Using SAILS to Assess Speech Perception in Children with SSD

I am very excited to see an Australian replication of the finding that children with a Speech Sound Disorder (SSD) have difficulty with speech perception when tested with a word identification test implemented with recordings of children’s speech. Hearnshaw, Baker, and Munro (2018) created a task modeled on my Speech Assessment and Interactive Learning (SAILS) program. A different software platform was used to present the stimuli and record the children’s responses. The critical elements of SAILS were otherwise replicated but there were some significant differences as shown in the table below.

Hearnshaw compare SAILS

The most important differences are the younger age of the children and the targeting of phonemes with older expected ages of acquisition. Furthermore there are 12 stimuli per block and two target words per target phoneme in Hearnshaw versus 10 stimuli per block and one target word per target phoneme in my own assessment studies. In Hearnshaw the practice procedures involved fewer stimuli and less training on the task. Finally, the response mode was more complex in Hearnshaw and the response alternatives do not replicate mine. Therefore this study does not constitute a replication of my own studies and I might expect lower performance levels compared to that observed by the children tested in my own studies (I say this before setting up the next table, let’s see what happens). None-the-less, we would all expect that children with SSD would underperform their counterparts with typically developing speech especially given the close matching on age and receptive vocabulary in Hearnshaw and my own studies.

Hearnshaw SAILS data comparison table

Looking at the data in the above table, the performance of the children with SSD is uniformly lower than that of the typically developing comparison groups. Hearnshaw’s SSD group obtained a lower score overall when compared to the large sample that I reported in 2006 but slightly higher when compared to the small sample that I reported in 2003 (that study was actually Alyssa Ohberg’s undergraduate honours thesis). It is not clear that any of these differences are statistically significant so I plotted them with standard error bars below.

Hearnshaw SAILS comparison figure

The chart does reinforce the impression that the differences between diagnostic groups are significant. It is not clear about the differences across studies. It is possible that the children that Alyssa tested were more severely impaired than all the others (the GFTA is not the same as the DEAP so it is difficult to compare) or more likely the best estimate is in the third study with the largest sample size. Nonetheless, the message is clear that typically developing children in this age range will achieve scores above 70% accurate whereas children with SSD are more likely to achieve scores below 70% accurate which suggests that they are largely guessing when making judgements about incorrectly produced exemplars of the target words. Hearnshaw et al. and I both emphasize the within group variance in perceptual performance by children with SSD. Therefore, it is important to assess these children’s speech perception abilities in order to plan the most suitable intervention.

And with that I am happy to announce that the iPad version of SAILS is now available with all four modules necessary to compare to the normative data that is presented below for three age groups.

SAILS Norms RBL 2018

Specifically, the modules that are currently available for purchase ($5.49 CAD per module) are as follows:

-“k”: cat (free)

-“l”: lake

-“r”: rat, rope, door

“s”: Sue, soap, bus

Please see www.dialspeech.com for more information from me and Alex Herbay who wrote the software, or go directly to the app store: SAILS by Susan Rvachew and Alex Herbay

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Reproducibility: On the Nature of Scientific Consensus

The idea that scientists who raise questions about whether (ir)reproducibility is a crisis or not are like the “merchants of doubt” is argued via analogy with, for example, climate change deniers. It’s a multistep analogy. First there is an iron-clad consensus on the part of scientists that humans are causing a change in the climate that will have catastrophic consequences. Because the solutions to the problem threaten corporate interests, those big money interests astroturf groups like “Friends of Science” to sow doubt about the scientific consensus in order to derail the implementation of positive policy options. For the analogy on Bishop’s Blog to work, there must first be a consensus among scientists that the publication of irreproducible research is a crisis, a catastrophe even. I am going to talk about this issue of consensus today although it would be more fun to follow that analogy along and try to figure out whether corporate interests are threatened by more or less scientific credibility and how the analogy works when it is corporate money that is funding the consensus and not the dissenters! But anyway, on the topic of consensus…

