Conversation and pragmatics in children who are hard-of-hearing: a scoping review.

Technological and therapeutic advances have allowed many children who are born hard-of-hearing (HoH) to start school with age-appropriate spoken language skills, yet many of these children continue to find everyday conversations challenging. This scoping review maps the evidence related to development of conversation and pragmatic skills in children who are HoH and learning spoken language. The review followed Arksey and O'Malley's methodological framework and the PRISMA Extension for Scoping Reviews guidelines. Quality appraisal, data extraction, and thematic analysis were used to describe the data. Systematic searches identified 36 articles for inclusion. Sample sizes were small and heterogenous. Most studies focused on school-aged children with severe hearing loss or greater. Methodological rigor varied. Thematic analysis revealed two global themes. First, children who are HoH continue to find conversation and pragmatics difficult to master, and second, there are a set of audiological, communication, environmental, and demographic characteristics that are associated with better conversation and pragmatic outcomes, some of which are fixed, whereas others are malleable. Focused attention on designing valid and reliable assessments for conversation and pragmatic skills, and on developing therapeutic approaches targeting early conversation and pragmatic skill development, is needed to reduce the impact conversation and pragmatic differences across the lifespan.

Speech Development Across Subgroups of Autistic Children: A Longitudinal Study.

Subgroups of children with different speech profiles have been described however, little is known about the trajectories of speech development or stability of subgroups over time. This longitudinal study described both speech trajectories and subgroup stability of 22 autistic children, aged 2;0-6;11 years, over 12 months. Independent and relational speech analyses, vocabulary size and nonverbal communication were used in clustering. Results suggest varied speech trajectories, particularly for children with 'low language and low speech' at Time 1. Receptive vocabulary and consonant inventory at Time 1 may predict speech outcomes after 12 months. A small subgroup of children (n = 3) present with low expressive vocabulary and speech but higher receptive vocabulary and use of gestures. This unique profile remained stable.

Speech Abilities in a Heterogeneous Group of Children With Autism.

PURPOSE: This study aimed to provide detailed descriptive information about the speech of a heterogeneous cohort of children with autism spectrum disorder (ASD) and to explore whether subgroups exist based on this detailed speech data. High rates of delayed and disordered speech in both low-verbal and high-functioning children with ASD have been reported. There is limited information regarding the speech abilities of young children across a range of functional levels. METHOD: Participants were 23 children aged 2;0-6;11 (years;months) with a diagnosis of ASD. Comprehensive speech and language assessments were administered. Independent and relational speech analyses were conducted from single-word naming tasks and spontaneous speech samples. Hierarchical clustering based on language, nonverbal communication, and spontaneous speech descriptive data was completed. RESULTS: Independent and relational speech analyses are reported. These variables are used in the cluster analyses, which identified three distinct subgroups: (a) children with high language and high speech ability (n = 10), (b) children with low expressive language and low speech ability but higher receptive language and use of gestures (n = 3), and (c) children with low language and low speech development (n = 10). CONCLUSIONS: This is the first study to provide detailed descriptive speech data of a heterogeneous cohort of children with ASD and use this information to statistically explore potential subgroups. Clustering suggests a small number of children present with low levels of speech and expressive language in the presence of better receptive language and gestures. This communication profile warrants further exploration. Replicating these findings with a larger cohort of children is needed. Supplemental Material https://doi.org/10.23641/asha.16906978.

Acoustic voice characteristics with and without wearing a facemask.

Facemasks are essential for healthcare workers but characteristics of the voice whilst wearing this personal protective equipment are not well understood. In the present study, we compared acoustic voice measures in recordings of sixteen adults producing standardised vocal tasks with and without wearing either a surgical mask or a KN95 mask. Data were analysed for mean spectral levels at 0-1 kHz and 1-8 kHz regions, an energy ratio between 0-1 and 1-8 kHz (LH1000), harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPS), and vocal intensity. In connected speech there was significant attenuation of mean spectral level at 1-8 kHz region and there was no significant change in this measure at 0-1 kHz. Mean spectral levels of vowel did not change significantly in mask-wearing conditions. LH1000 for connected speech significantly increased whilst wearing either a surgical mask or KN95 mask but no significant change in this measure was found for vowel. HNR was higher in the mask-wearing conditions than the no-mask condition. CPPS and vocal intensity did not change in mask-wearing conditions. These findings implied an attenuation effects of wearing these types of masks on the voice spectra with surgical mask showing less impact than the KN95.

