Developing novice analysts' videofluoroscopic swallowing study skills in speech-language pathology: A randomised control trial comparing blended and online training approaches.

PURPOSE: This research investigates the relative effectiveness of independent online and blended learning approaches for novice analysts' development of videofluoroscopic swallowing study (VFSS) analytical skills. The secondary aims were to explore the impact of training on decision-making and to describe learners' perspectives of training outcomes. METHOD: Undergraduate speech-language pathology students (n = 74) who had completed the dysphagia academic curriculum in an undergraduate speech-language pathology program were recruited for a randomised control trial. The ability to identify swallowing impairments in adults was compared pre- and post-training across three conditions: independent online (n = 23), peer-supported (n = 23), and expert-facilitated training (n = 28). The training comprised online VFSS training and practice with a commercially available digital video disc (DVD). RESULT: The three training approaches were equal in improving novice analysts' identification of impairments on VFSS. Participants' analysis improved pre- to post-training (p = <.001), with no statistical difference amongst training conditions (p = .280). However, the expert facilitation condition resulted in better decision-making skill for novice analysts, as well as higher levels of confidence and greater engagement in the learning. CONCLUSION: Well-designed independent online methods are appropriate to prepare novice analysts for VFSS analytical training. Expert facilitation and peer-supported environments may have benefits for more advanced skill development and engagement, and should be investigated in future studies.

Diagnosing inconsistent phonological disorder: quantitative and qualitative measures.

Studies of children's consistency of word production allow identification of speech sound disorder. Inconsistent errors are reported for two groups of children: childhood apraxia of speech (CAS) due to difficulty with the motoric precision and consistency of speech movements; and inconsistent phonological disorder (IPD) attributed to impaired phonological planning. This paper describes the inconsistent productions of children with IPD in comparison to typically developing children. In two studies of suspected SSD (N = 135), 22 children pronounced ≥40% of 25 words inconsistently on three repeated trials. No participant had symptoms of CAS. They were monolingual and spoke Australian- or Irish-English. Assessment determined the proportions of words said consistently (i.e. the same across productions: all correct or with the same error) or inconsistently (i.e. differently across productions: at least one correct and one error or different errors in productions). Qualitative analyses examined error types and explored the effect of target words' characteristics on inconsistency. Children with IPD produced 52% of words with different errors. While 56% of all phoneme errors were developmental (age appropriate or delayed), atypical errors typified inconsistency: default sounds and word structure errors. Words with more phonemes, syllables and consonant clusters were vulnerable to inconsistency, but their frequency of occurrence had no effect. TD children and those with IPD had different quantitative and qualitative error profiles, confirming IPD as a diagnostic category of SSD. Qualitative analyses supported the hypothesised deficit in phonological planning of words' production for children with IPD.

Factors that influence development of speech pathology skills required for videofluoroscopic swallowing studies.

BACKGROUND: Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. AIMS: This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts' VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self-efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts' skill development. METHODS & PROCEDURES: Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected-the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing-Adults, self-reported the number of dysphagia cases they managed on placement, and self-rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. OUTCOMES & RESULTS: Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. CONCLUSIONS & IMPLICATIONS: Novice analysts vary in the acquisition of beginner-level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development. WHAT THIS PAPER ADDS: What is already known on the subject The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work? Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images.

Preschool children's consistency of word production.

Consistency of word production contributes to carers' ability to understand children's speech. Reports of the proportion of words produced consistently by typically developing preschool children, however, vary widely from 17% to 87%. This paper examines the quantitative (consistency count) and qualitative (e.g. phonemic analysis) characteristics of word consistency in 96 children aged 36-60 months. Children named 15 pictures twice, in separate trials, in the same assessment session. The mean consistency of the production for the whole group was 82%. Older children were more consistent than younger children. Girls were more consistent than boys. Words produced correctly in one trial and in error in another may indicate resolving error patterns. Words produced in error in two different ways provided useful evidence about the nature of inconsistent word production in typically developing children. The clinical and theoretical implications are discussed.

Is children's speech development changing? Preliminary evidence from Australian English-speaking 3-year-olds.

