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Phonological representations in children with SLI

It has been hypothesized that children with specific language impairment (SLI) have difficulty processing sound-based information, including storing and accessing phonological representations in the lexicon. Tasks are emerging in the literature that provide a measure of the quality of stored phonological representations, without requiring a verbal response. This article describes the performance of children with specific language impairment (SLI) (n = 21), typically developing children matched for age (n = 21), and typically developing children matched for language (n = 21) on two measures of phonological representations – the Quality of Phonological Representations (QPR) and the Silent Deletion of Phonemes (SDOP) – and a measure of phonological awareness, the Sutherland Phonological Awareness Test: Revised (SPAT-R). As predicted the age-matched (AM) group demonstrated significantly better performance on all tasks than the SLI group. The AM group performed significantly better than the language-matched (LM) group on the SDOP and SPAT tasks, but not significantly differently on the QPR task. The SLI group performed significantly better than the LM group on both the SDOP and SPAT, but their performance on the QPR was significantly weaker than the LM group. The findings of this study provide support for the notion of lower quality phonological representations in children with SLI thus placing them at increased risk of ongoing language and literacy difficulties.

Phonological processing skills in specific language impairment.

Abstract In order to provide effective intervention for children with specific language impairment (SLI), it is crucial that there is an understanding of the underlying deficit in SLI. This study utilized a battery of phonological processing tasks to compare the phonological processing skills of children with SLI to typically-developing peers matched for age or language. The children with SLI had significantly poorer performance than age-matched peers on measures of phonological representations, phonological awareness, rapid automatized naming, phonological short-term memory, and one measure of working memory. Of particular significance, the SLI group also demonstrated significantly weaker performance than language-matched peers on one measure of phonological representations, and one measure of working memory. The findings provide some support for a phonological processing account of SLI and highlight the utility of using tasks that draw on a comprehensive model of speech processing to profile and consider childrens phonological processing skills in detail.

Retrospective parent report of early vocal behaviours in children with suspected Childhood Apraxia of Speech (sCAS)

Parents of children with suspected Childhood Apraxia of Speech (sCAS, n = 20), Specific Language Impairment (SLI, n = 20), and typically developing speech and language skills (TD, n = 20) participated in this study, which aimed to quantify and compare reports of early vocal development. Via a questionnaire, parents reported on their childs early babbling and vocalizations, along with other developmental milestones. Consistent with previous anecdotal reports and theoretical predictions, the sCAS children were reported to be significantly less vocal, less likely to babble, later in the emergence of first words and later in the emergence of two-word combinations than the TD children. However, on many (but not all) of the items, the SLI children were reported similarly to the sCAS group. Notable exceptions where the sCAS group differed significantly to the SLI group were with the percentage of children reported to have babbled and the reported age of emergence of two-word combinations. The results support previous anecdotal clinical suggestions relating to children with CAS but highlight the need for longitudinal studies to analyse speech and language trajectories over time.

Beyond narrative: Is there an implicit structure to the way in which adults organise their discourse?

Abstract Understanding the structure of discourse in healthy adults is fundamental to the assessment and diagnosis of discourse level impairments in clinical populations and the development of effective treatment regimes. Exploring discourse genre in healthy speakers that extend beyond the traditional narrative is equally paramount in facilitating maximum impact of clinical interventions in everyday speaking contexts. This study aimed to characterise the discourse of 30 healthy adult speakers across three age groups (20–39, 40–59 and 60+ years) and four discourse genres (recount, procedural, exposition and narrative), drawing on discourse frameworks used in classroom teaching. A clinically useful discourse protocol and analytic procedure using SALT was developed that profiled the macrostructure and key aspects of linguistic microstructure of the different genres, exploring coherence and cohesion within and across genre in a systematic manner. Analyses considered whether there were differences in coherence and cohesion among the different age groups, different genres and specific topics. Results showed that, while individual variability was present, healthy adults structured their discourse consistently, adhering to the frameworks described in the developmental literature, across all four genres. Significant age differences were only seen in the amount of information contained in the body of the discourse (i.e. events, steps or statements offered) with older participants offering less information. This dataset will enable comparisons to be drawn with clinical populations to determine the utility and the feasibility of the use of this framework for diagnosis and intervention.

