Patricia McCabe

Features of developmental dyspraxia in the general speech-impaired population?

A typical clinical population with speech impairment was investigated to determine the extent of the presence of features of developmental dyspraxia and its interaction between the severity of impairment. Thirty diagnostic features of developmental dyspraxia were identified from the post-1981 literature and two scales of severity were devised. First the severity of these 30 features was measured (feature severity rating, FSR), and secondly severity of speech impairment was based on percentage of consonants correct (PCC). Using these features and severity ratings a retrospective file audit was conducted of 50 paediatric clients aged 2-8 years with impaired articulation or phonology. It was found that many characteristics regarded as diagnostic for developmental dyspraxia occur in the general speech-impaired population. The relationship between the variables was analysed, and support was found for the hypotheses that: (a) there is a relationship between the number of dyspraxic features expressed and the severity of impairment of speech production and (b) developmental dyspraxia is not characterized by severe impairment, but may occur in a range of severities from mild to severe.

Paediatric speech-language pathology service delivery: an exploratory survey of Australian parents.

Abstract Consideration of client values and preferences for service delivery is integral to engaging with the evidence-based practice triangle (E3BP), but as yet such preferences are under-researched. This exploratory study canvassed paediatric speech-language pathology services around Australia through an online survey of parents and compared reported service delivery to preferences, satisfaction, and external research evidence on recommended service delivery. Respondents were 154 parents with 192 children, living across a range of Australian locations and socio-economic status areas. Children had a range of speech and language disorders. A quarter of children waited over 6 months to receive initial assessment. Reported session type, frequency, and length were incongruent with both research recommendations and parents’ wishes. Sixty per cent of parents were happy or very happy with their experiences, while 27% were unhappy. Qualitative responses revealed concerns such as; a lack of available, frequent, or local services, long waiting times, cut-off ages for eligibility, discharge processes, and an inability to afford private services. These findings challenge the profession to actively engage with E3BP including; being cognisant of evidence-based service delivery literature, keeping clients informed of service delivery policies, individualizing services, and exploring alternative service delivery methods.

The attitudes, knowledge and beliefs of Arab parents in Kuwait about stuttering

UNLABELLED An Arabic version of the Public Opinion Survey of Human Attributes Inventory [POSHA-E; St Louis, K. O. (2005), a global instrument to measure public attitudes about stuttering. (The ASHA Leader, 22, 2-13)] was administered to 424 Arab parents of preschool and school age children in 18 government schools across all six governorates in Kuwait. The survey questions pertained to and investigated attitudes, knowledge and beliefs towards stuttering as well as comparative attitudes toward several other conditions. The aim was to identify whether potential barriers existed that might hinder the establishment and conduct of treatment programs for stuttering within Kuwait. These potential barriers might be negative stereotypes, misconceptions about stuttering, cultural beliefs as well as lack of awareness of the disorder within Kuwaiti society. The instrument successfully sampled a variety of beliefs, reactions and emotions that identified cultural beliefs, societal ignorance and confusion about the disorder. It was found that although stuttering appears to be a disorder that most people in Kuwait are aware of and familiar with, their level of knowledge about stuttering in general and about some specific aspects of the disorder was limited. This indicates a need to disseminate scientific information about stuttering in Kuwait and possibly other Arabic speaking countries. EDUCATIONAL OBJECTIVES Readers will be able: (1) to evaluate the status of speech-language pathology in Kuwait and the Middle East and compare it to that in other countries, such as Australia and the United States; (2) to list similarities in the stereotypes and attitudes towards stuttering cross-culturally. Readers will also be able to: (3) discuss the differences in knowledge and attitudes according to age, gender and educational level in Kuwait; (4) discuss public awareness and knowledge of stuttering among Arabs in Kuwait specifically.

Differential Diagnosis of Children with Suspected Childhood Apraxia of Speech

PURPOSE The gold standard for diagnosing childhood apraxia of speech (CAS) is expert judgment of perceptual features. The aim of this study was to identify a set of objective measures that differentiate CAS from other speech disorders. METHOD Seventy-two children (4-12 years of age) diagnosed with suspected CAS by community speech-language pathologists were screened. Forty-seven participants underwent diagnostic assessment including presence or absence of perceptual CAS features. Twenty-eight children met two sets of diagnostic criteria for CAS (American Speech-Language-Hearing Association, 2007b; Shriberg, Potter, & Strand, 2009); another 4 met the CAS criteria with comorbidity. Fifteen were categorized as non-CAS with phonological impairment, submucous cleft, or dysarthria. Following this, 24 different measures from the diagnostic assessment were rated by blinded raters. Multivariate discriminant function analysis was used to identify the combination of measures that best predicted expert diagnoses. RESULTS The discriminant function analysis model, including syllable segregation, lexical stress matches, percentage phonemes correct from a polysyllabic picture-naming task, and articulatory accuracy on repetition of /pətəkə/, reached 91% diagnostic accuracy against expert diagnosis. CONCLUSIONS Polysyllabic production accuracy and an oral motor examination that includes diadochokinesis may be sufficient to reliably identify CAS and rule out structural abnormality or dysarthria. Testing with a larger unselected sample is required.

