Empowering Hong Kong Chinese families with autism: A preliminary study of the online Hanen More Than Words Program.

Purpose: Parent involvement is crucial for tailored early intervention programs. The Hanen More Than Words (HMTW) program is a parent-implemented language intervention for autistic children. The current study examined the effectiveness of the HMTW program delivered online among Chinese families. Methods: Using a randomized controlled trial design, 22 Chinese families of autistic children in Hong Kong completed the trial. Baseline and post-intervention assessments were conducted to measure changes in parent-child interaction, parents' use of linguistic facilitation techniques (LFTs), and children's communication skills. Additionally, the influence of parental self-efficacy and parenting stress on treatment outcomes was explored. Results: The intervention group demonstrated significant improvements in parent-child attention synchrony. Although the treatment effect on children's spontaneous communication was not significant, the intervention group showed a larger effect size compared to the controls. The treatment outcomes were mainly influenced by the parents' initial levels of self-efficacy but not by parenting stress. Conclusion: These findings provide preliminary evidence of the effectiveness of the online-delivered HMTW program for Chinese parents of autistic children. Further research involving a larger sample and focusing on long-term effects is needed.

Brief Report: Atypical Temporal Sensitivity in Coarticulation in Autism: Evidence from Sibilant-Vowel Interaction in Cantonese.

PURPOSE: Atypicalities in the prosodic aspects of speech are commonly considered in clinical assessments of autism. While there is an increasing number of studies using objective measures to assess prosodic deficits, such studies have primarily focused on the intonational and rhythmic aspects of prosody. Little is known about prosodic deficits that are reflected at the segmental level, despite the strong connection between prosody and segmental realization. This study examines the nature of sibilant-vowel coarticulation among male adult native speakers of Cantonese with autism and those without. METHODS: Fifteen Cantonese-speaking autistic (ASD) adults (mean age = 25 years) and 23 neuro-typical (NT) adults (mean age = 20 years) participated. Each participant read aloud 42 syllables with a sibilant onset in carrier phrase. Spectral means and variance, skewness and kurtosis were measured, and regressed by vocalic rounding (rounded vs. unrounded), cohort (ASD vs. NT), sibilant duration, and articulation rate. RESULTS: While neurotypical participants exhibit sibilant-vowel coarticulation that are sensitive to variation in sibilant duration, autistic participants show no sensitivity to segmental temporal changes. CONCLUSION: These findings point to the potential for atypicalities in prosody-segment interaction as an important characteristic of autistic speech.

Efficacy of a Self-Directed Video-Based Caregiver-Implemented Language Programme.

INTRODUCTION: Caregiver-implemented language programmes are effective for alleviating early language difficulties. This study examined the efficacy of a self-directed video-based caregiver-implement language programme in Chinese families. METHOD: This study consisted of two stages. In stage 1, 31 caregiver-child dyads (typically developing children) completed the training programme (group 1) in the form of six video-based training modules. In stage 2, 28 caregiver-child dyads (children with language difficulties) receiving active speech therapy were randomly assigned to the training (group 2) and control arms (group 3). Group 2 received the same training as group 1 in addition to their regular therapy while group 3 was kept as status quo. Caregivers completed a quiz on their knowledge of language facilitation techniques (LFTs) and submitted caregiver-child interaction videos at the start and end of the training. Outcome measures included programme completion rate, quiz scores, and use of LFTs and children's communication skills in the videos. A pre-post design and a between-group design were adopted in the stage 1 and 2 studies, respectively. RESULTS: A completion rate of about 60% in both stages was noted. Significantly higher post-training knowledge scores were found in groups 1 and 2. General but nonsignificant growth in use of parallel talk and gesture, and significant gains in children's vocalization in the training arm were observed. CONCLUSION: The self-directed video-based training programme would be useful in imparting information to caregivers. However, the modest improvements in the use of LFTs suggested direct coaching appeared to still play a significant role in enhancing the actual implementation of LFTs. Further investigation on a larger scale is required to evaluate the effectiveness of the training programme for promoting the wider use of this mode as a preventive measure.