The promoters of the reproducibility crisis have taken to simply stating that there is a consensus, citing most frequently a highly unscientific Nature poll. I know how to create scientific questionnaires (it used to be part of my job in another life before academia) and it is clear that the question “Is there a reproducibility crisis?” with the options “crisis,” “slight crisis” (an oxymoron) and “no crisis” is a push poll. The survey was designed to make it possible for people to claim “90% of respondents to a recent survey in Nature agreed that there is a reproducibility crisis” which is how you sell toothpaste, not determine whether there is a crisis or not. On twitter I have been informed, with no embarrassment, that unscientific polls are justified because they are used to “raise awareness”. The problem comes when polls that are used to create a consensus are also used as proof of that consensus. How does scientific consensus usually come about?

In many areas of science it is not typical for groups of scientists to formally declare a consensus about a scientific question but when there are public or health policy implications working groups will create consensus documents, always starting with a rigorous procedure for identifying the working group, the literature or empirical evidence that will be considered, the standards by which that evidence will be judged and the process by which the consensus will emerge. Ideally it is a dynamic and broad based exercise. The Intergovernmental Panel on Climate Change is a model in this regard and it is the rigorous nature of this process that allows us to place our trust in the consensus conclusion even when we are not experts in the area of climate. A less complex and for us more comprehensible example is the recent process employed by the CATALISE consortium to propose that Specific Language Impairment be reconceptualised as Developmental Language Disorder. This process meets all the requirements of a rigorous process with the online Delphi technique an intriguing part of the series of events that led to a set of consensus statements about the identification and classification of developmental language disorders. Ultimately each statement is supported by a rationale from the consortium members including scientific evidence when available. The consortium itself was broad based and the process permitted a full exposition of points of agreement and disagreement and needs for further research. For me, importantly, a logical sequence of events and statements is involved-the assertion that the new term be used was the end of the process, not the beginning of it. The field of speech-language pathology as a whole has responded enthusiastically even though there are financial disincentives to adopting all of the recommendations in some jurisdictions. Certainly the process of raising awareness of the consensus documents has had no need of push polls or bullying. One reason that the process was so well received, beyond respect for the actors and the process, is that the empirical support for some of the key ideas seems unassailable. Not everyone agrees on every point and we are all uncomfortable with the scourge of low powered studies in speech and language disorders (an inevitable side effect of funder neglect); however, the scientific foundation for the assertion that language impairments are not specific has reached a critical mass, and therefore no-one needs to go about beating up any “merchants of doubt” on this one. We trust that in those cases where the new approach is not adopted it is generally due to factors outside the control of the individual clinician.

The CATALISE process remains extraordinary however. More typically a consensus emerges in our field almost imperceptibly and without clear rationale. When I was a student in 1975 I was taught that children with “articulation disorders” did not have underlying speech perception deficits and therefore it would be a waste of time to implement any speech perception training procedures (full stop!). When I began to practice I had reason to question this conclusion (some things you really can see with your own eyes) so I drove into the university library (I was working far away in a rural area) and started to look stuff up. Imagine my surprise when I found that the one study cited to support this assertion involved four children who did not receive a single assessment of their speech perception skills (weird but true). Furthermore there was a long history of studies showing that children with speech sound disorders had difficulties with speech discrimination. I show just a few of these in the chart below (I heard via Twitter that, at the SPA conference just this month in Australia, Lise Baker and her students reported that 83% of all studies that have looked at this question found that children with a speech sound disorder have difficulties with speech perception). So, why was there this period from approximately 1975 through about 1995 when it was common knowledge that these kids had no difficulty with speech perception? In fact some textbooks still say this. Where did this mistaken consensus come from?

