Preliminary Speech Perception Performance Profiles of School-Age Children With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development.

PURPOSE: Limited research exists assessing speech perception in school-age children with speech sound disorder (SSD) and childhood apraxia of speech (CAS); despite early evidence that speech perception may lead to error-prone motor planning/programming. In this study, we examine speech perception performance in school-age children with and without speech production deficits. METHOD: Speech perception was assessed using the Wide Range Acoustic Accuracy Scale to determine the just-noticeable difference in discrimination for three consonant-vowel syllable contrasts (/bɑ/-/wɑ/, /dɑ/-/gɑ/, /ɹɑ/-/wɑ/), each varying along a single acoustic parameter for seven children with CAS with rhotic errors, seven children with SSD with rhotic errors, and seven typically developing (TD) children. RESULTS: Findings revealed statistically significant mean differences between perceptual performance of children with CAS when compared to TD children for discrimination of /ɹɑ/-/wɑ/ contrasts. Large effect sizes were also observed for comparisons of /ɹɑ/-/wɑ/ contrasts between children with CAS, SSD, and TD peers. Additionally, large effect sizes were observed for /dɑ/-/gɑ/ contrasts between children with CAS and SSD and TD children despite nonsignificant mean differences in group performance. CONCLUSIONS: Overall, mean outcome scores suggest that school-age children with CAS and persistent rhotic errors demonstrated less accurate speech perception skills relative to TD children for the /ɹɑ/-/wɑ/ contrasts. However, the relatively small sample sizes per group limit the extent to which these findings may be generalized to the broader population.

Subtract Before You Add: Toward the Development of a De-Implementation Approach in School-Based Speech Sound Therapy.

PURPOSE: It is often difficult for school-based speech-language pathologists (SLPs) to prioritize implementing new practices for children with speech sound disorders (SSDs), given burgeoning caseloads and the myriad of other workload tasks. We propose that de-implementation science is equally as important as implementation science. De-implementation science is the recognition and identification of areas that are of "low-value and wasteful." Critically, the idea of de-implementation suggests that we first remove something from a clinician's workload before requesting that they learn and implement something new. METHOD: Situated within the Sustainability in Healthcare by Allocating Resources Effectively (SHARE) framework, we review de-implementation science and current speech sound therapy literature to understand the mechanisms behind continuous use of practices that are no longer supported by science or legislation. We use vignettes to highlight real-life examples that clinicians may be facing in school-based settings and to provide hypothetical solutions, resources, and/or next steps to these common challenges. RESULTS: By focusing on Phase 1 of the SHARE framework, we identified four primary practices that can be de-implemented to make space for new evidence-based techniques and approaches. These four practices were determined based on an in-depth review of SLP-based survey research: (a) overreliance on speech sound norms for eligibility determinations, (b) the omission of phonological processing skills within evaluations, (c) homogeneity of service delivery factors, and (d) the use of only one treatment approach for all children with SSDs. CONCLUSIONS: De-implementation will take work and may lead to some difficult discussions. Implementing a framework, such as SHARE, can guide SLPs toward a reduction in workloads and improved outcomes for children with SSDs.

Clinical Considerations for Speech Perception in School-Age Children With Speech Sound Disorders: A Review of the Current Literature.

PURPOSE: The purpose of this study was to synthesize the methodological variability in the speech perception literature for school-age children with residual speech sound disorder (RSSD), with the primary intention of using the existing knowledge to inform clinical decisions and optimize treatment outcomes for children. METHOD: Ten electronic databases were systematically searched to identify articles examining the speech perception skills of school-age children with RSSD. A total of 11 articles met inclusion criteria, reporting of methodological characteristics was rated and compared across studies, and findings were summarized. RESULTS: The majority of studies reviewed here confirmed the presence of a perceptual deficit for a subset of children with RSSD. However, marked variability across study methodologies limits clinical interpretation and application of the findings. CONCLUSIONS: Despite limited research in children with RSSD and wide variability across study procedures, stimulus type, perception type, and task type emerged as potential key factors that provide critical insight into a child's perceptual skill. The current evidence suggests that deficits in speech perception may significantly impact acquisition of accurate phoneme production for children with RSSD. Furthermore, these findings suggest that assessment and treatment of speech perception may be a critical component of an intervention program for school-age children, although further research is needed to determine effective clinical procedures.