Corrigendum: Systematic review and meta-analysis of screening tools for language disorder.

[This corrects the article DOI: 10.3389/fped.2022.801220.].

Oral Diadochokinetic Performance on Perceptual and Acoustic Measures for Typically Developing Cantonese-Speaking Preschool Children.

PURPOSE: This study investigated native Cantonese-speaking preschool children's diadochokinetic performance, including rate, accuracy, and regularity. The second aim of this study was to examine whether language-specific patterns exist by comparing diadochokinetic rates with the average DKK rate for native English speakers. METHOD: Sixty-four typically developing preschool children who were native Cantonese speakers participated. The diadochokinetic task administered to the children involved repetitions of monosyllabic, disyllabic, and trisyllabic words and nonsense words. The maximum performance of the children was compared by diadochokinetic rate (number of syllables per second), accuracy (percentage of matched production), and regularity (pairwise variability indexes, known as PVIs). RESULTS: Monosyllabic units were produced faster, more accurately, and more regularly than multisyllabic units. Word repetition showed higher accuracy and generally lower regularity than nonsense words but similar rates. Older children were faster and more regular (higher raw PVI of initial consonants) than younger children, but younger children performed as accurately as them. When compared with data from English speakers, the diadochokinetic rates of Cantonese children were generally lower. CONCLUSIONS: Developmental progression was evident in terms of rate and regularity. The distinctive accuracy and regularity patterns between word and nonsense word repetition suggest a clinical value for both stimulus types. Language typology plays a role in diadochokinetic rate, supporting the use of language-specific reference data in practice. The typical diadochokinetic profile obtained in this study could serve as a clinical reference for speech motor assessments.

Systematic Review and Meta-Analysis of Screening Tools for Language Disorder.

Language disorder is one of the most prevalent developmental disorders and is associated with long-term sequelae. However, routine screening is still controversial and is not universally part of early childhood health surveillance. Evidence concerning the detection accuracy, benefits, and harms of screening for language disorders remains inadequate, as shown in a previous review. In October 2020, a systematic review was conducted to investigate the accuracy of available screening tools and the potential sources of variability. A literature search was conducted using CINAHL Plus, ComDisCome, PsycInfo, PsycArticles, ERIC, PubMed, Web of Science, and Scopus. Studies describing, developing, or validating screening tools for language disorder under the age of 6 were included. QUADAS-2 was used to evaluate risk of bias in individual studies. Meta-analyses were performed on the reported accuracy of the screening tools examined. The performance of the screening tools was explored by plotting hierarchical summary receiver operating characteristic (HSROC) curves. The effects of the proxy used in defining language disorders, the test administrators, the screening-diagnosis interval and age of screening on screening accuracy were investigated by meta-regression. Of the 2,366 articles located, 47 studies involving 67 screening tools were included. About one-third of the tests (35.4%) achieved at least fair accuracy, while only a small proportion (13.8%) achieved good accuracy. HSROC curves revealed a remarkable variation in sensitivity and specificity for the three major types of screening, which used the child's actual language ability, clinical markers, and both as the proxy, respectively. None of these three types of screening tools achieved good accuracy. Meta-regression showed that tools using the child's actual language as the proxy demonstrated better sensitivity than that of clinical markers. Tools using long screening-diagnosis intervals had a lower sensitivity than those using short screening-diagnosis intervals. Parent report showed a level of accuracy comparable to that of those administered by trained examiners. Screening tools used under and above 4yo appeared to have similar sensitivity and specificity. In conclusion, there are still gaps between the available screening tools for language disorders and the adoption of these tools in population screening. Future tool development can focus on maximizing accuracy and identifying metrics that are sensitive to the dynamic nature of language development. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=210505, PROSPERO: CRD42020210505.

Phonological Development in Urdu-Speaking Children: A Systematic Review.

