abstract: Speech sound disorders (SSDs) are the most prevalent type of communication disorder in children. Clinically, speech-language pathologists (SLPs) rely on behavioral methods for assessing and treating SSDs. Though clients typically experience improved speech outcomes as a result of therapy, there is evidence that underlying deficits may persist even in individuals who have completed treatment for surface-level speech behaviors. Advances in the field of genetics have created the opportunity to investigate the contribution of genes to human communication. Due to the heterogeneity of many communication disorders, the manner in which specific genetic changes influence neural mechanisms, and thereby behavioral phenotypes, remains largely unknown. The purpose of this study was to identify genotype-phenotype associations, along with perceptual, and motor-related biomarkers within families displaying SSDs. Five parent-child trios participated in genetic testing, and five families participated in a combination of genetic and behavioral testing to help elucidate biomarkers related to SSDs. All of the affected individuals had a history of childhood apraxia of speech (CAS) except for one family that displayed a phonological disorder. Genetic investigation yielded several genes of interest relevant for an SSD phenotype: CNTNAP2, CYFIP1, GPR56, HERC1, KIAA0556, LAMA5, LAMB1, MDGA2, MECP2, NBEA, SHANK3, TENM3, and ZNF142. All of these genes showed at least some expression in the developing brain. Gene ontology analysis yielded terms supporting a genetic influence on central nervous system development. Behavioral testing revealed evidence of a sequential processing biomarker for all individuals with CAS, with many showing deficits in sequential motor skills in addition to speech deficits. In some families, participants also showed evidence of a co-occurring perceptual processing biomarker. The family displaying a phonological phenotype showed milder sequential processing deficits compared to CAS families. Overall, this study supports the presence of a sequential processing biomarker for CAS and shows that relevant genes of interest may be influencing a CAS phenotype via sequential processing. Knowledge of these biomarkers can help strengthen precision of clinical assessment and motivate development of novel interventions for individuals with SSDs. / Dissertation/Thesis / Doctoral Dissertation Communication Disorders 2020

Children with speech sound disorders (SSD) often have difficulties with speech perception. Speech perception is the ability to intake speech sounds and interpret them for meaning. Understanding children’s speech perception abilities is pertinent because children use perceptual skills to hone accurate production during SSD treatment. Different types of stimuli have been used in speech perception research. At present, it is unclear how different types of speech stimuli differentially impact speech perception in typical listeners or children with SSD. In this study, we investigated perceptual skills for different speech types in neurotypical adults to better understand how stimulus type impacts perception in individuals without SSD. Thus, we asked the following two research questions: 1) Is there a difference between synthetic speech (generated through a computer) and natural speech perception for adult listeners? 2) Is there a difference in interpersonal (listening to speech from another person) versus intrapersonal (listening to your own speech) natural speech perception for adult listeners? Twenty-five neurotypical adults participated in this study. Participants completed the Wide Range Acoustic Accuracy Scale (WRAAS) discrimination task for syllable pairs beginning with the phonemes /b/-/w/, /d/-/g/ and /r/-/w/ for synthetic speech, and rhyming words beginning with the same phonemes (‘bot’-‘watt’, ‘dot’-‘got’, ‘rot’-‘wot’) interpersonal synthetically altered natural speech (a standard speaker), and intrapersonal synthetically altered natural speech (each participant’s own voice recordings) for nine tasks total. Results show there was no statistical difference in discrimination ability between stimulus types for most phoneme contrasts, except for /d/-/g/ between synthetic and intrapersonal synthetically altered natural speech. There was no difference between interpersonal and intrapersonal perception of synthetically altered natural speech for any phoneme pair. Findings from this study will provide information for future similar studies conducted on children with and without SSD to determine how children perceive different types of speech. This future work will be used to help inform speech therapy decisions for children with SSD who may have speech perception difficulties.