Exploring the Overlap Between Dyslexia and Speech Sound Production Deficits.

Purpose: Children with dyslexia have speech production deficits in a variety of spoken language contexts. In this article, we discuss the nature of speech production errors in children with dyslexia, including those who have a history of speech sound disorder and those who do not, to familiarize speech-language pathologists with speech production-specific risk factors that may help predict or identify dyslexia in young children. Method: In this tutorial, we discuss the role of a phonological deficit in children with dyslexia and how this may manifest as speech production errors, sometimes in conjunction with a speech sound disorder but sometimes not. We also briefly review other factors outside the realm of phonology that may alert the speech-language pathologist to possible dyslexia. Results: Speech-language pathologists possess unique knowledge that directly contributes to the identification and remediation of children with dyslexia. We present several clinical recommendations related to speech production deficits in children with dyslexia. We also review what is known about how and when children with speech sound disorder are most at risk for dyslexia. Conclusion: Speech-language pathologists have a unique opportunity to assist in the identification of young children who are at risk for dyslexia.

Children With Dyslexia Benefit From Orthographic Facilitation During Spoken Word Learning.

Purpose: Orthographic facilitation describes the phenomenon in which a spoken word is produced more accurately when its corresponding written word is present during learning. We examined the orthographic facilitation effect in children with dyslexia because they have poor learning and recall of spoken words. We hypothesized that including orthography during spoken word learning would facilitate learning and recall. Method: Children with dyslexia and children with typical development (n = 46 per group), 7-9 years old, were matched for grade and nonverbal intelligence. Across 4 blocks of exposure in 1 session, children learned pairings between 4 spoken pseudowords and novel semantic referents in a modified paired-associate learning task. Two of the pairings were presented with orthography present, and 2 were presented with orthography absent. Recall of newly learned spoken words was assessed using a naming task. Results: Both groups showed orthographic facilitation during learning and naming. During learning, both groups paired pseudowords and referents more accurately when orthography was present. During naming, children with typical development showed a large orthographic facilitation effect that increased across blocks. For children with dyslexia, this effect was present initially but then plateaued. Conclusions: We demonstrate for the first time that children with dyslexia benefit from orthographic facilitation during spoken word learning. These findings have direct implications for teaching spoken vocabulary to children with dyslexia.

Short-term Memory in Childhood Dyslexia: Deficient Serial Order in Multiple Modalities.

In children with dyslexia, deficits in working memory have not been well-specified. We assessed second-grade children with dyslexia, with and without concomitant specific language impairment, and children with typical development. Immediate serial recall of lists of phonological (non-word), lexical (digit), spatial (location) and visual (shape) items were included. For the latter three modalities, we used not only standard span but also running span tasks, in which the list length was unpredictable to limit mnemonic strategies. Non-word repetition tests indicated a phonological memory deficit in children with dyslexia alone compared with those with typical development, but this difference vanished when these groups were matched for non-verbal intelligence and language. Theoretically important deficits in serial order memory in dyslexic children, however, persisted relative to matched typically developing children. The deficits were in recall of (1) spoken digits in both standard and running span tasks and (2) spatial locations, in running span only. Children with dyslexia with versus without language impairment, when matched on non-verbal intelligence, had comparable serial order memory, but differed in phonology. Because serial orderings of verbal and spatial elements occur in reading, the careful examination of order memory may allow a deeper understanding of dyslexia and its relation to language impairment. Copyright © 2017 John Wiley & Sons, Ltd.

Speech Perception and Working Memory in Children with Residual Speech Errors: A Case Study Analysis.

Some children with residual deficits in speech production also display characteristics of dyslexia; however, the causes of these disorders--in isolation or comorbidly--remain unknown. Presently, the role of phonological representations is an important construct for considering how the underlying system of phonology functions. In particular, two related skills--speech perception and phonological working memory--may provide insight into the nature of phonological representations. This study provides an exploratory investigation into the profiles of three 9-year-old children: one with residual speech errors, one with residual speech errors and dyslexia, and one who demonstrated typical, age-appropriate speech sound production and reading skills. We provide an in-depth examination of their relative abilities in the areas of speech perception, phonological working memory, vocabulary, and word reading. Based on these preliminary explorations, we suggest implications for the assessment and treatment of children with residual speech errors and/or dyslexia.