Background Speech and language researchers study phonological acquisition and evaluate the errors that children make to understand this complex process. This information provides clinicians with a scientific reference for better assessment and intervention services to children with articulation/phonological disorders. Urdu is a language spoken by more than 200 million speakers worldwide. However, research on Urdu phonological development is in its infancy. Purpose This systematic review aimed to identify relevant studies and provide a comprehensive review of which aspects of Urdu phonological development have been targeted, along with the reported findings. Method Five phases of the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed. All retrieved studies published between January 1980 and March 2020 and focusing on Urdu speech sound acquisition and/or phonological processes in typically developing native Urdu speakers aged up to 8 years were included in the review. The final search was conducted on May 4, 2020. Results A total of 873 records were identified from five databases and a manual search. Nine studies fulfilling the inclusion criteria were included in the final review. All studies were published in the English language, five of which were unpublished master's theses and four were peer-reviewed journal articles. Four of these studies focused on consonant acquisition, whereas five explored phonological processes. No study focused on the acquisition of Urdu vowels, diphthongs, or consonant clusters. These shortlisted studies were reviewed in detail to determine participants' demographic characteristics, focused areas of phonological acquisition, data elicitation methods and contexts, transcription systems, and major findings. Conclusion This study provides a comprehensive review of the available literature on Urdu phonological development and highlights areas for future research.

Effect of Complexity on Speech Sound Development: Evidence From Meta-Analysis Review of Treatment-Based Studies.

In the current study, we aimed at understanding the effect of exposure to complex input on speech sound development, by conducting a systematic meta-analysis review of the existing treatment-based studies employing complex input in children with speech sound disorders. In the meta-analysis review, using a list of inclusion criteria, we narrowed 280 studies down to 12 studies. Data from these studies were extracted to calculate effect sizes that were plotted as forest plots to determine the efficacy of complexity-based treatment approaches. The outcome variables of interest were improvement on the treated and generalization to the untreated sounds. Meta-analysis revealed that the exposure to complex input not only promoted improvement in production of complex speech sounds (d = 1.08, CI = 0.98-1.19) but also facilitated the production of untreated simple speech sounds (d = 2.69, CI = 1.98-3.54). Overall, the current findings revealed that the exposure to complex input promotes acquisition of both complex and simple speech sounds. The current findings are in line with the models of language learnability. The current findings have implications in the treatment of speech sound disorders.

Lifelong Tone Language Experience does not Eliminate Deficits in Neural Encoding of Pitch in Autism Spectrum Disorder.

Atypical pitch processing is a feature of Autism Spectrum Disorder (ASD), which affects non-tone language speakers' communication. Lifelong auditory experience has been demonstrated to modify genetically-predisposed risks for pitch processing. We examined individuals with ASD to test the hypothesis that lifelong auditory experience in tone language may eliminate impaired pitch processing in ASD. We examined children's and adults' Frequency-following Response (FFR), a neurophysiological component indexing early neural sensory encoding of pitch. Univariate and machine-learning-based analytics suggest less robust pitch encoding and diminished pitch distinctions in the FFR from individuals with ASD. Contrary to our hypothesis, results point to a linguistic pitch encoding impairment associated with ASD that may not be eliminated even by lifelong sensory experience.

Temporal Coordination and Prosodic Structure in Autism Spectrum Disorder: Timing Across Speech and Non-speech Motor Domains.

Individuals with autism spectrum disorder (ASD) often exhibit disordered speech prosody, but sources of disordered prosody remain poorly understood. We explored patterns of temporal alignment and prosodic grouping in a speech-based metronome repetition task as well as manual coordination in a drum tapping task among Cantonese speakers with ASD and normal nonverbal IQ and matched controls. Results indicate similar group results for prosodic grouping patterns, but significant differences in relative timing and longer syllable durations at phrase ends for the ASD group. Variability on the speech task was significantly correlated with variability on the drumming task, consistent with the view that impairment in both speech and non-speech motor domains can be linked with deficits in temporal processing.

Revisiting the Cutoff Criteria of Intelligibility in Context Scale-Traditional Chinese.