When I first found out that this mistaken consensus was contrary to the published evidence I was quite frankly incandescent with rage! I was young and naïve and I couldn’t believe I had been taught wrong stuff. But interestingly the changes in what people believed to be true were based on changes in the underlying theory which is changing all the time. In the chart below I have put the theories and the studies alongside each other in time. Notice that the McReynolds, Kohn, and Williams (1975) paper which found poorer speech perception among the SSD kids, actually concluded that they didn’t, contrary to their own data but consistent with the prevailing theory at the time!

History of Speech Perception Research

What we see is that in the fifties and sixties, when it was commonly assumed that higher level language problems were caused by impairments in lower level functions, many studies were conducted to prove this theory and in fact they found evidence to support that theory with some exceptions. In the later sixties and seventies a number of theories were in play that placed strong emphasis on innate mechanisms. There were few if any  studies conducted to examine the perceptual abilities of children with speech sound disorders because everyone just assumed they had to be normal on the basis of the burgeoning field of infant perceptual research showing that neonates could perceive anything (not exactly true but close enough for people to get a little over enthusiastic). More recently emergentist approaches have taken hold and more sophisticated techniques for testing speech perception have allowed us to determine how children perceive speech and when they will have difficulty perceiving it. The old theories have been proved wrong (not everyone will agree on this because the ideas about lower level sensory or motor deficits are zombies; the innate feature detector idea, that is completely dead; for the most part, the evidence is overwhelming and we have moved on to theories that are considerably more complex and interesting, so much so that I refer you to my book rather than trying to explain them here).

The question is, on the topic of reproducibility, whether it would have been or would be worthwhile for anyone to try and reproduce, let’s say Kronvall and Diehl (1952) just for kicks? No! That would be a serious waste of time as my master’s thesis supervisor explained to me in the eighties when he dragged me more-or-less kicking and screaming into a room with a house-sized vax computer to learn how to synthesize speech (I believe I am the first person to synthesize words with fricatives, it took me over a year). It is hard to assess the clinical impact of all that fuzzy thinking through the period 1975 – 1995. But somehow, in the long run we have ended up in a better place. My point is that scientific consensus arises from an odd and sometimes unpredictable mixture of theory and evidence and it is not always clear what is right and what is wrong until you can look back from a distance. And despite all the fuzziness and error in the process, progress marches on.

Speech Perception and Persistent Speech Errors

Jon Preston is in my opinion the most interesting researcher to watch in the field of speech sound disorders. His recent studies on structural and functional brain differences in older children with persistent speech errors are very interesting. The two studies complement each other and point to structural and functional differences in supra superior temporal gyrus, consistent with repeated findings of perceptual deficits in children with speech deficits. Additional differences in supramarginal gyrus implicate integration of auditory and somatosensory information during feedback processes that are important for learning to produce speech sounds as well as monitoring and fine-tuning speech sound production as the articulatory system matures.

Given these neuroimaging findings, it makes sense to look for behavioral indices of perceptual difficulties in this population of children with persistent speech sound errors. Recently Preston et al (2015) used SAILS to do this with two different groups of school aged children. SAILS is a tool that I developed for speech therapy with preschoolers. Each module consists of natural speech recordings of adults and children producing a word that begins with a commonly misarticulated phoneme, for example, the word “rat”. Half the words are produced correctly and the remainder are misarticulated, e.g., [wæt], [jæt], [ɹ̮æt]. Each module is designed as a series of blocks in which the contrasts are theoretically closer, e.g., practice [ɹæt] versus [mæt], block 1 [ɹæt] versus [wæt], [jæt] and block 2 [ɹæt] versus [ɹ̮æt].  The child’s task is to identify the words that are “good” representatives of the target word. Although the blocks are numbered, they do not necessarily fall into a linear difficulty scale because each child can be quite idiosyncratic in terms of the features that they attend to. I’ll come back to this point later. After establishing that the tool was effective as an intervention for improving children’s speech perception and speech production skills, I found that it also had some value as an assessment tool (Rvachew & Grawburg, 2006) although I do not feel that the psychometric qualities are particularly good and I certainly did not design it for that purpose.

