Exploring the phonological profiles of children with reading difficulties: A multiple case study.

Studies of group differences have established that the phonological profiles of people with reading difficulties contain both strengths and weaknesses. The current study extends this work by exploring individual differences in phonological ability using a multiple case study approach. A heterogeneous sample of 56 children (M age = 9 years) with reading difficulties completed a battery of tasks measuring literacy, phonological processing, expressive vocabulary and general ability. The phonological tasks included measures of phonological awareness (PA), phonological memory (PM), and rapid naming (RAN). A majority-although not all-of the children had phonological processing impairments. However, there was also substantial variability in the nature of children's phonological difficulties. While multiple impairments encompassing two or more phonological domains were most common, impairments that were specific to PA, PM or RAN also occurred frequently. Even within the domain of PA, where children completed three well-matched tasks, individual children were rarely impaired across all three measures and a number of different profiles were observed. Additional, group-level analyses indicated that PA was a significant predictor of decoding while RAN was a significant predictor of automatic word recognition and comprehension. Findings are discussed with reference to conceptual models of phonological processing and implications for assessment.

Normative Nasalance Scores for Brazilian Portuguese Using New Speech Stimuli.

OBJECTIVE: Normative data were established for newly developed speech materials for nasalance assessment in Brazilian Portuguese. MATERIALS AND METHODS: Nasalance scores of preexisting passages (oral ZOO-BR, low-pressure oral ZOO-BR2 and NASAL-BR), new nasalance passages (oral Dudu no zoológico, oral Dudu no bosque, oral-nasal O cãozinho Totó and nasal O nenê) and Brasilcleft articulation screening sentences were collected from 245 speakers of Brazilian Portuguese, including 121 males and 124 females, divided into 4 groups: children (5-9 years), adolescents (10-19 years), young adults (20-24 years) and adults (25-35 years). RESULTS: Across all nasalance passages, adult females scored on average 2 percentage points higher than males. Children scored 2-4 percentage points lower than older groups for the preexisting nasalance passages ZOO-BR and ZOO-BR2. Nasalance scores for the new nasalance passages were not significantly different from the preexisting passages. Scores for high-pressure sentences did not differ significantly from the oral nasalance passage Dudu no bosque. CONCLUSION: The nasalance scores for the new nasalance passages were equivalent to the preexisting materials. The new shortened and simplified nasalance passages will be useful for assessing young children. Normative scores for the Brasilcleft high-pressure sentences were equivalent to the new oral passage Dudu no bosque.

Speech outcome in unilateral complete cleft lip and palate patients: a descriptive study.

AIM: In this study, resonance and articulation disorders were examined in a group of patients surgically treated for cleft lip and palate, considering family social background, and children's ability of self monitoring their speech output while speaking. MATERIALS AND METHODS: Fifty children (32 males and 18 females) mean age 6.5 ± 1.6 years, affected by non-syndromic complete unilateral cleft of the lip and palate underwent the same surgical protocol. The speech level was evaluated using the Accordi's speech assessment protocol that focuses on intelligibility, nasality, nasal air escape, pharyngeal friction, and glottal stop. Pearson product-moment correlation analysis was used to detect significant associations between analysed parameters. RESULTS: A total of 16% (8 children) of the sample had severe to moderate degree of nasality and nasal air escape, presence of pharyngeal friction and glottal stop, which obviously compromise speech intelligibility. Ten children (10%) showed a barely acceptable phonological outcome: nasality and nasal air escape were mild to moderate, but the intelligibility remained poor. Thirty-two children (64%) had normal speech. Statistical analysis revealed a significant correlation between the severity of nasal resonance and nasal air escape (p ≤ 0.05). No statistical significant correlation was found between the final intelligibility and the patient social background, neither between the final intelligibility nor the age of the patients. CONCLUSION: The differences in speech outcome could be explained with a specific, subjective, and inborn ability, different for each child, in self-monitoring their speech output.

How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems.