Background This study evaluated the validity of the Intelligibility in Context Scale-Traditional Chinese (ICS-TC) and explored its potential as a screening tool for speech sound disorder (SSD) in Cantonese-speaking children in Hong Kong. Method The parents of 789 Cantonese-speaking children aged between 2;4 (years;months) and 6;9 completed the ICS-TC. Children were categorized into 2 groups: (a) an SSD group whose initial consonant scores in a standardized assessment were equal to or lower than -1.33 SD and (b) a non-SSD group whose scores were higher than -1.33 SD. The screening accuracy of ICS-TC using a previously proposed cutoff was appraised. A cutoff score for each age group was determined when the effect of age on the ICS-TC mean scores was significant and the corresponding screening accuracy was appraised. Results When the previously proposed cutoff was applied to the whole sample, sensitivity and specificity were unsatisfactory. Given the significant age effect, new cutoff scores for each age group were estimated. The new cutoff scores only led to remarkably improved screening accuracy for Age Group 4 (4;0-4;5) but little to no improvement for other age groups. Conclusions There is limited clinical use of ICS-TC as a screening tool with a single cutoff score for children at different ages. Its clinical utility might be limited to children of about 4 years of age, where ICS-TC scores demonstrated the best differentiation between children with and without speech concerns. Future studies could refine the screening criteria to further minimize the number of false positives.

Rhythmic speech and stuttering reduction in a syllable-timed language.

Speaking rhythmically, also known as syllable-timed speech (STS), has been known for centuries to be a fluency-inducing condition for people who stutter. Cantonese is a tonal syllable-timed language and it has been shown that, of all languages, Cantonese is the most rhythmic (Mok, 2009). However, it is not known if STS reduces stuttering in Cantonese as it does in English. This is the first study to investigate the effects of STS on stuttering in a syllable-timed language. Nineteen native Cantonese-speaking adults who stutter were engaged in conversational tasks in Cantonese under two conditions: one in their usual speaking style and one using STS. The speakers' percentage syllables stuttered (%SS) and speech rhythmicity were rated. The rhythmicity ratings were used to estimate the extent to which speakers were using STS in the syllable-timed condition. Results revealed a statistically significant reduction in %SS in the STS condition; however, this reduction was not as large as in previous studies in other languages and the amount of stuttering reduction varied across speakers. The rhythmicity ratings showed that some speakers were perceived to be speaking more rhythmically than others and that the perceived rhythmicity correlated positively with reductions in stuttering. The findings were unexpected, as it was anticipated that speakers of a highly rhythmic language such as Cantonese would find STS easy to use and that the consequent reductions in stuttering would be great, even greater perhaps than in a stress-timed language such as English. The theoretical and clinical implications of the findings are discussed.

Lexical tone and stuttering in Cantonese.

Cantonese is a tone language, in which the variation of the fundamental frequency contour of a syllable can change meaning. There are six different lexical tones in Cantonese. While research with Western languages has shown an association between stuttering and syllabic stress, nothing is known about whether stuttering in Cantonese speakers is associated with one or more of the six lexical tones. Such an association has been reported in conversational speech in Mandarin, which is also a tone language, but which varies markedly from Cantonese. Twenty-four native Cantonese-speaking adults who stutter participated in this study, ranging in age from 18-33 years. There were 18 men and 6 women. Participants read aloud 13 Cantonese syllables, each of which was produced with six contrastive lexical tones. All 78 syllables were embedded in the same carrier sentence, to reduce the influence of suprasegmental or linguistic stress, and were presented in random order. No significant differences were found for stuttering moments across the six lexical tones. It is suggested that this is because lexical tones, at least in Cantonese, do not place the task demands on the speech motor system that typify varying syllabic stress in Western languages: variations not only in fundamental frequency, but also in duration and intensity. The findings of this study suggest that treatments for adults who stutter in Western languages, such as speech restructuring, can be used with Cantonese speakers without undue attention to lexical tone.

