Literature Review - Optima Speech Therapy \n\n\n

Literature Review

by Kate Beckett, 2013

Introduction

Speech sound disorders (SSD) are the most frequently occurring communication impairments (Broomfield and Dodd 2004; Gierut 1998). In Ireland, children may wait up to two years for Speech and Language Therapy (SLT) (Children’s Rights Alliance 2011). An effective generic home programme (HP) developed by Speech and Language Therapists (SLTs) and delivered by parents within the parent-child dyad, would be a useful alternative treatment resource, as intervention could be provided immediately after diagnosis. Previous generations of this project have used traditional measures to establish significant gains in consonant accuracy (Brady et al 2011; Elomari and McElhinney 2012), suggesting a parent-led HP is effective, however, the parental perception (PP) of this intervention has yet to be fully explored.

 

SSD subgroups and current intervention approaches

Literature has long documented the heterogeneity of SSD and lack of universally recognised categorisation system. According to Dodd (1995; 2005) SSD can be differentially diagnosed using psycholinguistic presentations into five speech subgroups, unrestrained by severity (appendix xxx). Waring and Knight (2012) concluded that a universal system may lead to improved treatment efficacy. Dodd’s system has been utilised to select Phonological Delay (PD) and Consistent Phonological Disorder (CPD), as target populations for the current research. Both the selected subgroups are characterised by delayed developmental phonological processes typically evident in, but attributable to, children of a younger chronological age. In addition to this feature, CPD encompasses atypical (non-developmental) error patterns.

Minimal pair (MP) contrast therapy is a well-documented approach used to treat children with both PD and CPD (Williams et al 2010). Baker and McLeod (2004) suggest developmental phonological processes will benefit from MP intervention, while Gierut (2001) advocates this technique with sounds consistently in error or omitted from the phonemic inventory. This approach draws the child’s attention to homonymy and resulting communicative confusion (Gierut 2001), with the aim of reorganising the child’s linguistic system through introduction of missing phonemic contrasts and suppression of erroneous patterns (Holm et al 2005).

Phonological awareness (PA) refers to conscious knowledge about the sound structure of words at syllable and phoneme level (Hesketh 2009), and has been identified as an area of weakness in children with SSD (Gillion 2005; Hesketh et al 2007). This knowledge may be developed to support and contribute to phonological inventory reorganisation and improved speech production (Hesketh 2010; Bowen 2009). PA development has been successfully associated with early reading and spelling experiences for children with SSD (Gillon 2005).

Whole language approach is a top-down technique which has been applied, albeit somewhat controversially, to phonological impairments under the theory that phonology is an integral and interdependently linked part of language (Norris and Hoffman 2005). Tenets of this approach focuses on learning context, acquisition through rich environment immersion (Adams et al 1997), and parental assistance in learning through modelling (Sawyer 1991).

 

Impact of delayed intervention on quality of life

The International Classification of Functioning, Disability and Health-Children and Youth (ICF–CY) may be used to holistically measure the impact impairment has on quality of life (QOL) (WHO 2001). Reduced intelligibility addresses ICF-CY code b320: Articulation Functions, but is commonly observed to impact the activities and participation aspect of health in terms of 1) social impact of speaking and conversation, 2) influence of the impairment on learning and applying knowledge, 3) personal interaction and relationships, and finally 4) community, social and civic life (McLeod and Bleile 2004).

Parents in Glogowska and Campbell (2000) research on parental views of SLT, reported quantifying ‘getting there’ with intervention as when they perceived their child was managing typical learning, making friends and not being identifiable as different from peers. Data supporting the PP of functional communication may be captured in the therapeutic goals of ICF-CY activities and participation.

Reduced intelligibility caused by SSD may have a detrimental psychosocial impact on children (McLeod and Bleile 2004). Resulting communication breakdowns also place children at risk of literacy difficulties (Anthony et al 2011; Harrison and McLeod 2010), academic failure (Gillon 2004; Fujiki et al 2001), reduced phonological processing skills (Preston and Edwards 2010; Hesketh, 2004), and at increased risk of bullying (Marcharey and von Suchodoletz 2008). Overby et al (2007) also found teachers had lower expectations of students with SSD.

