Purpose The aim of this tutorial is to support speech-language pathologists (SLPs) undertaking assessments of multilingual children with suspected speech sound disorders, particularly children who speak languages that are not shared with their SLP. Method The tutorial was written by the International Expert Panel on Multilingual Children's Speech, which comprises 46 researchers (SLPs, linguists, phoneticians, and speech scientists) who have worked in 43 countries and used 27 languages in professional practice. Seventeen panel members met for a 1-day workshop to identify key points for inclusion in the tutorial, 26 panel members contributed to writing this tutorial, and 34 members contributed to revising this tutorial online (some members contributed to more than 1 task). Results This tutorial draws on international research evidence and professional expertise to provide a comprehensive overview of working with multilingual children with suspected speech sound disorders. This overview addresses referral, case history, assessment, analysis, diagnosis, and goal setting and the SLP's cultural competence and preparation for working with interpreters and multicultural support workers and dealing with organizational and government barriers to and facilitators of culturally competent practice. Conclusion The issues raised in this tutorial are applied in a hypothetical case study of an English-speaking SLP's assessment of a multilingual Cantonese- and English-speaking 4-year-old boy. Resources are listed throughout the tutorial.

Abstract The multiple oppositions approach (Williams, 1992; 2000) was incorporated as the beginning point of intervention for 10 children who exhibited moderate-to-profound phonological impairments. Several variables that potentially affect phonological change were examined in a longitudinal case study of these children. Different models of intervention (multiple oppositions, minimal pairs, and naturalistic speech intelligibility training) were incorporated within different structures of treatment (vertical, horizontal, and cyclical) using a model of phonologic learning that was based on a developmental structuring of intervention. This nontraditional research paradigm is proposed as a possible bridge to link the science and practice of clinical research. Specifically, the clinical reality of providing intervention to children from their initial treatment to discharge provides a broader perspective of treatment efficacy while also serving as a foundation for future areas of more controlled investigations of specific variables.

Abstract A multiple opposition approach to phonological intervention is described as an alternative contrastive approach for the treatment of severe speech disorders in children. The development and theoretical constructs of this approach are presented within the context of a clinical case study. The multiple opposition approach is based on the premise that the systemic level of phonological organization is essential in the description and intervention of disordered sound systems. Phonological descriptions identify phoneme collapses, which are viewed as phonologic strategies developed by the child to accommodate a limited sound system relative to the full adult system of the ambient language. Intervention is then directed systemically across the child’s entire rule, or collapse, by using larger treatment sets of multiple oppositions rather than by one contrast at a time.

Currently a need exists in South Africa for an age-, linguistically- and culturally appropriate perceptual speech assessment protocol for Zulu-speaking pre-school children with cleft palate. The aim of this study was to develop a reliable perceptual speech assessment protocol for Zulu-speaking pre-school children with cleft palate based on the international guidelines (www.eurocran.org). Furthermore the clinical applicability and relevance of these guidelines for the perceptual assessment of cleft palate speech in the Zulu language were determined. The aims were reached by following a mixed methods research approach and by conducting the research in four phases. In phase one the protocol was compiled with the assistance of an expert Zulu linguist, in phase two the protocol was pre-tested on 12 normal Zulu-speaking pre-school children between three and six years of age; in phase three the perceptions of speech-language therapists regarding the clinical applicability of the protocol were determined after administration thereof on 12 Zulu-speaking pre-school children with cleft palate between the ages of three and six years; and finally in phase four the relevance of applying the international guidelines to the Zulu language was reflected on. A critical analysis of the protocol indicated that the international guidelines (www.eurocran.org) could be used to develop a perceptual speech assessment protocol in an African language namely Zulu. Results of the pilot study revealed that the protocol was age, culturally and linguistically appropriate for normal Zulu-speaking pre-school children. The speech-language therapist participants indicated that the protocol was clinically applicable to Zulu-speaking pre-school children with cleft lip and palate in terms of cultural sensitivity, administration time and its ability to elicit and identify cleft palate speech characteristics. The international guidelines (www.eurocran.org) could be applied to the Zulu language