Update on Identification and Treatment of Infants and Toddlers With Suspected Childhood Apraxia of Speech.

PURPOSE: The purpose of this tutorial is to (a) provide an updated review of the literature pertaining to proposed early features of childhood apraxia of speech (CAS), (b) discuss the findings of recent treatment studies of infants and toddlers with suspected CAS (sCAS), and (c) present evidence-based strategies and tools that can be used for the identification of and intervention for infants and toddlers with sCAS or at high risk for the disorder. METHOD: Since Davis and Velleman's (2000) seminal work on assessment and intervention in infants and toddlers with sCAS, limited research has guided clinicians in the complex task of identifying and treating early speech motor difficulties prior to a definitive diagnosis of CAS. Following the structure of Davis and Velleman, we explore the proposed early characteristics of CAS with reference to contemporary research. Next, we describe the limited treatment studies that have investigated intervention for infants and toddlers at risk of or suspected of having CAS. Finally, we present practical suggestions for integrating this knowledge into clinical practice. CONCLUSIONS: Many of the originally proposed correlates of CAS in infants and toddlers now have research supporting their presence. However, questions remain about the developmental trajectory of the disorder. Although limited in number and restricted by lack of experimental control, emerging treatment studies can help guide clinicians in providing appropriate intervention to infants and toddlers with sCAS who need not wait for a definitive diagnosis to initiate intervention.

Early diagnostic indicators of childhood apraxia of speech in young children with 7q11.23 duplication syndrome: preliminary findings.

Limited evidence for early indicators of childhood apraxia of speech (CAS) precludes reliable diagnosis before 36 months, although a few prior studies have identified several potential early indicators. We examined these possible early indicators in 10 toddlers aged 14-24 months at risk for CAS due to a genetic condition: 7q11.23 duplication syndrome (Dup7). Phon Vocalisation analyses were conducted on phonetic transcriptions of each child's vocalisations during an audio-video recorded 30-minute play session with a caregiver and/or a trained research assistant. The resulting data were compared to data previously collected by Overby from similar-aged toddlers developing typically (TD), later diagnosed with CAS (LCAS), or later diagnosed with another speech sound disorder (LSSD). The Dup7 group did not differ significantly from the LCAS group on any measure. In contrast, the Dup7 group evidenced significant delays relative to the LSSD group on canonical babble frequency, volubility, consonant place diversity, and consonant manner diversity and relative to the TD group not only on these measures but also on canonical babble ratio, consonant diversity, and vocalisation structure diversity. Toddlers with Dup7 also demonstrated expressive vocabulary delay as measured by both number of word types orally produced during the play sessions and primary caregivers' responses on a standardised parent-report measure of early expressive vocabulary. Examining babble, phonetic, and phonotactic characteristics from the productions of young children may allow for earlier identification of CAS and a better understanding of the nature of CAS.

Clinicians' Perspectives of Treatment for Lateralization Errors: A Quantitative and Qualitative Study.

PURPOSE: This mixed-methods study aimed to obtain information regarding speech-language pathologists' (SLPs) perspectives about treatment of lateralization errors (LEs), challenges to implementing evidence-based LE treatment practice, and the sources SLPs' use to find evidence to treat LEs. This information can assist our understanding of ways to facilitate the uptake of evidence-based practice into the everyday treatment of clients with this disorder. METHOD: A convergent parallel mixed-methods design was used to collect data from SLPs (N = 214) using 24 questions from an online survey distributed through electronic mailing lists and Speech and Hearing State Associations. Quantitative data were analyzed using frequencies and averages; themes and subthemes of qualitative data were analyzed using a content analysis approach with no a priori codes. Quantitative and qualitative results were compared and integrated. RESULTS: Participants believed that LEs required individualized treatment before the age of 5 years, were largely caused by structural and neuromuscular factors, and required an understanding of orofacial and dental structure and function. Challenges to implementing LE treatment included a lack of skills and knowledge specific to LEs, competing demands on clinicians' time and resources, and a research-practice gap. Sources of evidence frequently used to obtain information about LE treatment were colleagues, trainings, workshops, and American Speech-Language-Hearing Association journals. CONCLUSIONS: Clinicians believe that LE treatment is challenging and requires skill training. Future research in LEs will need to consider the real-world decisions clinicians must make when treating this disorder as well as clinicians' everyday constraints and challenges.

Retrospective video analysis of the early speech sound development of infants and toddlers later diagnosed with lateralisation errors.

