American Journal of Speech-Language Pathology

Children with severe disabilities typically require systematic instruction to develop their communication abilities. Intervention can begin by teaching functional communication skills related to requesting and rejecting. Although a considerable amount of research has focused on teaching requesting, there is an emerging literature on teaching rejecting. The aim of this tutorial is to review the emerging literature on teaching communicative rejecting to children with severe disabilities. This review considers (a) the definition of communicative rejecting, (b) reasons for teaching communicative rejecting, (c) types of communicative rejecting, and (d) empirically validated strategies for teaching communicative rejecting to children with severe disabilities. The authors include a case study to illustrate the major steps in teaching communicative rejecting to children with severe disabilities.

To compare maternal report of children's vocabularies on the MacArthur Communicative Development Inventories Words and Gestures form (CDI:WG; Fenson et al., 1993) with spontaneous production data in both low- and middle-income families. As part of a longitudinal investigation, language samples were gathered from 23 mother-child dyads based on Stoel-Gammon's (1987) protocol for the Language Production Scale when the children were 16 and 18 months of age. The mothers also completed the CDI:WG at both visits. The words that the children produced were compared with those the mothers reported on the vocabulary checklist, with family income and vocabulary size as grouping factors. Maternal reporting did not differ as a function of socioeconomic status but did increase from 16 to 18 months. The vocabulary differences observed on the CDI:WG for children from low-income families do not appear to be a reflection of inaccurate maternal reporting. Further research is needed to determine whether these findings will generalize more broadly.

Purpose: In this study, the authors aimed to evaluate instruments designed to assess children's speech production in languages other than English. Method: Ninety-eight speech assessments in languages other than English were identified: 62 were commercially published, 17 published within journal articles, and 19 informal assessments. A review was undertaken of 30 commercially published assessments that could be obtained. Results: The 30 instruments assessed 19 languages: Cantonese, Danish, Finnish, German, Greek, Japanese, Korean, Maltese-English, Norwegian, Pakistani-heritage languages (Mirpuri, Punjabi, Urdu), Portuguese, Putonghua (Mandarin), Romanian, Slovenian, Spanish, Swedish, and Turkish. The majority (70.0%) assessed speech sound production in monolingual speakers, 20.0% assessed one language of bilingual speakers, and 10.0% assessed both languages of bilingual speakers. All used single-word picture elicitation. Approximately half (53.3%) were norm-referenced, and the number of children in the normative samples ranged between 145 and 2,568. The remaining assessments were criterion-referenced (50.0%) (one fitted both categories). The assessments with English manuals met many of the psychometric criteria for operationalization; however, only 2 provided sensitivity and specificity data. Conclusions: Despite the varying countries of origin, there were many similarities between speech assessments in languages other than English. Few were designed for use with multilingual children, so validation is required for use in English-speaking contexts.

To complete a systematic review, incorporating trial quality assessment, of published research about pharmacological treatments for stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence. Multiple readers reviewed 31 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations. Articles were then assessed using 5 methodological criteria and 4 outcomes criteria, also developed from previously published recommendations. None of the 31 articles met more than 3 of the 5 methodological criteria (M = 1.74). Four articles provided data to support a claim of short-term improvement in social, emotional, or cognitive variables. One article provided data to show that stuttering frequency was reduced to less than 5%, and 4 additional articles provided data to show that stuttering may have been reduced by at least half. Among the articles that met the trial quality inclusion criterion for the second stage of this review, none provided uncomplicated positive reports. None of the pharmacological agents tested for stuttering have been shown in methodologically sound reports to improve stuttering frequency to below 5%, to reduce stuttering by at least half, or to improve relevant social, emotional, or cognitive variables. These findings raise questions about the logic supporting the continued use of current pharmacological agents for stuttering.

To complete a systematic review, with trial quality assessment, of published research about behavioral, cognitive, and related treatments for developmental stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence about stuttering treatment for preschoolers, school-age children, adolescents, and adults. Multiple readers reviewed 162 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations. Articles were then assessed using 5 methodological criteria and 4 outcomes criteria, also developed from previously published recommendations. Analyses found 39 articles that met at least 4 of the 5 methodological criteria and were considered to have met a trial quality inclusion criterion for the purposes of this review. Analysis of those articles identified a range of stuttering treatments that met speech-related and/or social, emotional, or cognitive outcomes criteria. Review of studies that met the trial quality inclusion criterion established for this review suggested that response-contingent principles are the predominant feature of the most powerful treatment procedures for young children who stutter. The most powerful treatments for adults, with respect to both speech outcomes and social, emotional, or cognitive outcomes, appear to combine variants of prolonged speech, self-management, response contingencies, and other infrastructural variables. Other specific clinical recommendations for each age group are provided, as are suggestions for future research.

A census of effect-size practices in the past 5 volumes of American Speech-Language-Hearing Association journals was accomplished. Inclusion of effect size in quantitative research reports increased from 5 reports with effect size in 1990 to 1994 to 120 reports in 1999 to 2003. Nonetheless, effect size was reported less than 30% of the time when inferential statistics were used, and only half of those reports included an interpretation of effect size. This article presents case exemplars to illustrate the use and value of effect size and includes suggestions for interpreting effect size. Researchers are encouraged to routinely report effect size and to interpret effect size in a way that facilitates the application of research to practice.

