Gradient speech change during intervention for school-aged children and adults with cleft palate ± lip.

Gradient speech change, where speech sound production develops in a broadly step-wise fashion towards the standard adult form, is a well-recognised phenomenon in children developing typical speech, but is much less studied in speakers with developmental speech sound disorders. Instrumental techniques, such as electropalatography (EPG), may be useful for identifying gradient speech change and may supplement phonetic transcription in important ways. This study investigated whether gradient speech change occurred in six participants with cleft palate ± lip undergoing intervention within a usage-based phonology framework (2/6 participants with speech distortions; 4/6 with pattern-based speech substitutions; combined total of 25 speech sounds targeted for intervention). Participants received weekly therapy in a hospital setting and were aged 10-27 years. Gradient speech change with target speech sounds was examined using EPG analysis, which was undertaken after every fifth session of therapy. The presence of gradient change was determined by visually examining EPG palatograms and EPG indices for target speech sounds across successive EPG test points. This study found gradient speech change occurred in 22/25 target sounds over the course of intervention. This gradient change occurred for both speech distortions and pattern-based speech substitutions. The remaining 3/25 target sounds showed categorical change. Usage-based phonology was suggested as a theory with potential for explaining gradient speech change, with both typical and atypical speech, and with speech distortions and pattern-based speech substitutions. This finding adds to other research showing that the objective data provided by instrumental techniques, such as EPG, may be a valuable complement to phonetic transcription.

Clinical application of usage-based phonology: Treatment of cleft palate speech using usage-based electropalotography.

PURPOSE: To investigate whether a novel electropalatography (EPG) therapy, underpinned by usage-based phonology theory, can improve the accuracy of target speech sounds for school-aged children and adults with persistent speech sound disorder (SSD) secondary to cleft palate +/- lip. METHOD: Six consecutively treated participants (7-27 years) with long-standing speech disorders associated with cleft palate enrolled in a multiple baseline (ABA) within-participant case series. The usage-based EPG therapy technique involved high-volume production of words. Speech was assessed on three baselines prior to therapy, during weekly therapy, at completion of therapy, and 3 months post-therapy. Percent correct of target phonemes in untreated words and continuously connected speech were assessed through acoustic phonetic transcription. Intra- and inter-transcriber agreement was determined. RESULT: Large to medium treatment effect sizes were shown for all participants following therapy (15-33 sessions). Percentage of targets correct for untreated words improved from near 0% pre-therapy, to near 100% for most target sounds post-therapy. Generalisation of target sounds to spontaneous connected speech occurred for all participants and ranged from 78.95-100% (M = 90.66; SD = 10.14) 3 months post-therapy. CONCLUSION: Clinically significant speech change occurred for all participants following therapy. Response to the novel therapeutic technique is encouraging and further research is indicated.

Editorial Perspective: Maximising the benefits of intervention research for children and young people with developmental language disorder (DLD) - a call for international consensus on standards of reporting in intervention studies for children with and at risk for DLD.

Current methods for reporting interventions do not allow key questions of importance to practitioners, service providers, policy-makers and people with DLD to be answered, and hence limit the implementation of effective interventions in the real world. To extend the existing EQUATOR guidelines to the context of speech language therapy/pathology for children with language disorder and to provide more specific guidance on participants, interventions and outcomes within the CONSORT checklist (used to improve the reporting of randomised controlled trials) and TIDieR (Template for Intervention Description and Replication) to ensure consistency of reporting. We will develop a core team to include representatives from each of the key groups who will either use or be influenced by the final reporting guidance across different countries. To achieve each set of aims, we will conduct reviews of the literature (which present typologies of intervention characteristics in (D)LD and related disorders); carry out focus groups; and use systematic consensus methods such as the Delphi technique, nominal group technique or consensus development conferences. Through the development and adoption of standard intervention reporting criteria, we anticipate that we will overcome the numerous barriers for practitioners, services and policy-makers in applying intervention evidence to practice. We believe that establishing international consensus on reporting guidelines would significantly accelerate progress in DLD research and the ease with which it can be used in clinical practice, by capitalising on the growth in intervention studies to enable international collaboration and new methodologies of data pooling, meta-analyses and cross-study comparisons.