Purpose: Although lateralisation errors (LEs) are a common speech sound disorder, no studies have examined their early development. The purpose of this exploratory small-scale investigation was to compare the early (birth-24 months) speech sound development between children later diagnosed with LEs and typically developing children.Method: This was a between-group case-controlled design with six monolingual English-speaking participants. Participants were White, non-Hispanic girls with at least one college-educated parent. As children, three had been diagnosed with lateralisation speech sound errors and three demonstrated typical speech sound development. Participants' parents provided home video-recordings of the participants as infants/toddlers between birth and age 2. These videos were then analysed for the amount, type and diversity of sounds, and canonical babbling onset.Result: There was no statistically significant between-group difference in the volubility (i.e. combined frequency of non-resonant and resonant utterances) or in the age at which [s] or [z] emerged. However, infants/toddlers who were later diagnosed with LEs showed reduced frequency/minute in production of resonant utterances and consonants (including [s, z]), used fewer different consonants/minute, and used fewer syllable shapes/minute compared to typically developing infants/toddlers. At 7-12 months, none of the infants/toddlers later diagnosed with LEs, but all participants in the comparison group had reached the canonical babbling stage.Conclusion: Children who have LEs may have had a less robust speech sound system as infants/toddlers than their typically developing peers. However, these findings must be considered with caution due to the significant limitations of this investigation.

A retrospective video analysis of canonical babbling and volubility in infants later diagnosed with childhood apraxia of speech.

Canonical babbling and volubility are common indicators of infant vocal development. If either indicator falls below values found in typical infants, it may be an early signal of a developmental disorder. The aim of this retrospective investigation was to examine home videos for the frequency of canonical babbles, age of canonical babbling onset, and overall volubility of eight infants later diagnosed with childhood apraxia of speech and compare these data to that of six typically developing infants as well as four infants later diagnosed with a speech sound disorder. Results revealed the infants later identified with childhood apraxia of speech used fewer canonical babbles, had later onset of canonical babbling, and fewer syllables per minute (volubility) than the comparison groups. These results suggest that infants later diagnosed with childhood apraxia of speech may be less adept in vocal exploration and in the production of canonical babbles, perhaps due to fewer opportunities for mapping articulatory movement with auditory speech sound outcomes.

Volubility, Consonant Emergence, and Syllabic Structure in Infants and Toddlers Later Diagnosed With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development: A Retrospective Video Analysis.

Purpose Studies of infants' early vocalizations have proven helpful in describing the developmental characteristics of various communication disorders. However, few studies have addressed the early vocalizations of infants and toddlers who were later diagnosed, as older children, with childhood apraxia of speech (CAS). We refer to these infants and toddlers as LCAS. Extant studies also often lack a comparison group of infants and toddlers who were later diagnosed, as older children, with a speech sound disorder (SSD). We refer to these infants and toddlers as LSSD. We aimed to compare the volubility, consonant emergence, and syllabic structure from birth to age of 2 years, as observed in home videos, among 3 groups of infants and toddlers: LCAS, LSSD, and typically developing (TD). Method We assessed the speech-language skills of 17 children (3.5-8.8 years old; 7 with CAS, 5 with SSD, and 5 TD) and transcribed home videos (obtained from parents) of these same children from birth to age of 2 years. Early vocalizations were coded as nonresonant or resonant. Nonresonant vocalizations could not be transcribed with the International Phonetic Alphabet. Resonant (speechlike) vocalizations were broadly transcribed, and resonant consonants were categorized by place, manner, and voicing. Results Effect size comparisons revealed LCAS infants and toddlers were less voluble, used fewer resonant consonants, had a less diverse phonetic repertoire, and acquired resonant consonants later than either the LSSD or TD participants. For LSSD infants and toddlers, means for these dependent variables were lower than the means demonstrated by the TD group, but effect size were not strong due to LSSD variability. Conclusions Findings imply there might be clinical "red flags" that could assist the identification of infants and toddlers at risk for later diagnosis of CAS. Data did not support red flags for identifying infants and toddlers at risk for later diagnosis of SSD. Because of significant study limitations, results obtained should be considered preliminary. Supplemental Material https://doi.org/10.23641/asha.8233334.

Stakeholders' qualitative perspectives of effective telepractice pedagogy in speech-language pathology.

