Speech and Language Therapy as a Transactional Process

I fell across this very intriguing paper in which the researchers used “bug in ear” devices to reinforce early childhood educators when they used language stimulation techniques with children in the preschool environment, specifically: following the child’s lead, offering the child choices, modeling correct language, waiting for responses, reinforcing desired responses, and expanding the child’s utterances. Three of these behaviors were selected individually for each educator because they did not or rarely used the strategy in practice. The researcher taught the educator to implement the strategy using modeling and role play activities and then deployed the “bug in ear” technology to reinforce use of the strategy while the educator was interacting with a specific child during play sessions in the natural preschool environment. Each strategy was introduced in turn using a multiple baseline single subject design, keeping child constant across each single subject experiment. The children were toddlers with autism spectrum and/or communication disorders. Child outcomes were described in terms of number of communicative attempts per minute whereas educator outcomes were described in terms of number of strategy uses per minute. The results were evaluated using an effect size metric designed for single subject experiments – the “improvement rate difference”. I have made a table of the results below for each of the four educator-child dyads, showing IRDs for the educator and the child during the intervention and maintenance phases, relative to baseline. Note that these verbal descriptions of effect size do not necessarily reflect the source of the effect. However, the raw data presentations of the multiple baseline experiments provide considerable confidence that the “bug in ear” technique was responsible for increases in strategy use by the educators. At the same time, any increases in communicative attempts by the children were not clearly associated with the intervention.


It can be seen from the table that the educators learned to use the strategies that were taught. The figures in the paper tell a more dramatic story with large and immediate increases in the use of each strategy as it was introduced to the educator by the researchers and reinforced using the “bug in ear” technology. Therefore this technology and the teaching strategies that were used proved to be a very effective option for improving clinical practice by practitioners. Presumably these teaching techniques could be used with our pre-professional students in our clinical programs. However, it was disappointing to see use of the strategies decline markedly after the researchers left the building (notice that IRDs are smaller during the maintenance phase (no bug in ear) than the intervention phase (bug in ear training phase). This is a known phenomenon – many researchers have remarked that extraordinary efforts must be made to maintain use of these strategies by educators. This study provides some clues as to why that might be. It can be seen that educators maintain their use of the strategies while they are receiving external reinforcement for doing so. During the active intervention stage the reinforcement comes from the researchers via the “bug in ear” technology. After the researchers stop providing this “unnatural” reinforcement, one might expect that the children themselves would provide ongoing reinforcements for the use of strategies designed to improve their communication skills. It can be seen here however that “natural” reinforcement is not forthcoming from the environment because the children are not substantially increasing their communicative attempts and most certainly not in direct response to the educators’ efforts.

This outcome reminds me of some old papers by Yoder and colleagues on the transactional nature of communicative exchanges between children with developmental delays and their parents and/or therapists. They were able to show that when prelinguistic milieu teaching changed the child’s behavior (i.e., increase in intentional communication), mothers changed their behavior in response (i.e., increased mapping of linguistic responses to the referent of the child’s communication). This transactional effect occurred even though the mothers were not involved in the direct (and rather directive) intervention that changed the child’s communication behaviors.

Francoise Brosseau-Lapré and I observed a similar effect in our recent study of speech therapy interventions to improve speech accuracy and phonological awareness. The study had multiple phases. Initially the children received individual speech therapy, observed by the parents. Then the parents were taught to implement a home program, in some cases a dialogic reading program in which the parents adopted a more active and directive teaching style when reading books with their child each evening. When this home program was preceded by an input oriented intervention, the dialogic reading intervention was a success, we believe because we first taught the children to listen carefully to speech input and to engage in reciprocal adult-child interactions. Alternatively, when the dialogic reading program was preceded by a traditional articulation therapy program, the parents reported that their children were annoyed by this new style of reading, preferring to be passive while the parent simply read the book. The children who experienced this combination of interventions did not experience as good outcomes as the children who experienced the former combination of interventions. We were unable to follow-up these families due to an unfortunate change in priorities by the funder. However, I strongly suspect the parents whose children were annoyed by dialogic reading would not be motivated to keep it up!

Currently when young children show delays in the development of communication skills it is common to work with the parents, entreating them to learn and increase the use of strategies that come naturally to middle class parents of children with normally developing speech and language. It is critical to understand the role of the child in eliciting and maintaining those behaviors however. Speech and language therapy cannot be expected to be effective without simultaneous attention to the child and the child’s environment.


Rvachew, S., & Brosseau-Lapré, F. (2015). A randomized trial of twelve week interventions for the treatment of developmental phonological disorder in francophone children. American Journal of Speech-Language Pathology, 24, 637-658.

Flowers, H., Girolametto, L., Weitzman, E., & Greenberg, J. (2007). Promoting early literacy skills: Effects of in-service education for early childhood educators. Canadian Journal of Speech-Language Pathology and Audiology, 31, 6-18

Ottley, J. R., & Hanline, M. F. (2014). Bug-in-Ear Coaching: Impacts on Early Childhood Educators’ Practices and Associations With Toddlers’ Expressive Communication. Journal of Early Intervention, 36(2), 90-110. doi:10.1177/1053815114563614

Wasik, B. A., Bond, M. A., & Hindman, A. (2006). The effects of a language and literacy intervention on Head Start children and teachers. Journal of Educational Psychology, 98(1), 63-74.

Yoder, P.J., Warren, S.F., Kim, K. & Gazdag, G.E. (1994). Facilitating prelinguistic communication skills in young children with developmental delay II: Systematic replication and extension. Journal of Speech and Hearing Research, 37, 841-851.