with an emphasis on the click sounds in Zulu. The results have clinical implications for cleft palate service delivery in South Africa. These implications were for in-service training of speech-language therapists regarding cleft palate to provide them with evidence-based guidelines for clinical practice. Implications for further research included the development of norms of speech development in the Zulu language and the standardization of the perceptual speech assessment protocol. This study is valuable as it is the first tool for the perceptual assessment of cleft palate speech in Zulu. The research methodology may serve as an example for the development of similar speech assessment protocols for children with cleft palate in other African languages. AFRIKAANS: Tans bestaan daar ‘n behoefte in Suid-Afrika vir ‘n ouderdoms-, taal- en kultureel toepaslike persepsuele spraak assesseringsmateriaal vir Zoeloe-sprekende voorskoolse kinders met gesplete lip en verhemelte. Die doel van hierdie studie was om ‘n betroubare en geldige Zoeloe persepsuele spraak assesseringsprotokol vir voorskoolse kinders met gesplete lip en verhemelte te ontwikkel gebasseer op die internasionale riglyne (www.eurocran.org). Die kliniese toepaslikheid en relevansie van die internasionale riglyne vir die persepsuele assessering van gesplete lip en verhemelte is bepaal. Die doelwitte is bereik deur ‘n gemengde kwalitatiewe en kwantitatiewe navorsingsmetode te volg asook deur die navorsing in vier fases uit te voer. In fase een is die protokol ontwikkel met die bystand van ‘n Zoeloe taalkundige, in fase twee is die protokol getoets op 12 normale Zoeloe-sprekende kinders tussen drie en ses jaar, in fase drie is die persepsies van drie spraak-taalterapeute verkry aangaande die kliniese toepaslikheid van die protokol na afloop van evaluasies op 12 Zoeloe-sprekende voorskoolse kinders met gesplete lip en verhemelte tussen drie en ses jaar, in fase vier is gereflekteer op die toepaslikheid van die internasionale riglyne vir Zoeloe. ‘n Kritiese analise van die protokol het aangedui dat die internasionale riglyne (www.eurocran.org) gebruik kon word om ‘n persepsuele spraak assesseringsprotokol in ‘n Afrika taal, naamlik Zoeloe, op te stel. Resultate van die voorstudie het aangedui dat die protokol taal-, ouderdoms- en kultureel toepaslik was vir die normale Zoeloe-sprekende voorskoolse kinders. Die spraak-taalterapeute as deelnemers het aangedui dat die protokol klinies toepaslik was vir voorskoolse kinders met gesplete lip en verhemelte in terme van die kulturele sensitiwiteit van die protokol, administrasie tyd asook die vermoë om die spesifieke gesplete lip en verhemelte spraakkenmerke te ontlok. Die internasionale riglyne (www.eurocran.org) kon gevolg word vir Zoeloe met insluiting van die suigklanke in die Zoeloe taalstruktuur. Die resultate het implikasies vir dienslewering in Suid-Afrika met betrekking tot gesplete lip en verhemelte. Hierdie implikasies sluit in-diens opleiding van spraak-taalterapeute in om aan hul riglyne te verskaf vir beste praktyk. Implikasies vir verdere navorsing omsluit die ontwikkeling van norme in terme van die spraak ontwikkeling in Zoeloe asook die moontlike standardisering van die persepsuele spraak asesseringsprotokol. Die studie is waardevol aangesien dit die eerste poging was om ‘n persepsuele spraak assesseringsprotokol in Zoeloe te ontwikkel vir die evaluasie van kinders met gesplete lip en verhemelte. Die navorsingsmetodologie kan gevolg word vir die ontwikkeling van soortgelyke spraak assesseringprotokolle vir kinders met gesplete lip en verhemelte in ander Afrika tale. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted

La maladie d'Alzheimer (MA) – la forme la plus courante de trouble neurocognitif majeur – se caractérise typiquement par des troubles progressifs et insidieux de la mémoire épisodique. Des déficits langagiers font également partie du portrait clinique de la maladie, et sont déjà présents au stade préclinique du trouble neurocognitif léger (TNCL). Des difficultés sur le plan de la production du langage ont été rapportées dans la MA et même le TNCL, ce qui suggère que son évaluation pourrait représenter une opportunité unique de détection précoce du déclin cognitif. Un consensus croissant propose d’ailleurs que le langage spontané (LS) pourrait permettre une évaluation écologiquement valide des capacités de production langagière. Toutefois, les résultats d’études s’étant penchées sur l’évaluation du LS ne convergent pas tous pour dresser un portrait clair de l’impact du déclin cognitif sur la production langagière dans la MA, et moindrement encore dans le TNCL. La première partie de la thèse visait ainsi à décrire de façon exhaustive l’étendue de la recherche dans le domaine de l'évaluation du LS dans les populations MA et TNCL, en réalisant un examen de la portée (étude 1). Les résultats ont révélé que l’évaluation traditionnelle du LS consistait le plus souvent en une analyse quantitative d’une sélection de variables microlinguistiques de LS obtenu à l’aide d’une mesure descriptive standardisée. Ayant répliqué le patron des déficits langagiers largement répandu dans les écrits scientifiques, les résultats de l’examen de la portée soulignent l’apport complémentaire de l’évaluation du LS à l’évaluation globale du langage dans les populations MA et TNCL. Toutefois, l’examen de la portée a également souligné d’importantes lacunes