Parents as agents of therapy: the changing role of SLTs

Current demand for services has led SLTs to employ a pragmatic approach to caseload management. In particular, service delivery models are being closely scrutinised regarding e.g. agent of therapy (Dodd 2005). Law et al (2002; 2004) discuss consultative service delivery whereby an indirect approach is taken to intervention, placing emphasis on parents to carry out intervention under SLT guidance. This approach facilitates more children receiving frequent intervention (Hayes 2012) and may provide a unique opportunity to maximise therapeutic outcomes, generalisation and maintenance (Schooling et al 2010).

Research conducted on parent-led phonological intervention is limited (Glogowska and Campbell 2000; Washington et al 2012). However, when Watts-Pappas et al (2008) surveyed SLTs (n=2200) 98% responded positively that parental involvement is essential for effective speech intervention. Studies that have investigated parents as agents of therapy have involved lengthy parent training e.g. Dodd and Barker (1990) examined the efficacy of parents and teachers implementing MP following 22 hours of parent training, and found significant improvements in percentage consonants correct (PCC). Eiserman et al (1992) also found no significant difference between a clinician-led and parent-led programme, although clinical preparation time proved equally resource-heavy. Other parent-led interventions e.g. It Takes Two to Talk language intervention, equally require extensive parent training, but findings include more balanced interaction and transferable communication strategies (Konza et al 2010). However, a parallel goal of empowering parents to become their child’s primary facilitator is noteworthy.

Is a home programme needed?

In Ireland 2,406 children were registered with a speech and language disability in 2011 (Department of Children and Youth Affairs 2012) and an estimated 23,000 children were on SLT national waiting lists in 2010, with approximately 4,000 children waiting one to two years (Children’s Rights Alliance 2011). While specific Irish statistics are not available, in the UK clients aged 2-6 diagnosed with PD account for 57.5% of referrals (Broomfield and Dodd 2004).

For some children, difficulties are neither confined to speech or early childhood (McCormack et al 2009), and for this reason a generic HP may positively impact holistic development. The HP is particularly relevant as Dodd and Whithworth (2005) found children may go past the key intervention age while prevention of literacy issues through phonological intervention is recommended before starting school (Bird et al 1995; Leitao and Fletcher 1997; Nathan et al 2004).

Why measure parental perception?

SLT research tends to focus on traditional measures of child outcome ratings (i.e. PCC) instead of PP (Glogowska and Campbell 2000), and the previous generations of this research are no exception. However, an essential and unique insight is offered through inclusion and understanding of PP (Washington et al 2012). With 95% of SLTs reporting usually recruiting parents as agents of therapy through homework activities (Watts-Pappas et al 2008) PP is an understudied phenomenon. Watts-Pappas and colleagues continue that consultation and enjoyment of intervention are crucial factors in therapeutic gains and compliance. A sentiment reiterated by Brookman-Frazee (2004) who further suggests that PP may enable intervention development that will suit family routine. PP is therefore a necessary and fundamental element to development of the HP.

Adams, C., Byers-Brown, B. and Edwards, M. (1997) Developmental Disorders of Language, 2nd ed., London: Whurr.

Alcorn, M., Jarret, T., Martin, W. and Dodd, B. (1995) ‘Intensive group therapy: efficacy of a whole-language approach’, in Dodd, B., Differential Diagnosis and Treatment of Children with Speech Disorders, London: Whurr, 181-198.

Anthony, J. L., Greenblatt Aghara, R., Dunkelberger, M. J., Anthony, T., Williams, J. M., Zhang, Z. (2011) ‘What factors place children with speech sound disorders at risk for reading problems?’, American Journal of Speech-Language Pathology, 20, 146-160.

