Sharynne McLeod

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.

Prevalence of communication disorders compared with other learning needs in 14 500 primary and secondary school students

BACKGROUND Prevalence data are of interest to health professionals and educators to assist in the planning of service delivery, allow for the calculation of the level of impact of intervention, and allow for the consideration of the boundaries between typical development and impairment. AIMS To determine the prevalence of children with communication disorders and other learning needs as identified by their teachers within all primary and secondary schools in an Australian school district over a 3-year period. METHODS & PROCEDURES Children with learning needs were identified from 14,514 students in the first year (wave 1) and the 14,533 students 2 years later (wave 2). Children were identified via a four-phased data-collection process designed to reduce selection and misclassification bias. Identification included teacher training, teacher referral, confirmation by documentation from relevant professionals including speech and language therapists, audiologists, psychologists and doctors, and verification by the school district learning needs advisors. OUTCOMES & RESULTS Overall 5309 students were identified as having some area of learning need in the first year and 4845 students were identified 2 years later. In order of prevalence, the areas of learning need were: specific learning difficulty (17.93% in wave 1; 19.10% in wave 2), communication disorder (13.04%; 12.40%), English as a second or other language (9.16%; 5.80%), behavioural/emotional difficulty (8.16%; 6.10%), early achiever/advanced learner (7.30%; 5.50%), physical/medical disability (1.52%; 1.40%), intellectual disability (1.38%; 1.20%), hearing impairment (0.96%; 0.80%), and visual impairment (0.16%; 0.30%). The male:female ratio for all children was 1.57:1 (wave 1) and 1.66:1 (wave 2) and was the highest for the categories of behavioural/emotional difficulty, communication disorders. There were significant differences between learning need and socio-economic status quantile for all areas except early achievers/advanced learners and physical/medical disability. There was a higher prevalence of behavioural/emotional difficulty, and intellectual disability, in the lower socio-economic status quantiles and a higher prevalence of communication disorders in the mid-to-high socio-economic status quantiles. More children were identified as having an additional learning need in grades 1-3 (5-9 years of age). The children who were perceived as requiring the highest level of teacher support were those with an intellectual disability. CONCLUSIONS This study provides comparative prevalence data for children with additional learning needs. There was a high prevalence of children typically seen in the caseloads of speech and language therapists, and teachers identified that many of these children required high levels of support within the classroom.

Speech-language pathologists’ assessment and intervention practices with multilingual children

Abstract Within predominantly English-speaking countries such as the US, UK, Canada, New Zealand, and Australia, there are a significant number of people who speak languages other than English. This study aimed to examine Australian speech-language pathologists’ (SLPs) perspectives and experiences of multilingualism, including their assessment and intervention practices, and service delivery methods when working with children who speak languages other than English. A questionnaire was completed by 128 SLPs who attended an SLP seminar about cultural and linguistic diversity. Approximately one half of the SLPs (48.4%) reported that they had at least minimal competence in a language(s) other than English; but only 12 (9.4%) reported that they were proficient in another language. The SLPs spoke a total of 28 languages other than English, the most common being French, Italian, German, Spanish, Mandarin, and Auslan (Australian sign language). Participants reported that they had, in the past 12 months, worked with a mean of 59.2 (range 1–100) children from multilingual backgrounds. These children were reported to speak between two and five languages each; the most common being: Vietnamese, Arabic, Cantonese, Mandarin, Australian Indigenous languages, Tagalog, Greek, and other Chinese languages. There was limited overlap between the languages spoken by the SLPs and the children on the SLPs’ caseloads. Many of the SLPs assessed childrens speech (50.5%) and/or language (34.2%) without assistance from others (including interpreters). English was the primary language used during assessments and intervention. The majority of SLPs always used informal speech (76.7%) and language (78.2%) assessments and, if standardized tests were used, typically they were in English. The SLPs sought additional information about the childrens languages and cultural backgrounds, but indicated that they had limited resources to discriminate between speech and language difference vs disorder.

