Language, Speech, and Hearing Services in Schools recent issues

Oxford Dysfluency Conference: An International Gathering [From the Editor...]

Nippold, M. A. — 2012-01-03T09:26:36-08:00

Narrative Writing in Children and Adolescents: Examining the Literate Lexicon [Article]

Sun, L., Nippold, M. A. — 2012-01-03T09:26:36-08:00

Purpose

This study was designed primarily to examine the use of abstract nouns and metacognitive verbs in the narrative writing of school-age children and adolescents.

Method

Three groups of typically developing students ages 11, 14, and 17 years (n = 40 per group) were asked to write a story about something funny, sad, or scary that had happened to them and a friend. Each student's narrative essay was examined for the use of abstract nouns (e.g., accomplishment, loneliness, mystery) and metacognitive verbs (e.g., assume, discover, realize) and for the production of complex syntax as measured by mean length of T-unit (MLTU) and clausal density (CD).

Results

Age-related growth in narrative writing was documented for both types of words. Additionally, the use of abstract nouns and metacognitive verbs was associated with the production of complex syntax, reflecting the lexicon–syntax interface.

Conclusion

The narrative writing task employed in this study was effective in eliciting literate words and complex syntax in school-age children and adolescents.

Survey of High School Students' Perceptions About Their iPod Use, Knowledge of Hearing Health, and Need for Education [Article]

2012-01-03T09:26:36-08:00

Purpose

High school students' knowledge about hearing health and their perceptions of how they use personal listening devices (PLDs) including iPods were surveyed to determine the need, content, and preferred format for educational outreach to them.

Method

This study was a descriptive convenience survey of students at a California high school. An 83-item questionnaire was administered in December 2009 to assess students' demographics, knowledge of hearing health, perceived iPod use, and risk activities.

Results

The response rate was 56%. Most of the students perceived that they used iPods safely. However, responses indicated that many of the respondents could be at risk of injury to themselves or others if they became unaware of their surroundings while listening to iPods. Some students were knowledgeable about hearing health and safe iPod use, but most needed information about hearing loss and hearing conservation.

Conclusion

Most of the students needed education (e.g., via health classes or the Internet) about hearing health, the warning signs of hearing loss, and how to prevent hearing loss. Resources for educational audiologists are provided.

How Grammatical Are 3-Year-Olds? [Article]

Eisenberg, S. L., Guo, L.-Y., Germezia, M. — 2012-01-03T09:26:36-08:00

Purpose

This study investigated the level of grammatical accuracy in typically developing 3-year-olds and the types of errors they produce.

Method

Twenty-two 3-year-olds participated in a picture description task. The percentage of grammatical utterances was computed and error types were analyzed.

Results

The mean level of grammatical accuracy in typical 3-year-olds was ~71%, with a wide range of variability. The current study revealed a variety of error types produced by 3-year-olds, most of which were produced by fewer than 5 children. The pattern observed for most of the children was to produce a scattering of errors with no more than a few of any 1 error type.

Conclusion

The level of grammatical accuracy in 3-year-olds was skewed toward the high end. Although tense marking errors were the most frequent error type, they accounted for only 1/3 of the errors produced by 3-year-olds. A more general measure of grammaticality that considers additional aspects of language might, therefore, be useful in assessing language at this age.

Acquiring Knowledge of Derived Nominals and Derived Adjectives in Context [Article]

Marinellie, S. A., Kneile, L. A. — 2012-01-03T09:26:36-08:00

Purpose

This research investigated children's ability to acquire semantic and syntactic knowledge of derived nominals and derived adjectives in the context of short passages. The study also investigated the relation of morphological awareness and the ability to acquire knowledge of derived words in context.

Method

A total of 106 children in Grade 4 were given an author-created evaluation, the Derivational Acquisition in Context Evaluation (DAICE), which consisted of several short passages. Each passage contained two instances of a target base word followed by one instance of a derived form of the base word. A multiple-choice measure was administered to assess the children's knowledge of 12 derived words (6 nominals and 6 adjectives). A measure of morphological awareness was given to assess the children's relational knowledge between root words and their suffixes.

Results

No significant differences were found for overall performance on derived nominals and derived adjectives. However, the acquisition of semantic and syntactic knowledge was dependent on target word type. A significant relation was found between performance on the measure of morphological awareness and performance on derived nominals.

Conclusion

This research provided evidence for fast mapping of derived nominals and derived adjectives within the context of short passages. Future directions of related research are suggested.

Overlap in Speech-Language and Reading Services for Kindergartners and First Graders [Article]

Gosse, C. S., Hoffman, L. M., Invernizzi, M. A. — 2012-01-03T09:26:36-08:00

Purpose

Speech-language pathologists (SLPs) and reading professionals provide educational services to children who are at risk for reading difficulties, although these professions do not necessarily coordinate efforts. To date, there is limited evidence regarding the proportion of children who receive services from both professionals. The current study reports the prevalence and overlap of speech-language and reading services provided to kindergartners and first graders in Virginia.