Purpose: Around 9% of children have difficulty acquiring intelligible speech despite typical sensory, neuro-motor and cognitive function. Speech-language pathologists (SLPs) rely on descriptions of children's speech errors to identify speech sound disorder (SSD) and determine intervention targets and goals. Existing normative data, however, need re-evaluation to reflect changes in populations and the language learning environment. This research evaluates whether developmental phonological patterns widely accepted as describing typical acquisition predict speech errors in a recent sample of pre-school children.Method: In 2015, 99 neurotypical children aged 3;0-3;8 years;months were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP). Their performance was compared to studies describing speech development by children of the same age for phone repertoire and phonological patterns.Result: There were differences for both measures. Phone repertoire differences were marginal, but changes in phonological pattern use were unexpected. Suppression of three developmental phonological patterns (stopping of fricatives, final consonant deletion and voicing contrasts) was delayed compared to previous norms. Atypical consonant cluster reduction, sometimes considered a marker for disorder, was observed in 10% of children.Conclusion: There were qualitative differences in the speech development of the 2015 cohort of children compared to previous developmental norms. Valid and current normative data are necessary for the accurate identification of children needing intervention. The differences we found reinforce the need for regular updating of assessment tools, as well as greater understanding of how children's language learning environments are changing and potentially influencing speech development.

Speech and language phenotype in Phelan-McDermid (22q13.3) syndrome.

Communication difficulties are a core feature of Phelan-McDermid syndrome (PMS). However, a specific speech and language phenotype has not been delineated, preventing prognostic counselling and development of targeted therapies. We examined speech, language, social and functional communication abilities in 21 individuals with PMS (with SHANK3 involvement), using standardised assessments. Mean age was 9.7 years (SD 4.1) and 57% were female. Deletion size ranged from 41 kb to 8.3 Mb. Nine participants (45%) were non-verbal. Four (19%) had greater verbal ability, speaking in at least 4-5 word sentences, but with speech sound errors. Standard scores for receptive and expressive language were low (typically >3 SD below the mean). Language age equivalency was 13-16 months on average (range 2-53 months). There was a significant association between deletion size and the ability to use phrases. Participants with smaller deletion sizes were more likely to be able to use phrases (odds ratio: 0.36, 95% CI: 0.14-0.95, p = 0.040). Adaptive behaviour (life skills) was low in all areas (>2 SD below mean). Scores in communication were markedly lower than for daily living (p = 0.008) and socialisation (p < 0.001). A common linguistic profile was characterised by severe impairment across receptive, expressive and social language domains. Yet data indicated greater communicative intent than appeared to be capitalised by current therapies. Early implementation of augmentative (e.g. computer-assisted) modes of communication, alongside promotion of oral language, is essential to harness this intent, accelerate language development and reduce frustration. Future trials should examine the added benefit of targeted speech motor interventions in those with greater verbal capacity.

Conceptual distance and word learning: patterns of acquisition in Samoan-English bilingual children.

This study investigated cross-linguistic influence in acquisition of a second lexicon, evaluating Samoan-English sequentially bilingual children (initial mean age 4 ; 9) during their first 18 months of school. Receptive and Expressive Vocabulary tasks evaluated acquisition of four word types: cognates, matched nouns, phrasal nouns and holonyms. Each word type had varying phonological and conceptual difference between Samoan (L1) and English (L2). Results highlighted conceptual distance between L1 and L2 as a key factor in L2 lexical acquisition. The children acquired L2 lexical items earlier if their conceptual representation was similar to that of L1. Words with greater conceptual distance between L1 and L2 emerged more slowly. This suggests that L1 knowledge influences L2 lexical consolidation for sequential bilinguals. Words that require a conceptual shift from L1 take longer to consolidate and strengthen within the L2 lexicon.

Narrative skills of children born preterm.