Kinematic changes in jaw and lip control of children with cerebral palsy following participation in a motor-speech (PROMPT) intervention

Abstract This study evaluates kinematic movements of the jaw and lips in six children (3–11 years) with moderate-to-severe speech impairment associated with cerebral palsy before, during, and after participation in a motor-speech (PROMPT) intervention program. An ABCA single subject research design was implemented. Subsequent to the baseline phase (A), phase B targeted each participants first intervention priority on the PROMPT motor-speech hierarchy. Phase C then targeted one level higher. A reference group of 12 typically-developing peers, age- and sex-matched to each participant with CP, was recruited for comparison in the interpretation of the kinematic data. Jaw and lip measurements of distance, velocity, and duration, during the production of 11 untrained stimulus words, were obtained at the end of each study phase using 3D motion analysis (Vicon Motus 9.1). All participants showed significant changes in specific movement characteristics of the jaw and lips. Kinematic changes were associated with significant positive changes to speech intelligibility in five of the six participants. This study makes a contribution to providing evidence that supports the use of a treatment approach aligned with dynamic systems theory to improve the motor-speech movement patterns and speech intelligibility in children with cerebral palsy.

Daily or weekly? The role of treatment frequency in the effectiveness of grammar treatment for children with specific language impairment

Abstract This study compared the effectiveness of a school-based treatment for expressive grammar in 5-year-olds with specific language impairment delivered in two different dose frequencies: eight sessions delivered daily over 8 consecutive school days or eight sessions delivered weekly over 8 consecutive weeks. Eighteen children received treatment daily and 13 children received treatment weekly. In both groups, treatment consisted of eight 1-hour sessions of small group activities in a classroom setting. Techniques included explicit instruction, focused stimulation, recasting, and imitation. Results were analysed at the group level and as a case series with each child as their own control in a single-subject design. The 8-weeks group showed significantly greater gain in test scores over the treatment period than in an equal time period prior to treatment, whereas the 8-days group did not (Cohens d = 1.64 for 8-weeks group). Single-subject analyses indicated that 46% of children in the 8-week group and 17% of children in the 8-day group showed a significant treatment effect. It is concluded that expressive grammar treatment was most effective when dose frequency was weekly over 8 weeks rather than daily over 8 days for 5-year-old children with specific language impairment.

Speech impairment and literacy difficulties: Underlying Links

Abstract Despite clinical observation of the problems in emergent literacy experienced by unintelligible children, there are conflicting data about the possible relationship of expressive speech problems to literacy acquisition. Several confounding factors may explain the inconsistency in results across studies. Potential confounds include specificity and severity of speech impairment, age of participants, and pattern of speech errors. It was hypothesised that the presence of nondevelopmental speech errors can be considered a symptom of a breakdown at the level of processing phonological information that has an impact on both speech and literacy development. A cohort of 21 specifically speech-impaired children entering Year 1 at school was selected and classified into subgroups based on pattern of speech errors. Phonological awareness measures were administered early in Year 1 and literacy measures in Year 3. The results confirmed thot the presence of nondevelopmental speech errors predicted poorer phonological awareness skills and weaker literacy outcomes, particularly spelling.

NARNIA: a new twist to an old tale. A pilot RCT to evaluate a multilevel approach to improving discourse in aphasia