Method

This study analyzed a population-level database of reading screening scores from 74,730 kindergartners and 75,088 first graders. Information regarding the speech-language services received by these children was obtained. Prevalence rates of speech-language impairment, reading risk, and comorbidity were calculated. The distribution of children receiving speech-language services across categories of reading competence was examined.

Results

Findings indicated that ~6% of the children received speech-language services and 11.1% of the kindergartners and 13.7% of the first graders received reading services. One-quarter of the children receiving speech-language services also received reading services. Furthermore, children receiving speech-language services received reading services at twice the rate of children who were not receiving speech-language services in both kindergarten (23.1% vs. 9.1%) and first grade (25.2% vs. 11.3%).

Clinical Implications

This study provides empirical support for improving coordination between SLPs and reading professionals.

Dynamic Assessment of Word Learning Skills: Identifying Language Impairment in Bilingual Children [Article]

Kapantzoglou, M., Restrepo, M. A., Thompson, M. S. — 2012-01-03T09:26:36-08:00

Purpose

Bilingual children are often diagnosed with language impairment, although they may simply have fewer opportunities to learn English than English-speaking monolingual children. This study examined whether dynamic assessment (DA) of word learning skills is an effective method for identifying bilingual children with primary language impairment (PLI).

Method

Fifteen 4- and 5-year-old predominantly Spanish-speaking children with typical language development (TLD) and 13 with PLI each participated in a 30- to 40-min session of DA of word learning skills following a pretest–teach–posttest design.

Results

Results indicated that TLD children made associations between the phonological and semantic representations of the new words faster than children with PLI did, showing greater modifiability. Further, a combination of word learning in the receptive modality and the Learning Strategies Checklist (Lidz, 1991; Peña, 1993) provided the best accuracy in identifying PLI in these children.

Conclusion

Findings suggest that a brief DA is a promising method for accurately differentiating children with TLD from children with PLI.

Preliteracy Speech Sound Production Skill and Later Literacy Outcomes: A Study Using the Templin Archive [Article]

Overby, M. S., Trainin, G., Smit, A. B., Bernthal, J. E., Nelson, R. — 2012-01-03T09:26:36-08:00

Purpose

This archival study examined the relationship between the speech sound production skill of kindergarten children and literacy outcomes in Grades 1–3 in a data set where most children's vocabulary skills were within normal limits, speech therapy was not provided until 2nd grade, and phonological awareness instruction was discouraged at the time data were collected.

Method

Data were accessed from the Templin Archive (2004), and the speech sound production skill of 272 kindergartners were examined relative to literacy outcomes in 1st and 2nd grade (reading) and 3rd grade (spelling).

Results

Kindergartners in the 7th percentile for speech sound production skill scored more poorly in 1st- and 2nd-grade reading and 3rd-grade spelling than did kindergartners with average speech sound production skill; kindergartners in the 98th percentile achieved superior literacy skills compared to the mean. Phonological awareness mediated the effects of speech sound production skill on reading and spelling; vocabulary did not account for any unique variance.

Conclusion

Speech sound disorders appear to be an overt manifestation of a complex interaction among variables influencing literacy skills, including nonlanguage cognition, vocabulary, letter knowledge, and phonological awareness. These interrelationships hold across the range of speech sound production skill, as children with superior speech sound production skill experience superior literacy outcomes.

Language Intervention in the Classroom: What It Looks Like [From the Editor...]

Nippold, M. A. — 2011-10-03T10:41:01-07:00

The Use of Sound-Field Amplification Devices in Different Types of Classrooms [Report]

Wilson, W. J., Marinac, J., Pitty, K., Burrows, C. — 2011-10-03T10:41:01-07:00

Purpose

The purpose of this study was to determine if sound-field amplification (SFA) devices affected student performance in 3 different types of classrooms.

Method

The classroom performance of 147 children (77 males, 70 females, ages 8;2 [years;months] ± 5 months) was measured at the beginning and end of the second semester of their third year in 1 of 4 primary schools in Brisbane, Australia. Each school contained 2 participating classrooms, 1 with and 1 without an SFA device.

Results

The SFA devices contributed to small but significant improvements in student listening (p < .01) and auditory analysis (p < .05) skills, but only in the school where the participating classrooms were in a brick building (vs. a demountable building) with neighboring classrooms separated by solid walls (vs. open spaces). The classrooms in this school showed the lowest background noise measures (47–50 dB 1 hr, A weighted) and the second lowest reverberation times (0.87–0.91 s) overall, although these values still exceeded the maximums recommended by American National Standards Institute S12.60-2002 (2002).

Conclusion

These results suggest that any potential benefits of SFA devices are more likely to be realized in classrooms with better acoustics.

Addressing Clinician-Client Mismatch: A Preliminary Intervention Study With a Bilingual Vietnamese-English Preschooler [Article]

Pham, G., Kohnert, K., Mann, D. — 2011-10-03T10:41:01-07:00

Purpose

This project examined receptive vocabulary treatment outcomes in the two languages of a bilingual preschooler with moderate to severe language impairment.