Speech sound disorders or differences: Insights from bilingual children speaking two Chinese languages.

The study investigated how Putonghua-Cantonese bilingual children differ from monolinguals in their acquisition of speech sound and phonological patterns. Fifty-four typically developing Putonghua-Cantonese bilingual children aged 3;6-6;0 were recruited from nurseries in the North District of Hong Kong. The Hong Kong Cantonese Articulation Test (Cheung et al., 2006) and a Putonghua picture-naming task (Zhu & Dodd, 2000) were used to elicit single-word samples of both languages. Acquisition of speech sound and phonological patterns exhibited by ≥20% of the children in an age group were compared to the normative data on children who were Cantonese native or Putonghua monolingual speakers. The bilingual children demonstrated smaller sound inventory in both languages and more delayed and atypical phonological processes. The atypical patterns could be explained by phonological interference between Putonghua and Cantonese. The findings serve as a preliminary reference for clinicians in differentiating language difference from true speech sound disorders in Putonghua-Cantonese bilingual children in Hong Kong.

A Review of Phonological Development of Mandarin-Speaking Children.

PURPOSE: Research into the phonological development of Chinese children is in its infancy compared with the relatively extensive data available on the English-speaking population. This article provided a comprehensive review of empirical studies on the acquisition of Mandarin phonology. METHOD: Studies over the past 45 years that describe phonological development in Mandarin-speaking children were located through electronic databases, citation searches, keyword searches through online search engines, and manual searches of libraries. The research design of the studies was reviewed, and findings of acceptable studies were summarized. RESULTS: After reviewing the abstracts of 798 studies, a total of 12 that met the inclusion criteria were retained. These studies are discussed with reference to the demographic background of participants, geographic regions, aspects of speech sounds measured, data collection tools, transcription systems used, reliability, and the main findings. CONCLUSIONS: The general developmental patterns reported were consistent. The methodological design varied substantially. These discrepancies, however, provide insights for further systematic investigations into phonological development in Mandarin.

Pitch Perception in Tone Language-Speaking Adults With and Without Autism Spectrum Disorders.

Enhanced low-level pitch perception has been universally reported in autism spectrum disorders (ASD). This study examined whether tone language speakers with ASD exhibit this advantage. The pitch perception skill of 20 Cantonese-speaking adults with ASD was compared with that of 20 neurotypical individuals. Participants discriminated pairs of real syllable, pseudo-syllable (syllables that do not conform the phonotactic rules or are accidental gaps), and non-speech (syllables with attenuated high-frequency segmental content) stimuli contrasting pitch levels. The results revealed significantly higher discrimination ability in both groups for the non-speech stimuli than for the pseudo-syllables with one semitone difference. No significant group differences were noted. Different from previous findings, post hoc analysis found that enhanced pitch perception was observed in a subgroup of participants with ASD showing no history of delayed speech onset. The tone language experience may have modulated the pitch processing mechanism in the speakers in both ASD and non-ASD groups.

The Topography of Stuttering in Cantonese.

OBJECTIVE: This is the first study to investigate the behavioral nature (topography) of stuttering in Cantonese. Cantonese, a Sino-Tibetan language, is both tonal and syllable-timed. Previous studies of stuttering topography have mainly been in Western languages, which are mainly stress-timed. METHODS: Conversational speech samples were collected from 24 native Cantonese-speaking adults who stuttered. Six consecutive stuttering moments from each participant were analyzed using the Lidcombe behavioral data language (LBDL). A complexity analysis based on the LBDL was developed to indicate the proportion of multiple-behavior stuttering moments for each participant. RESULTS: There was no significant difference in the frequency of the 7 LBDL behaviors. Almost half the stuttering moments across participants were reported as complex, containing more than 1 stuttering behavior, and stuttering complexity correlated significantly with stuttering severity. CONCLUSIONS: These preliminary findings require replication because of their important theoretical and clinical implications. Differences in topography across languages have the potential to contribute to our understanding of the nature of stuttering. Clinically, the recognition of such differences may assist practitioners in identifying stuttering, for example when screening for early stuttering. The LBDL complexity score developed in this study has the potential to be used in other languages.