The ICF: a framework for setting goals for children with speech impairment

The International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001) is proposed as a framework for integrative goal setting for children with speech impairment. The ICF incorporates both impairment and social factors to consider when selecting appropriate goals to bring about change in the lives of children with speech impairment. Speech-language therapists and teachers can work together not only to provide direct intervention with the child, but also to work in partnership with the childs family, friends, school and society.

The Influence of Bilingualism on Speech Production: A Systematic Review.

BACKGROUND Children who are bilingual and have speech sound disorder are likely to be under-referred, possibly due to confusion about typical speech acquisition in bilingual children. AIMS To investigate what is known about the impact of bilingualism on childrens acquisition of speech in English to facilitate the identification and treatment of bilingual children with speech sound disorder. METHODS & PROCEDURES A systematic review of studies from the last 50 years was conducted. Studies investigating speech acquisition in bilingual infants and children (where one language was English) were identified through searching seven electronic databases, bibliographies of relevant articles and e-mailing authors. Sixty-six studies investigating bilingual speech production met inclusion criteria, with 53 describing typically developing children and 13 describing children with speech sound disorder. The 66 studies were analysed thematically and summarized in terms of methods, key findings and underlying theories. MAIN CONTRIBUTION There was limited evidence to suggest that bilingual children develop speech at a slower rate than their monolingual peers; however, there was evidence for qualitative differences and increased variation in speech production. Nearly all studies provide evidence for transfer between the two phonological and language structures, although the amount of transfer varied between studies. There was evidence of positive and negative transfer of features from the dominant language (L1) to the second language (L2) as well as from L2 to L1. Positive transfer became more evident with increased age and length of exposure to a second language. More recently researchers have moved away from investigating whether there are one or two phonological systems and accept that there are two systems that interact. Interest has shifted to examining how phonological systems interact and to identifying factors that influence interactions. The review revealed a number of inconsistencies in the findings of studies due to differences in methodology, languages investigated and degree of language exposure. Overall, measurement issues were addressed well but most studies provided limited sample information about language experience, schooling and socio-economic status. CONCLUSIONS & IMPLICATIONS There are differences in speech sound acquisition between monolingual and bilingual children in terms of rate and patterns of error, with both positive and negative transfer occurring in bilingual children.

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.

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.

An holistic view of a child with unintelligible speech: Insights from the ICF and ICF-CY

This paper provides an holistic and systematic view of a 7 year old boy, Jarrod, as a unique individual with unintelligible speech. Jarrod was considered using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) beta draft. Consideration was made of Body Function, Body Structure, Activity and Participation, Environmental Factors and Personal Factors that impacted on his life and were affected by his speech impairment. Intervention was recommended to be directed in two ways. The first towards amelioration of Jarrods speech impairment using an evidence-based approach and monitored by a data-based decision making model. The second approach was directed towards others in Jarrods immediate environment such as his peers and teachers as well as towards policy makers and others in society who have an effect on the provision of a facilitative environment and appropriate services for children with speech impairment. This paper is a preliminary attempt to determine salient dimensions and codes of the ICF-CY (beta draft) for use by speech-language pathologists working with children with unintelligible speech.

Tongue/palate contact for the production of /S/ and /z/

Productions of /s/ and /z/ by ten adult speakers were investigated using the electropalatograph (EPG). The participants, ten speech researchers who spoke English as their first language, recorded productions of /s/ and /z/ in nonsense and real words. The maximum contact frame was used as the point of reference to compare tongue/palate contact for each production. Each speaker had alveolar contact, lateral bracing and most had a midline groove for both /s/ and /z/; however, the array of contacted electrodes was unique for each speaker. The groove widths and lengths ranged from 0–3 electrodes. There was significantly greater alveolar tongue/palate contact for /z/ compared to /s/ in word‐initial position, but not in word‐final position for the following measures: alveolar palatal contact, medial groove width, medial groove length. However, when measures of total palate contact and centre of gravity were considered, there was a complex interaction between the phonemes /s/ and /z/, coarticulation with the vowel, word position, and word context (real and nonsense words).

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.