BACKGROUND: Children with speech sound disorders (SSD) form a heterogeneous group who differ in terms of the severity of their condition, underlying cause, speech errors, involvement of other aspects of the linguistic system and treatment response. To date there is no universal and agreed-upon classification system. Instead, a number of theoretically differing classification systems have been proposed based on either an aetiological (medical) approach, a descriptive-linguistic approach or a processing approach. AIMS: To describe and review the supporting evidence, and to provide a critical evaluation of the current childhood SSD classification systems. METHODS & PROCEDURES: Descriptions of the major specific approaches to classification are reviewed and research papers supporting the reliability and validity of the systems are evaluated. MAIN CONTRIBUTION: Three specific paediatric SSD classification systems; the aetiologic-based Speech Disorders Classification System, the descriptive-linguistic Differential Diagnosis system, and the processing-based Psycholinguistic Framework are identified as potentially useful in classifying children with SSD into homogeneous subgroups. The Differential Diagnosis system has a growing body of empirical support from clinical population studies, across language error pattern studies and treatment efficacy studies. The Speech Disorders Classification System is currently a research tool with eight proposed subgroups. The Psycholinguistic Framework is a potential bridge to linking cause and surface level speech errors. CONCLUSIONS & IMPLICATIONS: There is a need for a universally agreed-upon classification system that is useful to clinicians and researchers. The resulting classification system needs to be robust, reliable and valid. A universal classification system would allow for improved tailoring of treatments to subgroups of SSD which may, in turn, lead to improved treatment efficacy.

Differences of articulation rate and utterance length in fluent and disfluent utterances of preschool children who stutter.

PURPOSE: The purpose of this study was to investigate characteristics of four types of utterances in preschool children who stutter: perceptually fluent, containing normal disfluencies (OD utterance), containing stuttering-like disfluencies (SLD utterance), and containing both normal and stuttering-like disfluencies (SLD+OD utterance). Articulation rate and length of utterance were measured to seek the differences. Because articulation rate may reflect temporal aspects of speech motor control, it was predicted that the articulation rate would be different between perceptually fluent utterances and utterances containing disfluencies. The length of utterance was also expected to show different patterns. METHOD: Participants were 14 preschool children who stutter. Disfluencies were identified from their spontaneous speech samples, and articulation rate in syllables per second and utterance length in syllables were measured for the four types of utterances. RESULTS AND DISCUSSION: There was no significant difference in articulation rate between each type of utterance. Significantly longer utterances were found only in SLD+OD utterances compared to fluent utterances, suggesting that utterance length may be related to efforts in executing motor as well as linguistic planning. The SLD utterance revealed a significant negative correlation in that longer utterances tended to be slower in articulation rates. Longer utterances may place more demand on speech motor control due to more linguistic and/or grammatical features, resulting in stuttering-like disfluencies and a decreased rate.

Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy.

INTRODUCTION: Closure and long-term retention of anterior open bites are significant concerns for orthodontists and their patients. In this study, we investigated the efficacy of orofacial myofunctional therapy (OMT) for maintaining closure of open bites in conjunction with orthodontic treatment. METHODS: The sample included 76 subjects with dental anterior open bites referred for OMT before, during, or after relapse of orthodontic treatment. The experimental cohort consisted of 27 subjects who received OMT and orthodontic treatment or retreatment. The control cohort comprised 49 subjects who had a history of orthodontic treatment with open-bite relapse. Overbite was evaluated by an OMT professional or orthodontist 2 months to 23 years after removal of the fixed appliances. Measurements were compared with t tests. RESULTS: Overbite relapse means were 0.5 mm (range, 0.0-4.0 mm) in the experimental group and 3.4 mm (range, 1.0-7.0 mm) in the control group, a difference that was clinically and statistically significant (P <0.0001). CONCLUSIONS: This study demonstrated that OMT in conjunction with orthodontic treatment was highly effective in maintaining closure of anterior open bites compared with orthodontic treatment alone.

Confirmational study: a positive-based thumb and finger sucking elimination program.

This article emphasizes the critical need for information specifically regarding the topic of retained sucking behaviors. The study aimed to confirm results provided by Van Norman of 723 subjects in 1997. Parent surveys were collected on 441 subjects who received an orofacial myofunctional treatment program provided by one certified orofacial myologist. Results of this study do confirm that retained digit sucking behavior may be addressed successfully and expediently by a program based on positive behavior modification techniques.

Development of guideline for rating the physical impairment of otolaryngologic field.

We develop a guideline for rating the physical impairment of otolaryngologic fields. Assessment of hearing disturbance and tinnitus required physical examination, pure tone audiometry, speech audiometry, impedance audiometry, brainstem evoked response audiometry, Bekesy audiometry, otoacoustic emission test, and imaging examination. History taking, physical examination, and radiological examination for the vestibular organ and brain, righting reflex test, electronystagmography, and caloric test are taken for evaluation of balance disorder. Olfactory function tests include University of Pennsylvania Smell Identification test, Connecticut Chemosensory Clinical Research Center test, T and T olfactometry and Korean Version of Sniffin's Sticks test. Medical history and physical examination is mandatory to evaluatezseverity of respiration difficulty. Examinations include flexible fiberoptic nasopharyngoscope, bronchoscopy, simple soft-tissue radiography films of upper airway and high resolution computed tomography. Evaluation of mastication and swallowing are history taking, physical examination, examination for upper jaw, lower jaw, and temporomandibular joint, dental examination and radiological studies. Endoscopy and esophagography are also needed. Voice disorder is evaluated based on physical examination, oral pharynx and larynx endoscopy, larynx stroboscopy, hearing assessment, laryngeal electromyography, sound analysis test, aerodynamic test, electroglottography, and radiologic examination. Articulation disorder is assessed by picture consonant articulation test. These are position articulation test, Lee-Kim Korean articulation picture and speech intelligibility assessment.

