One Size Doesn't Fit All: A Pilot Study Toward Performance-Specific Speech Intervention in Children With a Cleft (Lip and) Palate

Purpose: Speech-language pathologists usually apply a “one size fits all” approach to eliminate compensatory cleft speech characteristics (CSCs). It is necessary to investigate what intervention works best for a particular patient. This pilot study compared the effectiveness of two therapy approaches (a motor-phonetic approach and a linguistic-phonological approach) on different subtypes of compensatory CSCs in Dutch-speaking children with a cleft (lip and) palate (CP ± L). Method: Fourteen children with a CP ± L ( M age = 7.71 years) were divided into two groups using block randomization stratified by age, gender, and type of compensatory CSC. Six children received intervention to eliminate anterior oral CSCs ( n = 3 motor-phonetic intervention, n = 3 linguistic-phonological intervention). Eight children received intervention to eliminate non-oral CSCs ( n = 4 motor-phonetic intervention, n = 4 linguistic-phonological intervention). Each child received 10 hr of speech intervention divided over 2 weeks. Perceptual and psychosocial outcome measures were used to determine intervention effects. Results: Children who received linguistic-phonological intervention to eliminate anterior oral CSCs had significantly higher correctly produced consonant scores and health-related quality of life (HRQoL) scores compared to children who received motor-phonetic intervention to eliminate anterior oral CSCs. In the group of children who received intervention to eliminate non-oral CSCs, no significant differences were found in the correctly produced consonant scores nor in the HRQoL scores between the two intervention approaches. Conclusions: Linguistic-phonological intervention seems to be more appropriate to eliminate anterior oral CSCs. The beneficial effects of linguistic-phonological intervention were less pronounced in children with non-oral CSCs. Perhaps, children with non-oral CSCs benefit more from a hybrid phonetic-phonological approach. This study is a step forward in the provision of performance-specific intervention in children with a CP ± L. Replication in larger samples is needed and will aid to tailor treatment plans to the needs of our patients.

Cross-Language Transfer and Attentional Control in Early Bilingual Speech

Purpose: This study investigated the roles of cross-language transfer of first language (L1) and attentional control in second-language (L2) speech perception and production of sequential bilinguals, taking phonological overlap into account. Method: Twenty-five monolingual Dutch-speaking and 25 sequential bilingual Turkish–Dutch-speaking 3- and 4-year-olds were tested using picture identification tasks for speech perception in L1 Turkish and L2 Dutch, single-word tasks for speech production in L1 and L2, and a visual search task for attentional control. Phonological overlap was manipulated by dividing the speech tasks into subsets of phonemes that were either shared or unshared between languages. Results: In Dutch speech perception and production, monolingual children obtained higher accuracies than bilingual peers. Bilinguals showed equal performance in L1 and L2 perception but scored higher on L1 than on L2 production. For speech perception of shared phonemes, linear regression analyses revealed no direct effects of attention and L1 on L2. For speech production of shared phonemes, attention and L1 directly affected L2. When exploring unshared phonemes, direct effects of attentional control on L2 were demonstrated not only for speech production but also for speech perception. Conclusions: The roles of attentional control and cross-language transfer on L2 speech are different for shared and unshared phonemes. Whereas L2 speech production of shared phonemes is also supported by cross-language transfer of L1, L2 speech perception and production of unshared phonemes benefit from attentional control only. This underscores the clinical importance of considering phonological overlap and supporting attentional control when assisting young sequential bilinguals' L2 development.

Emotional Speech Processing in 3- to 12-Month-Old Infants: Influences of Emotion Categories and Acoustic Parameters

Purpose: The aim of this study was to investigate infants' listening preference for emotional prosodies in spoken words and identify their acoustic correlates. Method: Forty-six 3- to-12-month-old infants ( M age = 7.6 months) completed a central fixation (or look-to-listen) paradigm in which four emotional prosodies (happy, sad, angry, and neutral) were presented. Infants' looking time to the string of words was recorded as a proxy of their listening attention. Five acoustic variables—mean fundamental frequency (F0), word duration, intensity variation, harmonics-to-noise ratio (HNR), and spectral centroid—were also analyzed to account for infants' attentiveness to each emotion. Results: Infants generally preferred affective over neutral prosody, with more listening attention to the happy and sad voices. Happy sounds with breathy voice quality (low HNR) and less brightness (low spectral centroid) maintained infants' attention more. Sad speech with shorter word duration (i.e., faster speech rate), less breathiness, and more brightness gained infants' attention more than happy speech did. Infants listened less to angry than to happy and sad prosodies, and none of the acoustic variables were associated with infants' listening interests in angry voices. Neutral words with a lower F0 attracted infants' attention more than those with a higher F0. Neither age nor sex effects were observed. Conclusions: This study provides evidence for infants' sensitivity to the prosodic patterns for the basic emotion categories in spoken words and how the acoustic properties of emotional speech may guide their attention. The results point to the need to study the interplay between early socioaffective and language development.