A new training package (3Cs: Connect, Communicate and Collaborate) for improving family responsive service delivery in early intervention for children with hearing loss: A proof of concept study.

BACKGROUND: An objective of early intervention for children with hearing loss is to enhance family engagement in therapy to maximise a child's speech and language potential. However, requiring a service provider to work collaboratively with a child's family can create problems in developing and underdeveloped countries, where skilled service providers and services for children with hearing loss are lacking and where an expert model of intervention prevails. OBJECTIVES: To determine the preliminary effectiveness of a new training package Connect, Communicate and Collaborate (3Cs), in improving the knowledge and confidence of service providers in the delivery of family responsive services in an early intervention program for children with hearing loss. METHODS: Five learning modules were developed based on service provider experience working with children with hearing loss, and parents of children with hearing loss. Six participants completed the training package comprising five training modules and an introductory session over a 6-week period. Participants' confidence and knowledge in providing family responsive practice was measured pre and post training using visual analogue scales, and participants were also invited to provide their reflections on the program. RESULTS: Pre- and post-training confidence ratings revealed significant improvements in the perceptions of participants in the implementation of responsive family practice across four of five of programme learning modules (p < 0.002). Participant reflection statements indicate they became more considerated in their family responsive practice. Despite positive experiences working with parents, participants stated they had ongoing difficulties guiding families through the decision-making processes of habilitation. The reflection process assisted learning and improved practice by supporting participants to build on their strengths. CONCLUSION: The 3Cs package improved the confidence in and knowledge of delivery of responsive family services for six participants in Kuwait. It also improved the participant's self-evaluation skills. The 3Cs provides professional development that meets the needs of service providers working with children with hearing loss to improve inclusion of families in the therapy process.

Parents' views about factors facilitating their involvement in the oral early intervention services provided for their children with hearing loss in Kuwait.

OBJECTIVES: Developed countries (such as the Unites States of America, the United Kingdom, and Australia) provide high-quality services to children with hearing loss and their parents, including universal newborn hearing screening, early fitting of hearing devices and access to high quality early, aural intervention. In contrast, many developing countries lack the resources to provide these services. Research evidence suggests that one way to compensate for delays in identification and rehabilitation for children with hearing loss is to involve the family in the early intervention process. However, evidence is deficient around the facilitation of parental involvement in early intervention for families from developing countries. The aim of this study was to investigate the perception of parents from a developing country who have a child with hearing loss to discover the factors that may influence their involvement in early intervention, identify facilitators/barriers for their involvement, and identify the specific needs of involved parents. METHOD: A qualitative collective case study methodology was used in the form of semi-structured interviews with twenty-one participants. RESULTS: Two global themes emerged. Firstly, factors influencing parental involvement. This included five subthemes: better communication as the key to building rapport and providing support; disappointment with the service; physical and human resources make a difference; consideration of life beyond the habilitation sessions; and my child matters the most. The second global theme-parental needs-included four subthemes: building trust; ensuring generalization; improving child outcomes; and managing needs of parents versus services. All the discussed themes are supported by quotations from the interviews. CONCLUSION: The findings suggest that parents of children with hearing loss in developing countries perceive the services provided for their children to be disjointed and not well coordinated. Based on the parent perceptions a set of guidelines that provide a scaffold for service providers working with children with hearing loss in developing countries is outlined. The guidelines are designed to assist services for children with hearing loss in developing countries improve the delivery of their services and increase family involvement, which in turn; will assist in improving their child and family related outcomes.

Evidence-based practice self-efficacy of undergraduate speech pathology students following training.