Now, back to Jon Preston’s study. In the first study, older children with [ɹ] distortions were compared to children with correctly produced [ɹ] and no history of speech delay. They were administered only the “most difficult” levels of SAILS modules including the [ɹ] Level 2 module. Although 1/20 children with typical speech and 6/27 misarticulators failed the [ɹ] SAILS module, the mean difference between groups was not significant. In the second study, a group of 25 children who received speech therapy as preschoolers was tested with SAILS, 3 years later when the speech deficit was resolved except in some cases for a persistent speech sound distortion. Performance on the “most difficult” [s] or [ɹ] module was correlated with their performance on an [s] or [ɹ] production probe. There was no correlation. (I was initially mystified by the perception results because they didn’t look like anything I had seen before but that was before I realized that the children were not presented with the complete test!).

So, how do we interpret these results? I have three comments.

First, Preston, Irwin, & Turcios have done us all a good turn by establishing that SAILS is NOT a good tool for assessing speech perception in 7 to 14 year old children with persistent speech errors. I never intended it for that purpose and I am pleased to have empirical evidence that supports a clear answer to the question when it comes up (we should be grateful to Seminars in Speech and Language for publishing it I suppose, despite the small samples, because rumour has it that ‘negative results’ are hard to publish). Anyway, we need something better for testing speech perception, especially for older children. I invite reader comments on what that “something better” would be. We know from many studies using synthetic speech that this population is at risk for perceptual deficits. We need to be able to identify those children in the clinic.

Second, if you are going to use SAILS for assessment (with children aged 4 to 7) it is very important to administer the complete module to the child, working through all the levels of the module, in order as intended. We cannot be sure that the child’s response to, for example Level 3 /s/, will mirror that of the normative samples who encountered Level 3 after first working through Practice, Level 1 and Level 2 before getting there. I will come back to this in another post in which I will give a sneak peek at the upcoming second edition of our book Developmental Phonological Disorders: Foundations of Clinical Practice.

Third, the relationship between speech perception and speech production is not linear. Even though I have found relationships between speech perception and speech production in the past using some rather fancy statistics with large groups (Rvachew & Grawburg, 2007; Rvachew, 2006), I cannot at the individual child level relate in a simple fashion SAILS score with number of correct productions of a phoneme. The reason is that the child’s production and perception of a phoneme is related to the way in which the child attends to the features associated with phoneme contrasts and certain features have different information value for perception versus production. We give an example of this in Chapter 4 of DPD (from Alyssa Ohberg’s masters thesis): preschoolers who were stimulable for /θ/ and /s/ but had not mastered this contrast were administered the SAILS /θ/ assessment module. Some children, in their speech, differentiated /s/-/θ/ by manipulating the duration cue whereas others differentiated /s/-/θ/ by manipulating the spectral cue; as you would expect, manipulating the spectral cue resulted in comparatively better articulatory accuracy but these two groups produced roughly comparable perceptual performance but with some interesting differences. The children who attended to the spectral cue actually did better on the supposedly “harder” level 3 stimuli than the supposedly “easier” level 2 stimuli, highlighting again that there is not a linear difficulty gradient across the stimulus blocks. The children who attended to the duration cue did surprisingly well at levels 2 and 3.  For some stimuli, attention to the duration cue actually provides an advantage. This results occurs because duration is actually a pretty reliable cue for perception of /θ/ but it does not provide any information that helps the child achieve the critical articulatory gestures (e.g., grooved versus nongrooved tongue,interdental versus alveolar tongue tip placement). In this case, there is no direct linear relationship between the child’s speech perception score and their speech production score on the tests that we gave. However, there is a direct relation between the child’s perceptual focus on only one of the relevant acoustic cues and their inability to produce the phoneme correctly. The only children who achieved good perception scores and good production scores attended to both the duration and the centroid cues.