Acquisition of Fricatives in Icelandic and French

I point out in this blog a recent paper by Bernhardt and colleagues describing fricative production by Icelandic preschoolers with “protracted phonological development”. Icelandic-speaking children with speech problems produced /f,s,θ/ with about 70% accuracy by four years of age. The English-speaking children with speech problems achieved less than 15% accuracy on the single word naming task (those of us who work with those children are not surprised!). Error patterns were different as well (for example, the Icelandic children substituted [t] for /f/ whereas the English children substituted [p] for /f/). The study is a nice reminder of the need for language specific articulation tests for children with intelligibility problems whose first language is not the majority language. There are no universal developmental patterns. Therefore we can be grateful to Sharynne McLeod and the International Working Group on Multilingual Children’s Speech for their great site.

A point of theory in the paper was the failure to support the hypothesis of “higher overall fricative accuracy for English, because English has more fricative types.” This hypothesis was put forward because Edwards, Beckman and Munson concluded that “the more words containing a sound that a child has learned to say, the more practiced the child becomes at recognizing and reproducing the sound abstracted away from the phonological contexts of a few specific words.” One example given is the case of /ð/ in English. I was surprised that an alternative hypothesis, considering the prosodic structure of Icelandic, was not tested. Perhaps the authors didn’t want to attempt this because it is so hard to understand the prosodic structure of Icelandic! I certainly will not try to do this. However I point out that French and Icelandic are characterized by earlier acquisition of fricatives compared to English:

Acq of Fric

Françoise and I have previously pointed out that the prosody of French helps children learn the segments. Several studies now confirm that French-speaking children learn consonants early: they have a complete consonant repertoire at an early age and they master accurate production of the consonants at an early age (compared to English). Furthermore, French-speaking children with speech problems produce more syllable structure and fewer segmental errors (compared to English-speaking children with speech problems). How does the prosody of French explain these findings? French is a syllable timed language with a tendency toward long words made of several syllables having equal stress. The syllables tend to have a simple CV structure even though complex onsets and codas are allowed. The difference between the two languages can be observed in the ratio of consonants to vowels, being 1.6 in French and 2.1 in English.

Recall that when children first learn to speak, they learn to produce “whole words” and not strings of individual segments; these first whole words act as templates for the production of more words. These initial templates are often made up of reduplicated or partially reduplicated syllables. Possibly, if the initial word shape template is easy to learn or construct, more processing power is left over to acquire the segments inside the syllables. Furthermore, simple stressed syllables in French may increase the perceptual salience of those segments. Vihman provides wonderful examples of this process in her very excellent paper on templatic phonology. The French child, Gael, saying words like ‘accroché’ [χʁoʃe] at age 21 months is rather fun to see!

Possibly the same process occurs in Icelandic which has a very particular prosody that may also increase the perceptual salience of postvocalic consonants, fricatives in particular. I will not attempt an explanation, the phonology of Icelandic being quite beyond me, but any explanation for the early acquisition of these phonemes must take the prosodic (word shape) characteristics of early child input into account.

In the meantime some more general points strike me. It is impossible for us as speech-language pathologists or academics to understand the process of speech development without data and it is disheartening how little data there is on these languages. Basic information such as the types and tokens of fricatives that are presented to children in the input across languages is difficult to find. We need to know much more about the prosody of all these languages but prosody receives scandalously little attention compared to, for example, consonants.

We also need to know more about the processes by which children select and construct their early word templates. This requires painstaking small sample detailed longitudinal work and large, large sample laboratory work using creative paradigms, some probably not invented yet. However, all our work is perilously underpowered and underfunded.

Finally we need huge diversity in academia – lots and lots of movement of students across the world, bringing new techniques to new languages. Unfortunately in the past few days, in the aftermath of Brexit, I have encountered many depressing conversations on the internet about the control of borders. Even in the domain of “highly qualified personnel”, some graduates are deemed more worthy than others and we all know where the humanities fall on the ranking! I prefer not to counter this sort of thinking with purely utilitarian arguments, but clearly it is short sighted given the importance of communication and communication disorders. On a more positive note I close by congratulating the excellence of child phonology projects sustained on a wing and a prayer such as the Cross-linguistic Child Phonology Project led by Bernhardt and colleagues and also the Paidologos project led by Edwards and colleagues.



Bernhardt, B. M., Másdóttir, T., Stemberger, J. P., Leonhardt, L., & Hansson, G. Ó. (2015). Fricative acquisition in English- and Icelandic-speaking preschoolers with protracted phonological development. Clinical Linguistics & Phonetics, 29(8-10), 642-665. doi:10.3109/02699206.2015.1036463

Brosseau-Lapré, F., & Rvachew, S. (2014). Cross-linguistic comparison of speech errors produced by English- and French-speaking preschool age children witih developmental phonological disorders. International Journal of Speech-Language Pathology, 16(2), 98-108.

Edwards, J., Beckman, M. E., & Munson, B. (2015). Frequency effects in phonological acquisition. Journal of Child Language, 42(02), 306-311. doi:doi:10.1017/S0305000914000634

MacLeod, A. A. N., Sutton, A., Trudeau, N., & Thordardottir, E. (2011). The acquisition of consonants in Québec French: A cross-sectional study of preschool aged children. International Journal of Speech-Language Pathology, 13, 93-109.

Rvachew, S., Marquis, A., Brosseau-Lapré, F., Paul, M., Royle, P., & Gonnerman, L. M. (2013). Speech articulation performance of francophone children in the early school years: Norming of the Test de Dépistage Francophone de Phonologie. Clinical Linguistics & Phonetics, 27(12), 950-968. doi:doi:10.3109/02699206.2013.830149