A systematic review of published intervention studies of acquired Apraxia of Speech, by appointed committee of the Academy of Neurological Communication Disorders and Sciences, updating the previous committee's review from 2006. A systematic search of 11 databases identified 215 articles, with 26 meeting inclusion criteria of (1) stating intention to measure effects of treatment on AOS and (2) data representing treatment effects for at least one individual stated to have AOS. All studies involved within-participant experimental designs, with sample sizes of 1 to 44 (median = 1). Confidence in diagnosis was rated high to reasonable in 18/26 studies. Most studies (24/26) reported on articulatory-kinematic approaches; two applied rhythm/rate control methods. Six studies had sufficient experimental control for Class III rating (American Academy of Neurology Clinical Practice Guidelines Process Manual, 2011) with 15 others satisfying all criteria for Class III except use of independent or objective outcome measurement. The most important global clinical conclusion from this review is that the weight of evidence supports a strong effect for both articulatory-kinematic and rate/rhythm approaches to AOS treatment. The quantity of work, experimental rigor, and reporting of diagnostic criteria continue to improve and strengthen confidence in the corpus of research.

To refute the alleged practice of "pseudoscience" by P. Finn, A. K. Bothe, and R. E. Bramlett (2005) and to illustrate their experimental and systematic bias when evaluating the SpeechEasy, an altered auditory feedback device used in the management of stuttering. We challenged the experimental design that led to the seemingly predetermined outcome of pseudoscience rather than science: Limited preselected literature was submitted to a purposely sampled panel of judges (i.e., their own students). Each criterion deemed pseudoscientific was contested with published peer-reviewed data illustrating the importance of good rhetoric, testability, and logical outcomes from decades of scientific research. Stuttering is an involuntary disorder that is highly resistant to therapy. Altered auditory feedback is a derivation of choral speech (nature's most powerful stuttering "inhibitor") that can be synergistically combined with other methods for optimal stuttering inhibition. This approach is logical considering that in stuttering no single treatment is universally helpful. Also, caution is suggested when attempting to differentiate science from pseudoscience in stuttering treatments using the criteria employed by Finn et al. For example, evaluating behavioral therapy outcomes implements a post hoc or untestable system. Speech outcome (i.e., stuttered or fluent speech) determines success or failure of technique use, placing responsibility for failure on those who stutter.

These comments are written in response to an article by A. Odekar and B. Hallowell (2005) which argues that the use of plus-minus scoring may be faster and more efficient than "traditional multidimensional scoring" in current clinical contexts. As a long-time clinician and as the developer of binary choice multidimensional scoring as used in the Porch Index of Communicative Ability (PICA), I felt it necessary to correct some inaccuracies, to provide some clarifications and cautions, and to give the readers an alternative point of view regarding scoring issues. Four major issues are addressed. First, there is a growing trend to develop more, not fewer, multidimensional scoring systems because the older plus-minus method loses too much information about the patient. Second, although the Odekar and Hallowell article has an extensive discussion on the PICA, implying that this test battery is to be the focus of the study, the actual experiment employed the Revised Token Test and had little to do with the PICA. Third, the stated aim of the study, to demonstrate that plus-minus scoring is faster and less time consuming than multidimensional scoring, was not included in the experimental design. Finally, changes that replace established and effective clinical methods must not affect patient care negatively.

To critically assess the quality, methodology, and conclusions in A. K. Bothe, J. H. Davidow, R. E. Bramlett, D. M. Franic, and R. J. Ingham's (2006) systematic review of pharmacological approaches to stuttering. A. D. Oxman and G. H. Guyatt's (1988) guidelines for reading literature reviews and A. D. Oxman and G. H. Guyatt's (1991) criteria for assessing the scientific quality of systematic reviews were adopted to accomplish the purpose. Bothe et al.'s review was rated on a 7-point scale from extensive flaws on the high end to minimal flaws on the low end of the scale. The ratings varied from poor to good. We judged Bothe et al.'s review of the pharmacological literature as it pertains to stuttering as flawed in its methodology and conclusions. However, we agree that the existing evidence for the use of pharmacological agents with persons who stutter is insufficient to recommend them in practice. Directions for improving the quality of clinical trials are suggested. In addition, we advocate for the multimethod measurement in stuttering research, including comparison, subjective evaluation, and social impact measures.

Purpose The authors write this letter to clarify some of the points raised by Dr. Giselle Carnaby about their article titled “Clinical Experience Using the Mann Assessment of Swallowing Ability (MASA) for Identification of Patients at Risk for Aspiration in a Mixed-Disease Population” (González-Fernández, Sein, & Palmer, 2011). The intention of this letter is to ensure that the reader has a balanced perspective and the information necessary to interpret the results of the original publication.

The observation that typical users of augmentative and alternative communication (AAC) systems vary widely in their characteristics raises issues about the utility of a nomothetic approach for investigating and evaluating important variables, as well as about the value of studying children without disabilities to contribute to the understanding of AAC systems. To provide an initial basis for examining the fruitfulness of the nomothetic approach, the effects of 2 fundamental variables, number of display levels (single vs. dual) and vocabulary abstractness (concrete vs. abstract words), on vocabulary acquisition were examined for children without disabilities and for speech impaired children with cerebral palsy (CP). Children demonstrated the same pattern of acquisition, regardless of disability status. Both groups of children made more errors on the dual-level display than on the single-level display and made more abstract errors than concrete errors. Importantly, the performance of individuals consistently conformed to group performance. These findings suggest that a nomothetic research approach that includes results of children without disabilities can usefully illuminate consequences of important variables in AAC systems. Clinical implications based on these findings were also discussed.

Purpose: The purpose of this study was to examine how the interface design of an augmentative and alternative communication (AAC) device influences the communication behaviors of people with aphasia during a narrative retell task. Method: A case-series design was used. Four narratives were created on an AAC device with combinations of personally relevant (PR) photographs, line drawings (LDs), and text for each participant. The narrative retells were analyzed to describe the expressive modality units (EMUs) used, trouble sources experienced, and whether trouble sources were repaired. The researchers also explored the participants' perceived helpfulness of the interface features. Results: The participants primarily used spoken EMUs to retell their narratives. They relied on PR photographs more frequently than LDs; however, they reported both picture types to be equally helpful. Text was frequently used and reported as helpful by all 4 people with aphasia. Participants experienced similar rates of trouble sources across conditions; however, they displayed unique trends for successful repairs of trouble sources. Conclusion: For narrative retells, LDs may serve as an effective visual support when PR photographs are unavailable. Individual assessment is necessary to determine the optimum combination of supports in AAC systems for people with aphasia.