This example raises a fourth point and that is, drawing on Shuster’s findings, the best test for older children may well involve using the child’s own speech production output. The most important question is, does the child mistakenly believe that their own productions are accurate and acceptable representations of the target category? I cannot recommend Shuster’s brilliant study highly enough for anyone treating this population. If the child does prove to have incomplete perceptual knowledge of /ɹ/ or /s/ however, treatment that includes highly variable (multi-talker) stimuli remains important, as a general rule of perceptual learning.

Further Reading

Preston, J. L., Felsenfeld, S., Frost, S. J., Mencl, W. E., Fulbright, R. K., Grigorenko, E. L., . . . Pugh, K. R. (2012). Functional Brain Activation Differences in School-Age Children With Speech Sound Errors: Speech and Print Processing. Journal of Speech, Language, and Hearing Research, 55(4), 1068-1082. doi: 10.1044/1092-4388(2011/11-0056)

Preston, J. L., Molfese, P. J., Mencl, W. E., Frost, S. J., Hoeft, F., Fulbright, R. K., … & Pugh, K. R. (2014). Structural brain differences in school-age children with residual speech sound errors. Brain and Language, 128(1), 25-33.

Preston, J. L., Irwin, J. R., & Turcios, J. (2015). Perception of Speech Sounds in School-Aged Children with Speech Sound Disorders. Seminars in Speech and Language, 36(04), 224-233. doi: 10.1055/s-0035-1562906

Rvachew, S. (2006). Longitudinal prediction of implicit phonological awareness skills. American Journal of Speech-Language Pathology, 15, 165-176.

Rvachew, S., & Grawburg, M. (2006). Correlates of phonological awareness in preschoolers with speech sound disorders. Journal of Speech, Language, and Hearing Research, 49, 74-87.

Shuster, L. I. (1998). The perception of correctly and incorrectly produced /r/. Journal of Speech, Language, and Hearing Research, 41, 941-950.

 

 

 

 

 

 

Support for Speech Perception Interventions in Speech Therapy

I am writing a third blog on this strange experimental protocol in which the talker produces a syllable repeatedly and the talker’s speech output is altered in a systematic fashion so that the talker hears him or herself say something that does not correspond to their own articulatory gestures. I am fascinated by these experiments because they are a window onto feedback control which is essential for a successful speech therapy outcome. Initially in traditional speech therapy the SLP is providing a lot of external feedback about the child’s articulatory gestures (knowledge of performance feedback) and the correctness of the child’s speech output (knowledge of results feedback). But given that the SLP cannot follow the child around outside the clinic room, eventually the child must learn to use self-generated feedback for speech motor learning to occur. Can children use auditory feedback to change their own speech?

In a previous blog, On Birds and Speech Therapy, I discussed interesting work from Queen’s University  suggesting that toddlers do not use feedback control like adults do during speech motor learning.  These researchers found that adults will compensate for perturbations of their own speech by adjusting their articulation to get the desired auditory feedback. In contrast, very young children do not compensate in this way. I suggested that this may be because toddlers do not perceive speech with the same degree of precision as adults. This hypothesis was supported by another study in which speakers of French and English did not show the same compensation effect to a perturbation that made their vowels sound like a French vowel. The English talkers did not respond to a perturbation to which they were not perceptually sensitive (see Feedback Control and Speech Therapy Revisited).

Recently, I was delighted to find another study involving children provides even stronger confirmation that perceptual representations play a key role in the child’s ability to use feedback for speech motor learning. Shiller and Rochon (2014)  randomly assigned 5- to 7-year-old children with typical speech to two training conditions: the control group received speech perception training for the /b/-/d/ contrast; the experimental group received speech perception training for the /ɛ/-/æ/ contrast. Prior to and subsequent to this training both groups experienced the perturbation experiment: both groups repeated said “Beb” while their own speech was altered to sound more like “Bab”. Prior to perceptual training, both groups showed a small compensation for this perturbation in the feedback of their own speech. After speech perception training the experimental group showed twice as much compensation as before whereas the control group showed no change in the amount of compensation.  The results show that children can indeed use feedback for speech motor adaptation; furthermore, this ability improves as perceptual boundaries between phoneme categories become better defined —with age or with training.

