Karla N. Washington

Using the ICF within speech-language pathology: Application to developmental language impairment

The conceptual framework proposed by the World Health Organization (WHO), the International Classification of Functioning, Disability, and Health, (ICF), provides a multidimensional approach to the investigation of various communication disorders, including developmental language impairments. The comprehensive view of health and common language offered by the ICF framework is useful for guiding clinical and research practices within speech-language pathology. Some sub-specialities (e.g., aphasia and traumatic brain injury (TBI)) have already begun to use the ICF framework to guide assessment and treatment practices. However, its application for children with specific language impairment (SLI), a type of developmental language impairment and one of the most common communication disorders in preschool and school-age children, is somewhat limited. The purpose of this paper is two-fold: (1) to emphasize the usefulness of the ICF framework as a tool for describing SLI and (2) to illustrate how consideration of the ICF framework may be helpful in the management and evaluation of outcomes for children with SLI.

Measuring communicative participation using the FOCUS©: Focus on the Outcomes of Communication Under Six.

Background The FOCUS© is a new outcome tool for use by both parents and clinicians that measures changes in the communicative participation skills of preschool children. Changes in communicative participation skills as measured by the FOCUS were compared across three groups of children: those with speech impairments only (SI), those with language impairments only (LI) and those with both speech and language impairments (S/LI). Methods Participating families (n = 112, 75 male children) were recruited through 13 Canadian organizations. Children ranged from 10 months to 6 years 0 months (mean = 2.11 years; SD = 1.18 years) and attended speech-language intervention. Parents completed the FOCUS at the start and end of treatment. There were 23 children in the SI group, 62 children in the LI group and 27 children in the S/LI group. The average amount of the childrens therapy varied from 7 to 10 h. Results The FOCUS captures changes in communicative participation for children with a range of communication disorder types and severities. All three groups of children made clinically important improvements according to their FOCUS scores (MCID ≥ 16 points). The FOCUS captured improvements in intelligibility, independent communication, play and socialization. Conclusions The FOCUS measured positive changes in communicative participation skills for all three groups of children after 7–10 h of speech-language therapy. An outcome measure that targets only specific speech and language skills would miss many of the important social function changes associated with speech-language treatment.

Exploring the Outcomes of a Novel Computer-Assisted Treatment Program Targeting Expressive-Grammar Deficits in Preschoolers with SLI

PURPOSE The impact of a newly designed computer-assisted treatment (C-AT) program, My Sentence Builder, for the remediation of expressive-grammar deficits in children with specific language impairment (SLI) was explored. This program was specifically designed with features to directly address expressive-grammar difficulties, thought to be associated with hypothesized deficits in verbal working memory (VWM). METHOD Thirty-four preschoolers with deficits in expressive-grammar morphology participated. Using the randomization procedure of consecutive sampling, participants were recruited. Twenty-two participants were consecutively assigned to one of two treatment groups, C-AT or non C-AT (nC-AT). The nC-AT utilized conventional language stimulation procedures containing features which have been traditionally used to address expressive-grammar deficits. A group of equivalent children awaiting treatment and chosen from the same sample of children as the treatment participants served as a control group. Blind assessments of outcomes were completed pre-, post-, and 3-months post-treatment in a formal and informal context. RESULTS C-AT and nC-AT participants significantly outperformed controls pre-to-post to 3-months post-treatment in both assessment contexts. No significant differences in treatment gains were found between C-AT and nC-AT. CONCLUSION Results suggested that treatments designed to directly address expressive-grammar deficits were better than no treatment for preschool SLI. Further, use of a C-AT program may be another feasible treatment method for this disorder population. LEARNING OUTCOMES As a result of this activity, the reader will recognize that: (1) expressive-grammar treatment is better than no treatment for immediate and continued language growth, (2) use of a C-AT program containing specific features designed to directly address expressive-grammar deficits is another viable, but not necessarily a better treatment option for the remediation of expressive-grammar deficits in preschool children with SLI, and (3) different outcome contexts yield distinct yet equally important findings about growth in childrens expressive-grammar skills with treatment.

Outcomes and Predictors in Preschoolers with Speech-Language and/or Developmental Mobility Impairments.

The purpose of this article is to describe communicative-participation outcomes measured by the Focus on the Outcomes of Communication Under Six (FOCUS©; Thomas-Stonell et al., 2013) for interventions provided by speech-language pathologists (SLPs) in different community settings for preschoolers with speech-language impairments (Sp/LI) with and without developmental mobility impairments (MI). The predictive relationships between communicative-participation and (1) functioning-and-disability, and (2) contextual factors, was also investigated. Sixty-one preschoolers with Sp/LI and their parents participated. Twenty-six preschoolers were identified with Sp/LI and received speech-language interventions (Group 1), 20 preschoolers were identified with Sp/LI and MI and received speech-language interventions (Group 2), and 15 preschoolers with Sp/LI awaiting intervention served as waitlist controls (Group 3). Parents completed structured interviews about children’s communicative-participation outcomes using the FOCUS© at three time points (pre-intervention, post-intervention, and 3-months post-intervention) with an SLP. Only Groups 1 and 2 experienced statistically and clinically meaningful communicative-participation outcomes over time as measured by the FOCUS©. Pre- to post-intervention communicative-participation was predicted by functioning-and-disability and contextual factors, initial social skills and intervention status, respectively. Post-intervention to 3-month post-intervention scores were also predicted by functioning-and-disability and contextual factors, risk status (Sp/LI only, Sp/LI+developmental MI) and intervention status, respectively. Significant and clinically meaningful changes in communicative-participation over time are associated with speech-language interventions for preschoolers with Sp/LI.

