Telepractice in service delivery: A survey of perspectives and practices of speech and language therapists in Ireland during COVID-19

BACKGROUND: COVID-19 accelerated telepractice implementation in speech and language therapy (SLT) in Ireland. OBJECTIVE: This study documents the service delivery changes that took place in the SLT profession in Ireland during the public health crisis. METHODS: An online survey of speech and language therapists (SLTs) in Ireland was conducted from June-September 2020 to investigate their perceptions of telepractice. Data were analysed using descriptive and inferential statistics and frequency distribution. RESULTS: 173 SLT responses were analysed. Over half of the participants worked in urban locations. Respondents’ years of experience varied from less than four years to over 20 years. Slightly over half the participants reported using telepractice, with 85% starting to use telepractice in the six months prior to the survey. Telepractice uptake was not influenced by participants’ professional experience or geographical location (p > 0.05). Almost all participants who used telepractice were trained informally (92%,). Telepractice was most commonly used with school-aged children with developmental language and speech sound disorders. Respondents perceived that telepractice was not suitable for all individuals who need SLT, including those with complex needs. Clinicians reported that telepractice facilitated access to therapy for clients and opportunities to see clients in their own environments. Technology barriers were the biggest hurdle to telepractice use. CONCLUSIONS: Uptake of telepractice by the SLT profession in Ireland was widespread during COVID-19, highlighting the profession’s flexibility and innovation. Respondents indicated they are likely to continue to use telepractice as a complementary service delivery model post-COVID due to the distinct benefits for clinicians and clients.

Nonword Repetition Performance Differentiates Children Who Stutter With and Without Concomitant Speech Sound and Developmental Language Disorders

Purpose: The aim of this study was to examine how nonword repetition (NWR) performance may be impacted by the presence of concomitant speech and language disorders in young children who stutter (CWS). Method: One hundred forty-one children (88 CWS and 53 children who do not stutter [CWNS]) participated. CWS were divided into groups based on the presence of speech sound and/or language disorder or typical speech sound production and language abilities. NWR abilities were measured using stimuli composed of one- to four-syllable nonwords. Results: CWS with typical speech and language and CWNS had higher accuracy scores than CWS with concomitant speech and language disorders. We found no difference in accuracy scores between CWNS and CWS with typical speech and language abilities, nor did we find differences between CWS with speech sound disorder and CWS with both speech sound and language disorders. Accuracy decreased as nonword length increased for all groups. Conclusions: We found that the presence of a concomitant speech and language disorder was a driving factor behind poorer NWR performance in CWS. Accuracy scores differentiated CWS with concomitant disorders from CWS with typical speech and language but not CWS with typical speech and language from CWNS. Considering the speech and language abilities of CWS helped clarify poorer NWR performance and enhances generalizability to the population that exists clinically.

Risk Factors for Subtypes of Children with Speech Sound Disorders Classified by Linguistic Symptoms

Objectives: The purpose of this study is to investigate 22 risk factors for speech sound disorders (SSDs) and to find out whether there are differences in risk factors for each subtype of SSDs of Dodd’s model.Methods: Sixty-two children with SSDs aged 3-9 years participated in the study, and 22 risk factors reported in literature were investigated through parental interviews and a nonverbal intelligibility test. Children with SSDs were divided into children with articulation disorders, phonological delays, and consistent/inconsistent phonological disorders.Results: As a result of the principal component analysis, 22 risk factors were classified into 1) language and gross motor development, 2) gender and early development, 3) otitis media with effusion, 4) socioeconomic status, and 5) family history. Among all risk factors, only general developmental delay around 2 years of age showed a significantly different frequency among subtypes of SSDs.Conclusion: This study directly investigated the risk factors of children with SSDs and classified a number of risk factors into five categories. This study suggests that if children show early general developmental delays, they should be closely monitored and early evaluation and interventions should be planned.