Development of Guideline for Rating the Physical Impairment of Otolaryngologic Field

We develop a guideline for rating the physical impairment of otolaryngologic fields. Assessment of hearing disturbance and tinnitus required physical examination, pure tone audiometry, speech audiometry, impedance audiometry, brainstem evoked response audiometry, Bekesy audiometry, otoacoustic emission test, and imaging examination. History taking, physical examination, and radiological examination for the vestibular organ and brain, righting reflex test, electronystagmography, and caloric test are taken for evaluation of balance disorder. Olfactory function tests include University of Pennsylvania Smell Identification test, Connecticut Chemosensory Clinical Research Center test, T and T olfactometry and Korean Version of Sniffin's Sticks test. Medical history and physical examination is mandatory to evaluatezseverity of respiration difficulty. Examinations include flexible fiberoptic nasopharyngoscope, bronchoscopy, simple soft-tissue radiography films of upper airway and high resolution computed tomography. Evaluation of mastication and swallowing are history taking, physical examination, examination for upper jaw, lower jaw, and temporomandibular joint, dental examination and radiological studies. Endoscopy and esophagography are also needed. Voice disorder is evaluated based on physical examination, oral pharynx and larynx endoscopy, larynx stroboscopy, hearing assessment, laryngeal electromyography, sound analysis test, aerodynamic test, electroglottography, and radiologic examination. Articulation disorder is assessed by picture consonant articulation test. These are position articulation test, Lee-Kim Korean articulation picture and speech intelligibility assessment.

A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability.

OBJECTIVES: To describe speech based on perceptual evaluation in a group of 10-year-old children with cleft palate. A secondary aim was to investigate the reliability of speech-language pathologists' perceptual assessment of cleft palate speech. DESIGN: Retrospective cross-sectional study in children with cleft palate. External raters made assessments from randomized speech recordings. SUBJECTS: Thirty-eight children with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO) and 10 children in a comparison group. MAIN OUTCOME MEASURES: Ratings of hypernasality, hyponasality, audible nasal air leakage, weak pressure consonants, and articulation. Exact agreement and weighted kappa values were used for reliability. RESULTS: Hypernasality was found in 25% of children with a cleft of the soft palate (CSP), 33% of children with a cleft of the hard and soft palate (CHSP), and 67% of children with a UCLP. Similar results were found for audible nasal air leakage. Articulation errors were found in 6% of the CHSP group and 25% of the UCLP group, whereas no child in the CSP group had articulation errors. The reliability was moderate to good for different variables, with lowest values for hypernasality. CONCLUSIONS: Speech results in this series seem less satisfactory than those reported in other published international studies, but it is difficult to draw any certain conclusions about speech results because of large methodological differences. Further developments to ensure high reliability of perceptual ratings of speech are called for.

[Validated diagnostics for dysgrammatism]. / Validierte Diagnostik des Dysgrammatismus.

BACKGROUND: Non-standardized procedures are used to evaluate, in particular, grammatical performance in most German institutions performing diagnostic procedures on children with impaired speech and language development. This makes a comparison of results difficult. METHODS: We studied 181 boys and 72 girls aged between 5 and 6 years using four subtests of IDIS additionally to the routine procedure. Results were compared to the "degree of dysgrammatism" determined from the traditional evaluation based on expert rating. RESULTS: The new procedure is able to divide the children into groups with normal speech and language ability, with deficits accessible to a traditional logopedic treatment, and with severe speech and language impairment that necessitates intensive treatment. DISCUSSION: The proposed tests allow an accurate evaluation of grammatical performance instead of subjective estimates.

[A perceptual analysis of dysarthria following cranial trauma]. / La dysarthrie chez les patients traumatisés crâniens: une analyse perceptive.