Method

A series of single-subject experimental designs was used to compare English-only (EO) and bilingual (BI) approaches to receptive vocabulary treatment. The participant, Nam, was a boy age 3;11 (years;months) who was learning Vietnamese as a first language at home and English in his early childhood education program. Treatment was implemented by an EO interventionist using a computer interface and prerecorded audio files in Vietnamese and English. The dependent measure was the percentage of items that were correctly identified in each language.

Results

Combined studies revealed that the BI approach increased Nam's attention to task and was as effective as the EO approach for increasing his receptive vocabulary in English. Nam made vocabulary gains in both treatment conditions; receptive vocabulary gains were evident in both Vietnamese and English.

Conclusion

This project showed that it is feasible for an EO clinician to promote gains in both the home and school languages of a BI child through creative collaborations with BI colleagues and the use of technology. Replication with additional participants and treatment activities is needed to make further generalizations.

Do Developmental Communication Disorders Exist in the Signed Modality? Perspectives From Professionals [Article]

Quinto-Pozos, D., Forber-Pratt, A. J., Singleton, J. L. — 2011-10-03T10:41:01-07:00

Purpose

This study focused on whether developmental communication disorders exist in American Sign Language (ASL) and how they might be characterized. ASL studies is an emerging field; educators and clinicians have minimal access to descriptions of communication disorders of the signed modality. Additionally, there are limited resources for assessing ASL acquisition. This article is designed to raise clinicians' awareness about developmental communication disorders in ASL and categorize types of atypicality that have been witnessed.

Method

We conducted 4 focus groups and one 1-on-1 interview with a total of 22 adults (7 Deaf, 15 hearing) who work at bilingual–bicultural (ASL–English) schools for the Deaf. Experiences of these educators and language professionals were analyzed qualitatively using a combination of grounded theory (Charmaz, 2001; Strauss & Corbin, 1998) and a modified van Kaam approach (Moustakas, 1994).

Results

Participants confirmed observations of children with suspected communication disorders and considered the prevalence, possible etiologies, and psychosocial aspects of such disorders in ASL. They reported frustration at the lack of diagnostic tools for reliable identification and intervention strategies to be used in educational settings.

Conclusion

This work provides us with practitioner accounts proving that developmental communication disorders do exist in ASL. Future reports will describe primary data from signers with atypical language attributes.

Educational Audiologists: Their Access, Benefit, and Collaborative Assistance to Speech-Language Pathologists in Schools [Article]

Richburg, C. M., Knickelbein, B. A. — 2011-10-03T10:41:01-07:00

Purpose

The main goals of this study were to determine if school-based speech-language pathologists (SLPs) have access to the services of an audiologist and if those SLPs felt they obtained benefit from the audiologist's services. Additional goals included gathering information about SLPs' (a) understanding of basic audiological concepts typical for a school setting, (b) added job responsibilities brought about by lack of access to an audiologist, and (c) collaboration with audiologists.

Method

A 36-item survey was e-mailed to 1,000 SLPs listed with the American Speech-Language-Hearing Association as being employed in schools. Two-hundred and nine respondents from 42 states returned the survey.

Results

Seventy-six percent of the responding SLPs had access at some time to an audiologist, with 88% of them believing they received benefit from the services provided by that audiologist, primarily in the areas of hearing screenings and in-services. Thirty-eight SLPs (58%) who did not have access to an audiologist reported having additional job responsibilities.

Conclusion

Many school-based SLPs believed they received benefit from an audiologist when they had access to one. Collaboration between these professionals was strong, yet findings indicate that audiologists could improve their collaborative efforts with SLPs and assist them in working within their scope of practice and maintaining their ethical standards.

Program Intensity and Service Delivery Models in the Schools: SLP Survey Results [Article]

Brandel, J., Frome Loeb, D. — 2011-10-03T10:41:01-07:00

Purpose

School-based speech-language pathologists (SLPs) routinely work with team members to make recommendations regarding an intervention program's intensity and method of service delivery for children with speech and language impairments. In this study, student, SLP, and workplace characteristics that may influence SLPs' recommendations were examined.

Method

Almost 2,000 school-based SLPs completed an online survey about the factors they consider when making recommendations regarding program intensity and service delivery model that students on their caseloads receive.

Results

SLPs reported that student characteristics, rather than SLP or workplace characteristics, were the factors they considered the most when making these recommendations. However, these same SLPs reported that current students on their caseload with severe to moderate disabilities participated in intervention 2–3 times a week for 20–30 min in groups outside of the classroom. Students with the least severe disability received intervention 1 time a week for 20–30 min in groups outside of the classroom.

Conclusion

The limited variety of intervention program intensities and service delivery models used suggests that student characteristics may not be the most important factor considered when making intervention recommendations, as reported by the SLPs. Instead, caseload size and years of practice appear to influence SLPs' recommendations regarding which program intensity and service delivery models to use.

The Integration of Lexical, Syntactic, and Discourse Features in Bilingual Adolescents' Writing: An Exploratory Approach [Article]

Danzak, R. L. — 2011-10-03T10:41:01-07:00

Purpose

The purpose of this study was to assess the bilingual writing of adolescent English language learners (ELLs) using quantitative tools. Linguistic measures were applied to the participants' writing at the lexical, syntactic, and discourse levels, with the goal of comparing outcomes at each of these levels across languages (Spanish/English) and genres (expository/narrative).