Clinical Practice Patterns of Fitting Advanced Device Features in Children With Cochlear Implants

Purpose: The purpose of this study was to identify common clinical practice patterns for providing advanced noise management features in children with cochlear implants (CIs) and evaluate trends in consideration of clinician experience and comfort with CI manufacturer-specific technology. Method: A mixed-model survey including quantitative and qualitative questions regarding providing advanced noise management features in the pediatric CI population was collected electronically via research electronic data capture. Survey questions spanned approach/philosophy toward provision of features, age of provision, and demographics of respondents. Descriptive statistics were completed to define common clinical practice patterns and demographic information. Results: A total of 160 pediatric audiologists from 35 U.S. States and five Canadian provinces completed the survey. Most audiologists (73.8%) reported enabling automatic directional microphones, and a vast majority (91%) reported enabling advanced noise processing features such as automatic noise cancellers, wind noise cancellers, and impulse noise cancellers in recipients' main programs. Audiologists ranked features in terms of importance for a school-age child with the top three ranked as automatic noise reduction, automatic directional microphones, and concha-level microphones. Importance of child-specific factors varied depending upon the specific feature of interest. Conclusions: Variability exists among providers in enabling advanced noise management features for pediatric CI recipients. Multiple factors, including patient characteristics, provider characteristics, and limited evidence-based guidance, could account for much of the variation. Overall, there is a trend toward automaticity for noise management. Additional studies are warranted to provide the evidence base for confidently programming advanced features for children using CIs.

Effects of First Language Background and Learning Experience in Perceiving Mandarin Lexical Tones: Learners and Nonlearners From English- and Japanese-Speaking Backgrounds

Purpose: This research compared individuals from two first language (L1) backgrounds (English and Japanese) to determine how they may differ in their perception of Mandarin tones (Tones 1 vs. 2 [T1–T2], Tones 1 vs. 3 [T1–T3], Tones 1 vs. 4 [T1–T4], Tones 2 vs. 3 [T2–T3], Tones 2 vs. 4 [T2–T4], Tones 3 vs. 4 [T3–T4]) on account of their L1. Method: The participants included two groups of learners of Mandarin (23 English speakers, 18 Japanese speakers), two groups of nonlearners of Mandarin (24 English speakers, 21 Japanese speakers), and a control group of 10 Mandarin speakers. A four-alternative forced-choice discrimination task that included 360 trials was presented in three blocks of 120 trials. Results: The native Mandarin group was more accurate in their tonal discrimination of all six tone pairs than all the nonnative groups. While Japanese nonlearners generally outperformed English nonlearners in their overall perception of Mandarin lexical tones, L1-based differences were less extensive for the two groups of learners. Both learner groups were least accurate on T2–T3 and most accurate on T3–T4. Conclusion: The results suggest that with classroom experience, English speakers can overcome their initial disadvantage and learn lexical tones in a new language as successfully as speakers of Japanese with classroom experience.

Psychometric Properties of the English–Spanish Vocabulary Inventory in Toddlers With and Without Early Language Delay

Purpose: Despite the increasing population of dual language learners (DLLs) in the United States, vocabulary measures for young DLLs have largely relied on instruments developed for monolinguals. The multistudy project reports on the psychometric properties of the English–Spanish Vocabulary Inventory (ESVI), which was designed to capture unique cross-language measures of lexical knowledge that are critical for assessing DLLs' vocabulary, including translation equivalents (whether the child knows the words for the same concept in each language), total vocabulary (the number of words known across both languages), and conceptual vocabulary (the number of words known that represent unique concepts in either language). Method: Three studies included 87 Spanish–English DLLs ( M age = 26.58 months, SD = 2.86 months) with and without language delay from two geographic regions. Multiple measures (e.g., caregiver report, observation, behavioral tasks, and standardized assessments) determined content validity, construct validity, social validity, and criterion validity of the ESVI. Results: Monolingual instruments used in bilingual contexts significantly undercounted lexical knowledge as measured on the ESVI. Scores on the ESVI were related to performance on other measures of communication, indicating acceptable content, construct, and criterion validity. Social validity ratings were similarly positive. ESVI scores were also associated with suspected language delay. Conclusions: These studies provide initial evidence of the adequacy of the ESVI for use in research and clinical contexts with young children learning English and Spanish (with or without a language delay). Developing tools such as the ESVI promotes culturally and linguistically responsive practices that support accurate assessment of DLLs' lexical development. Supplemental Material https://doi.org/10.23641/asha.17704391