INTRODUCTION: Dysarthria is a frequent cause of handicap for patients with traumatic brain injury. Clinical assessment and quantification of the disorder is necessary before treatment. METHODS: We report a perceptual analysis of speech in a population of 18 patients with traumatic brain injury, in comparison with 18 control subjects. Evaluation was provided with a 33-item clinical scale. RESULTS: Interjuge reliability was good. Speech analysis distinguished controls from patients. Main perceptual deviances were impairment of naturalness, prosodic and phonetic disturbances.

Does the speech of Turkish-speaking phonologically disordered children differ from that of children speaking other languages?

How phonological disorders should be categorized in Turkish children remained vague for a long period of time due to a lack of normative studies. This paper reports the phonological systems of 70 phonologically disordered children, aged 4;0-8;0, in comparison with the results of a normative study of 665 Turkish-speaking children, aged 1;3-8;0. The current focus is on two aspects of development, mainly the differences between disordered and normal consonant acquisition and phonological error patterns from both longitudinal and cross-sectional data. The second concern of the paper is to sub-classify phonological disorders as proposed in the existing literature by examining the applicability of these proposals to Turkish, a typologically different language. It has been indicated that similar developmental trends occur across languages but consonant acquisition is more rapid and developmental errors are more predictable in Turkish. There is evidence for ambient language influence. Mostly, the sub-classifications of phonological disorders are valid for Turkish-speaking children with apparent saliency to language.

[Clinical characteristics and speech therapy of lingua-apical articulation disorder].

OBJECTIVE: To explore the clinical characteristics and speech therapy of 62 children with lingua-apical articulation disorder. METHODS: Peabody Picture Vocabulary Test (PPVT), Gesell development scales (Gesell), Wechsler Intelligence Scale for Preschool Children (WPPSI) and speech test were performed for 62 children at the ages of 3 to 8 years with lingua-apical articulation disorder. PPVT was used to measure receptive vocabulary skills. GESELL and WPPSI were utilized to represent cognitive and non-verbal ability. The speech test was adopted to assess the speech development. The children received speech therapy and auxiliary oral-motor functional training once or twice a week. Firstly the target sound was identified according to the speech development milestone, then the method of speech localization was used to clarify the correct articulation placement and manner. It was needed to change food character and administer oral-motor functional training for children with oral motor dysfunction. RESULTS: The 62 cases with the apical articulation disorder were classified into four groups. The combined pattern of the articulation disorder was the most common (40 cases, 64.5%), the next was apico-dental disorder (15 cases, 24.2%). The third was palatal disorder (4 cases, 6.5%) and the last one was the linguo-alveolar disorder (3 cases, 4.8%). The substitution errors of velar were the most common (95.2%), the next was omission errors (30.6%) and the last was absence of aspiration (12.9%). Oral motor dysfunction was found in some children with problems such as disordered joint movement of tongue and head, unstable jaw, weak tongue strength and poor coordination of tongue movement. Some children had feeding problems such as preference of eating soft food, keeping food in mouths, eating slowly, and poor chewing. After 5 to 18 times of therapy, the effective rate of speech therapy reached 82.3%. CONCLUSION: The lingua-apical articulation disorders can be classified into four groups. The combined pattern of the articulation errors is the most common one. Most of the apical sounds are replaced by velar sounds. The speech localization method is very useful in the therapy of apical articulation disorder. For children with feeding problems and oral motor dysfunction, it is needed to improve food texture and administer oral motor skill training.

Dimensions of early speech sound disorders: A factor analytic study.

UNLABELLED: The goal of this study was to classify children with speech sound disorders (SSD) empirically, using factor analytic techniques. Participants were 3-7-year olds enrolled in speech/language therapy (N = 185). Factor analysis of an extensive battery of speech and language measures provided support for two distinct factors, representing the skill dimensions of articulation/phonology and semantic/syntactic skills. To validate these factors, 38 of the children were followed to school age to re-evaluate speech and language skills and assess reading/spelling achievement. The validity of the two factors was supported by their differential associations with school-age reading and spelling achievement, persistence of SSD, and affection status in family members. A closer relationship of the family member to the proband and male gender predicted higher odds of a disorder. The findings suggest that articulation/phonology and language abilities are at least partially independent in children with SSD and that these constructs have distinct clinical and biological correlates. LEARNING OUTCOMES: The reader will develop knowledge about subtypes of speech sound disorders, understand the relationship between early speech sound disorders and later reading and spelling difficulties, and obtain information concerning familial transmission of speech sound disorders.

