Comparing the Informativeness of Single-Word Samples and Connected Speech Samples in Assessing Speech Sound Disorders.

Purpose Speech-language pathologists (SLPs) are faced with the challenge of quickly and accurately identifying children who present with speech sound disorders (SSD) compared to typically developing (TD) children. The goal of this study was to compare the clinical relevance of two speech sampling methods (single-word vs. connected speech samples) in how sensitive they are in detecting atypical speech sound development in children, and to know whether the information obtained from single-word samples is representative enough of children's overall speech sound performance. Method We compared the speech sound performance of 37 preschool children with SSD (M age = 4;11 years) and 37 age-sex-matched typically developing children (M age = 5;0 years) by eliciting their speech in two ways: (a) a picture-naming task to elicit single words, and (b) a story-retelling task to elicit connected speech. Four speech measures were compared across sample type (single words vs. connected speech) and across groups (SSD vs. TD): intelligibility, speech accuracy, phonemic inventory, and phonological patterns. Results Interaction effects were found between sample type and group on several speech sound performance measures. Single-word speech samples were found to differentiate the SSD group from the TD group, and were more sensitive than connected speech samples across various measures. The effect size of single-word samples was consistently higher than connected speech samples for three measures: intelligibility, speech accuracy, and phonemic inventory. The gap in sample type informativeness may be attributed to salience and avoidance effects, given that children tend to avoid producing unfamiliar phonemes in connected speech. The number of phonological patterns produced was the only measure that revealed no gap between two sampling types for both groups. Conclusions On measures of intelligibility, speech accuracy, and phonemic inventory, obtaining a single-word sample proved to be a more informative method of differentiating children with SSD from TD children than connected speech samples. This finding may guide SLPs in their choice of sampling type when they are under time pressure. We discuss how children's performance on the connected speech sample may be biased by salience and avoidance effects and/or task design, and may, therefore, not necessarily reveal a poorer performance than single-word samples, particularly in intelligibility, speech accuracy, and the number of phonological patterns, if these task limitations are circumvented. Our findings show that the performance gap, typically observed between the two sampling types, largely depends on which performance measures are evaluated with the speech sample. Our study is the first to address sampling type differences in SSD versus TD children and has significant clinical implications for SLPs looking for sampling types and measures that reliably identify SSD in preschool-aged children.

Prognostic Factors for Communication Improvement in Young Children After Cochlear Implant Surgery.

OBJECTIVE: Our objective was to examine the prognostic factors for post-cochlear implant (CI) communication improvement and determine whether the otologist's and speech-language pathologist's (SLP's) recommendations exhibited the same predictive performance regarding children's post-CI verbal expression acquisition. STUDY DESIGN: Retrospective, diagnostic study. SETTING: Hospital. PATIENTS: The study reviewed 339 medical charts of preschool children who underwent CI surgery before the age of 6 years during 1999 to 2016. After these medical charts were assessed, the cohort comprised of 79 preschool children with pre- and post-CI surgery speech-language assessment reports and medical records. INTERVENTION: A senior SLP and an otologist conducted blind testing of CI candidacy according to the 79 children's pre-CI reports. MAIN OUTCOME MEASURES: Spoken mean length of utterance (MLU). RESULTS: Children with superior skills in comprehending facial and gesture expressions or using gestures or sounds for expression were significantly more likely to receive the SLP's recommendation for CI surgery. The SLP's CI candidacy recommendation, based on background information, communication skill assessments, and magnetic resonance imaging (provided by an otologist), had significant predictive effects. Children recommended by the SLP exhibited a 20 times higher probability of benefiting from CI surgery; such a benefit would be a longer MLU after 2 years. CONCLUSION: CI candidacy testing for young children with prelingual hearing impairment based on a SLP's recommendations provided significant predictive effects. LEVEL OF EVIDENCE: 4 (Evidence from well-designed case-control or cohort studies).

The development of phonological representations in Mandarin-speaking children: Evidence from a longitudinal study of phonological awareness.

Two competing approaches to the analysis of the phonological structure of Mandarin syllables have been put forward. The first and more traditional approach is that a syllable can be segmented into initial consonant, medial glide, nucleus plus coda and tone. The second approach does not distinguish the non-compulsory medial glide as an independent element. To compare and evaluate these two different approaches, the development of phoneme-level awareness was investigated in 67 Mandarin-speaking children in Year 1 of school (mean age: 6;9) and Year 5 (mean age: 10;1). Results showed that at school entry some children were sensitive to glides and to a lesser extent to codas; their number increased by Year 5. This suggests that spoken language experience is enough for some children to acquire the representation of glides and codas; this is consistent with the traditional model of the Mandarin syllable, with both glides and codas as independent elements. However, the children's task performance was generally rather poor, even in Year 5, suggesting that development of phonemic sensitivity in Mandarin speaking children is not substantially improved by increased literacy experience.

[Exploring self-management in patients with chronic obstructive pulmonary disease].

The purpose of this study was to describe chronic obstructive pulmonary disease (COPD) patients' disease management defined as prescription management (medication adherence), symptom management (COPD knowledge and self-care efficacy) and emotional management. A purposive sampling of 104 COPD patients from southern Taiwan enrolled in a case management program was recruited. After agreeing to participate, patients completed a questionnaire describing their medication adherence, self-care efficacy, and emotional state and provided personal demographic information. Medication adherence ranged from 20% to 30%. Mean COPD knowledge, as tested using a specially developed questionnaire, was 64.4%. Very few subjects (3.8%) expressed confidence in performing self-care behaviors. Only eight patients (7.7%) reported significant depression. Analysis of variance determined that COPD patients who lived alone or in assisted living facilities had less symptom management competency. COPD severity was not found to be a determinant of self-management behavior. The findings of this study challenge the widespread belief that COPD case management program should be determined based on disease severity.