A school-based intervention designed to increase the positive nature of children's attitudes toward peers who use AAC is described. Small groups of children were given only information about AAC or they were given information about AAC and the opportunity to role-play being nonspeaking. Results indicated a greater positive effect of the information plus role-play experience compared to the effects of being given information alone for older children and boys. Clinical implications and suggestions for future research are discussed.

This research explored the use of dynamic assessment (DA) for language-learning abilities in signing deaf children from deaf and hearing families. Thirty-seven deaf children, aged from six to eleven years of age, were identified as either stronger (N = 26) or weaker (N = 11) language learners according to teacher or speech language pathologist report. All children received two scripted, mediated learning experience (MLE) sessions targeting vocabulary knowledge, specifically the use of semantic categories that were carried out in American Sign Language (ASL). Participant responses to learning were measured in terms of an index of child modifiability. This index was separately determined at the end of both individual sessions. It combined ratings reflecting each child's learning abilities and responses to mediation, including social-emotional behavior, cognitive arousal, and cognitive elaboration. Group results showed that modifiability ratings were significantly greater for stronger than for weaker language learners. The strongest predictors of language ability were cognitive arousal and cognitive elaboration. Mediator ratings of child modifiability (i.e., combined score of socio-emotional factors and cognitive factors) are highly sensitive to language learning abilities in deaf children, who use sign as primary mode of communication. This method can be used to design targeted interventions.

The present study investigated the validity of the MacArthur-Bates Communicative Development Inventory (CDI) for a group of toddlers 30 months of age. Study 1 examined the concurrent validity of the CDI for a group of 38 late talkers. Significant correlations were found between the CDI and direct measures of language abilities. Study 2 used likelihood ratio analysis to determine how well the CDI sorted 100 toddlers (38 late talkers and 62 children with a history of normal language development) according to language status based on direct assessment measures. The analyses showed that the CDI was effective in identifying children with low language skills up to the 11th percentile and in identifying children with normal language skills above the 49th percentile.

To examine the validity of the MacArthur-Bates Communicative Development Inventories (CDI) for measuring language abilities in children with profound hearing loss who are using cochlear implants. Twenty-four children with cochlear implants and their mothers participated in this study. Children ranged in age from 32 months to 86 months (the majority were 32 to 66 months old). The number of months postimplantation ranged from 3 to 60 (the majority were around 24 months). Mothers completed the CDI before behavioral testing. Behavioral measures included the Reynell Developmental Language Scales and measures of vocabulary and grammar from a spontaneous language sample. Both the Words and Gestures and the Words and Sentences forms of the CDI were shown to have excellent validity for this sample of children, if they had language that was in the range measured by the instrument. Correlations with behavioral measures ranged from .41 to .93 and were comparable to those reported for children with typical development. The CDI forms are valid tools to use with children who are using cochlear implants and who are in the early stages of language development, even if they are older than the norming sample. Age-equivalence may be obtained if children score below the median for the oldest age norms. They may also be used to describe the language of children who are not at ceiling. Specific recommendations for interventionists are provided.

To identify, integrate, and summarize evidence from empirical studies of the language abilities of children who stutter (CWS) and children who do not stutter (CWNS). Candidate studies were identified through electronic databases, the tables of contents of speech-language journals, and reference lists of relevant articles and literature reviews. The 22 included studies met the following criteria: studied both children who did and did not stutter between ages 2;0 (years;months) and 8;0, and reported norm-referenced language measures and/or measures from spontaneous language samples amenable to effect size calculation. Data were extracted using a coding manual and were assessed by application of general and specialized analytical software. Mean difference effect size was estimated using Hedges's g (Hedges, 1982). Findings indicated that CWS scored significantly lower than CWNS on norm-referenced measures of overall language (Hedges's g = -0.48), receptive (Hedges's g = -0.52) and expressive vocabulary (Hedges's g = -0.41), and mean length of utterance (Hedges's g = -0.23). Present findings were taken to suggest that children's language abilities are potentially influential variables associated with childhood stuttering.

Children with Down syndrome (DS) have cognitive disabilities resulting from trisomy 21. Language-learning difficulties, especially expressive language problems, are an important component of the phenotype of this population. Many individuals with DS are born into bilingual environments. To date, however, there is almost no information available regarding the capacity of these individuals to acquire more than 1 language. The present study compared the language abilities of 8 children with DS being raised bilingually with those of 3 control groups matched on developmental level: monolingual children with DS (n = 14), monolingual typically developing (TD) children (n = 18), and bilingual TD children (n = 11). All children had at least 100 words in their productive vocabularies but a mean length of utterance of less than 3.5. The bilingual children spoke English and 1 other language and were either balanced bilinguals or English-dominant. English testing was completed for all children using the following: the Preschool Language Scale, Third Edition; language sampling; and the MacArthur Communicative Development Inventories (CDI). Bilingual children were also tested in the second language using a vocabulary comprehension test, the CDI, and language sampling. Results provided evidence of a similar profile of language abilities in bilingual children as has been documented for monolingual children with DS. There was no evidence of a detrimental effect of bilingualism. That is, the bilingual children with DS scored at least as well on all English tests as their monolingual DS counterparts. Nonetheless, there was considerable diversity in the second-language abilities demonstrated by these individuals with DS. Clinical implications are addressed.