Ultrasound Visual Feedback Treatment and Practice Variability for Residual Speech Sound Errors

PURPOSE The goals were to (a) test the efficacy of a motor-learning-based treatment that includes ultrasound visual feedback for individuals with residual speech sound errors and (b) explore whether the addition of prosodic cueing facilitates speech sound learning. METHOD A multiple-baseline, single-subject design was used, replicated across 8 participants. For each participant, 1 sound context was treated with ultrasound plus prosodic cueing for 7 sessions, and another sound context was treated with ultrasound but without prosodic cueing for 7 sessions. Sessions included ultrasound visual feedback as well as non-ultrasound treatment. Word-level probes assessing untreated words were used to evaluate retention and generalization. RESULTS For most participants, increases in accuracy of target sound contexts at the word level were observed with the treatment program regardless of whether prosodic cueing was included. Generalization between onset singletons and clusters was observed, as was generalization to sentence-level accuracy. There was evidence of retention during posttreatment probes, including at a 2-month follow-up. CONCLUSION A motor-based treatment program that includes ultrasound visual feedback can facilitate learning of speech sounds in individuals with residual speech sound errors.

Older people who stutter: barriers to communication and perceptions of treatment needs

BACKGROUND Little is known about the experience of stuttering for people over 55 years of age. Recent research has established that the same types of stuttering behaviours, cognitions, and emotional consequences experienced during young adulthood persist into older age. AIMS The aims were to investigate perceptions of limitations to activity and participation in a group of older people who stuttered into adulthood. A further aim was to find out their perceptions about treatment. METHODS & PROCEDURES This was a qualitative study involving eleven participants, eight males and three females over 55 years of age (mean age = 70.7, standard deviation = 9.13 years, range = 57.2-83.8 years) who self-reported stuttering into adulthood. Participants were randomly assigned to two focus groups for the discussion of topic questions posed by a moderator. The discussion was video- and audio-recorded, transcribed, and analysed using a comparative thematic analysis to derive emergent themes in relation to the topic questions. OUTCOMES & RESULTS Stuttering can impact on the lives of older people in a similar way to younger people who stutter. Participants who continued to work felt more limited by their stuttering because work involved unpredictable speaking situations with unfamiliar people. Others who had retired experienced some relief from these limitations because they were no longer required to communicate in a work context. The acceptance of stuttering was a theme expressed by some participants, and acceptance diminished the limitations because these older people were less fearful of the consequences of their stuttering. However, others remained constrained by the impact of stuttering on their communication and struggled with a fear of speaking and a fear of negative evaluation by others. They applied learnt and self-devised techniques to assist their speech and felt that if fear of speaking was removed and their self-confidence increased, communication might be better. They would like effective, individual, and short-term treatment with speech-language pathologists who are knowledgeable about stuttering and sensitive to their emotional needs. CONCLUSIONS & IMPLICATIONS Older people who stutter experienced limitations to participation because of their stuttering and there are implications for their future ability to remain independent and connected to relevant people and services. Further investigation of these limitations and research into effective intervention is indicated.

A life-time of stuttering: How emotional reactions to stuttering impact activities and participation in older people

Purpose: The International Classification of Functioning, Disability and Health (ICF) framework has a pragmatic focus on how impairment impacts the individuals activities and participation. Stuttering is known to impact communication in younger adults but this has not been established in older people who stutter. In this study, emotional reactions to stuttering were investigated in a group 55 years and older who self-reported stuttering since childhood. Method: This was a cross-sectional descriptive design. Twelve participants who self-reported that they still stuttered and in whom stuttering was confirmed, and 14 controls completed the Fear of Negative Evaluation Scale (FNES), The Endler Multi-dimensional Anxiety Scales-Trait (EMAS-T) and The Australian Personal Wellbeing Index (PWA-I). Participants whose stuttering persisted also completed the Overall Assessment of Speakers Experience of Stuttering (OASES). Results: The group who stuttered scored significantly higher on the FNES, with scores in the social phobia range. Responses on the OASES showed that stuttering continues to be a negative experience for this older group. Results for the EMAS-T and PWA-I were within the average range across both participant groups however significant differences existed between the groups in the social evaluative and physical danger domains of the EMAS-T, and the satisfaction with health domain of the PWA-I. Conclusions: Significant fear of negative evaluation, which is the key feature for social anxiety, was found in the group of older people who stuttered with a higher level of trait anxiety in social evaluative domains. The OASES showed that they also reacted to stuttering and communication in daily situations with moderate to severe impact scores which showed that stuttering impacted on speaking activities and by those negative experiences limited communication. Limited communication and restricted participation in the lives of older people have implications for healthy productive ageing and this is discussed.

