcriptions. The measures are discussed in relation to current knowledge of the anatomical and physiological characteristics of DS.

Tongue reading : comparing the interpretation of visual information from inside the mouth, from electropalatographic and ultrasound displays of speech sounds

Speakers possess a natural capacity for lip reading; analogous to this, there may be an intuitive ability to “tongue-read.” Although the ability of untrained participants to perceive aspects of the speech signal has been explored for some visual representations of the vocal tract (e.g. talking heads), it is not yet known to what extent there is a natural ability to interpret speech information presented through two clinical phonetic tools: EPG and ultrasound. This study aimed to determine whether there is any intuitive ability to interpret the images produced by these systems, and to determine whether one tool is more conducive to this than the other. Twenty adults viewed real-time and slow motion EPG and ultrasound silent movies of 10 different linguo-palatal consonants and 4 vowels. Participants selected which segment they perceived from four forced-choice options. Overall, participants scored above chance in the EPG and ultrasound conditions, suggesting that these images can be interpreted intuitively to some degree. This was the case for consonants in both the conditions and for vowels in the EPG condition.

A perceptual and electropalatographic study of /∫/ in young people with Down's syndrome

Speech production in young people with Downs syndrome has been found to be variable and inconsistent. Errors tend to be more in the production of sounds that typically develop later, for example, fricatives and affricates, rather than stops and nasals. It has been suggested that inconsistency in production is a result of a motor speech deficit. Late acquired fricatives such as /s/ and /∫/ are complex articulations, which may require more precise motor programming and may therefore show highly inconsistent productions. Other factors potentially affecting speech production in this population are abnormal palatal structure, hearing loss, and hypotonia. A group of 20 young people with Downs syndrome were recorded using Electropalatography (EPG), reading a wordlist containing the phrase ‘a sheep’. The wordlist contained seven other phrases and was repeated 10 times. Eight typically developing, cognitively matched children and eight adults were also recorded producing the same data set. Articulatory (EPG pattern analysis) and perceptual analyses of the 10 productions of /∫/ were carried out. /∫/ production was found to be inconsistent in the young people with Downs syndrome, with more errors both in the auditory analysis and articulatory analysis than in the typical sample, which may be due to a motor programming or motor control problem. There were a greater number of errors in the EPG analysis than in the perceptual analysis. This suggests that some young people with DS were able to produce perceptually acceptable /∫/ with atypical EPG patterns. The use of typical, adult-modelled /∫/ EPG patterns in therapy may be inappropriate for some children with DS who present with atypical palatal structures.

ULTRAX2020: Ultrasound Technology for Optimising the Treatment of Speech Disorders : Clinicians' Resource Manual

Ultrasound Visual Biofeedback (U-VBF) uses medical ultrasound to image the tongue in real-time during speech. Clinicians can use this information to both assess speech disorders and as a biofeedback tool to guide children in producing correct speech. Ultrasound images of the tongue are thought to be relatively intuitive to interpret, however, there is no easy way of using the ultrasound to diagnose speech disorders, despite it having the potential to identify imperceptible errors which are diagnostically important. This manual describes how to use ultrasound for the assessment and treatment of speech sound disorders in children. It is designed to be used in combination with Articulate Instruments Ltd. Sonospeech software by clinical partners of the Ultrax2020 project. However, the basic principles and resources contained within this document will be of use to anyone interested in using ultrasound in the speech therapy clinic.