Method

Twenty Spanish-speaking ELLs, ages 11–14 years, each produced 8 expository and narrative autobiographical texts. Texts were coded and scored for lexical sophistication, syntactic complexity, and overall text quality. Scores were analyzed using Friedman's 2-way analysis of variance by ranks (Siegel & Castellan, 1988); resulting ranks were compared across languages and genre topics.

Results

The text topic impacted rank differences at all levels. Performance at the three levels was similar across languages, indicating that participants were emerging writers in both Spanish and English. The impact of genre was generally inconsequential at all levels.

Conclusion

Similar results across languages implied the potential transfer of writing skills. Overall, students appeared to apply a knowledge-telling strategy to writing rather than strategically planning, composing, and revising their writing. Finally, outcomes highlighted the synergistic relationships among linguistic levels in text composition, indicating a need to address the interaction of vocabulary, morphosyntax, and text-level structures in the instruction and assessment of ELL writing.

The Interface of Language Proficiency and Identity: A Profile Analysis of Bilingual Adolescents and Their Writing [Article]

Danzak, R. L. — 2011-10-03T10:41:01-07:00

Purpose

The purpose of this study was to explore how adolescent English language learners' (ELLs') language and literacy experiences impacted their identities as bilingual writers.

Method

Six students were randomly selected from a group of 20 Spanish-speaking ELLs, ages 11–14, who participated in a larger, mixed-methods study on bilingual writing (see Danzak, 2011). The participants produced 10 written journal entries in their language of choice (English, Spanish, or both) and were interviewed. Qualitative analyses were applied to the participants' writing and interviews, both individually and cross-case. Findings were integrated to some extent with the outcomes of quantitative measures applied to the students' writing.

Results

Three patterns emerged: ethnic differences, language discrimination, and language preference. Also, the students' self-identification as monolingual or bilingual was reflected in their attitudes toward language learning and their outcomes on writing measures. Three portraits of emerging bilingual writers are discussed: struggling emerging, dominant emerging, and balanced emerging. Language and literacy learning strategies are recommended for each.

Conclusions

Qualitative profiles of adolescent ELLs offer an understanding of students' experiences and identities that augments information provided by quantitative writing measures. Additionally, a mixed-methods profile analysis may aid in the identification of adolescent ELLs who may be struggling with undiagnosed language learning disabilities.

Peer Victimization Among Students With Specific Language Impairment, Attention-Deficit/Hyperactivity Disorder, and Typical Development [Article]

Redmond, S. M. — 2011-10-03T10:41:01-07:00

Purpose

The potential contributions of behavioral and verbal liabilities to social risk were examined by comparing peer victimization levels in children with specific language impairment (SLI) to those in children with attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) children.

Method

Sixty children (age range: 7–8 years) participated in the study. Standardized verbal measures and parent ratings of behavioral difficulties were combined with children's self-reports of their school and peer environments to examine the risk for negative peer experiences associated with clinical status.

Results

Clinical status was associated with elevated levels of victimization, especially for participants with SLI. A potential buffering effect for number of close friendships was found for participants with ADHD and TD participants, but not for participants with SLI. Peer victimization was associated with elevated levels of hyperactivity and stronger narrative skills for participants with SLI.

Conclusion

These results highlight the importance of peer victimization in the social adjustment of students with developmental language disorders.

Classification Accuracy of Brief Parent Report Measures of Language Development in Spanish-Speaking Toddlers [Article]

Guiberson, M., Rodriguez, B. L., Dale, P. S. — 2011-10-03T10:41:01-07:00

Purpose

The purpose of the current study was to examine the concurrent validity and classification accuracy of 3 parent report measures of language development in Spanish-speaking toddlers.

Method

Forty-five Spanish-speaking parents and their 2-year-old children participated. Twenty-three children had expressive language delays (ELDs) as determined through multiple sources of information, and 22 had typical language development (TD). Parents completed the Spanish version of the Ages and Stages Questionnaire (Spanish ASQ; Squires, Potter, & Bricker, 1999) and the short-form of the Inventarios del Desarrollo de Habilidades Comunicativas Palabras y Enunciados (INV–II; Jackson-Maldonado, Bates, & Thal, 1992; Jackson-Maldonado et al., 2003), which is the Spanish version of the MacArthur-Bates Communicative Development Inventories Words and Sentences form, and reported children's 3 longest utterances (M3L–W). Children were administered the Preschool Language Scale, Fourth Edition, Spanish Edition (SPLS–4; Zimmerman, Steiner, & Pond, 2002) at early childhood centers.

Results

All 3 parent report measures were significantly correlated with the SPLS–4, establishing their concurrent validity. Children with ELDs scored significantly lower than TD children on all 3 parent report measures. The Spanish ASQ demonstrated less than desirable levels of sensitivity and specificity; both the short-form INV–II and M3L–W measures demonstrated favorable sensitivity and specificity. Of these measures, M3L–W demonstrated the strongest classification accuracy qualities, including sensitivity, negative predictive value, and area under the receiver operating characteristics curve.