A Systematic Review of Treatment Outcomes for Children With Childhood Apraxia of Speech

PURPOSE To present a systematic review of single-case experimental treatment studies for childhood apraxia of speech (CAS). METHOD A search of 9 databases was used to find peer-reviewed treatment articles from 1970 to 2012 of all levels of evidence with published communication outcomes for children with CAS. Improvement rate differences (IRDs) were calculated for articles with replicated (n > 1), statistically compared treatment and generalization evidence. RESULTS Forty-two articles representing Phase I and II single-case experimental designs (SCEDs; n = 23) or case series or description studies ( n = 19) were analyzed. Six articles showed high CAS diagnosis confidence. Of the 13 approaches within the 23 SCED articles, treatments were primarily for speech motor skills ( n = 6), linguistic skills ( n = 5), or augmentative and alternative communication ( n = 2). Most participants responded positively to treatment, but only 7 of 13 approaches in SCED studies reported maintenance and/or generalization of treatment effects. Three approaches had preponderant evidence (Smith, 1981). IRD effect sizes were calculated for Integral Stimulation/Dynamic Temporal and Tactile Cueing, Rapid Syllable Transition Treatment, and Integrated Phonological Awareness Intervention. CONCLUSIONS At least 3 treatments have sufficient evidence for Phase III trials and interim clinical practice. In the future, efficacy needs to be established via maintenance and generalization measures.

A Randomized Controlled Trial for Children With Childhood Apraxia of Speech Comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme–Third Edition

PURPOSE This randomized controlled trial compared the experimental Rapid Syllable Transition (ReST) treatment to the Nuffield Dyspraxia Programme-Third Edition (NDP3; Williams & Stephens, 2004), used widely in clinical practice in Australia and the United Kingdom. Both programs aim to improve speech motor planning/programming for children with apraxia of speech (CAS), but they differ in types of stimuli used, level of stimulus complexity at initiation of treatment, and the principles of motor learning that they apply. METHOD Treatment was delivered to 26 children with mild to severe CAS aged 4-12 years through trained and supervised speech-language pathology students in 1-hr sessions, 4 days a week for 3 weeks at a university clinic. Articulation and prosodic accuracy were assessed at pretreatment, 1 week, 1 month, and 4 months posttreatment using blinded independent assessors to compare treatment, maintenance, and generalization effects. RESULTS The ReST and NDP3 treatments demonstrated large treatment effects. ReST maintained treatment gains from 1-week to 4-months posttreatment more effectively than the NDP3. Significant generalization to untreated stimuli was observed for both ReST and NDP3. CONCLUSIONS ReST and NDP3 have strong evidence of treatment and generalization gains in children with CAS when delivered intensively. Overall, ReST has greater external evidence from multiple sources but both treatments have support for clinical use.

A comparison of two treatments for childhood apraxia of speech: methods and treatment protocol for a parallel group randomised control trial.

BackgroundChildhood Apraxia of Speech is an impairment of speech motor planning that manifests as difficulty producing the sounds (articulation) and melody (prosody) of speech. These difficulties may persist through life and are detrimental to academic, social, and vocational development. A number of published single subject and case series studies of speech treatments are available. There are currently no randomised control trials or other well designed group trials available to guide clinical practice.Methods/DesignA parallel group, fixed size randomised control trial will be conducted in Sydney, Australia to determine the efficacy of two treatments for Childhood Apraxia of Speech: 1) Rapid Syllable Transition Treatment and the 2) Nuffield Dyspraxia Programme – Third edition. Eligible children will be English speaking, aged 4–12 years with a diagnosis of suspected CAS, normal or adjusted hearing and vision, and no comprehension difficulties or other developmental diagnoses. At least 20 children will be randomised to receive one of the two treatments in parallel. Treatments will be delivered by trained and supervised speech pathology clinicians using operationalised manuals. Treatment will be administered in 1-hour sessions, 4 times per week for 3 weeks. The primary outcomes are speech sound and prosodic accuracy on a customised 292 item probe and the Diagnostic Evaluation of Articulation and Phonology inconsistency subtest administered prior to treatment and 1 week, 1 month and 4 months post-treatment. All post assessments will be completed by blinded assessors. Our hypotheses are: 1) treatment effects at 1 week post will be similar for both treatments, 2) maintenance of treatment effects at 1 and 4 months post will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment, and 3) generalisation of treatment effects to untrained related speech behaviours will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment. This protocol was approved by the Human Research Ethics Committee, University of Sydney (#12924).DiscussionThis will be the first randomised control trial to test treatment for CAS. It will be valuable for clinical decision-making and providing evidence-based services for children with CAS.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12612000744853