BACKGROUND: Academic programmes in speech-language pathology are increasingly providing telehealth/telepractice clinical education to students. Despite this growth, there is little information describing effective ways to teach it. AIMS: The current exploratory study analyzed the perceptions of speech-language pathology/therapy (SLP/SLT) faculty, student and SLP/SLT clinicians to ascertain effective pedagogical approaches for telepractice service delivery, rank the relative importance of telepractice skills and knowledge competencies, and define any pedagogical challenges to teaching them. METHODS & PROCEDURES: Qualitative data were collected from two sources: three open-ended questions within an online survey (SLP/SLT faculty n = 31, graduate students n = 16, telehealth ('telepractice') clinicians n = 16); and follow-up telephone interviews (n = 22). Data were analyzed with a grounded theory approach followed by a summative rank-order analysis of themes. OUTCOMES & RESULTS: All three groups agreed the most effective telepractice instructional approach was telepractice demonstrations (such as students role playing or watching a supervisor). Professional development approaches such as workshops or training manuals were less effective and didactic approaches such as lecture-only were ineffective. Skills and knowledge competencies students needed before entering the workforce were, in order of implied importance: telepractice clinical skills, telepractice technology skills, legal knowledge pertinent to telepractice and knowledge of telepractice literature. The most important telepractice clinical skills students needed to acquire were appropriate selection of telepractice materials and engaging the client over the internet. Many participants said teaching and learning telepractice was more challenging than in-person service delivery because of the difficulties in selecting appropriate telepractice clinical materials, managing technology problems and engaging with clients over the internet. CONCLUSIONS & IMPLICATIONS: Despite substantial limitations to this investigation, findings imply that telepractice instruction, like other methods of SLP/SLT clinical education, may be most effective when students engage in critical thinking and problem-solving issues through intense practice. Because the skills and competencies associated with telepractice appear to vary in their perceived value, academic programmes may wish to consider prioritizing how they are taught, giving students additional instruction in the selection of telepractice clinical materials and development of online interpersonal communication skills. For some clinical educators, the challenges associated with telepractice may necessitate additional educator training.

Perceptions of telepractice pedagogy in speech-language pathology: A quantitative analysis.

Introduction Despite the growth of telecommunication applications to provide clinical healthcare services, there has been little attention to the pedagogical framework needed to train healthcare students to deliver these services. Methods In this exploratory investigation, perceptions of speech-language pathology/therapy (SLP/SLT) faculty ( n = 31), graduate students ( n = 16), and telehealth ("telepractice") clinicians ( n = 16) were examined with a 15-item survey regarding the 1) comparative pedagogical importance of four skills common to telepractice and face-to-face service (f2f) delivery, and 2) relative pedagogical value of seven skills and competencies unique to telepractice. Results Statistical analyses revealed nonverbal communication skills and knowledge of the literature related to service delivery methods were more important in telepractice than in f2f service delivery. Among seven skills unique to telepractice, participants believed the most important was solving problems related to the Internet and recommended at least two hours of instruction each in telepractice technology, patient confidentiality, and role-playing telepractice. Results suggest that SLP/SLT students may need additional and/or focused academic training in nonverbal communication, telepractice literature, and in solving connectivity issues to enter the telepractice marketplace with sufficient preparation. Discussion Further study is needed to compare the relative importance of additional SLP/SLT skills and competencies, describe components of effective healthcare training telepractice programs, and explore effective pedagogical strategies for healthcare telepractice instruction.

Preliteracy Speech Sound Production Skill and Linguistic Characteristics of Grade 3 Spellings: A Study Using the Templin Archive.

PURPOSE: This archival investigation examined the relationship between preliteracy speech sound production skill (SSPS) and spelling in Grade 3 using a dataset in which children's receptive vocabulary was generally within normal limits, speech therapy was not provided until Grade 2, and phonological awareness instruction was discouraged at the time data were collected. METHOD: Participants (N = 250), selected from the Templin Archive (Templin, 2004), varied on prekindergarten SSPS. Participants' real word spellings in Grade 3 were evaluated using a metric of linguistic knowledge, the Computerized Spelling Sensitivity System (Masterson & Apel, 2013). Relationships between kindergarten speech error types and later spellings also were explored. RESULTS: Prekindergarten children in the lowest SPSS (7th percentile) scored poorest among articulatory subgroups on both individual spelling elements (phonetic elements, junctures, and affixes) and acceptable spelling (using relatively more omissions and illegal spelling patterns). Within the 7th percentile subgroup, there were no statistical spelling differences between those with mostly atypical speech sound errors and those with mostly typical speech sound errors. CONCLUSIONS: Findings were consistent with predictions from dual route models of spelling that SSPS is one of many variables associated with spelling skill and that children with impaired SSPS are at risk for spelling difficulty.