The conclusions of the study are very gratifying. Citing my own work on the importance of speech perception training as a strategy to facilitate speech production learning by children with speech sound disorders, the authors conclude:

“The results of the present study complement this work nicely, demonstrating that improvements in children’s auditory perceptual abilities do not simply improve motor performance, but also alter the capacity for auditory-feedback based speech motor learning—a process that is central to the clinical treatment of speech production disorders.” (p. 1314)

No surprise that I like this study a lot!

Feedback Control and Speech Therapy Revisited

In August 2012 I posted a comment about MacDonald, E. N., Johnson, E. K., Forsyth, J., Plante, P., & Munhall, K. G. (2012). Children’s development of self-regulation in speech production. Current Biology, 22, 113-117. (see On Birds and Speech Therapy). In this paper the authors reported that toddlers did not compensate for perturbations of their own vowel formants and they concluded that toddlers “do not monitor their own voice when speaking in the same way as adults do”. I was skeptical of this claim since it is hard to imagine how children learn to talk at all if they do not have access to feedback control mechanisms. I suggested that perceptual explanations would make more sense and now there is published evidence that this is indeed the case, interestingly from a paper including Munhall as author, specifically, Mitsuya, T., Samson, F., Ménard, L., & Munhall, K. (2013). Language dependent vowel representation in speech production. Journal of the Acoustical Society of America, 133, 2993-3003.

The paper is fascinating because it shows that English and French talkers to not show the same compensation effect when participating in this experimental paradigm and when the vowels involve French rounded vowel categories (i.e., English talkers do not change their own speech to compensate to a perturbation that makes their own speech sound more like a French vowel whereas French speakers do). Furthermore, the amount of compensation that a talker produces is related to the talker’s underlying phonological representation of the vowel space, as represented in acoustic-phonetic terms. In this study, when the English listeners did not respond to the particular perturbation of their vowel formants that was used, the researchers did not conclude that English people are incapable of using feedback control mechanisms! Rather they concluded that “the function of error reduction itself appears to be language universal, while detection of error is language specific.” However, the use of feedback for error reduction is dependent upon the talker’s perception of the feedback which in turn is related to the listener’s phonological representations (previously this was not clear because the research participants are not always consciously aware of the way that the experimenters are manipulating their speech).

Obviously the same logic should be applied to the toddlers’ apparent failure to use feedback control in a similar experimental manipulation in which the toddler’s speech was changed from one English vowel to sound a little bit more like another English vowel. In fact, a perceptually motivated interpretation is favoured in Mitsuya et al.; when referring back to McDonald et al. they say “a stable phonemic representation is required for error detection and correction in speech, and sometime between 2 and 4 yr of age such a representation emerges and stabilizes.” This is not the interpretation that made the headline in Science Daily but it is the conclusion that makes more sense to me.

What are the implications for speech therapy? The research clearly supports my view that it is essential to ensure that your clients with speech sound errors have stable perceptual and phonological representations – this is a critical component of a treatment program aimed at establishing speech motor control and speech articulation accuracy As Mitsuya et al suggest, the acoustic target for speech is not just the phonetic category itself but the target category in relation to its neighbors. The treatment approach that I have always advocated is focused on phonemic perception: the important procedures include presenting the child with a large population of variable exemplars of the target category. These exemplars should identify the centre of the category, highlighting the important cues and the prototypical characteristics, while also allowing the child to explore the edges of the category so that the child can experience it in relation to similar but contrasting categories. Thus SAILS  presents the child with a task in which highly variable stimuli are judged to be the TARGET or NOT THE TARGET and some of the stimuli are rather ambiguous. SLPs do not always like the fact that not all of the stimuli are prototypical exemplars of the target category but in fact this amount of variability is important for the establishment of phonological representations. Mitsuya et al.’s paper is important because it reinforces the point that stable acoustic-phonetic representations for speech targets are essential for the use of feedback control in speech motor learning.