This study investigated the cognitive and linguistic factors presumed to be associated with adult comprehension of figurative language, including age, working memory (WM), figurative language type, and reading comprehension (RC). Forty younger (M = 22 years) and 40 older (M = 63 years) healthy African American adults completed WM and reading tasks, and the 60-item forced-choice multiple-category (20 idioms, 20 metaphors, and 20 metonyms) Figurative Language Comprehension Test. After controlling for WM and RC, the older adults outperformed the younger adults on idioms and metonyms. Metaphor comprehension was comparable between the groups. Findings demonstrate that WM and RC underlie adults' comprehension of figurative language and should be considered when interpreting performance on tests assessing figurative language competence in this population.

Purpose: The need for speech-language pathologists (SLPs) to consider an academic talk (AT) register in addition to an everyday casual talk (CT) register of oral language with children beginning in the preschool years is presented, the AT and CT registers are distinguished in a comprehensive manner, ideas regarding AT language assessment are proposed, and suggestions for fostering children's skills with the AT register are offered. Method: Extant research and scholarship from a wide variety of disciplines are integrated and organized. Results: The author discusses the role of the SLP in supporting AT skills beginning in the preschool years and the added risk of difficulties with the AT register for children with language impairment who are from diverse backgrounds. Two broad categories-social-interactive and cognitive-that give rise to linguistic features that differentiate between the CT and AT registers are deduced from extant scholarship. Conclusions: SLPs should consider children's competence with the AT register as they work to prepare preschoolers and older children for the language demands of school.

Purpose: This study investigated the relative outcomes of segmental and prosodic training of nonnative speakers of American English. Method: The study used a single-subject, alternating treatments, multiple baseline design with replication across participants and counterbalanced for order effect. Participants were 4 adult male native Hindi speakers proficient in English. Two participants received ABABCACA (A = baseline/withdrawal, B = segmental training, C = prosody training), and 2 participants received ACACBABA, with a minimum of 5 sessions per phase. Segmental accuracy and prosodic accuracy were probed at each session, as were perception of accentedness and ease of understanding. Results: Visual assessment of data and effect size calculation demonstrated that segmental and prosody training resulted in increased accuracy of pronunciation and prosody patterns, respectively, and those improvements appeared to be maintained over the short term. Listeners perceived lesser accent and easier understanding as a result of the combination of segmental and prosody training. The findings are uncertain with respect to the relative contribution of segmental and prosody training, and they may be speaker dependent, but the data do suggest that both components are important. Conclusion: Accent management, consisting of both segmental and prosody training, yielded positive outcomes. Further research with native language speakers of other languages is important to verify and expand on these findings.

Purpose: Workplace training for tracheostomy management is currently recognized to be inconsistent and insufficient. A novel approach, using technology-enhanced simulation, may provide a solution to training tracheostomy management skills by providing a consistent, time-efficient, and risk-free learning environment. The current research evaluated clinicians' tracheostomy skills acquisition after training in a simulated learning environment and explored changes in clinicians' confidence and perceptions after the experience. Method: Forty-two clinicians with no or low levels of tracheostomy skill attended one of six, 1-day simulation courses. The training involved both part-task skill learning and immersive simulated scenarios. To evaluate clinicians' acquisition of manual skills, performance of core tasks during the scenarios was assessed by independent observers. Questionnaires were used to examine perceived outcomes, benefits, and perceptions of the learning environment at pre-, post-, and 4 months post-training. Results: Only 1 clinician failed to successfully execute all core practical tasks. Clinicians' confidence increased significantly ( p < .05) from pre- to post-workshop and was maintained to 4 months post-workshop across most parameters. All clinicians reported positive perceptions regarding their learning outcomes and learning in a simulated environment. Conclusion: These findings validate the use of simulation as a clinical training medium and support its future use in tracheostomy competency-training pathways.

This investigation was designed to elucidate the effects of repeated practice treatment on sound production accuracy in individuals with apraxia of speech (AOS) and aphasia. A secondary purpose was to determine if the addition of rate/rhythm control to treatment provided further benefits beyond those achieved with repeated practice. A single-subject design was employed with 10 speakers with chronic AOS and aphasia. Articulation accuracy served as the dependent measure. Participants received repeated practice treatment until a plateau in performance was observed or high levels of accuracy were achieved. If performance criterion was not reached, rate/rhythm control was added to the treatment to determine if additional gains would be made. For 8 of the participants, improvements were evident for all applications of repeated practice treatment, and positive response generalization was observed in most cases. When rate/rhythm control treatment was applied, modest additional gains were apparent for the majority of the applications. The 2 participants who did not benefit from repeated practice treatment also did not show improvements with rate/rhythm control treatment. Repeated practice treatment resulted in improved articulation for the majority of participants. The amount of improvement varied within and across participants. Rate/rhythm control appeared to have limited additional benefits for some participants.

The current investigation compared directed scanning and group-item scanning among typically developing 4-year-old children. Of specific interest were their accuracy, selection speed, and efficiency of cursor movement in selecting colored line drawn symbols representing object vocabulary. Twelve 4-year-olds made selections in both directed and group-item scanning conditions using a 36-symbol array that required matching line drawn symbols to pictures. The majority of participants took more time in the directed scanning condition. Though not statistically significant, participants tended to be more accurate in their use of directed scanning. The cursor movements required (as a proportion of optimal cursor movements) were similar for both scanning selection techniques. Among typically developing 4-year-olds, there appears to be a trade-off between speed and accuracy in symbol selection when using directed or group-item scanning. Better accuracy with directed scanning appears to come at the cost of a slower response time. Whereas group-item scanning may be faster, it results in a decreased number of accurate responses. Applications for clinical practice and implications for future research are discussed.

