Contralateral suppression of transient evoked otoacoustic emissions in children with phonological disorder.

BACKGROUND: Perception of acoustic details in the speech signal is important for speech sound development. The medial olivocochlear pathway, a part of the auditory efferent system, plays a role in stimulus-related control of the cochlea. One clinical tool to evaluate the medial olivocochlear activity, which is thought to improve speech perception in noise, is the suppression of otoacoustic emissions. AIMS: This study investigated the suppression of transient evoked otoacoustic emissions in children with phonological disorder in comparison with that in typically developing controls. STUDY DESIGN: Case-control study. METHODS: A total of 23 children with phonological disorder (aged 5-10 years) and 21 age- and sex-matched controls (P > 0.05) participated in the study. Participants had pure-tone thresholds ≤ 15 dB hearing loss and normal middle ear functions. Transient evoked otoacoustic emissions with and without contralateral acoustic stimulation were measured. RESULTS: Although the mean transient evoked otoacoustic emissions suppressions were lower in the group with phonological disorder than in the controls, these differences were not statistically significant (P > 0.05). No left/right ear asymmetry of transient evoked otoacoustic emissions suppression was detected in either of the groups (P > 0.05). CONCLUSION: Children with phonological disorder did not show alterations in medial olivocochlear functioning in the medial olivocochlear activity as measured by the contralateral suppression of transient evoked otoacoustic emissions.

Orofacial function in children with Speech Sound Disorders persisting after the age of six years.

Purpose: The aim was to investigate, describe and analyse speech characteristics, intelligibility, orofacial function and co-existing neurodevelopmental symptoms in children with SSD of unknown origin, persisting after six years of age.Method: The study included 61 children with SSD (6-17 years) of unknown origin, referred for a speech and oral motor examination. The severity of SSD was estimated using Percentage Consonants Correct (PCC) and Percentage Vowels Correct (PVC) and assessments of resonance based on Swedish Articulation and Nasality Test (SVANTE). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Parents completed the Intelligibility in Context Scale (ICS) and a questionnaire including questions about heredity, medical and neurodevelopmental conditions, and speech development.Result: SSD varied according to PCC (8-95%) and PVC (55-100%) measurements. Percentages of co-occurring disorders included: 51% resonance deviations, 90% intelligibility issues, and 87% orofacial difficulties. The most affected orofacial domains were "Chewing and swallowing" (41%), "Masticatory muscles and jaw function" (38%) and "Sensory function" (38%). The majority (64%) had co-existing dysfunctions relating to general motor and neurodevelopmental disorders.Conclusion: Children with persistent SSD are at risk for orofacial dysfunction, general motor difficulties and other neurodevelopmental disorders and therefore should be screened for co-occurring disorders.

Motor Performance in Children With Childhood Apraxia of Speech and Speech Sound Disorders.

Purpose This study sought to determine if (a) children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development (TD) would perform differently on a standardized motor assessment and (b) whether comorbid language impairment would impact group differences. Method Speech, language, and motor abilities were assessed in children with CAS (n = 10), SSD (n = 16), and TD (n = 14) between the ages of 43 and 105 months. Motor skills were evaluated using the Movement Assessment Battery for Children-Second Edition (Henderson, Sugden, & Barnett, 2007), a behavioral assessment that is sensitive in identifying fine/gross motor impairments in children with a range of motor and learning abilities. Data were reanalyzed after reclassifying children by language ability. Results The CAS group performed below the normal limit on all components of the motor assessment and more poorly than the TD and SSD groups on Aiming and Catching and Balance. When children were reclassified by language ability, the comorbid CAS + language impairment group performed worse than the SSD-only and TD groups on Manual Dexterity and Balance and worse than the TD group on Aiming and Catching; all 7 children with CAS + language impairment evidenced performance in the disordered range compared to 1 of 3 children in the CAS-only group and 2 of 6 children in the SSD + language impairment group. Conclusions Children with CAS + language impairment appear to be at an increased risk for motor impairments, which may negatively impact social, academic, and vocational outcomes; referrals for motor screenings/assessments should be considered. Findings may suggest a higher order deficit that mediates cognitive-linguistic and motor impairments in this population.

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.

Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series.