THE SPEECH SOUND ERRORS AND LITERACY SKILLS IN CHILDREN WITH OROFACIAL CLEFTS

Objective: To investigate the speech sound errors and literacy skills in children with orofacial clefts (cleft palate& cleft lip and palate). Study Design: Comparative cross-sectional study. Place and Duration of Study: Centre for Clinical Psychology, University of the Punjab, Lahore, from Mar 2016 to Feb 2017. Methodology: A sample of 42 participants (cleft lip & palate: n=18 and cleft palate: n=24) was collected. Two stage sampling strategy was used. Each child was individually screened through Slosson intelligence test revised checklist of orofacial cleft and diagnostic statistical Manual-V checklist. Then children were provided with assessment measures which included demographic informational questionnaire, community developed VPI Screener, word list for articulation and phonological processes, annual status of education report (ASER) and curriculum-based measurement (Written Expression). Manual SODA (substitution, omission, distortion and addition) analysis was done to know about the type of speech sound errors. Results: Independent sample t-test was used to compare the differences of speech sound errors (52.11 ± 25.08), (47.29 ± 25.38), reading skills (3.67 ± 1.14), (3.75 ± 1.26) and writing skills (14.61 ± 13.49), (25.14 ± 29.16) in cleft lip & palate and cleft palate respectively, indicated that there were no differences; with p-value: p=0.54, 0.83, 0.13. Conclusion: Results indicated no significant differences in speech sound errors, reading, writing skills and resonance between children with cleft lip & palate and cleft palate.

Electrophysiological Measures of Tactile and Auditory Processing in Children With Autism Spectrum Disorder

Behavioral differences in responding to tactile and auditory stimuli are widely reported in individuals with autism spectrum disorder (ASD). However, the neural mechanisms underlying distinct tactile and auditory reactivity patterns in ASD remain unclear with theories implicating differences in both perceptual and attentional processes. The current study sought to investigate (1) the neural indices of early perceptual and later attentional factors underlying tactile and auditory processing in children with and without ASD, and (2) the relationship between neural indices of tactile and auditory processing and ASD symptomatology. Participants included 14, 6–12-year-olds with ASD and 14 age- and non-verbal IQ matched typically developing (TD) children. Children participated in an event-related potential (ERP) oddball paradigm during which they watched a silent video while being presented with tactile and auditory stimuli (i.e., 80% standard speech sound/a/; 10% oddball speech sound/i/; 10% novel vibrotactile stimuli on the fingertip with standard speech sound/a/). Children’s early and later ERP responses to tactile (P1 and N2) and auditory stimuli (P1, P3a, and P3b) were examined. Non-parametric analyses showed that children with ASD displayed differences in early perceptual processing of auditory (i.e., lower amplitudes at central region of interest), but not tactile, stimuli. Analysis of later attentional components did not show differences in response to tactile and auditory stimuli in the ASD and TD groups. Together, these results suggest that differences in auditory responsivity patterns could be related to perceptual factors in children with ASD. However, despite differences in caregiver-reported sensory measures, children with ASD did not differ in their neural reactivity to infrequent touch-speech stimuli compared to TD children. Nevertheless, correlational analyses confirmed that inter-individual differences in neural responsivity to tactile and auditory stimuli were related to social skills in all children. Finally, we discuss how the paradigm and stimulus type used in the current study may have impacted our results. These findings have implications for everyday life, where individual differences in responding to tactile and auditory stimuli may impact social functioning.

The Effectiveness of an Integrated Treatment for Functional Speech Sound Disorders—A Randomized Controlled Trial

Background: The treatment of functional speech sound disorders (SSDs) in children is often lengthy, ill-defined, and without satisfactory evidence of success; effectiveness studies on SSDs are rare. This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses on integrating phonological and phonetic processing according to the Integrated Psycholinguistic Model of Speech Processing (IPMSP). Methods: Thirty-two German-speaking children aged from 3.5 to 5.5 years (median 4.6) with functional SSD were randomly assigned to a treatment or a wait-list control group with 16 children each. All children in the treatment group and, after an average waiting period of 6 months, 12 children in the control group underwent PhonoSens treatment. Results: The treatment group showed more percent correct consonants (PCC) and a greater reduction in phonological processes after 15 therapy sessions than the wait-list control group, both with large effect sizes (Cohen’s d = 0.89 and 1.04). All 28 children treated achieved normal phonological abilities: 21 before entering school and 7 during first grade. The average number of treatment sessions was 28; the average treatment duration was 11.5 months. Conclusion: IPMSP-aligned therapy is effective in the treatment of SSD and is well adaptable for languages other than German.