Two experiments examined whether listening to multiple presentations of recorded speech stimuli influences the reliability and accuracy of judgments of children's speech production accuracy. In Experiment 1, 10 listeners phonetically transcribed words produced by children with phonological impairments after a single presentation and after the word was played 7 times. Inter- and intratranscriber reliability in the single- and multiple-presentation conditions did not differ significantly. In Experiment 2, 18 listeners provided binary correct/incorrect judgments of /s/ accuracy in single- and multiple-presentation conditions. There was no systematic effect of presentation condition on either accuracy or intrarater reliability. However, greater interrater reliability was noted in the multiple-presentation condition, particularly for tokens of /s/ that were incorrect or acoustically intermediate between an incorrect and a correct /s/. Taken together, the results suggest that multiple presentations have no measurable effect on the accuracy and intrarater reliability of judgments of children's phonetic accuracy, but that they do have a small effect on interrater reliability. Clinical implications are discussed.

The present study investigated the effects of selected measures of language experience (parent-reported estimates of frequency of output and language use) and language ability (parent-reported language proficiency and mean length of utterance in words) on the segmental accuracy of Spanish- and English-speaking bilingual children. The phonological skills of 50 typically developing bilingual Spanish-English children (mean age = 5;9 [years;months]) were examined. Independent variables included parent estimates of language use, language proficiency, and frequency of language output (5 groups), as well as a direct language measure (mean length of utterance in words) to predict the dependent segmental accuracy measures (percentage of consonants and vowels correct). Frequency of language output did not have an effect on any of the English or Spanish segmental accuracy measures. However, parent-reported language use and language proficiency as well as the direct measure of language ability (mean length of utterance in words) had various effects on segmental accuracy. Those effects differed, however, in language-specific patterns. Parental estimates of language use and language proficiency are useful for predicting the phonological skills of bilingual Spanish- and English-speaking children, and augmenting them with a direct measure of language ability as a predictor of segmental accuracy is desirable.

The present study investigated the intelligibility of digitized and synthesized speech output in background noise for children 3-5 years old. The purpose of the study was to determine whether there was a difference in the intelligibility (ability to repeat) of 3 types of speech output (digitized, DECTalk synthesized, and MacinTalk synthesized) in single words and sentences, presented within and out of context. The dependent variable was speech intelligibility (number of individual words repeated correctly). The study used a mixed-model design. Ninety typically developing children (3-5 years old) were assigned to each of 3 speech type conditions. Participants were asked to repeat 20 words and 10 short sentences. Half of the stimuli were preceded by contextual information (topic cue), and half were presented without any context. Young children have difficulty accurately repeating some digitized and synthesized messages in background noise. Overall, the older children (4- and 5-year-olds) performed better than the 3-year-old children. Increasing information through context or longer messages (i.e., sentences) did facilitate intelligibility overall, although there was a statistically significant Message Length x Context x Speech Type interaction. For 3-5-year-olds, the intelligibility of single words is very low (55%-77%). The intelligibility of sentences is higher, but the sole use of sentences for communication is problematic. Contextual information facilitates intelligibility and is a promising approach for ensuring effective communication. Future research is needed to improve the intelligibility of speech output at the single word level in order to maximize the benefits of speech output.

This study tested the accuracy with which the MacArthur-Bates Communicative Development Inventories, Level III (CDI-III), a parent report measure of language ability, discriminated children with language impairment from those developing language typically. Parents of 58 children, 49 with typically developing language (age 30 to 42 months) and 9 with language impairment (age 31 to 45 months) completed the CDI-III, a 2-page questionnaire that includes 100 vocabulary items, 12 sentence pairs, and 12 questions regarding linguistic concepts. A discriminant analysis indicated that the CDI-III total score together with age classified children into language status groups with 96.6% accuracy overall. The corresponding likelihood ratios supported this strong level of accuracy, although precision may not be as high as indicated by broad confidence intervals. Results of this study contribute to the accumulating evidence on the types of valid inferences that may be made from the CDI-III, specifically its classification accuracy. Further research should continue to investigate classification accuracy in larger samples with broader maternal education levels and with different types of language impairments. Additional research should also investigate the classification accuracy when the CDI-III is used in combination with other tests.

Purpose: The authors of this study investigated the diagnostic accuracy of the Finite Verb Morphology Composite (FVMC; Bedore & Leonard, 1998) and the Tense and Agreement Productivity Score (TAPS; Hadley & Short, 2005) in identifying 3-year-olds with language impairment (LI). Method: Eighteen pairs of 3-year-olds with and without LI participated in the current study. The FVMC and the TAPS were computed from 100- and 50-utterance language samples. Results: The FVMC and TAPS demonstrated higher diagnostic accuracy in the 100-utterance samples than in the 50-utterance samples. For 100-utterance samples, when children's age or severity was not considered, the FVMC showed a slight advantage over the TAPS in diagnostic accuracy. However, when children's age or severity was considered, the opposite pattern was observed. Conclusion: Both the FVMC and TAPS can be used to differentiate 3-year-olds with and without LI. To reliably identify 3-year-olds with LI by using tense measures, language samples with at least 100 utterances are recommended.

Purpose: To compare young cochlear implant (CI) recipients' consonant production accuracy with that of age- and gender-matched peers who were typically developing (TD). In addition to examining initial consonants, the authors compiled new data regarding the accuracy of final consonants and the order of consonant acquisition. Methods: Eleven young CI recipients with 24 months of CI experience and 11 age- and gender-matched TD peers produced target words in short sentences. Consonant production accuracy was examined for total scores, initial and final word positions, and three developmental sound classes: Early, Middle, and Late. Results: Initial consonants were produced with relatively greater accuracy than were final consonants by the TD and CI groups. Whereas initial consonants appeared to be acquired in a typical order, descriptive data suggest that this might not be the case for final consonants. Conclusions: Although still delayed compared to age-matched peers, young CI recipients showed substantial progress in consonant acquisition. Their accuracy levels after 2 years of CI experience support the notion that implantation at a young age has added value for phonological development.