BACKGROUND: The majority of children born preterm are considered neurologically normal and free of disability. However, follow-up studies at school age report that preterm children born without major impairment have more subtle impairments, including language difficulties, which influence their ability to function. These findings indicate a need to examine specific language-processing skills in children born preterm across the school years. AIMS: To compare oral narrative skills of children born preterm with their peers born at full term. METHODS & PROCEDURES: The research used an independent groups design to examine the narrative ability of 30 children aged between 9 years; 8 months and 10 years; 11 months: 15 children born before 33 weeks' gestation (preterm group) and 15 children matched for chronological age born at full gestation (greater than 38 weeks). Seven measures assessed productivity, structure, complexity, and formulation abilities. The research used univariate analysis to examine variations in outcomes based on group status (preterm versus full term). OUTCOMES & RESULTS: The results showed group effects on the formulation measures but not the productivity, complexity or quality measures. Children born preterm produced more utterances with mazes and had more disruptions than children born at full term. The children born preterm demonstrated difficulties formulating a narrative even though they produced a similar amount and used similar structural aspects to their peers born full term. CONCLUSIONS & IMPLICATIONS: Children born preterm show subtle and specific linguistic deficits that continue to affect their ability to formulate a narrative in the upper primary school years.

Patterns in diversity: Lexical learning in Samoan-English bilingual children.

This study examined the lexical development of nine Samoan-English bilingual children during their first year in English speaking preschools in Australia. Receptive and expressive lexicon in Samoan and English was assessed when the children had completed their first term of school (approximately 10 weeks) and then 6 months later. The bilingual children's scores in each language and composite scores were examined over time. Performance was also compared with typically developing, age-matched (4-5-year-old) monolingual English-speaking peers. Results indicated that the group made significant gains in both languages over time. The bilingual children's receptive composite scores were comparable to monolingual English scores, with clear changes in lexical composition (singlets and translation equivalents) over time. Expressive composite scores of bilingual children were lower than scores of monolingual peers. Results appeared to be highly influenced by the language environment and patterns of language use in this group. The potential use of composite score methodology as a clinical assessment tool in bilingual children is discussed.

The impact of selecting different contrasts in phonological therapy.

Previous research indicates that the extent of progress made by children with phonological disorders depends upon the nature of the word pairs contrasted in therapy. For example, phonemes that differ maximally in terms of place, manner, voicing and sound class (e.g., fan - man) in comparison to therapy where the word pairs presented differ minimally (e.g., fan - van). To investigate the implications of target selection within a typical clinical context (as opposed to a rigorous research setting) eight speech-language pathologists implemented intervention with appropriate children from their caseloads. Nineteen children each received 6 hours of therapy over one school term. They were randomly allocated to two groups. One group (of nine children) received intervention based on a traditional minimal pair approach, targeting homonymy as well as distinctive feature contrast. The other group (ten children) received intervention targeting contrasts differing across a range of distinctive features. Children made considerable progress in therapy in terms of speech accuracy and number of error patterns suppressed. However, there was no difference between the progress of the two groups. Follow-up assessment of 14 of the 19 children indicated maintenance of progress by both groups. Reasons for the lack of difference between the groups in the current study are considered and clinical implications are drawn.

Phonological awareness, reading accuracy and spelling ability of children with inconsistent phonological disorder.

BACKGROUND: Although children with speech disorder are at increased risk of literacy impairments, many learn to read and spell without difficulty. They are also a heterogeneous population in terms of the number and type of speech errors and their identified speech processing deficits. One problem lies in determining which preschool children with speech disorder will have difficulties acquiring literacy skills. AIMS: Two studies are presented that investigate the relationship between speech disorders and literacy. The first examined the phonological awareness abilities of children with different types of speech difficulties. The second study investigated the literacy skills of children with a history of inconsistent speech disorder. METHODS & PROCEDURES: Experiment 1 measured the syllable segmentation, rhyme awareness and alliteration awareness of 61 preschool children: 46 with speech disorder (14 with delayed development, 17 who made consistent non-developmental errors, and 15 who made inconsistent errors) and 15 typically developing controls. Experiment 2 assessed the reading accuracy, spelling and phonological awareness abilities of nine 7-year-old children with a history of inconsistent phonological errors. OUTCOMES & RESULTS: The first study indicated unexpected patterns of performance. While the Delayed group performed less well than controls on all tasks, the Consistent group showed poor performance on rhyme and alliteration but appropriate performance on syllable segmentation. The Inconsistent group performed most poorly on syllable segmentation but no differently from controls on the other two tasks. The second study indicated that children with a history of inconsistent phonological disorder performed no differently from controls on measures of phonological awareness and reading, but less well on measures of spelling ability. CONCLUSIONS: The results support classification of speech disorders and show a differentiation of phonological awareness skills across groups. Children with consistent atypical speech errors have poor phonological awareness and are most at risk for literacy difficulties. Those with inconsistent phonological disorder are at increased risk of spelling difficulties. The findings indicate that phonological awareness and spelling skill are distinct processing systems and highlight the role of phonological assembly skills (i.e. storing and/or retrieving phonological output plans) in spelling output. The interactive processes between reading and spelling are discussed.