Conclusion

The short-form INV–II and M3L–W demonstrated highly satisfactory classification accuracy of ELDs, but M3L–W demonstrated slightly stronger accuracy. These results indicate that these measures may be useful in screening for ELDs in Spanish-speaking toddlers.

Grammatical Morphology in School-Age Children With and Without Language Impairment: A Discriminant Function Analysis [Article]

Moyle, M. J., Karasinski, C., Weismer, S. E., Gorman, B. K. — 2011-10-03T10:41:01-07:00

Purpose

The purpose of this study was to test Bedore and Leonard's (1998) proposal that a verb morpheme composite may hold promise as a clinical marker for specific language impairment (SLI) in English speakers and serve as an accurate basis for the classification of children with and without SLI beyond the preschool level.

Method

The language transcripts of 50 school-age children with SLI (M_age = 7;9 [years;months]) and 50 age-matched typically developing peers (M_age = 7;9) were analyzed. Following the Bedore and Leonard (1998) procedure, 3 variables were measured: a finite verb morpheme composite, a noun morpheme composite, and mean length of utterance in morphemes (MLU_m).

Results

Overall findings indicated that neither grammatical morpheme composite alone adequately discriminated the groups at this developmental level. However, combining the verb and noun grammatical morpheme composite measures with MLU_m resulted in good discriminant accuracy in classifying subgroups of the youngest children with and without SLI in the school-age sample.

Conclusion

Verb morphology alone is not a useful clinical marker of SLI in school-age children. Potential explanations for these findings and ideas for future research are discussed.

Narrative Ability of Children With Speech Sound Disorders and the Prediction of Later Literacy Skills [Article]

2011-10-03T10:41:01-07:00

Purpose

The main purpose of this study was to examine how children with isolated speech sound disorders (SSDs; n = 20), children with combined SSDs and language impairment (LI; n = 20), and typically developing children (n = 20), ages 3;3 (years;months) to 6;6, differ in narrative ability. The second purpose was to determine if early narrative ability predicts school-age (8–12 years) literacy skills.

Method

This study employed a longitudinal cohort design. The children completed a narrative retelling task before their formal literacy instruction began. The narratives were analyzed and compared for group differences. Performance on these early narratives was then used to predict the children's reading decoding, reading comprehension, and written language ability at school age.

Results

Significant group differences were found in children's (a) ability to answer questions about the story, (b) use of story grammars, and (c) number of correct and irrelevant utterances. Regression analysis demonstrated that measures of story structure and accuracy were the best predictors of the decoding of real words, reading comprehension, and written language. Measures of syntax and lexical diversity were the best predictors of the decoding of nonsense words.

Conclusion

Combined SSDs and LI, and not isolated SSDs, impact a child's narrative abilities. Narrative retelling is a useful task for predicting which children may be at risk for later literacy problems.

Increasing the Odds: Applying Emergentist Theory in Language Intervention [Review]

Poll, G. H. — 2011-10-03T10:41:01-07:00

Purpose

This review introduces emergentism, which is a leading theory of language development that states that language ability is the product of interactions between the child's language environment and his or her learning capabilities. The review suggests ways in which emergentism provides a theoretical rationale for interventions that are designed to address developmental language delays in young children.

Method

A review of selected literature on emergentist theory and research is presented, with a focus on the acquisition of early morphology and syntax. A significant method for developing and testing emergentist theory, connectionist modeling, is described. Key themes from both connectionist and behavioral studies are summarized and applied with specific examples to language intervention techniques. A case study is presented to integrate elements of emergentism with language intervention.

Conclusions

Evaluating the theoretical foundation for language interventions is an important step in evidence-based practice. This article introduces three themes in the emergentist literature that have implications for language intervention: (a) sufficiency of language input, (b) active engagement of the child with the input, and (c) factors that increase the odds for correctly mapping language form to meaning. Evidence supporting the importance of these factors in effective language intervention is presented, along with limitations in that evidence.

What Is Orthographic Knowledge? [Tutorial]

Apel, K. — 2011-10-03T10:41:01-07:00

Purpose

Orthographic knowledge refers to the information that is stored in memory that tells us how to represent spoken language in written form. Unfortunately, terms used to talk about orthographic knowledge and the two individual components that contribute to it have varied widely in the literature. Thus, consensus on the term, its meaning, and the tasks used to assess orthographic knowledge is needed.

Method

In this tutorial, the problems and inconsistencies in terms and tasks used to define and measure orthographic knowledge are reviewed, and suggestions for using specific terms are offered. Additionally, orthographic knowledge development, considerations of its role in literacy development, and its independence from other factors that contribute to literacy development are discussed. Finally, ideas for overcoming current obstacles in discussions of orthographic knowledge and suggestions for future research endeavors are offered.

Conclusion

With consensus on what orthographic knowledge is and how it should be measured, practitioners should be better prepared for assessing orthographic knowledge and implementing instructional practices accordingly.

How To Be a Critical Consumer of Treatment Studies [From the Editor...]