Conversations with SLPs (2)

Some of you know that SAILS, my speech perception intervention software, is available for free to any speech therapist working with children who speak a North American dialect of English. The license is available from McGill University and I receive many requests every week along with some feedback and questions from users.  Gissella wrote to me with the following interesting question and I would like to share it and the answer with my readers:

“I am currently using the SAILS program with some children and have found it very helpful. I was wondering if the program could be used by parents with the help (training and treatment) of the treating S-LP. If that is possible, how would the parent go around getting the software.”

I answered that I am not comfortable with releasing the licence directly to parents because I would prefer that the parent be working under the guidance of an SLP so the best thing is for the SLP to apply for the license on behalf of the parent via flintbox .  (By the way I have worked out a way to make this old software run on 64-bit computers – you can download instructions in the revised BACKGROUNDER from the flintbox site. The tablet app is still under construction but I am hopeful that it will be available in 2014).

Further to the topic of parent application of SAILS, I also sent Gissella a copy of my paper – Rvachew, Nowak, & Cloutier (2004) – describing a randomized control trial in which we taught parents to administer SAILS to their children in the clinic, after their child’s regularly scheduled speech therapy session. Children in the control group played with Living Books after their speech therapy session and their parent asked them questions about the story according to sImagecripts that we provided. Both groups showed similar gains in phonological awareness but the SAILS (Sp Percn) group made dramatically better improvements in articulation accuracy as measured by number of errors on the Goldman-Fristoe Test of Articulation (see Figure inserted into this post) and by Percent Consonants Correct as reported in the paper. In that study we didn’t send SAILS home with the parents – as Gissella commented in a subsequent e-mail: “I now realize that the frequency of once per week seems to be sufficient, and therefore it can be done within the clinic most of the time, no need for the parent to do this at home.” This is absolutely correct, in all of my studies we have found that the intensity of the speech perception intervention does not have to be that great – a 20 minute session once per week during the first three sessions on a new phoneme works just fine.

In a follow-up e-mail, Gissella had another really interesting question however; “often times parents ask if they can have this program at home as they see it is easy to use and enjoyable for the child. There has been one case where we had treated the phonological delay, but there was residual articulation (frontal lisp) that will be treated at a later time. The parent had seen how SAILS worked for the phonology part and was interested in continuing exposing the child to the samples for /s/.”  I think that this would be a really interesting application for SAILS but unfortunately there is no empirical evidence to prove that this would be effective. I have always wanted to do a randomized control trial in which children with residual errors in kindergarten were treated with SAILS and then measures of speech accuracy, functional communication and psychosocial outcomes were collected at 6-month intervals for the next two years. Would we see more cases of “spontaneous” resolution of the residual errors in the SAILS group than in the control group? Unfortunately I can’t get decent funding for randomized control trials that involve even children with severe speech sound disorders so I doubt that I could get enough funding for something like this (to have enough statistical power it would have to be a big multisite study with a lot of funding even though 18 percent of 8 year olds can be expected to have speech errors; see Roulstone et al., 2009). You cannot believe how often other researchers, even those working in the field of speech sound disorders, tell me that this most common of neurodevelopmental disorders is just “not important” (see Bishop, 2010)!

Conversations with SLPs (1)

I have been enjoying conversations with SLPs about Developmental Phonological Disorders, discussing questions either about the book or about their patients in relation to the clinical advice offered in the book. I am going to share the gist of some of these exchanges on this blog from time to time, with the permission of the parties in involved.