Purpose: This investigation examined the effect of repeated exposure to novel and repeated spoken words in typical environments on the intelligibility of 2 synthesized voices and human recorded speech in preschools. Method: Eighteen preschoolers listened to and repeated single words presented in human-recorded speech, DECtalk Paul, and AT&T Voice Michael during 5 experimental sessions. Stimuli consisted of repeated and novel words presented in each speech output condition during each session. Sessions took place in the presence of typically occurring noise in classroom or home settings. Results: There was a significant main effect for voice as participants accurately identified significantly more words in the human-recorded speech and AT&T Voice than in the DECtalk speech output condition. When averaged across speech output conditions, children increased their accuracy as they participated in additional sessions. There was a statistically significant interaction between session and voice. DECtalk had a slightly larger effect of session than did AT&T Voice and human-recorded speech.

Directed scanning and group-item scanning both represent options for increased scanning efficiency. This investigation compared accuracy and speed of selection with preschoolers using each scanning method. The study's purpose was to describe performance characteristics of typically developing children and to provide a reliable assessment protocol to evaluate scanning skills. Investigators examined within-participant performance on an identity matching-to-sample task using directed and group-item scanning with 13 typically developing preschoolers. Children selected line-drawn symbols from a 36-symbol display configured for each scanning method. Children were more accurate using directed than group-item scanning. They required a greater number of cursor movements to accurately select symbols with group-item than with directed scanning; however, no differences in actual selection time were apparent. Further analyses comparing performance using group-item scanning for selections requiring either a low or a high number of cursor movements revealed no differences in children's accuracy or efficiency. Children were more accurate using directed scanning to select target symbols. However, directed scanning did not afford a relative advantage in children's selection efficiency compared with group-item scanning. Performance using group-item scanning does not appear to be affected by requisite cursor movements for selection. Limitations and educational implications are discussed.

Communication about feelings is a core element of human interaction. Aided augmentative and alternative communication systems must therefore include symbols representing these concepts. The symbols must be readily distinguishable in order for users to communicate effectively. However, emotions are represented within most systems by schematic faces in which subtle distinctions are difficult to represent. We examined whether background color cuing and spatial arrangement might help children identify symbols for different emotions. Thirty nondisabled children searched for symbols representing emotions within an 8-choice array. On some trials, a color cue signaled the valence of the emotion (positive vs. negative). Additionally, the symbols were either (a) organized with the negatively valenced symbols at the top and the positive symbols on the bottom of the display or (b) distributed randomly throughout. Dependent variables were accuracy and speed of responses. The speed with which children could locate a target was significantly faster for displays in which symbols were clustered by valence, but only when the symbols had white backgrounds. Addition of a background color cue did not facilitate responses. Rapid search was facilitated by a spatial organization cue, but not by the addition of background color. Further examination of the situations in which color cues may be useful is warranted.

To describe the concurrent validity and classification accuracy of 2 Spanish parent surveys of language development, the Spanish Ages and Stages Questionnaire (ASQ; Squires, Potter, & Bricker, 1999) and the Pilot Inventario-III (Pilot INV-III; Guiberson, 2008a). Forty-eight Spanish-speaking parents of preschool-age children participated. Twenty-two children had expressive language delays, and 26 had typical language development. The parents completed the Spanish ASQ and the Pilot INV-III at home, and the Preschool Language Scale, Fourth Edition: Spanish Edition (PLS-4 Spanish; Zimmerman, Steiner, & Pond, 2002) was administered to the children at preschool centers. The Spanish ASQ and Pilot INV-III were significantly correlated with the PLS-4 Spanish, establishing concurrent validity. On both surveys, children with expressive language delays scored significantly lower than children with typical development. The Spanish ASQ demonstrated unacceptably low sensitivity (59%) and good specificity (92%), while the Pilot INV-III demonstrated fair sensitivity (82%) and specificity (81%). Likelihood ratios and posttest probability revealed that the Pilot INV-III may assist in detection of expressive language delays, but viewed alone it is insufficient to make an unconditional screening determination. Results suggest that Spanish parent surveys hold promise for screening language delay in Spanish-speaking preschool children; however, further refinement of these tools is needed.

This research examined how the color distribution of symbols within a visual aided augmentative and alternative communication array influenced the speed and accuracy with which participants with and without Down syndrome located a target picture symbol. Eight typically developing children below the age of 4 years, 8 typically developing children over the age of 4 years, and 10 children with Down syndrome participated. Participants were asked to find a target line drawing among an array of 12. Line drawings represented either foods (e.g., grapes, cherries), clothing (e.g., a red shirt, a yellow shirt), or activities (e.g., soccer, swimming). In one condition, symbols that shared a color were clustered together, creating a subgroup within which to search. In another condition, symbols that shared a color were distributed across the display, allowing each to appear individually. Dependent measures were accuracy and speed of finding the target symbol. Clustering same-color symbols facilitated the speed of locating the target for all participants, and facilitated search accuracy in the younger preschool children and participants with Down syndrome. These effects held when targets were foods, clothing, or activities. Clinicians should consider the internal color of visual symbols when constructing aided symbol displays, at least for children with Down syndrome. Further research is needed on a number of dimensions, however, including visual processing in other etiological categories, the role of background color, and the relation of color to other stimulus dimensions.

To propose that the diagnostic category of "expressive language disorder" as distinct from a disorder of both expressive and receptive language might not be accurate. Evidence that casts doubt on a pure form of this disorder is reviewed from several sources, including the literature on genetic findings, theories of language impairments, and the outcomes of late talkers with expressive language delays. Areas of language that are problematic in production but not readily amenable to comprehension testing are also discussed. The notion of expressive language disorder has been formalized in classification systems and is implicit if not explicit in the organization of many standardized tests. However, a close inspection of the evidence suggests that deficits in language expression are typically accompanied by limitations in language knowledge or difficulties processing language input. For this reason, the diagnostic category of expressive language disorder should be used with considerable caution. This view has implications for both research and clinical practice.