Background: Developing effective interventions for people with aphasia, which both ameliorate impaired language and directly impact on real-life communication, is a key focus of aphasia research. While single-word and sentence-level models of language processing have informed effective interventions, there is limited evidence of intervention approaches that extend the principles from these models to discourse. Aims: This pilot randomised controlled trial (RCT) aimed to compare a novel multilevel intervention, a Novel Approach to Real-life communication: Narrative Intervention in Aphasia (NARNIA), with usual care (UC), with a view to assess the feasibility and acceptability of the approach and estimate effect sizes to design and power a definitive trial. Methods & Procedures: In a prospective, single-blind, RCT, 14 people with mild to moderate aphasia, between 2 and 165 months following stroke, were randomised to the two interventions. Both therapy conditions were delivered four times weekly over 5 weeks. The NARNIA intervention specifically combined word retrieval, sentence production, and discourse macrostructure across a range of everyday discourse (ED) genres. UC comprised any speech-language therapy routinely used in clinical practice, individually tailored to meet the assessed needs of the participant. The Curtin University Discourse Protocol (CUDP) was used to measure verb access, sentence production, and discourse structure. Outcomes & Results: Eight participants were assigned to the NARNIA intervention and six participants to UC. No significant differences were present in baseline prognostic factors between the two groups prior to intervention. Following intervention, orientation aspects of macrostructure were significantly greater in the NARNIA group on ED measures than in the UC group, with no other between-group differences found. Significant changes were, however, seen within groups across ED genres. The NARNIA group made significant gains across all language levels, while the UC made isolated gains in sentence production. Few changes were seen in narrative discourse for either group. While single-word processing was not significantly different between groups, significant within-group differences were seen. While both groups significantly improved in retrieving nouns in isolation, only the NARNIA group made significant improvement in verb processing. No change was seen in constrained sentence production for either group. Conclusions: These findings are highly promising in demonstrating the use of macrostructure to scaffold production of words and sentences and improve discourse organisation. The significantly greater within-group gains for the NARNIA participants will provide a platform to power a larger trial to evaluate the effectiveness of this integrated multilevel intervention for aphasia.

Investigating children's ability to reflect on stored phonological representations: the Silent Deletion of Phonemes Task

BACKGROUND The development of childrens speech, language, and literacy skills is considered to build on a robust and intact speech-processing system, with normally functioning skills at all levels of input and output processing, as well as storage. There are a range of tasks available that assess input and output processing skills, however there are few tasks described in the literature that require a child to reflect on and analyse the internal structure of their own phonological representations. AIMS This paper will describe the development of the Silent Deletion of Phonemes (SDOP) task. This task is designed to assess a childs ability to delete and manipulate sounds silently within their own stored representations while minimizing the impact of any output difficulties. METHODS & PROCEDURES The SDOP task was presented to 69 typically developing mainstream Year 2 children (aged 7;2-8;1 years) as part of a battery of phonological processing skills and literacy measures. OUTCOMES & RESULTS Scores for the population of typically developing Year 2 children were normally distributed and above a basal level but not approaching ceiling. Performance on the SDOP was significantly correlated with other measures of phonological processing but not a measure of non-verbal ability. It was most highly correlated with the measure of phonological awareness as expected, as both tasks measure awareness of the internal structure of words. However, the SDOP provided more information about the accuracy and specificity of a childs underlying phonological representations. The SDOP explained a significant amount of concurrent variance in both reading and spelling performance beyond the variance accounted for by the predictors that have been used by researchers to date. In combination, the SDOP and rapid-naming measure accounted for 58.8% of variance in performance on the reading measure and 54.4% of variance in spelling performance. CONCLUSIONS & IMPLICATIONS The SDOP task appears to be a valid and reliable tool to assess the internal structure of a childs stored phonological representations. Profiling phonological representations allows clinicians to explore childrens speech-processing skills which may be particularly useful with children with complex literacy difficulties.

An evaluation of the effectiveness of PROMPT therapy in improving speech production accuracy in six children with cerebral palsy

Abstract This study evaluates perceptual changes in speech production accuracy in six children (3–11 years) with moderate-to-severe speech impairment associated with cerebral palsy before, during, and after participation in a motor-speech intervention program (Prompts for Restructuring Oral Muscular Phonetic Targets). An A1BCA2 single subject research design was implemented. Subsequent to the baseline phase (phase A1), phase B targeted each participants first intervention priority on the PROMPT motor-speech hierarchy. Phase C then targeted one level higher. Weekly speech probes were administered, containing trained and untrained words at the two levels of intervention, plus an additional level that served as a control goal. The speech probes were analysed for motor-speech-movement-parameters and perceptual accuracy. Analysis of the speech probe data showed all participants recorded a statistically significant change. Between phases A1–B and B–C 6/6 and 4/6 participants, respectively, recorded a statistically significant increase in performance level on the motor speech movement patterns targeted during the training of that intervention. The preliminary data presented in this study make a contribution to providing evidence that supports the use of a treatment approach aligned with dynamic systems theory to improve the motor-speech movement patterns and speech production accuracy in children with cerebral palsy.