Phonological variations in typically-developing Italian-speaking children aged 3;0-4;11.

Normative data on phonological acquisition of a language are a prerequisite for evaluating children's speech sound competences. To date, these data are not sufficiently available for Italian. This study, therefore, aimed to describe the phonological development of 183 typically developing monolingual Italian-speaking children aged 3;0-4;11 (four 6-months age bands). Participants were assessed through a picture naming task, and performances analysed in terms of number of phonological variations (Tokens), Types and percentage of occurrence of patterns, and number of infrequent variants (InfrVar) as a measure of stability in speech production. Two cut-off criteria to distinguish InfrVar from phonological patterns were applied. Results showed a gradual reduction of all measures with increasing age. Twenty-two patterns generally in line with previous Italian and cross-linguistic studies were observed, with only five patterns and two phonetic distortions occurring across all age groups. Eight patterns only emerged when applying the lower cut-off criterion, while further seven patterns only occurred with very low frequency or in isolated age groups. These findings highlight the influence of the selected cut-off criterion on the identification of patterns and raise the question of whether some patterns should rather be considered InfVar. Data on younger children are still needed to clarify whether low-frequency patterns are patterns of younger typically developing children that have almost resolved in the age groups assessed. At least half of the phonological variation Tokens fell into the category of InfrVar, indicating a need to pay more attention to this so far ignored measure.

Effects of an Early Literacy Intervention for Linguistically Diverse Children: A Quasi-Experimental Study.

Phonological awareness and letter-sound knowledge underpin children's early literacy acquisition. Promoting these foundational skills in kindergarten should therefore lead to a better response to formal literacy instruction once started. The present study evaluated a 12-week early literacy intervention for linguistically diverse children who are learning to read in German. The study was set in Luxembourg where kindergarten education is in Luxembourgish and children learn to read in German in Grade 1 of primary school. One hundred and eighty-nine children (mean age = 5;8 years) were assigned to an early literacy intervention in Luxembourgish or to a business as usual control group. Trained teachers delivered the intervention to entire classes, four times a week, during the last year of kindergarten. The early literacy program included direct instruction in phonological awareness and letter-knowledge, while promoting print and book awareness and literacy engagement. Children were assessed pre-intervention, immediately post-intervention and at a 9 months delayed follow-up using measures in Luxembourgish and in German. At the end of the intervention, children in the intervention group performed significantly better than the control group on phonological awareness and letter-knowledge measures in Luxembourgish and the gains in phonological awareness were maintained at 9 months follow-up. The effects generalized to measures of phonological awareness, word-level reading comprehension and spelling in German (effect sizes d > 0.25), but not to German single word/pseudoword reading, at delayed follow-up. Intervention programs designed to support foundational literacy skills can be successfully implemented by regular teachers in a play-based kindergarten context. The findings suggest that early literacy intervention before school entry can produce educationally meaningful effects in linguistically diverse learners.

The efficacy of early language intervention in mainstream school settings: a randomized controlled trial.

BACKGROUND: Oral language skills are a critical foundation for literacy and more generally for educational success. The current study shows that oral language skills can be improved by providing suitable additional help to children with language difficulties in the early stages of formal education. METHODS: We conducted a randomized controlled trial with 394 children in England, comparing a 30-week oral language intervention programme starting in nursery (N = 132) with a 20-week version of the same programme starting in Reception (N = 133). The intervention groups were compared to an untreated waiting control group (N = 129). The programmes were delivered by trained teaching assistants (TAs) working in the children's schools/nurseries. All testers were blind to group allocation. RESULTS: Both the 20- and 30-week programmes produced improvements on primary outcome measures of oral language skill compared to the untreated control group. Effect sizes were small to moderate (20-week programme: d = .21; 30-week programme: d = .30) immediately following the intervention and were maintained at follow-up 6 months later. The difference in improvement between the 20-week and 30-week programmes was not statistically significant. Neither programme produced statistically significant improvements in children's early word reading or reading comprehension skills (secondary outcome measures). CONCLUSIONS: This study provides further evidence that oral language interventions can be delivered successfully by trained TAs to children with oral language difficulties in nursery and Reception classes. The methods evaluated have potentially important policy implications for early education.