On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data

Purpose: Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). The peer-reviewed evidence for the benefit of SLT has been uncertain. Our objective was to systematically review and meta-analytically summarize the benefit of SLT for individuals born with CLP. Method: A systematic search was conducted (last search on February 19, 2021) on studies evaluating SLT with pre and post measures on speech production, language ability, intelligibility, and/or patient-reported outcomes. We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT. Meta-analyses and meta-regressions were applied to synthesize IPD across studies. Results: Thirty-four eligible studies were found. Nineteen studies provided IPD ( n = 343) for the main analysis on speech production. The synthesized information suggests that, during SLT, speech production improved to a clinically relevant degree for many individuals (95% CI [61%, 87%]) and that speech production was on a level with peers for some individuals after SLT (95% CI [10%, 34%]). Conclusions: The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance. This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful. Supplemental Material https://doi.org/10.23641/asha.17700992

Predicting Language Performance From Narrative Language Samples

Purpose: Analysis of narrative language samples is a recommended clinical practice in the assessment of children's language skills, but we know little about how results from such analyses relate to overall oral language ability across the early school years. We examined the relations between language sample metrics from a short narrative retell, collected in kindergarten, and an oral language factor in grades kindergarten through 3. Our specific questions were to determine the extent to which metrics from narrative language sample analysis are concurrently related to language in kindergarten and predict language through Grade 3. Method: Participants were a sample of 284 children who were administered a narrative retell task in kindergarten and a battery of vocabulary and grammar measures in kindergarten through Grade 3. Language samples were analyzed for number of different words, mean length of utterance, and a relatively new metric, percent grammatical utterances (PGUs). Structural equation models were used to estimate the concurrent and longitudinal relationships. Results: The narrative language sample metrics were consistently correlated with the individual vocabulary and grammar measures as well as the language factor in each grade, and also consistently and uniquely predicted the language factor in each grade. Standardized path estimates in the structural equation models ranged from 0.20 to 0.39. Conclusions: This study found narrative language sample metrics to be predictive, concurrently and longitudinally, of a latent factor of language from kindergarten through Grade 3. These results further validate the importance of collecting and analyzing narrative language samples, to include PGU along with more traditional metrics, and point to directions for future research. Supplemental Material https://doi.org/10.23641/asha.17700980

Determining the Relationship Between Hyoid Bone Kinematics and Airway Protection in Swallowing

Purpose: Research remains equivocal regarding the links between hyoid movement and penetration–aspiration. The aims of this study were (a) to explore associations between hyoid parameters, laryngeal vestibule closure (LVC) parameters, and penetration–aspiration on thin liquids; and (b) to determine which of these parameters are the strongest predictors of penetration–aspiration. Method: This study involved retrospective analysis of an existing videofluoroscopy data set, collected in 305 participants (152 males) with noncongenital/nonsurgical/non-oncological risk for dysphagia. We extracted data for six thin liquid swallows per participant, and obtained measures of hyoid movement (peak position, speed) and LVC (complete/incomplete, timing, duration). Resulting values were coded as typical/atypical relative to healthy reference data. Relationships were explored using chi-square tests and odds ratios (a) for the entire data set and (b) for the subset of data with complete LVC. Hierarchical logistic regression models determined the strongest predictors of penetration–aspiration. Results: Significant associations were found between penetration–aspiration and incomplete LVC, prolonged time-to-most-complete-LVC, short LVC duration, reduced anterior hyoid peak position, and reduced hyoid speed. Hyoid measures were also significantly associated with LVC parameters. In the first regression model, incomplete LVC and prolonged time-to-most-complete-LVC were the only significant predictors of penetration–aspiration. For cases with complete LVC, the only significant predictor was prolonged time-to-most-complete-LVC. Conclusions: Although reduced anterior hyoid peak position and speed are associated with penetration–aspiration on thin liquids, these measures do not independently account for penetration–aspiration when considered in conjunction with measures of LVC. When identifying mechanisms explaining penetration–aspiration, clinicians should focus on LVC (complete/incomplete) and timeliness of LVC.

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.