Baker, E. (2006). ‘Management of speech impairment in children: the journey so far and the road ahead’, Advances in Speech-Pathology, 8(3), 156-163.

Baker, E. and McLeod, S. (2004) ‘Evidence-based management of phonological impairment in children’, Child Language Teaching and Therapy, 20(3), 265-285.

Bird, J., Bishop, D. V. M. and Freeman, N. H. (1995) ‘Phonological awareness and literacy development in children with expressive phonological impairments’, Journal of Speech and Hearing Association, 38, 446-462.

Bowen, C. (2009) Children’s Speech Sound Disorders, Oxford: Wiley Blackwell.

Brady, D. (2011) A Home Programme for Speech Delay and Disorder: A Novel Intervention, unpublished thesis (MSc), University of Limerick.

Broen, P. A. and Westman, M. J. (1990) ‘Project parent: a preschool speech program implemented through parents’, The Journal of Speech and Hearing Disorders, 55(3), 495-502.

Broomfield, J. and Dodd, B. (2004) ‘Children with speech and language disability: caseload characteristics’, International Journal of Communication Disorders, 39(3), 303-324.

Carey, C. (2011) Parents as Agents of Therapy for Speech Sound Disorders: Does it Work?, unpublished thesis (MSc), University of Limerick.

Children’s Rights Alliance (2011) Is the Government Keeping its Promises to Children? Report Card 2011 [online], available: http://www.rte.ie/news/2011/0124/childrensreport.pdf [accessed 27 Oct 2012].

Crosbie, S., Holm, A. and Dodd, B. (2005) ‘Intervention for children with severe speech disorder: a comparison of two approaches’, International Journal of Language and Communication Disorders, 40, 467-491.

Dodd, B. (1995) Differential Diagnosis and Treatment of Children with Speech Disorders, London: Whurr.

Dodd, B. (2005) Differential Diagnosis and Treatment of Children with Speech Disorders, 2nd ed., London: Whurr.

Dodd, B. and Barker, R. (1990) ‘The efficacy of utilising parents and teachers as agents of therapy for children with phonological disorders’, Australian Journal of Human Communication Disorders, 18(1), 29-45.

Dodd B., and Bradford, A. (2000) ‘A comparison of three therapy methods for children with different types of developmental phonological disorders’, International Journal of Language and Communication Disorders, 35, 189-209.

Dodd, B. and Whitworth, A. (2005) ‘A problem-solving approach to clinical management’, in Dodd, B., Differential Diagnosis and Treatment of Children with Speech Disorder, London: Whurr, 119–139.

Dunst, C. J., Simkus, A., and Hamby, D. W. (2012) Relationship Between Age of Onset and Frequency of Reading to Infants and Toddlers and Later Language and Literacy Development [online], available: http://www.earlyliteracylearning.org/cellreviews/cellreviews_v5_n3.pdf [accessed 21 Nov 2012].

Eiserman, W., Weber, C. and McCoun, M. (1992) ‘Two alternative programme models of serving speech-disordered preschoolers: a second year follow-up’, Journal of Communication Disorders, 25, 77-106.

Ebert, K. A. and Prelock, P. A. (1994) ‘Teachers’ perceptions of their students with communication disorders’, Language, Speech, and Hearing Service in Schools, 25(4), 211-214.

Elomari, J. (2012) Patterns or Stories? Evaluation of the Efficacy of Elements of a Home Program for Children with Phonological Delay and Disorder, unpublished thesis (MSc), University of Limerick.

Fujiki, M., Brinton, B., Isaacson, T. and Summers, C. (2001) ‘Social behaviours of children with language impairment in the playground: a pilot study’, Language, Speech, and Hearing Services in Schools, 32, 101-113.

Gierut, J. A. (2001) ‘Complexity in phonological treatment: clinical factors’, Language, Speech, and Hearing Services in Schools, 32, 229–241.