Gabrielle has been reading the book, valiantly page by page, with a view to the implications for her primary clientele which is students with dyslexia as well as speech and language disorders. She has two interesting questions regarding Chapter 7. The questions relate to the discussion of the perceptual abilities of children with DPD generally and the results of Rvachew and Jamieson (1989) in particular.

In Rvachew and Jamieson (1989), the participants who were preschoolers with phonological disorders were required to identify the words seat and sheet via a picture pointing task when presented with the words live-voice, in order to be enrolled in the study. Even though the children were able to complete the live-voice task, about half of them were unable to identify synthetic versions of these words. I relate these results to Nittrouer’s finding that some children have immature cue weighting strategies such that they identify these fricatives based on the formant transitions between the fricative and the vowel rather than attending the steady-state spectrum of the fricative noise. Gabrielle asks: “What is the difference between a spectral cue and a formant transition, and if the kids can hear the difference during “live” speech does it matter that they can’t use spectral information during synthetic listening tasks?” The way in which these fricative sounds are perceived in words by adults and children is described in pages 43 to 45 (see also Nittrouer, 2002). Like all speech sounds, the perception of fricatives requires the integration of many acoustic cues that are spread across the word.  When the child attends primarily to one cue (the dynamic formant frequency changes between consonant and vowel) and ignores other cues (such as the peak frequency of the fricative noise) there are consequences for both perception and production of these phonemes. The child can achieve accurate perception with live-voice stimuli under some conditions with an immature cue-weighting strategy but this strategy will be unreliable, leading to perceptual errors under difficult listening conditions (unfamiliar listeners, fast speech, background noise). The consequences for speech production are greater however; if the child believes that the primary cues to the /s/-/ʃ/ contrast lie in the dynamic transition between the fricative and the vowel, the child is not attending to a critical piece of information that will help him or her learn to manipulate tongue placement and groove width in order to produce /s/ with higher frequency centroid frequencies and /ʃ/ with lower frequency centroid frequencies. Testing the child with synthetic speech that isolates these cues highlights the fact that even though the child can perceive the contrast in some circumstances, the child’s perceptual knowledge is incomplete. Developmentally, perceptual and productive knowledge of phonological contrasts is acquired gradually, with perceptual knowledge leading somewhat but iterative gains occurring over time in both domains.

The second question was “about auditory processing difficulties (on page 551 and 552), as different from speech perception difficulties it was my understanding that often “auditory processing” evaluations include speech perception tasks. Was the original concept of auditory processing based on non-speech tasks?” Indeed, in this section I am making a distinction between the hypothesis that auditory processing deficits cause speech or language disorders (such as Tallal’s proposal that temporal processing difficulties are a causal factor) versus the hypothesis that speech perception deficits play a role (as in Ramus’ proposal about phonological representations). Traditionally, auditory processing skills would be attributed to lower levels of the auditory system, midbrain and primary auditory cortex for example, whereas the formation of phonological representations necessary for speech perception takes place at higher cortical levels (see discussion of dual-stream model on pages 127-130). Of course the development of the system is influenced by all kinds of auditory input and perception of speech requires the entire system working together. However, certain nonspeech tasks such as gap detection or the binaural masking level difference are supposed to measure functioning at lower levels of the auditory system. It is true that batteries of tests that are supposed to measure central auditory processing involve speech input and, at least to me, often appear to be measures of language processing. It is not for me to explain the choice of tests in those batteries (although you may enjoy this RALLI video in which Dorothy Bishop discusses the controversy about central auditory processing disorder as a diagnosis). My point was that it is important to not mix up the literature on the auditory processing skills of children with speech and language deficits with the literature on the speech perception and phonological processing skills of children with speech and language deficits. The unreliable findings on auditory processing have no bearing on the more consistent finding that children with speech production difficulties have problems with speech perception.

I welcome interesting questions such as these and invite more from pre-practice and practicing speech-language pathologists.