Nippold, M. A. — 2011-07-14T08:14:22-07:00

The Role of the Speech-Language Pathologist in Identifying and Treating Children With Auditory Processing Disorder [Prologue]

Richard, G. J. — 2011-07-14T08:14:22-07:00

Purpose

The purpose of this prologue is to provide a historical perspective regarding the controversial issues surrounding auditory processing disorder (APD), as well as a summary of the current issues and perspectives that will be discussed in the articles in this forum.

Method

An evidence-based systematic review was conducted to examine treatment efficacy data in regard to APD, with inconclusive results. The review raised several issues and highlighted the differences in how various professionals approach APD. Consequently, experts who were members of an ad hoc American Speech-Language-Hearing Association committee charged with delineating the role of the speech-language pathologist in addressing APD attempted to describe in more detail their individual author perspectives on the topic.

Conclusion

Despite concerted efforts by researchers and clinical professionals, minimal concrete evidence is available to guide practicing professionals responsible for the diagnosis and treatment of APD. The role of the speech-language pathologist in diagnosing and treating APD remains under discussion, with varying perspectives advocated by individuals based on their research and clinical experience.

Auditory Processing Disorder and Auditory/Language Interventions: An Evidence-Based Systematic Review [Clinical Forum: The Role of the Speech-Language Pathologist in Identifying and Treating Children With Auditory Processing Disorder]

2011-07-14T08:14:22-07:00

Purpose

In this systematic review, the peer-reviewed literature on the efficacy of interventions for school-age children with auditory processing disorder (APD) is critically evaluated.

Method

Searches of 28 electronic databases yielded 25 studies for analysis. These studies were categorized by research phase (e.g., exploratory, efficacy) and ranked on a standard set of quality features related to methodology and reporting.

Results

Some support exists for the claim that auditory and language interventions can improve auditory functioning in children with APD and those with primary spoken language disorder. There is little indication, however, that observed improvements are due to the auditory features of these programs. Similarly, evidence supporting the effects of these programs on spoken and written language functioning is limited.

Conclusion

The evidence base is too small and weak to provide clear guidance to speech-language pathologists faced with treating children with diagnosed APD, but some cautious skepticism is warranted until the record of evidence is more complete. Clinicians who decide to use auditory interventions should be aware of the limitations in the evidence and take special care to monitor the spoken and written language status of their young clients.

What Speech-Language Pathologists Need to Know About Auditory Processing Disorder [Clinical Forum: The Role of the Speech-Language Pathologist in Identifying and Treating Children With Auditory Processing Disorder]

Kamhi, A. G. — 2011-07-14T08:14:22-07:00

Purpose

To consider whether auditory processing disorder (APD) is truly a distinct clinical entity or whether auditory problems are more appropriately viewed as a processing deficit that may occur with various developmental disorders.

Method

Theoretical and clinical factors associated with APD are critically evaluated.

Results

There are compelling theoretical and clinical reasons to question whether APD is in fact a distinct clinical entity. Not only is there little evidence that auditory perceptual impairments are a significant risk factor for language and academic performance (e.g., Hazan, Messaoud-Galusi, Rosan, Nouwens, & Shakespeare, 2009; Watson & Kidd, 2009), there is also no evidence that auditory interventions provide any unique benefit to auditory, language, or academic outcomes (Fey et al., 2011).

Conclusion

Because there is no evidence that auditory interventions provide any unique therapeutic benefit (Fey et al., 2011), clinicians should treat children who have been diagnosed with APD the same way they treat children who have been diagnosed with language and learning disabilities. The theoretical and clinical problems associated with APD should encourage clinicians to consider viewing auditory deficits as a processing deficit that may occur with common developmental language and reading disabilities rather than as a distinct clinical entity.

Peeling the Onion of Auditory Processing Disorder: A Language/Curricular-Based Perspective [Clinical Forum: The Role of the Speech-Language Pathologist in Identifying and Treating Children With Auditory Processing Disorder]

Wallach, G. P. — 2011-07-14T08:14:22-07:00

Purpose

This article addresses auditory processing disorder (APD) from a language-based perspective. The author asks speech-language pathologists to evaluate the functionality (or not) of APD as a diagnostic category for children and adolescents with language-learning and academic difficulties. Suggestions are offered from a curriculum-relevant/strategic-based language approach that places APD symptoms within a broader framework and takes into account the complex interaction among the language knowledge, skills, and strategies needed for academic success.

Method

Using the metaphor of peeling an onion to get to its core, the author demonstrates how auditory perceptual processing is influenced by and dependent on language abilities. Examples of curricular content are used to highlight the language savvy needed by students with language-learning disabilities (LLDs) to access the curriculum.

Conclusion

At the heart of the article is the question of what is (or are) the most effective way(s) to treat problems defined as "auditory" in nature. The article concludes with 10 suggestions that remind clinicians to consider the usefulness of viewing auditory processing problems as isolated events that can be "fixed." Practical guidelines for creating authentic and functional intervention targets at school-age levels are also provided.