Gierut, J. A. (1998) ‘Treatment efficacy: functional phonological disorders in children’, Journal of Speech, Language, and Hearing Research, 41, S85-S100.

Gierut, J. A. (1991) ‘Homonymy in phonological change’, Clinical Linguistics & Phonetics, 5(2), 119-137.

Gillon, G. T. (2005) ‘Phonological awareness: evidence to influence assessment and intervention practises’, Language, Speech, and Hearing Services in Schools, 36, 281-284.

Gillon, G. (2004) Phonological Awareness: From Research to Practice, New York: Guilford Press.

Harrison, L. J., McLeod, S. (2010) ‘Risk and protective factors associated with speech and language impairment in a nationally representative sample of 4- to 5-year old children’, Journal of Speech, Language, and Hearing Research, 53, 508-529.

Hayes, N., Keegan, S. and Goulding, E. (2012) Evaluation of the Speech and Language Therapy Service of Tallaght West Childhood Development Initiative, Dublin: Childhood Development Initiative (CDI).

Hesketh, A. (2004) ‘Early literacy achievement of children with a history of speech problems’, International Journal of Language and Communication Disorders, 39(4), 453-468.

Hesketh, A., Dima, E. and Nelson, V. (2007) ‘Reaching phoneme awareness to pe-literate children with speech disorder: a randomised controlled trial’, International Journal of Language and Communication Disorders, 42(3), 251-271.

Hodson, B. W. (2011) Enhancing Phonological Patterns of Young Children with Highly Unintelligible Speech [online], available: http://www.asha.org/Publications/leader/2011/110405/Enhancing-Phonological-Patterns-of-Young-Children-With-Highly-Unintelligible-Speech.htm [accessed on 21 November 2012].

Hoffman, P., Norris, J. and Monjure, J. (1990) ‘Comparison of process targeting and whole language treatments for phonologically delayed preschool children’, Language, Speech, and Hearing Services in Schools, 21, 102-109.

Holm, A., Crosbie, S. and Dodd, B. (2005) ‘Phonological approaches to intervention’, in Dodd, B., Differential Diagnosis and Treatment of Children with Speech Disorder, London: Whurr, 163-181.

IASLT (Irish Association of Speech and Language Therapists) (2007) Specific Speech and Language Impairment in Children: Definition, Service Provision and Recommendations for Change [online], available: http://www.iaslt.ie/docs/public/exec/IASLT%20SSLI%20Position%20Paper%20Oct%202007.pdf [accessed 27 Oct 2012].

Irwin, O. (1960) ‘Infant speech: effect of systematic reading of stories’, Journal of Speech & Hearing Research, 3, 187-190.

Joffe, V. and Pring, T. (2008) ‘Children with phonological problems: a survey of clinical practice’, International Journal of Communication Disorders, 43(2), 154-164.

Justice, L. M, Kaderavek, J., Bowles, R., and Grimm K. (2005) ‘Language impairment, parent-child shared reading, and phonological awareness: a feasibility study’, Topics in Early Childhood Special Education, 25(3), 143-56.

Laing, S. P. and Espeland, W. (2005) ‘Low intensity phonological awareness training in a preschool classroom for children with communication impairments’, Journal of Communication Disorders, 38(1), 65-82.

Law, J. (1992) ‘The early identification of language impairment in children’, in Dodd, B., 2nd ed., Differential Diagnosis and Treatment of Children with Speech Disorders, London: Whurr.

Law, J. (1997) ‘Evaluating intervention for language impaired children: a review of the literature’, European Journal of Disorders of Communication, 32, 1-14.

Law, J., Garrett, Z. and Nye, C. (2004) ‘The efficacy of treatment for children with developmental speech and language delay/disorder: a meta-analysis’, Journal of Speech, Language, and Hearing Research, 47, 924-943.

Law, J., Lindsay, G., Peacey, N., Gascoigne, N., Soloff, N., Radford, J. and Band, S. (2002) ‘Consultation as a model for providing speech and language therapy in schools: a panacea or one step too far?’, Child Language Teaching and Therapy, 18, 145–163.