This study had 2 principal aims: (a) to examine whether children who spoke Nonmainstream American English (NMAE) frequently in school at the end of kindergarten increased their production of Mainstream American English (MAE) forms by the end of first grade, and (b) to examine concurrent and predictive relations between children's NMAE use and reading skills. A longitudinal design was implemented with 49 children who varied in their spoken NMAE production in kindergarten. Word reading, phonological awareness, and receptive vocabulary skills were measured at both time points. Analyses indicated that most children significantly increased their production of MAE forms between the 2 time points; however, this change was not associated with change in letter-word reading and phonological awareness skills. Regression analyses showed that NMAE use in kindergarten contributed significantly and independently to the variance in word reading in first grade, even after accounting for phonological awareness (although word reading in kindergarten was the best predictor of word reading in first grade). The findings extend previous reports of a significant relation between NMAE use and reading among young children. Theoretical, research, and educational implications of the findings are discussed.

The purpose of this study was to evaluate adaptation to the electropalatograph (EPG) from the perspective of consonant acoustics, listener perceptions, and speaker ratings. Seven adults with typical speech wore an EPG and pseudo-EPG palate over 2 days and produced syllables, read a passage, counted, and rated their adaptation to the palate. Consonant acoustics, listener ratings, and speaker ratings were analyzed. The spectral mean for the burst (/t/) and frication (/s/) was reduced for the first 60-120 min of wearing the pseudo-EPG palate. Temporal features (stop gap, frication, and syllable duration) were unaffected by wearing the pseudo-EPG palate. The EPG palate had a similar effect on consonant acoustics as the pseudo-EPG palate. Expert listener ratings indicated minimal to no change in speech naturalness or distortion from the pseudo-EPG or EPG palate. The sounds [see text] were most likely to be affected. Speaker self-ratings related to oral comfort, speech, tongue movement, appearance, and oral sensation were negatively affected by the presence of the palatal devices. Speakers detected a substantial difference when wearing a palatal device, but the effects on speech were minimal based on listener ratings. Spectral features of consonants were initially affected, although adaptation occurred. Wearing an EPG or pseudo-EPG palate for approximately 2 hr results in relatively normal-sounding speech with acoustic features similar to a no-palate condition.

This study explored relationships among perceptual, ultrasound, and acoustic measurements of children's correct and misarticulated /r/ sounds. Longitudinal data documenting changes across these parameters were collected from two children who acquired /r/ over a period of intervention and compared with data from typically developing children. Participants were three typically developing children, recorded once, and two children with /r/ misarticulation, recorded over 7-8 months. We collected the following data from /r/ produced in nonwords: perceptually rated accuracy, ultrasound measures of tongue shape, and F3-F2 distance. Regression models revealed significant associations among perceptual, ultrasound, and acoustic measures of /r/ accuracy. The inclusion of quantitative tongue-shape measurements improved the match between ultrasound and perceptual/acoustic data. Perceptually incorrect /r/ productions were found to feature posteriorly located peaked tongue shapes. Of the children seen longitudinally, one developed a bunched /r/ and one demonstrated retroflexion. Typically developing children also differed in their tongue shapes. Our results support the validity of using qualitative and quantitative ultrasound measures to characterize the accuracy of children's /r/ sounds. Clinically, our findings suggest that it is important to encourage pharyngeal constriction while allowing children to find the /r/ tongue shape that best fits their individual vocal tract.

Deficits in auditory perception compromise a range of linguistic processes in persons with Parkinson's disease (PD), including speech perception and sensitivity to affective and linguistic prosody. An unanswered question is whether this deficit exists not only at the level of speech perception, but also at a more pervasive level of auditory perception. It is possible that PD produces a selective impairment in the perception of a salient acoustic feature such as frequency, amplitude, or duration. Auditory perception in persons with PD was investigated using a tone discrimination task where clients ( N = 12) and age-matched controls ( N = 15) made same/different judgments for pairs of pure tones that were factorially varied by acoustic feature (i.e., frequency, amplitude, or duration) crossed with perceptual distance (i.e., close vs. far). Relative to healthy age-matched controls, persons with PD showed marked impairment in tone discrimination. Persons with PD showed an acoustic feature by perceptual distance interaction that was characterized by deficits in detecting frequency and amplitude differences for perceptually near tones. These results suggest that persons with PD show a reduced ability to notice change in frequency and amplitude as compared to normal older adults. More generally, these findings implicate a frontal-striatal contribution to auditory perception.

Purpose: The purpose of this study was to investigate the relation of respiratory forced oscillation to the acoustic characteristics of vocal tremor. Method: Acoustical analyses were performed to determine the characteristics of the intensity and fundamental frequency (F0) for speech samples obtained by Farinella, Hixon, Hoit, Story, and Jones (2006) using a respiratory forced oscillation paradigm with 5 healthy adult males to simulate vocal tremor involving respiratory pressure modulation. The analyzed conditions were sustained productions of /a/ with amplitudes of applied pressure of 0, 1, 2, and 4 cmH2O and a rate of 5&emsp14;Hz. Results: Forced oscillation of the respiratory system produced modulation of the intensity and F0 for all participants. Variability was observed between participants and conditions in the change in intensity and F0 per unit of pressure change, as well as in the mean intensity and F0. However, the extent of modulation of intensity and F0 generally increased as the applied pressure increased, as would be expected. Conclusion: These findings suggest that individuals develop idiosyncratic adaptations to pressure modulations, which are important to understanding aspects of variability in vocal tremor, and highlight the need to assess all components of the speech mechanism that may be directly or indirectly affected by tremor.