Spoken Language Processing Model: Bridging Auditory and Language Processing to Guide Assessment and Intervention [Clinical Forum: The Role of the Speech-Language Pathologist in Identifying and Treating Children With Auditory Processing Disorder]

Medwetsky, L. — 2011-07-14T08:14:22-07:00

Purpose

This article outlines the author's conceptualization of the key mechanisms that are engaged in the processing of spoken language, referred to as the spoken language processing model. The act of processing what is heard is very complex and involves the successful intertwining of auditory, cognitive, and language mechanisms. Spoken language processing disorders occur when a breakdown in any of these mechanisms impacts an individual's ability to effectively process and use the information that is heard. The symptoms vary depending on the underlying deficit(s). The primary purpose of this article is to provide the reader with a basic understanding of these mechanisms, and, in turn, enable readers to (a) review the literature concerning processing disorders with discernment and (b) have a foundation for developing a test battery to derive composite profiles of individuals' processing abilities.

Method

A review of the literature, overview of the spoken language processing model, and suggested approach to diagnostic assessment are presented.

Conclusion

Spoken language processing can break down due to a myriad of underlying causes. Central auditory nervous system deficits can impact not only the initial processing of stimuli but possibly the development of effective language skills. On the other hand, deficits in various cognitive and language mechanisms can similarly impact the auditory processing of speech stimuli. Therefore, it is critical to understand how these mechanisms interact and contribute to the processing of speech stimuli.

The Role of the Speech-Language Pathologist in Identifying and Treating Children With Auditory Processing Disorder [Epilogue]

Richard, G. J. — 2011-07-14T08:14:22-07:00

Purpose

A summary of issues regarding auditory processing disorder (APD) is presented, including some of the remaining questions and challenges raised by the articles included in the clinical forum.

Method

Evolution of APD as a diagnostic entity within audiology and speech-language pathology is reviewed. A summary of treatment efficacy results and issues is provided, as well as the continuing dilemma for speech-language pathologists (SLPs) charged with providing treatment for referred APD clients.

Conclusion

The role of the SLP in diagnosing and treating APD remains under discussion, despite lack of efficacy data supporting auditory intervention and questions regarding the clinical relevance and validity of APD.

The Diagnosis and Management of Auditory Processing Disorder [Review]

Moore, D. R. — 2011-07-14T08:14:22-07:00

Purpose

To provide a personal perspective on auditory processing disorder (APD), with reference to the recent clinical forum on APD and the needs of clinical speech-language pathologists and audiologists.

Method

The Medical Research Council–Institute of Hearing Research (MRC-IHR) has been engaged in research into APD and auditory learning for 8 years. This commentary is informed by and describes that and other research.

Results

Currently, APD is ill defined, and training-based interventions appear to have limited effectiveness. However, there remains a huge clinical and caregiver appetite for evidence-based information about children's listening difficulties and how they might be managed. MRC-IHR research suggests that both the problem and the solution revolve around auditory cognition and, in particular, working memory and attention. Children who are poor listeners tend to have a range of cognitive difficulties. But, results of training studies within and beyond auditory science indicate that training primarily influences sustained attention (focus) rather than more basic sensory detection or discrimination.

Conclusion

Providing logical and rigorous scientific information on the nature and alleviation of listening difficulties in children should remain a high priority for speech, language, and hearing research. We should be optimistic that collaboration between clinicians and researchers will result in much greater understanding and improved management of listening disorders in the near future.

Auditory Processing Theories of Language Disorders: Past, Present, and Future [Review]

Miller, C. A. — 2011-07-14T08:14:22-07:00

Purpose

The purpose of this article is to provide information that will assist readers in understanding and interpreting research literature on the role of auditory processing in communication disorders.

Method

A narrative review was used to summarize and synthesize the literature on auditory processing deficits in children with auditory processing disorder (APD), specific language impairment (SLI), and dyslexia. The history of auditory processing theories of these 3 disorders is described, points of convergence and controversy within and among the different branches of research literature are considered, and the influence of research on practice is discussed. The theoretical and clinical contributions of neurophysiological methods are also reviewed, and suggested approaches for critical reading of the research literature are provided.

Conclusion

Research on the role of auditory processing in communication disorders springs from a variety of theoretical perspectives and assumptions, and this variety, combined with controversies over the interpretation of research results, makes it difficult to draw clinical implications from the literature. Neurophysiological research methods are a promising route to better understanding of auditory processing. Progress in theory development and its clinical application is most likely to be made when researchers from different disciplines and theoretical perspectives communicate clearly and combine the strengths of their approaches.

Guiding Principles and Clinical Applications for Speech-Language Pathology Practice in Early Intervention [Clinical Forum: First Years, First Words: SLPs Providing Early Intervention Services]

Paul, D., Roth, F. P. — 2011-07-14T08:14:22-07:00

Purpose

This article describes guiding principles in early intervention (EI) and demonstrates how speech-language pathologists (SLPs) can apply these principles to best serve infants and toddlers with communication and related problems and their families.

Method

Four principles guide the implementation of speech-language pathology services. EI services are services that are (a) family centered and culturally and linguistically responsive; (b) developmentally supportive, promoting children's participation in their natural environments; (c) comprehensive, coordinated, and team based; and (d) based on the highest quality evidence available. Actual clinical scenarios are presented to illustrate each principle.