Leitao, S. and Fletcher, J. (1997) ‘Literacy outcomes for students with speech impairment: long-term follow-up’, International Journal of Language & Communication Disorders, 39(2), 245-256.

Marcharey, G. and von Suchodoletz, W. (2008) ‘Perceived stigmatization of children with speech-language impairment and their parents’, Folia Phoniatr Logop, 60(5), 256-263.

McCormack, J., McLeod, S., McAllister, L. and Harrison, L. J. (2009) ‘A systematic review of the association between childhood speech impairment and participation across lifespan’, International Journal of Speech-Language Pathology, 11(2), 155-170.

McElhinney, L. (2012) Patterns or Stories? A Comparison of Two Home Therapy Programmes for Children with Phonological Delay and Consistent Phonological Disorder, unpublished thesis (MSc), University of Limerick.

McLeod, S. and Bleile, K. (2004) ‘The ICF: a framework for setting goals for children with speech impairment’, Child Language Teaching and Therapy, 20(3), 199-219.

McLeod, S. and Harrison, L. J. (2009) ‘Epidemiology of speech and language impairment in a nationally representative sample of 4- to 5-year old children’, Journal of Speech, Language, and Hearing Research, 52, 1213-1229.

Nathan, L., Stackhouse, J. and Goulandris, N. (2004) ‘The development of early literacy skills among children with speech difficulties: a test of the critical age hypothesis’, Journal of Speech, Language and Hearing Research, 47, 377-391.

Overby, M., Carrell, T., Bernthal, J. (2007) ‘Teachers perceptions of students with speech sound disorders; a quantitative and qualitative analysis’, Language, Speech, and Hearing Services in Schools, 38(4), 327-341.

Preston, J. and Edwards, M. (2010) ‘Phonological awareness and types of speech errors in preschoolers with SSD’, Journal of Speech, Language, and Hearing Research, 53, 44-60.

Ruscello, D. M., Cartwright, L. R., Haines, K. B., and Shuster, L. I. (1993) ‘The use of different service delivery models for children with phonological disorders’, Journal of Communication Disorders, 26, 193-203.

Rvachew, S. and Brosseau-Lapré, F. (2012) ‘An input-focused intervention for children with developmental phonological disorders’, Perspectives on Language Learning and Education, 19(1), 31-35.

Sawyer, D. J. (1991) ‘Whole language in context: insights into the current great debate’, Topics on Language Disorders, 11(3), 1–13.

Schofield, A. (2011) A Novel Parent Implemented Home Programme: A Sound Intervention for Children with Phonological Delay and Consistent Phonological Disorder?, unpublished thesis (MSc), University of Limerick.

Shriberg, L. (1997) ‘Developmental phonological disorders: one or many?’, in Bowen, C., Children’s Speech Sound Disorders. Oxford: Wiley Blackwell, 39.

Waring, R. and Knight, R. (2012) ‘How should children with speech sound disorders be classified? a review and critical evaluation of current classification systems’, International Journal of Language & Communication Disorders, 9 Nov, available: http://onlinelibrary.wiley.com/doi/10.1111/j.1460-6984.2012.00195.x/abstract [accessed on 21 November 2012].

Warrick, N., Rubin, H. and Rowe-Walsh, S. (1993) ‘Phoneme awareness in language-delayed children: comparative studies and intervention’, Annals of Dyslexia, 43, 153-173.

Williams, A. L., McLeod, S. and McCauley, R. J. (2010) Interventions for Speech Sound Disorders in Children, Baltimore: Brookes.

WHO (World Health Organisation) (2001) ICF: International Classification of Functioning, Disability and Health, Geneva: World Health Organisation.

My Mission

Empowering parents with an original, proactive and easy-to-use service for speech therapy at home.

Shopping Cart
Scroll to Top