Validation of the Intelligibility in Context Scale for Jamaican Creole-Speaking Preschoolers

Purpose To describe validation of the Intelligibility in Context Scale (ICS; McLeod, Harrison, & McCormack, 2012a) and ICS-Jamaican Creole (ICS-JC; McLeod, Harrison, & McCormack, 2012b) in a sample of typically developing 3- to 6-year-old Jamaicans. Method One-hundred and forty-five preschooler-parent dyads participated in the study. Parents completed the 7-item ICS (n = 145) and ICS-JC (n = 98) to rate childrens speech intelligibility (5-point scale) across communication partners (parents, immediate family, extended family, friends, acquaintances, strangers). Preschoolers completed the Diagnostic Evaluation of Articulation and Phonology (DEAP; Dodd, Hua, Crosbie, Holm, & Ozanne, 2006) in English and Jamaican Creole to establish speech-sound competency. For this sample, we examined validity and reliability (interrater, test-rest, internal consistency) evidence using measures of speech-sound production: (a) percentage of consonants correct, (b) percentage of vowels correct, and (c) percentage of phonemes correct. Results ICS and ICS-JC ratings showed preschoolers were always (5) to usually (4) understood across communication partners (ICS, M = 4.43; ICS-JC, M = 4.50). Both tools demonstrated excellent internal consistency (α = .91), high interrater, and test-retest reliability. Significant correlations between the two tools and between each measure and language-specific percentage of consonants correct, percentage of vowels correct, and percentage of phonemes correct provided criterion-validity evidence. A positive correlation between the ICS and age further strengthened validity evidence for that measure. Conclusions Both tools show promising evidence of reliability and validity in describing functional speech intelligibility for this group of typically developing Jamaican preschoolers.

Parent Report of Communication Skills of Jamaican Children With Autism Spectrum Disorder: A Pilot Study:

Most research related to communication skills in children with autism spectrum disorder (ASD) has been obtained from monolingual English-speaking children from high-income countries. Based on questionnaires completed by parents, this pilot study aimed to describe the communication characteristics of six children with ASD living in Jamaica. Parents had concerns about their child’s speech intelligibility, expressive language, and social communication. All children were reported to speak using Standard Jamaican English (SJE). Exposure to SJE and Jamaican Creole (JC) was reported by half of the parents. Emergent literacy was considered a relative strength. All parents reported that their child could recite the alphabet and identify some letters and that family members also helped their child print and read letters or words. Other aspects of the home literacy environment and early literacy skills were varied. Information from this group provides some insights into communication skills in children with ASD from Caribbean backgrounds.

Towards automated detection of similarities and differences in bilingual speakers

Bilingualism is increasingly the norm in the United States with at least 20% of Americans being bilingual. This change in linguistic demography has created a new challenge to accurately diagnose speech disorders among bilingual children. This study explores Acoustic Landmark Detection (ALD) system as an objective approach to characterizing similarities and differences in speech production in child speakers of Standard English and Jamaican Creole (JC). Eight JC-English bilingual children were recorded speaking eleven words three times in each language. Words were transcribed and entered into PROPH + to provide: (1) Phonological Mean Length of Utterance [pMLU], (2) phonotactic structure, and (3) Percent Consonants Correct (PCC). Landmarks were hand-marked to determine probable landmark sequences based on canonical word production. Canonical landmark sequences were aligned with detected landmark sequences in both languages using the Needleman-Wunsch global alignment algorithm. Analysis revealed that if PCC i...

Support for identifying predictors of functional communication in children with cerebral palsy

tra may be attributable at least in part, to the single voxel technique employed in this study. A multi-voxel technique would help correlate the MR spectroscopy better with the diffusivity changes. However, this technique is quite challenging to implement in the posterior fossa. Future studies should focus on correlating the morphological changes in OMS and the clinical manifestations, effect of treatment plans, and course of the illness by combining the structural analysis with functional activation maps. Serial studies in these patients during the course of the illness may help develop more effective treatment strategies. Comparison with autopsy material where available in patients who have undergone long-term imaging could help validate the volumetric changes and provide radiological-pathological correlation. I urge clinicians taking care of patients with OMS to acquire high quality imaging studies of the brain that can be used for volumetric analyses at various time points during the course of the disease and where available, request addition of MR spectroscopy of the posterior fossa and diffusion-weighted imaging to the protocol. This will enable detailed study over multiple time points in a larger population and enhance our understanding of this often debilitating and difficult to treat condition.