Interprofessional delivery of Read It Again - KindergartenQ!: Classroom, educator, and child outcomes of an Australian pilot study.

PURPOSE: Australian Early Development Census (AEDC) data for the Australian Capital Territory (ACT) indicates a concerning increase in the proportion of children who are at risk or developmentally vulnerable in the domains of communication and general knowledge, and language and cognitive skills. This study investigated the effectiveness of speech-language pathologist and educator collaboration to build educator capacity to promote oral language and emergent literacy skills in preschool children. METHOD: A quasi-experimental, pre-test post-test design was used to evaluate the effectiveness of interprofessional delivery of Read It Again - KindergartenQ! on (a) children's oral language and emergent literacy outcomes, (b) educators' oral language and emergent literacy instructional practices, and (c) quality of the classroom environment. RESULT: Children demonstrated improved print knowledge and narrative skills. One of the two educators demonstrated a significant increase in their use of oral language and emergent literacy promoting strategies in their day-to-day interactions with children. No significant changes were observed in the classroom environment. CONCLUSION: Interprofessional collaboration with a coaching component is an effective method of improving children's emergent literacy skills and educator instructional practices.

A Good start in life: Effectiveness of integrated multicomponent multisector support on early child development-Study protocol.

INTRODUCTION: Early childhood experiences have a lifelong impact on a child's future. Social and environmental experiences and interactions have a profound relational effect on children's physical and mental health which transfers agency to parents, caregivers and duty-bearers to care for the child's welfare. In the Australian context early child development indices have been in decline in some communities. Hence, there is a sense of urgency to reverse these trends from an integrated perspective. A multisector, multi component program of interventions named A Good Start in Life is proposed and is being tested in the Australian Capital Territory across suburbs with high levels of early childhood development disadvantage. The aim of this study is to evaluate the outcomes and processes related to targeted interventions, designed to integrate child and family services within the local district and embed allied health programs into early childhood education, care services and playgroups. METHODS AND ANALYSIS: The Good Start in Life study will use a quasi-experimental design (with a matched control geographical area) consisting of a combination of interventions that will build multisectoral collaboration across education, health and social services that connect and support families with children from birth to 5 years. The control area will be matched on demographic characteristics and early child development outcomes and trends over the pre-intervention period. Evaluation data will be collected at baseline, and then on an annual basis for a further three years. A mixed methods approach will be used to evaluate delivery processes: quantitative (checklists, questionnaires) and qualitative methods (observations, focus groups and key stakeholder interviews). Effectiveness of the programme will be evaluated by comparing early child development outcomes between the comparator areas from the Australian Early Development Census in 2024. The primary focus will be on reducing the number of children who are developmentally vulnerable on at least one early development index (EDI). Separate tests will be conducted for significant differences in the percentage of children at risk in each of the five individual EDI domains. These domains are physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication and general knowledge. TRIAL REGISTRATION: ACTRN12621001140842.

An Automated Lexical Stress Classification Tool for Assessing Dysprosody in Childhood Apraxia of Speech.

Childhood apraxia of speech (CAS) commonly affects the production of lexical stress contrast in polysyllabic words. Automated classification tools have the potential to increase reliability and efficiency in measuring lexical stress. Here, factors affecting the accuracy of a custom-built deep neural network (DNN)-based classification tool are evaluated. Sixteen children with typical development (TD) and 26 with CAS produced 50 polysyllabic words. Words with strong-weak (SW, e.g., dinosaur) or WS (e.g., banana) stress were fed to the classification tool, and the accuracy measured (a) against expert judgment, (b) for speaker group, and (c) with/without prior knowledge of phonemic errors in the sample. The influence of segmental features and participant factors on tool accuracy was analysed. Linear mixed modelling showed significant interaction between group and stress type, surviving adjustment for age and CAS severity. For TD, agreement for SW and WS words was >80%, but CAS speech was higher for SW (>80%) than WS (~60%). Prior knowledge of segmental errors conferred no clear advantage. Automatic lexical stress classification shows promise for identifying errors in children's speech at diagnosis or with treatment-related change, but accuracy for WS words in apraxic speech needs improvement. Further training of algorithms using larger sets of labelled data containing impaired speech and WS words may increase accuracy.

The influence of type of feedback during tablet-based delivery of intensive treatment for childhood apraxia of speech.

PURPOSE: One of the key principles of motor learning supports using knowledge of results feedback (KR, i.e., whether a response was correct / incorrect only) during high intensity motor practice, rather than knowledge of performance (KP, i.e., whether and how a response was correct/incorrect). In the future, mobile technology equipped with automatic speech recognition (ASR) could provide KR feedback, enabling this practice to move outside the clinic, supplementing speech pathology sessions and reducing burden on already stretched speech-language pathology resources. Here, we employ a randomized controlled trial design to test the impact of KR vs KP feedback on children's response to the Nuffield Dyspraxia Programme 3, delivered through an android tablet. At the time of testing, ASR was not feasible and so correctness of responses was decided by the treating clinician. METHOD: Fourteen children with CAS, aged 4-10 years, participated in a parallel group design, matched for age and severity of CAS. Both groups attended a university clinic for 1-hr therapy sessions 4 days a week for 3 weeks. One group received high frequency feedback comprised of both KR and KP, in the style of traditional, face-to-face intensive intervention on all days. The other group received high frequency KR + KP feedback on 1 day per week and high frequency KR feedback on the other 3 days per week, simulating the service delivery model of one clinic session per week supported by tablet-based home practice. RESULTS: Both groups had significantly improved speech outcomes at 4-months post-treatment. Post-hoc comparisons suggested that only the KP group showed a significant change from pre- to immediately post-treatment but the group difference had dissipated by 1-month post-treatment. Heterogeneity in response to intervention within the groups suggests that other factors, not measured here, may be having a substantive influence on response to intervention and feedback type. CONCLUSION: Mobile technology has the potential to increase motivation and engagement with therapy and to mitigate barriers associated with distance and access to speech pathology services. Further research is needed to explore the influence of type and frequency of feedback on motor learning, optimal timing for transitioning from KP to KR feedback, and how these parameters interact with task, child and context-related factors.

Comorbid morphological disorder apparent in some children aged 4-5 years with childhood apraxia of speech: findings from standardised testing.

There is continuing debate about the origins of productive morphological errors in children with speech sound disorders. This is the case for children with theorised phonetic and motor disorders, such as children with childhood apraxia of speech (CAS, e.g., Ekelman & Aram, 1983; McNeill & Gillon, 2013 ). The morphological skills of children with CAS remain relatively unexplored in pre-schoolers. We investigated English morphology in a retrospective, cross-sectional design of 26 children aged 4-5 years who completed the Clinical Evaluation of Language Fundamentals-Preschool (2nd edition; Wiig, Secord & Semel, 2006). The research aims were to determine: (1) the language profile of the children, (2) the accuracy of each morpheme type produced, and (3) how many of those morphological errors are explained by speech errors (clusters, late developing phonemes, central vowels or weak syllable stress)? The results indicate the group of children with CAS had poorer expressive language skills than receptive skills and 48% demonstrated difficulties with morphology in word structure and recalling sentences subtests. The children had poor accuracy and inconsistent production of a range of morphemes and despite many errors due to the speech characteristics of the stimuli on the CELF-P2, motor speech concerns could not explain all the child's morphological errors. The results suggest morphological difficulties are co-morbid to CAS and when this occurs, treatment for morphosyntax is indicated. There are also significant clinical implications in the assessment of morphosyntax for children with CAS which are discussed.