PURPOSE: There is a paucity of evidence to guide treatment for children with co-occurring stuttering and speech sound disorder. Some guidelines suggest treating the two disorders simultaneously using indirect treatment approaches; however, the research supporting these recommendations is over 20 years old. In this clinical case series, we investigate whether these co-occurring disorders could be treated concurrently using direct treatment approaches supported by up-to-date, high-level evidence, and whether this could be done in an efficacious, safe and efficient manner. METHOD: Five pre-school-aged participants received individual concurrent, direct intervention for both stuttering and speech sound disorder. All participants used the Lidcombe Program, as manualised. Direct treatment for speech sound disorder was individualised based on analysis of each child's sound system. RESULT: At 12 months post commencement of treatment, all except one participant had completed the Lidcombe Program, and were less than 1.0% syllables stuttered on samples gathered within and beyond the clinic. These four participants completed Stage 1 of the Lidcombe Program in between 14 and 22 clinic visits, consistent with current benchmark data for this programme. At the same assessment point, all five participants exhibited significant increases in percentage of consonants correct and were in alignment with age-expected estimates of this measure. Further, they were treated in an average number of clinic visits that compares favourably with other research on treatment for speech sound disorder. CONCLUSION: These preliminary results indicate that young children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct treatment approaches. This method of service delivery may have implications for cost and time efficiency and may also address the crucial need for early intervention in both disorders. These positive findings highlight the need for further research in the area and contribute to the limited evidence base.

Neural signatures of phonological deficits in Chinese developmental dyslexia.

There has been debate on whether phonological deficits explain reading difficulty in Chinese, since Chinese is a logographic language which does not employ grapheme-phoneme-correspondence rules and remote memorization seems to be the main method to acquire reading. In the current study, we present neuroimaging evidence that the phonological deficit is also a signature of Chinese dyslexia. Specifically, we found that Chinese children with dyslexia (DD) showed reduced brain activation in the left dorsal inferior frontal gyrus (dIFG) when compared to both age-matched controls (AC) and reading-matched controls (RC) during an auditory rhyming judgment task. This suggests that the phonological processing deficit in this region may be a signature of dyslexia in Chinese, rather than a difference due to task performance or reading ability, which was matched on DD and RC. At exactly the same region of the left dIFG, we found a positive correlation between brain activation and reading skill in DD, suggesting that the phonological deficit is associated with the severity of dyslexia. We also found increased brain activation in the right precentral gyrus in DD than both AC and RC, suggesting a compensation of reliance on articulation. Functional connectivity analyses revealed that DD had a weaker connection between the left superior temporal gyrus (STG) and fusiform gyrus (FG) than the two control groups, suggesting that the reduced connection between phonology and orthography is another neural signature of dyslexia. In contrast, DD showed greater connectivity between the left dIFG and the left inferior parietal lobule (IPL) than both control groups, suggesting a reduced segregation between the language network and default mode network in dyslexic children. We also found that connectivity between the left STG and the left dIFG was sensitive to task performance and/or reading skill rather than being dyslexic or not, because AC was greater than both RC and DD, while the connectivity between the left middle occipital gyrus (MOG) and left STG was sensitive to age, because both AC and DD were greater than RC. In summary, our study provides the very first neurological evidence of phonological deficits in Chinese developmental dyslexia and we successfully distinguished variations of brain activity/functional connectivity due to age, performance, and dyslexia by comparing AC, RC, and DD.

De la teoría fonológica a la identificación temprana de las dificultades específicas de aprendizaje de la lectura / From phonological theory to the early detection of specific learning difficulties in reading

Se revisa el marco teórico de investigación generado en torno a la teoría fonológica de la dislexia evolutiva. Este marco ha habilitado la posibilidad de realizar una identificación temprana de las dificultades específicas de aprendizaje de la lectura y ha justificado su necesidad práctica. Cuatro son las aportaciones fundamentales. Primero, la teoría fonológica defiende que la dislexia evolutiva se produce como consecuencia de un déficit fonológico general que afecta a diversos componentes del sistema fonológico, entre los que destacan la conciencia fonológica, la velocidad de los procesos léxicos y la memoria verbal a corto plazo. Segundo, la teoría fonológica ha puesto de manifiesto que la causa primaria de la dislexia está presente desde el periodo embrionario y produce consecuencias sobre el desarrollo del lenguaje oral durante todo el periodo previo al aprendizaje de la lectura. Tercero, la teoría fonológica ha defendido la tesis del lenguaje oral como causa primaria del déficit, y con ello ha revelado las relaciones entre los trastornos específicos del lenguaje y la dislexia evolutiva. Cuarto, la investigación ha mostrado el significativo impacto de los programas de prevención e intervención temprana, lo que obliga a complementar las estrategias reactivas y tardías de diagnóstico, con estrategias proactivas de prevención y/o identificación e intervención temprana. Finalmente, se argumenta que si las causas primeras y los sistemas de prevención e intervención de estas dificultades están directamente vinculados con el desarrollo del lenguaje, entonces la logopedia debería tener un papel protagonista en la implementación de las estrategias proactivas en el contexto escolar (AU)