dans le domaine de recherche, notamment le très peu d’études s’étant intéressées au TNCL comparativement à la MA, ainsi que le très peu d’approches écologiques à l’évaluation du LS. Prenant en compte ces lacunes, la deuxième partie de la thèse visait à examiner l’apport d’une évaluation écologique du LS auprès de participants TNCL et de contrôles, dans un contexte expérimental se rapprochant de la vraie vie (étude 2). Plus précisément, une évaluation fonctionnelle des actes de langage produits par ces deux groupes lors de la réalisation, dans un appartement-test, de tâches écologiques inspirées d'activités de la vie quotidienne a été réalisée. La description qualitative des actes de langage spontanément produits pendant la planification et l'exécution de ces tâches complexes a permis d'extraire des stratégies, des barrières et des réactions distinctes en réponse aux demandes des tâches ainsi qu'aux difficultés rencontrées chez les participants TNCL et contrôles. Ainsi, les résultats ont montré que les participants TNCL mettaient en place moins de stratégies proactives avant d’entamer l’expérimentation, puis davantage de stratégies compensatoires pour supporter leur organisation des tâches pendant leur exécution. Plus distraits et moins portés à tenir compte de l’assistance offerte, ils validaient et justifiaient davantage leur performance de façon défensive et étaient plus réactifs à leurs difficultés que les sujets contrôles. Les résultats de la deuxième étude de la thèse soulignent ainsi l’apport novateur d’une évaluation fonctionnelle du LS comme outil d'exploration de l'impact du déclin cognitif lors de tâches écologiques complexes se rapprochant d'activités de la vie quotidienne. Ensemble, les études de la thèse convergent pour appuyer l’apport complémentaire d'une évaluation fonctionnelle du LS à son évaluation traditionnelle dans l’avancement des connaissances au sujet de l’impact du déclin cognitif dans les populations TNCL et MA sur la production langagière. / Alzheimer's disease (AD) – the most common form of major neurocognitive disorder – is typically characterized by progressive and insidious impairment of episodic memory. Language deficits are also part of the clinical picture of the disease, and are already present in the preclinical stage of mild neurocognitive disorder (mild NCD). Difficulties in language production have been reported in AD and even in mild NCD, suggesting that its assessment may represent a unique opportunity for early detection of cognitive decline. There is a growing consensus that connected speech (CS) may provide an ecologically valid assessment of language production abilities. However, the results of studies that have examined CS assessment do not all converge to provide a clear picture of the impact of cognitive decline on language production in AD, and even less so in mild NCD. The first part of the thesis thus aimed to comprehensively describe the extent of research in the area of CS assessment in AD and mild NCD populations, by conducting a scoping review (study 1). The results revealed that traditional CS assessment most often consisted of quantitative analysis of a selection of microlinguistic variables of CS, obtained using a standardized descriptive measure. Having replicated the pattern of language deficits widely found in the scientific literature, the results of the scoping review highlight the complementary contribution of CS assessment to the overall assessment of language in AD and mild NCD populations. However, the scoping review also highlighted important gaps in the research field, including the very few studies that have focused on mild NCD in comparison to AD, as well as the very few ecological approaches to CS assessment. Taking these gaps into account, the second part of the thesis thus aimed to examine the contribution of a functional assessment of CS that is closer to the context of real life, with mild NCD participants and controls (study #2). More precisely, a functional assessment of the speech acts produced by these two groups during the performance of ecological tasks inspired by activities of daily living in a laboratory-apartment was carried out. Qualitative description of the speech acts spontaneously produced by these participants while performing complex tasks allowed for the extraction of distinct strategies, barriers and reactions in response to task demands as well as to the difficulties encountered by the mild NCD participants and controls. Thus, results showed that mild NCD participants implemented fewer proactive strategies before beginning the experiment, and then more compensatory strategies to support their task organization during task execution. More distracted and less likely to take into account the assistance offered, they validated and justified their performance more defensively and were more reactive to their difficulties than the control subjects. The results of the second article of the thesis thus highlight the innovative contribution of a functional assessment of CS as a tool for exploring the impact of cognitive decline in complex, ecological tasks that are similar to activities of daily living. Together, the studies in this thesis converge to support the complementary contribution of a functional assessment of CS to its traditional assessment in advancing knowledge about the impact of cognitive decline on language production in the mild NCD and AD populations.