AIM: The aims of this study were to determine the self-efficacy of speech pathology students in conducting evidence-based practice before and after a comprehensive evidence-based practice course, and the impact of timing of the course (Semester 1/2). METHOD: Students attended a 13-week course in their final year of study. The evidence-based practice confidence scale (EPIC) was used to measure the students' self-efficacy pre- and post-training. RESULTS: Ninety-two percent of students enrolled over six semesters participated. Students began the evidence-based practice course with high confidence in asking patients their preferences but low confidence in interpreting and analysing statistics. A significant improvement in confidence in all evidence-based practice areas was found, with greatest improvement occurring in the critical appraisal of research. Overall, the teaching had greatest effect on a group of skills for finding valid EBP information. There were significant differences between semester one and two students in only 18% of responses. Semester two students were more confident in half of these responses. CONCLUSIONS: An evidence-based practice course made a significant difference to student self-efficacy across all aspects, with few differences related to timing of the course. Implications are discussed. Implications for Rehabilitation Health professionals must be confident implementing evidence-based practice throughout the course of their careers, as best practice changes over time. A capstone unit of study/course for undergraduate speech pathology students significantly improved their self-efficacy in implementing evidence-based practice. This has positive implications for evidence-based practice across a wide range of clinical settings including rehabilitation and disability as the graduate entry level students enter the workforce. For on-going success, graduate entry level students must continue to implement evidence-based practice as clinicians if they are to maintain their confidence and further develop their skill set.

A Systematic Review of Speech Assessments for Children With Autism Spectrum Disorder: Recommendations for Best Practice.

PURPOSE: The purpose of this systematic review was to provide a summary and evaluation of speech assessments used with children with autism spectrum disorders (ASD). A subsequent narrative review was completed to ascertain the core components of an evidence-based pediatric speech assessment, which, together with the results of the systematic review, provide clinical and research guidelines for best practice. METHOD: A systematic search of eight databases was used to find peer-reviewed research articles published between 1990 and 2014 assessing the speech of children with ASD. Eligible articles were categorized according to the assessment methods used and the speech characteristics described. RESULTS: The review identified 21 articles that met the inclusion criteria, search criteria, and confidence in ASD diagnosis. The speech of prelinguistic participants was assessed in seven articles. Speech assessments with verbal participants were completed in 15 articles with segmental and suprasegmental aspects of speech analyzed. Assessment methods included connected speech samples, single-word naming tasks, speech imitation tasks, and analysis of the production of words and sentences. CONCLUSIONS: Clinical and research guidelines for speech assessment of children with ASD are outlined. Future comparisons will be facilitated by the use of consistent reporting methods in research focusing on children with ASD.

Hear here: children with hearing loss learn words by listening.

OBJECTIVES: Early use of hearing devices and family participation in auditory-verbal therapy has been associated with age-appropriate verbal communication outcomes for children with hearing loss. However, there continues to be great variability in outcomes across different oral intervention programmes and little consensus on how therapists should prioritise goals at each therapy session for positive clinical outcomes. This pilot intervention study aimed to determine whether therapy goals that concentrate on teaching preschool children with hearing loss how to distinguish between words in a structured listening programme is effective, and whether gains in speech perception skills impact on vocabulary and speech development without them having to be worked on directly in therapy. METHOD: A multiple baseline across subjects design was used in this within-subject controlled study. 3 children aged between 2:6 and 3:1 with moderate-severe to severe-profound hearing loss were recruited for a 6-week intervention programme. Each participant commenced at different stages of the 10-staged listening programme depending on their individual listening skills at recruitment. Speech development and vocabulary assessments were conducted before and after the training programme in addition to speech perception assessments and probes conducted throughout the intervention programme. RESULTS: All participants made gains in speech perception skills as well as vocabulary and speech development. Speech perception skills acquired were noted to be maintained a week after intervention. In addition, all participants were able to generalise speech perception skills learnt to words that had not been used in the intervention programme. CONCLUSIONS: This pilot study found that therapy directed at listening alone is promising and that it may have positive impact on speech and vocabulary development without these goals having to be incorporated into a therapy programme. Although a larger study is necessary for more conclusive findings, the results from this preliminary study are promising in support of emphasise on listening skills within auditory-verbal therapy programmes.