This paper presents a review of the research issued from the frame of the Phonological Theory of developmental dyslexia. This theory has set up the means to make an early identification of specific learning difficulties in reading, and has provided theoretical support for its implementation. There are four fundamental contributions. First, the Phonological Theory argues that developmental dyslexia is a consequence of a general phonological deficit that affects different components of the phonological system being phonological awareness, lexical processing speed and verbal short-term memory the most relevant. Second, the Phonological Theory has pointed out that the primary cause of dyslexia is present from the embryonic period and that it affects oral language development before learning to read. Third, the Phonological Theory has considered oral language as the main cause of the deficit, and consequently, has highlighted the relations between Specific Language Impairment and Developmental Dyslexia. Fourth, since research has proved the significant impact of Programs for prevention and early intervention, a clear need for adding proactive strategies of early prevention and/or identification to the late reactive diagnosis strategies has arisen. Finally, it is argued that if primary causes as well as prevention and intervention resources are directly attached to language development, then, speech therapists should play a main role in the implementation of proactive strategies in the school context (AU)

Social, Emotional, and Academic Impact of Residual Speech Errors in School-Aged Children: A Survey Study.

Children with residual speech errors face an increased risk of social, emotional, and/or academic challenges relative to their peers with typical speech. Previous research has shown that the effects of speech sound disorder may persist into adulthood and span multiple domains of activity limitations and/or participation restrictions, as defined by the World Health Organization's International Classification of Functioning, Disability and Health model. However, the nature and extent of these influences varies widely across children. This study aimed to expand the evidence base on the social, emotional, and academic impact of residual speech errors by collecting survey data from parents of children receiving treatment for /r/ misarticulation. By examining the relationship between an overall measure of impact (weighted summed score) and responses to 11 survey items, the present study offers preliminary suggestions for factors that could be considered when making decisions pertaining to treatment allocation in this population.

Association between audiological profile and primary language impairment in children.

OBJECTIVES: The aim of the present study was to characterize the Brazilian Portuguese speaking children seen at the Speech-Language Pathology Service of a Health Center, between 1985 and 2009, diagnosed with primary language impairments (PLI): language development impairment (LDI), phonological disorder (PD) and reading and writing impairment (RWI) regarding demographic and audiological profile; as well as investigate the association between PLI and demographic variables, and the association between PLI and hearing disorders. METHODS: A survey of medical records was carried out, collecting audiological and language impairment diagnostic data, totaling 2424 individuals in the study group. In addition, audiological evaluation data of 186 children without language disorders complaints were collected so that they constituted the control group. RESULTS: From the study group,1524 children (62.87%) had PLI. Considering the PLIs, the following occurrences were observed: PD=58.84%, LDI=30.75% and RWI=10.41%, with a predominance of males (64.19%) and age range up to 6 years (67.15%). For the audiological profile, there was a predominance of normal hearing thresholds (81.34%), followed by conductive hearing loss (15.47%). Tympanogram type A was more prevalent (56.24%), followed by B and C types (21.84% and 18.16%). Acoustic reflexes were present in the majority of subjects (51.7%). There was a significant association between belonging to the 7-12 years-old group and presenting with PD, belonging to the group up to 6 years and having LDI, and belonging to the older group and presenting with RWI. There was a significant association between males and presenting with LDI. There was statistically significant association between PLI and abnormal audiological profile. Individuals with abnormal audiological profile were 63% more likely to have PLI than those who had normal audiological profile. CONCLUSIONS: It is suggested that having an abnormal audiological profile would be a risk factor for PLI. Hence, these findings can serve as a basis for children hearing and speech-language monitoring, and as an important tool for the planning of health promotion and prevention actions, as well as the development and implementation of intervention programs.