Purpose: The authors designed this investigation to extend the development of a treatment for acquired apraxia of speech (AOS)--sound production treatment (SPT)--by examining the effects of 2 treatment intensities and 2 schedules of practice. Method: The authors used a multiple baseline design across participants and behaviors with 4 speakers with chronic AOS and aphasia. Accuracy of production of trained and untrained words in phrases served as the dependent measure. Participants received 4 permutations of SPT (i.e., intensive-blocked, intensive-random, traditional-blocked, and traditional-random) applied sequentially to different lists of words. Results: Positive changes in accuracy of articulation were observed for all participants for all phases of treatment. Two participants had a slightly poorer response to the traditional-random application of treatment. However, no clinically meaningful differences were noted among treatment applications when follow-up data were considered. Conclusions: Findings from this preliminary Phase II investigation suggest that similar outcomes may be achieved with SPT applied with different treatment intensities and different practice schedules. Extending treatment to achieve higher levels of accuracy may have improved maintenance effects, which may have revealed possible differences among conditions. In addition, overlap in methods used for random and blocked practice may have minimized distinctions between these conditions.

To determine the factors leading to successful recovery and productive lifestyles after acquired brain injury (ABI). Qualitative investigation examined semistructured interviews of 31 survivors of ABI. Thematic analysis followed a phenomenological approach and revealed 4 major themes and 28 subthemes in the interviews. Four participants stood out as exemplars of the themes embodied by all the participants in this investigation. Quotes from each are used to highlight the prevailing themes. The following 4 major themes emerged from the interviews: development of social support networks, grief and coping strategies, acceptance of the injury and redefinition of self, and empowerment. The issues raised in these interviews may serve to inspire other survivors and provide them with hope and motivation as they progress through the recovery process. Suggestions on how clinicians can help to facilitate this process are discussed.

This is a systematic review of assessment and treatment of cognitive and communicative abilities of individuals with acquired brain injury via telepractice versus in-person. The a priori clinical questions were informed by previous research that highlights the importance of considering any functional implications of outcomes, determining disorder- and setting-specific concerns, and measuring the potential impact of diagnostic accuracy and treatment efficacy data on interpretation of findings. A literature search of multiple databases (e.g., PubMed) was conducted using keywords and study inclusion criteria associated with the clinical questions. Ten group studies were accepted that addressed assessment of motor speech, language, and cognitive impairments; assessment of motor speech and language activity limitations/participation restrictions; and treatment of cognitive impairments and activity limitations/participation restrictions. In most cases, equivalence of outcomes was noted across service delivery methods. Limited findings, lack of diagnostic accuracy and treatment efficacy data, and heterogeneity of assessments and interventions precluded robust evaluation of clinical implications for telepractice equivalence and the broader area of telepractice efficacy. Future research is needed that will build upon current knowledge through replication. In addition, further evaluation at the impairment and activity limitation/participation restriction levels is needed.

This exploratory study builds upon the small body of existing research investigating reading comprehension deficits in college students with acquired brain injury (ABI). Twenty-four community college students with ABI completed a battery of questionnaires and standardized tests to characterize self-perceptions of academic reading ability, performance on a standardized reading comprehension measure, and a variety of cognitive functions of this population. Half of the participants in the sample reported traumatic brain injury (n = 12) and half reported non-traumatic ABI (n = 12). College students with both traumatic and non-traumatic ABI cite problems with reading comprehension and academic performance post injury. Mean performance on a standardized reading measure, the Nelson Denny Reading Test (NDRT), was low to below average and was significantly correlated with performance on the Speed and Capacity of Language Processing test (SCOLP). Injury status of traumatic versus non-traumatic ABI did not differentiate results. Regression analysis showed that measures of verbal attention and suppression obtained from the California Verbal Language Test-II (CVLT-II) predicted total scores on the NDRT. College students with ABI are vulnerable to reading comprehension problems. Results align with other research suggesting that verbal attention and suppression problems may be contributing factors.

This study examined the effect of manipulating several parameters of motor learning theory on participants' phonetic acquisition and retention of utterances in a foreign language (Korean). Thirty-two native English-speaking participants naïve to the Korean language were each given 10 Korean sentences to practice and learn. The independent variables in the study were the number of practice trials and the feedback schedule. The participants listened to sentences delivered by a native speaker and received feedback according to the schedule. Participant responses were then judged by a panel of native Korean speakers in terms of their intelligibility, naturalness, and precision. The combination of 20% feedback and 100 practice trials was more effective than other combinations of feedback and practice trial schedule for the retention of novel phonetic productions of Korean phrases both 1 day after training and 1 week later. These findings are in agreement with previously reported applications of motor learning-guided principles on the acquisition of motoric skills. These findings may have direct implications for both second-language learning and the treatment of neuromotor speech disorders such as apraxia of speech.

This study evaluated the extent to which the language of intervention, the child's development in Spanish, and the effects of English vocabulary, use, proficiency, and exposure predict differences in the rates of acquisition of English in Latino children with specific language impairment (SLI). In this randomized controlled trial, 188 Latino preschoolers with SLI participated in a small-group academic enrichment program for 12 weeks and were followed up 3 and 5 months later. Children were randomly assigned to either a bilingual or an English-only program. Predictors of English growth included measures of Spanish language skills and English vocabulary, use, proficiency, and exposure. Performance on English outcomes (i.e., picture description and narrative sample) was assessed over time. A series of longitudinal models were tested via multilevel modeling with baseline and posttreatment measures nested within child. Children demonstrated growth on the English outcomes over time. The language of intervention, Spanish skills, English vocabulary, and English use significantly predicted differences in rates of growth across children for specific measures of English development. This study underscores the role of the child's first language skills, the child's level of English vocabulary development, and level of English use for predicting differences in English acquisition in Latino preschoolers with SLI. These factors should be carefully considered in making clinical decisions.