Purpose: This study primarily investigates the effects and influence of frustration in children with childhood apraxia of speech (CAS) in the setting of intensive treatment. Additionally, the study examines the interrater reliability of the frustration rating scale used in an intensive CAS treatment study. Methods: Frustration and treatment data obtained from 17 participants (between 4;0-9;11 years) with CAS in an intensive treatment research study were retrospectively used to determine potential relationships related to frustration in treatment (target complexity, temporal conditions, session number, CAS severity). Interrater reliability of the frustration rating scale was assessed with 34 randomly selected treatment session videos scored by a blinded second rater and compared to original scores. Results: Interrater reliability of the scale was poor to fair but had relatively close agreement within one scale point. Frustration levels were observed to decrease over the course of the treatment period but were typically greater in the afternoon sessions compared to morning. Participants in the complex target treatment condition with lower frustration also exhibited better outcomes than those with greater frustration. No other relationships were observed. Conclusions: Due to relatively poor interrater reliability of frustration scoring system used to obtain data used in the current study, results of the study should be interpreted cautiously. There may be a relationship between frustration levels in children with CAS and treatment conditions and outcomes, but other factors may influence both variables and further investigation into frustration is necessary to draw stronger conclusions. / Public Health

Children with communication disorders are often at risk of literacy difficulties, especially students that present with autism and/or speech sound disorders. This quasi-experimental study was designed to examine the effects of a 10-week "hybrid" intervention for preschool students with and without communication disorders in an integrated classroom. The classroom intervention targets both vocabulary and phonological awareness, two critical components of literacy that are strongly correlated with one another. The objectives of this study were (1) to provide empirical evidence that classroom-based pre-literacy intervention can be effective for students with communication disabilities, allowing for more time with their peers in a potentially least-restrictive environment and (2) to demonstrate that typically-developing preschool children also benefit from classroom-based pre-literacy training.

This qualitative study analyzed interactions between clinicians and a male child, aged 5 years 9 months old, with significant phonological as well as language deficits within a meaning-based phonological intervention implemented over a nine-month period. Play-based intervention strategies were presented in activities that varied in communicative complexity. The clinician, along with graduate-student assistants, frequently modeled and elicited target word productions as they interacted with the child in routines and scripted play contexts. Transcriptions of interactions were analyzed using a conversational analysis that explored engagement and participation, turn taking, and linguistic complexity of utterances produced in adjacent turns. The analyses illustrated ways in which the clinicians structuring of the activities influenced the child's participation. The turn taking exchanges were topically related when dealing with shared, immediate context. The reciprocal nature of the turn taking exchanges, and the child's grammatical productions were analyzed. The study suggests that contextualized intervention can make speech sound production relevant for children with phonological production as well as language deficits.

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Despite a number of studies that have demonstrated positive outcomes for inducing clinical change in children with speech sound disorders (SSD), there is a need to address the question of whether resources are being applied in an optimal manner. As a consequence, there has been a call to look within interventions to examine parameters that may contribute to intervention outcomes; specifically the intensity of intervention (dose, frequency, duration, and cumulative intervention intensity). In this paper, empirical evidence from three intervention studies using multiple oppositions primarily, and a second contrastive approach, minimal pairs, is reported with regard to the parameters of intervention intensity. The findings indicated that greater intensity yields greater treatment outcomes. Further, quantitative and qualitative changes in intensity occur as intervention progresses, and there were differences in intensity based on severity of the SSD. Based on these data, suggestions were made toward establishing some prescribed amounts of intensity to affect treatment outcomes for children with SSD.

Purpose Our aim was to develop a taxonomy of elements comprising phonological interventions for children with speech sound disorders. Method We conducted a content analysis of 15 empirically supported phonological interventions to identify and describe intervention elements. Measures of element concentration, flexibility, and distinctiveness were used to compare and contrast interventions. Results Seventy-two intervention elements were identified using a content analysis of intervention descriptions then arranged to form the Phonological Intervention Taxonomy: a hierarchical framework comprising 4 domains, 15 categories, and 9 subcategories. Across interventions, mean element concentration (number of required or optional elements) was 45, with a range of 27 to 59 elements. Mean flexibility of interventions (percentage of elements considered optional out of all elements included in the intervention) was 44%, with a range of 29% to 62%. Distinctiveness of interventions (percentage of an intervention's rare elements and omitted common elements out of all elements included in the intervention [both optional and required]) ranged from 0% to 30%. Conclusions An understanding of the elements that comprise interventions and a taxonomy that describes their structural relationships can provide insight into similarities and differences between interventions, help in the identification of elements that drive treatment effects, and facilitate faithful implementation or intervention modification. Research is needed to distil active elements and identify strategies that best facilitate replication and implementation.