Early literacy and comprehension skills in children learning English as an additional language and monolingual children with language weaknesses.

Many children learning English as an additional language (EAL) show reading comprehension difficulties despite adequate decoding. However, the relationship between early language and reading comprehension in this group is not fully understood. The language and literacy skills of 80 children learning English from diverse language backgrounds and 80 monolingual English-speaking peers with language weaknesses were assessed at school entry (mean age = 4 years, 7 months) and after 2 years of schooling in the UK (mean age = 6 years, 3 months). The EAL group showed weaker language skills and stronger word reading than the monolingual group but no difference in reading comprehension. Individual differences in reading comprehension were predicted by variations in decoding and language comprehension in both groups to a similar degree.

Oral language skills intervention in pre-school-a cautionary tale.

BACKGROUND: While practitioners are increasingly asked to be mindful of the evidence base of intervention programmes, evidence from rigorous trials for the effectiveness of interventions that promote oral language abilities in the early years is sparse. AIMS: To evaluate the effectiveness of a language intervention programme for children identified as having poor oral language skills in preschool classes. METHODS & PROCEDURES: A randomized controlled trial was carried out in 13 UK nursery schools. In each nursery, eight children (N = 104, mean age = 3 years 11 months) with the poorest performance on standardized language measures were selected to take part. All but one child were randomly allocated to either an intervention (N = 52) or a waiting control group (N = 51). The intervention group received a 15-week oral language programme in addition to their standard nursery curriculum. The programme was delivered by trained teaching assistants and aimed to foster vocabulary knowledge, narrative and listening skills. OUTCOMES & RESULTS: Initial results revealed significant differences between the intervention and control group on measures of taught vocabulary. No group differences were found on any standardized language measure; however, there were gains of moderate effect size in listening comprehension. CONCLUSIONS & IMPLICATIONS: The study suggests that an intervention, of moderate duration and intensity, for small groups of preschool children successfully builds vocabulary knowledge, but does not generalize to non-taught areas of language. The findings strike a note of caution about implementing language interventions of moderate duration in preschool settings. The findings also highlight the importance of including a control group in intervention studies.

Efficacy of language intervention in the early years.

BACKGROUND: Oral language skills in the preschool and early school years are critical to educational success and provide the foundations for the later development of reading comprehension. METHODS: In a randomized controlled trial, 180 children from 15 UK nursery schools (n = 12 from each setting; M(age) = 4;0) were randomly allocated to receive a 30-week oral language intervention or to a waiting control group. Children in the intervention group received 30 weeks of oral language intervention, beginning in nursery (preschool), in three group sessions per week, continuing with daily sessions on transition to Reception class (pre-Year 1). The intervention was delivered by nursery staff and teaching assistants trained and supported by the research team. Following screening, children were assessed preintervention, following completion of the intervention and after a 6-month delay. RESULTS: Children in the intervention group showed significantly better performance on measures of oral language and spoken narrative skills than children in the waiting control group immediately after the 30 week intervention and after a 6 month delay. Gains in word-level literacy skills were weaker, though clear improvements were observed on measures of phonological awareness. Importantly, improvements in oral language skills generalized to a standardized measure of reading comprehension at maintenance test. CONCLUSIONS: Early intervention for children with oral language difficulties is effective and can successfully support the skills, which underpin reading comprehension.

Development of a test battery for assessing phonological awareness in German-speaking children.

The development of phonological awareness (PA), the ability to reflect on the sound structure of words independent of their meaning, has been extensively explored in English-speaking children. However, this is not the case for other languages. The aim of this study was to develop a comprehensive PA test battery for German-speaking preschool children, considering psycholinguistic, linguistic, and cognitive aspects and to carry out analyses of its psychometric properties. Cross-sectional data from a sample of 55 children (CA 4;0-6;11 years) were collected. Preliminary findings confirm validity and reliability of the test battery, and support previous findings that PA develops from larger to smaller linguistic units. Phoneme-level tasks were consistently associated with letter knowledge. The new instrument is a promising tool for basic research (e.g. cross-linguistic comparisons of PA development) as well as for clinical and educational practice (e.g. planning speech and language therapy or literacy-oriented intervention).