Results

The four principles provide a framework for the wide range of roles and responsibilities assumed by SLPs in EI: (a) screening/evaluation/assessment, (b) goal setting and intervention, (c) consultation with and education for team members, (d) service coordination, (e) transition planning, and (f) advocacy.

Conclusion

It is critical that families of infants and toddlers who are at risk for, or who have been diagnosed with, communication disorders receive all necessary services and supports. EI services should be tailored to the individual and the changing needs, preferences, and priorities of each family. The earlier services are provided, the more likely is the child's chance to develop effective communication.

Characterizing and Predicting Outcomes of Communication Delays in Infants and Toddlers: Implications for Clinical Practice [Clinical Forum: First Years, First Words: SLPs Providing Early Intervention Services]

Paul, R., Roth, F. P. — 2011-07-14T08:14:23-07:00

Purpose

This article focuses on using currently available data to assist speech-language pathologists (SLPs) in making decisions regarding a child's eligibility and considerations for recommended "dosage" of early intervention (EI) services.

Method

Literature describing the characteristics of infants and toddlers who are likely recipients of EI services was reviewed.

Results

Current literature provides information that can be used to inform clinical decisions for infants and toddlers with established medical conditions, as well as those with risk factors, for oral language, communication, and subsequent literacy disabilities. This information is summarized.

Conclusion

Extant literature suggests that EI makes a critical difference in the developmental course of communication as well as in other learning domains for children with a variety of established conditions. The literature also provides guidance to SLPs who must evaluate and weigh risk factors for children with less clear eligibility for services.

Testing and Beyond: Strategies and Tools for Evaluating and Assessing Infants and Toddlers [Clinical Forum: First Years, First Words: SLPs Providing Early Intervention Services]

Crais, E. R. — 2011-07-14T08:14:23-07:00

Purpose

This article is a condensation of the recent American Speech-Language-Hearing Association (ASHA) document entitled Roles and Responsibilities of Speech-Language Pathologists in Early Intervention: Guidelines (ASHA, 2008). The article presents information on recommended and evidence-based practices related to the screening, evaluation, and assessment of infants and toddlers with, or at risk for, communication deficits. It is intended to be used by clinicians to enhance their practices.

Method

The Guidelines document was developed using the available research evidence, expert clinical perspectives, and, when possible, family perspectives related to the screening, evaluation, and assessment process. The current article includes key definitions and an overview of recommended practices in screening, evaluation, assessment, and results interpretation.

Implications

The article provides important and timely information for professionals and families related to the screening, evaluation, and assessment of infants and toddlers with, or at risk for, communication deficits. Speech-language pathologists, other professionals, and family members can use the information to implement recommended and evidence-based practices when screening, evaluating, and assessing young children for communication deficits.

Participation as a Basis for Developing Early Intervention Outcomes [Clinical Forum: First Years, First Words: SLPs Providing Early Intervention Services]

Wilcox, M. J., Woods, J. — 2011-07-14T08:14:23-07:00

Purpose

This article describes how participation in activities/routines can be used as a basis for understanding children's communication and language skills and how that knowledge can be extended to collaborate with families and caregivers to develop meaningful early intervention outcomes.

Method

The approach is centered on children's use of communication and language skills to participate in typical activities/routines. Implementation of the approach is based on an understanding of children's performance abilities/disabilities and their use of those abilities to participate in family-identified activities/routines in their natural environments. Discussion and case examples illustrate how communication and language skills can enhance or enable participation in such activities. Family-centered procedures for gathering information about activities/routines from caregivers are described, and strategies for developing outcomes in collaboration with caregivers are presented.

Implications

Participation-based outcomes offer speech-language pathologists an option for embedding skills within important activities/routines, thereby promoting children's communication and language growth in natural contexts.

Collaborative Consultation in Natural Environments: Strategies to Enhance Family-Centered Supports and Services [Clinical Forum: First Years, First Words: SLPs Providing Early Intervention Services]

Woods, J. J., Wilcox, M. J., Friedman, M., Murch, T. — 2011-07-14T08:14:23-07:00

Purpose

This article presents current information on recommended practices related to the delivery of early intervention (EI) supports and services to infants and toddlers with, or at risk for, communication deficits and their families.

Method

The focus is on presenting the changing paradigm for speech-language pathologists (SLPs) working in EI based on the best available research evidence and expert opinion. The article includes a brief review of the recommended and promising practices for early communication intervention and applies the content to the role of the SLP as a consultant to caregivers. It provides strategies for "how to" join into the everyday activities/routines and places with the caregiver and child in order to facilitate caregiver-implemented intervention that will enhance caregiver–child interactions and promote the child's participation and learning. The importance of, and strategies for, collaborative consultation with diverse caregivers within a family-centered approach is presented.

Implications

This article provides important and timely information for professionals and families related to family-centered EI practices, caregiver-implemented interventions, adult teaching strategies, and collaborative consultation with families of infants and toddlers with, or at risk for, communication deficits. SLPs can use the information presented to inform their practices when working with these young children and their families.