Volubility, consonant, and syllable characteristics in infants and toddlers later diagnosed with childhood apraxia of speech: A pilot study.

PURPOSE: This pilot study explored the volubility, consonant singleton acquisition, and syllable structure development between infants and toddlers (birth-24 months) with typical speech sound production (TYP) and those later diagnosed with childhood apraxia of speech (CAS). METHOD: A retrospective longitudinal between- and within-subjects research design was utilized (TYP N=2; CAS N=4). Vocalizations from participants were analyzed between birth-24 months from home videotapes, volunteered by the children's parents, according to type (nonresonant vs. resonant), volubility, place and manner of consonant singletons, and syllable shape (V, CV, VC, CVC, VCV, CVCV, VCVC, and "Other"). RESULTS: Volubility between groups was not significant but statistically significant differences were found in the number of: resonant and non-resonant productions; different consonant singletons; different place features; different manner classes; and proportional use of fricative, glottal, and voiceless phones. Infants and toddlers in the CAS group also demonstrated difficulty with CVCs, had limited syllable shapes, and possible regression of vowel syllable structure. CONCLUSIONS: Data corroborate parent reports that infants and toddlers later diagnosed with CAS present differently than do those with typical speech sound skills. Additional study with infants and toddlers later diagnosed with non-CAS speech sound disorder is needed. LEARNING OUTCOMES: Readers will: (1) describe current perspectives on volubility of infants and toddlers later diagnosed with CAS; (2) describe current perspectives of the consonant singleton and syllable shape inventories of infants and toddlers later diagnosed with CAS; and (3) discuss the potential differences between the speech sound development of infants and toddlers later diagnosed with CAS and those with typical speech sound skill.

Preliteracy speech sound production skill and later literacy outcomes: a study using the Templin Archive.

PURPOSE: This archival study examined the relationship between the speech sound production skill of kindergarten children and literacy outcomes in Grades 1-3 in a data set where most children's vocabulary skills were within normal limits, speech therapy was not provided until 2nd grade, and phonological awareness instruction was discouraged at the time data were collected. METHOD: Data were accessed from the Templin Archive (2004), and the speech sound production skill of 272 kindergartners were examined relative to literacy outcomes in 1st and 2nd grade (reading) and 3rd grade (spelling). RESULTS: Kindergartners in the 7th percentile for speech sound production skill scored more poorly in 1st- and 2nd-grade reading and 3rd-grade spelling than did kindergartners with average speech sound production skill; kindergartners in the 98th percentile achieved superior literacy skills compared to the mean. Phonological awareness mediated the effects of speech sound production skill on reading and spelling; vocabulary did not account for any unique variance. CONCLUSION: Speech sound disorders appear to be an overt manifestation of a complex interaction among variables influencing literacy skills, including nonlanguage cognition, vocabulary, letter knowledge, and phonological awareness. These interrelationships hold across the range of speech sound production skill, as children with superior speech sound production skill experience superior literacy outcomes.

Teachers' perceptions of students with speech sound disorders: a quantitative and qualitative analysis.

PURPOSE: This study examined 2nd-grade teachers' perceptions of the academic, social, and behavioral competence of students with speech sound disorders (SSDs). METHOD: Forty-eight 2nd-grade teachers listened to 2 groups of sentences differing by intelligibility and pitch but spoken by a single 2nd grader. For each sentence group, teachers rated the speaker's academic, social, and behavioral competence using an adapted version of the Teacher Rating Scale of the Self-Perception Profile for Children (S. Harter, 1985) and completed 3 open-ended questions. The matched-guise design controlled for confounding speaker and stimuli variables that were inherent in prior studies. RESULTS: Statistically significant differences in teachers' expectations of children's academic, social, and behavioral performances were found between moderately intelligible and normal intelligibility speech. Teachers associated moderately intelligible low-pitched speech with more behavior problems than moderately intelligible high-pitched speech or either pitch with normal intelligibility. One third of the teachers reported that they could not accurately predict a child's school performance based on the child's speech skills, one third of the teachers causally related school difficulty to SSD, and one third of the teachers made no comment. CONCLUSION: Intelligibility and speaker pitch appear to be speech variables that influence teachers' perceptions of children's school performance.