Gravidade do distúrbio fonológico: julgamento perceptivo e porcentagem de consoantes corretas / Severity of phonological disorders: perceptual judgment and percentage of correct consonants

TEMA: distúrbio Fonológico. OBJETIVO: aplicar o índice de gravidade de Porcentagem de Consoantes Corretas (PCC) e verificar a correlação entre este índice e o aplicado perceptivamente pelos juízes. MÉTODO: calculou-se o índice de gravidade PCC de 50 sujeitos diagnosticados com distúrbio fonológico, após 60 juízes ouviram as provas de fonologia de cada sujeito e julgaram perceptivamente a gravidade. RESULTADO: o índice PCC aplicado aos sujeitos obteve uma variação entre 40 por cento e 98 por cento, com uma classificação predominante da população nos graus leve e levemente moderado. CONCLUSÃO: existe correlação entre o julgamento perceptivo dos juizes e os valores do índice PCC.

Rules for the classification of younger children with nonverbal learning disabilities and basic phonological processing disabilities.

Rules for the classification of Nonverbal Learning Disabilities (NLD) and Basic Phonological Processing Disabilities (BPPD) that had been generated and tested on older children (ages 9-15) were applied to younger children (ages 7-8). The goal was to evaluate the applicability of these classification rules for a younger population with NLD and BPPD, and to make revisions if necessary. These rules were used to differentiate these two subtypes of learning disabilities using levels and patterns of performance on motor/psychomotor, tactile/perceptual, visual-spatial, auditory-perceptual, problem solving, and language measures. An experienced child-clinical neuropsychologist classified each child. Only those children who received a classification of NLD or BPPD by the neuropsychologist and those who met criteria for definite or probable NLD and BPPD as defined by the rules were used in this study. Revisions were made to these rules for younger children. Revised rules allow for their use as a source of information to assist a clinician in deciding whether a comprehensive neuropsychological evaluation would be valuable. They may also be useful for research purposes.

[Severity of phonological disorders: perceptual judgment and percentage of correct consonants]. / Gravidade do disttúrbio fonológico: julgamento perceptivo e porcentagem de consoantes corretas.

BACKGROUND: Phonological disorder. AIM: To apply the percentage of correct consonant (PCC) index and to verify the correlation between this index and the one applied perceptually by judges. METHOD: The PCC index of 50 phonological disordered subjects was calculated, after 60 judges heard the phonological tests for each subject and perceptually attributed the severity. RESULTS: The PCC index varied from 40% to 98%, with the predominant classification of the population in the mild and mild-moderate levels. CONCLUSION: A correlation between the perceptual judgment and the PCC indexes exists.

[Working memory abilities and the severity of phonological disorders]. / Habilidades de memória de trabalho e o grau de severidade do desvio fonológico.

BACKGROUND: Working memory. AIM: To verify the performance of working memory abilities and their relation with the severity of phonological disorders. METHOD: 45 children, with ages between 5.0 and 7.11 years, with evolutional phonological disorders (EFD), 17 female and 18 male, were evaluated. All subjects were assessed using the Child Phonological Evaluation proposed by Yavas et al. (1991). The severity of the disorder was determined by the Percentage of Correct Consonants (PCC) proposed by Shriberg and Kwiatkowski (1982), classifying the phonological disorder as severe, moderate-severe, average-moderate and average. After that, subtest 5 of the Psycholinguistic Abilities Test (ITPA--Bogossian & Santos, 1977) and the non-word repetition test (Kessler, 1997) were applied. RESULTS: After analyzing the data according the statistical tests of Kruskal Wallis and Duncan, it was verified that the performance of moderate-severe and severe individuals in the non-word repetition test was inferior to that of average-moderate and average individuals. However, performance results in the digit repetition test did not present a positive correlation with severity. CONCLUSION: The performance of phonological memory has a relation with the severity of phonological disorders. This allows us to accept the idea that the phonologic memory is related to speech production. Regarding the central executor, the results indicate that the performance in digit repetition, used to assess the central executor, did not present a correlation with the severity of the disorder. This can be justified by the fact that the central executor is more directly related to vocabulary acquisition and is responsible for processing and storing information.

Determinant factors of severity rating of phonological disorder.

BACKGROUND: Phonological disorder. AIM: To analyze the severity descriptors used by graduation students of the Speech-Language Communication Sciences and Speech-Language Pathologists to classify the phonological disorder. METHOD: 60 judges classified the speech of 50 phonological disordered children regarding the severity of the disorder, after listening to their speech samples. RESULTS: The most used and applied severity descriptors, to justify the severity of the disorder, were: phonology, age, intelligibility, voice and speech. CONCLUSION: The judges used similar criteria in the perceptual judgment of the severity.