Differentiating normal variability from inconsistency in children's speech: normative data.

BACKGROUND: In young, typically developing children, some word production variability is expected, but highly inconsistent speech is considered a clinical marker for disorder. Speech-language pathologists need to identify variability versus inconsistency, yet these terms are not clearly differentiated. Not only is it important to identify inconsistency, but also it needs to be defined and measured so that clinical decisions are evidence based. In order to understand inconsistent speech production, typical variability must be described. AIMS: This paper differentiates between variability and inconsistent productions. Variability is defined as productions that differ, but can be attributed to factors described in normal acquisition and use of speech. Inconsistency is speech characterized by a high proportion of differing repeated productions with multiple error types, both segmental (phoneme) and structural errors (consonant-vowel sequence within a syllable). The study describes and quantifies the consistency of word production in typically developing children aged between 3;0 and 6;11 years. METHODS AND PROCEDURES: This paper reports a large cross-sectional study (n = 409) of the consistency of children's production of words within the same linguistic context. OUTCOMES AND RESULTS: The study found that the speech of typically developing children is highly consistent. Children in the youngest age group demonstrated the highest levels of variability, but it remained below 13% with 10% reflecting maturational influences. CONCLUSIONS: Inconsistent production cannot be considered a typical feature of speech development. The results inform differential diagnosis of speech disorder.

Intervention for children with severe speech disorder: a comparison of two approaches.

BACKGROUND: Children with speech disorder are a heterogeneous group (e.g. in terms of severity, types of errors and underlying causal factors). Much research has ignored this heterogeneity, giving rise to contradictory intervention study findings. This situation provides clinical motivation to identify the deficits in the speech-processing chain that underlie different subgroups of developmental speech disorder. Intervention targeting different deficits should result in a differential response to intervention across these subgroups. AIMS: To evaluate the effect of two different types of therapy on speech accuracy and consistency of word production of children with consistent and inconsistent speech disorder. METHODS & PROCEDURES: Eighteen children (aged 4;08-6;05 years) with severe speech disorder participated in an intervention study comparing phonological contrast and core vocabulary therapy. All children received two 8-week blocks of each intervention. Changes in consistency of production and accuracy (per cent consonants correct) were used to measure the effect of each intervention. OUTCOMES & RESULTS: All of the children increased their consonant accuracy during intervention. Core vocabulary therapy resulted in greater change in children with inconsistent speech disorder and phonological contrast therapy resulted in greater change in children with consistent speech disorder. CONCLUSIONS: The results provide evidence that treatment targeting the speech-processing deficit underlying a child's speech disorder will result in efficient system-wide change. Differential response to intervention across subgroups provides evidence supporting theoretical perspectives regarding the nature of speech disorders: it reinforces the concept of different underlying deficits resulting in different types of speech disorder.

Phonological development: a normative study of British English-speaking children.

This paper reports a normative study on the phonological development of British English-speaking children. Speech samples of 684 children, aged between 3;0 and 6;11 years, randomly selected from nurseries and schools in eight different areas throughout the UK, were collected and analysed to obtain normative data. This paper reports on two aspects of speech development: the age of acquisition of sounds (phonetic acquisition) and the age that error patterns were suppressed (phonemic acquisition). It discusses the effects of age, gender and socio-economic status on speech sound development. The study found that older children had more accurate production and fewer error patterns in their speech. It found no gender differences in the younger age groups. However, in the oldest age group, it found the phonological accuracy measures of girls' better than boys. It found no significant effects of socio-economic status on any of the phonological accuracy measures.