Do Individuals with High-Functioning Autism Who Speak a Tone Language Show Intonation Deficits?

This study investigated whether intonation deficits were observed in 19 Cantonese-speaking adults with high-functioning autism (HFA) when compared to 19 matched neurotypical (NT) controls. This study also investigated the use of sentence-final particles (SFPs) and their relationship with intonation in both groups. Standard deviations (SDs) of the fundamental frequency (F0), the total number and the type of SFPs were calculated based on narrative samples. The HFA group demonstrated significantly higher SD of F0 and a positive correlation between the type of SFPs and SD of F0. Both groups produced a similar total number and type of SFPs. The results supported the universality of atypical intonation in ASD. The relationship between intonation and SFPs could be further explored by focusing on sentences containing SFPs.

A Randomized Controlled Trial of Two Syntactic Treatment Procedures With Cantonese-Speaking, School-Age Children With Language Disorders.

PURPOSE: In this study, we aimed to evaluate the efficacy of sentence-combining (SC) and narrative-based (NAR) intervention approaches to syntax intervention using a randomized-controlled-trial design. METHOD: Fifty-two Cantonese-speaking, school-age children with language impairment were assigned randomly to either the SC or the NAR treatment arm. Seven children did not receive treatment as assigned. Intervention in both arms targeted the same complex syntactical structures. The SC group focused on sentence combination training, whereas the NAR group made use of narratives in which the target structures were embedded. Pretest and posttest performances measured using a standardized language assessment were subjected to analyses of covariance mixed-effect-model analyses of variance. RESULTS: Children in both treatment arms demonstrated significant growth after 4 months of intervention. The main effect between treatment arms and time was not significant after controlling the pretest performance, suggesting that both treatment approaches showed similar effects. The main effect of time was significant. CONCLUSIONS: This study provided evidence to support language intervention in the school years in Cantonese-speaking children. However, neither approach was shown to be more efficacious than the other. Future researchers could examine the effects of a longer treatment period and include functional outcome measures.

Phonetic variations and sound changes in Hong Kong Cantonese: diachronic review, synchronic study and implications for speech sound assessment.

The aim of this article was to describe phonetic variations and sound changes in Hong Kong Cantonese (HKC) to provide speech-language pathologists with information about acceptable variants of standard pronunciations for speech sound assessments. Study 1 examined the pattern of variations and changes based on past diachronic research and historical written records. Nine phonetic variations were found. Five in syllable-initial and syllabic contexts: (1) [n-] → [l-], (2) [ŋ-] → Ø-, (3) Ø- → [ŋ-], (4) [k(w)ɔ-] → [kɔ-], (5) syllabic [ŋ̍] → [mÌ©]; and four in syllable-final contexts: (6) [-ŋ] → [-n], (7) [-n] → [-ŋ], (8) [-k] → [-t], (9) [-t] → [-k]. Historical records demonstrated the pattern of variation and changes in HKC across time. In study 2, a large-scale synchronic study of speakers of differing ages was undertaken to determine acceptable phonetic variations of HKC for speech sound assessments. In the synchronic study, single-words were elicited from 138 children (10;8-12;4) and 112 adults (18-45 years) who spoke Cantonese and lived in Hong Kong. Synchronic evidence demonstrated five acceptable variants in syllable-initial and syllabic contexts: (1) [n-] → [l-], (2) [ŋ-] → Ø-, (3) Ø- → [ŋ-], (4) [k(w)ɔ-] → [kɔ-] and (5) syllabic [ŋ̍] → [mÌ©] and four incomplete sound changes in syllable-final contexts: (6) [-ŋ] → [-n], (7) [-n] → [-ŋ], (8) [-k] → [-t] and (9) [-t] → [-k]. The incomplete sound changes may still be accepted as variants in speech sound assessments unless related speech problems are indicated.