nancy j. scherer a. lynn williams east tennessee state university ann kaiser, megan roberts,...
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Nancy J. Scherer A. Lynn Williams
East Tennessee State University Ann Kaiser, Megan Roberts, Jennifer Frey,
Kristin Mullins Vanderbilt University
Carol Stoel-GammonUniversity of Washington
14th ICPLA ConferenceJune 27-30, Cork Ireland
Delayed in onset of canonical babbling Composition of babbling is less complex Smaller consonant inventories Poorer speech accuracy (Percent Consonants Correct)
Delayed onset and acquisition of words Lexical selectivity
◦ Produce more words beginning with the sounds they can produce (nasals, glides, vowels) & fewer beginning with high pressure consonants
◦ Preference for sounds at the extremes of the vocal tract (labials, velars, and glottals)
Targets both speech and vocabulary simultaneously
Is delivered in interactions that promote functional language use in meaningful contexts
Provides strategies to facilitate speech Increases the child’s communication attempts
1. Prelinguistic Stage (birth to 1 year)2. First Words Stage (1 year to 18
months) Early words learned as whole units
(not sequence of segments) Consonant production variable Active selection and avoidance
strategies used3. Phonemic Development Stage (18 months
to 4 years)4. Stabilization of the Phonological System
Stage (4 to 8 years)5. Stoel-Gammon &
Dunn, 1985
Selecting specific language and speech targets appropriate to the child’s level
Arranging the environment to increase likelihood of child initiations
Prompting the child’s engagement through mirroring and mapping
Responding to the child’s initiations with prompts for elaborated language and speech accuracy
Functionally rewarding the child’s communicative attempts by providing access to desired events
Providing focused feedback regarding the form of the child’s utterance
Time delay Least Support
Open questions Choice questions Model and expansions Speech recasting Most Support
Repeating target words the child uses while emphasizing a target sound in the word
Behavioral◦ Prompting strategies◦ Imitation and production practice◦ Contingencies for child’s communicative attempts
Developmental-Social Interactionist◦ Language learned in meaningful contexts◦ Responsiveness of the caregiver
Parents as speech-language facilitators
Target Selection
EMT/PE Responsive interaction & Environmental arrangement
Child Outcome
To assess the efficacy of an early intervention “Enhanced Milieu Teaching with Phonological Emphasis (EMT/PE)” on the speech and language development of children with CLP under 3 years of age. ◦ 48 children were randomly assigned to the
EMT/PE intervention or a “business as usual” control
Speech and language measures pre and post intervention◦ 27 children with CLP who have completed the
intervention 14 children in the EMT/PE intervention 13 children in the BAU
Compare to normative speech measures◦ 40 noncleft children at 18, 24, 30 and 36 months
15-36 months of age Non syndromic cleft lip and/or palate Palate repair <13 months Absence of sensorineural hearing loss English is the language of the home At least 5 words reported by parent Able to imitate words Recruited from 3 sites in middle and east
Tennessee
EMT/PE BAU
Gender Male Female
86
85
Cleft Type Cleft Palate CLP
212
211
Mother’s Education HS Some College College Grad Grad School
4631
1552
EMT/PE Mean
EMT/PESD
EMT/PERange
BAUMean
BAUSD
BAURange
Age Pre-TX 24.3 M 7.1 14, 32 26.6 M 7.2 16, 32
Age Post-TX 33.4 M 7.0 23, 35 34.7 M 7.7 23, 36
Mother’s Age
29.5 Y 4.2 22, 35 29.6 Y 5.2 21, 37
Age of Palate Repair
11.5 M 1.0 9, 12 11.1 M 1.0 9, 13
Pre-Post Assessment◦ Profiles of Early Expressive Phonological Skills
(PEEPS)◦ Preschool Language Scale-4◦ Language sample
Clinician-child (Play) Parent-child (Play, book, snack)
◦ Communicative Development Inventory◦ LENA (Weekday, weekend)◦ Bayley Scales of Infant Development◦ Parenting Stress Inventory◦ Hearing screen
EMT/PE Intervention◦ Clinician implemented◦ 48 sessions◦ 5 speech targets identified from single word
naming test (PEEPS) embedded in language goals◦ 5 play activities with at least 2 targets in each
session◦ Criteria for exposure: At least 10 presentations of
the targets in each play activity
BAU Control◦ Clinician implemented◦ 48 sessions
Characteristics of BAU Interventions
Total Children
Oral Motor/Massage
Speech Language
Other
13 12 8 2 4
Pre and post intervention assessments were compared using OLS regression models controlling for age, study group and pre intervention performance.
Outcome Measure
t p Effect Size
PLS4-AC 2.02 0.043* 0.39
PLS4-EC 2.59 0.021* 0.43
MCDI Total Words 1.17 0.26 0.40
# Different Words 2.31 0.048* 0.45
Word per minute
0.88 0.40 0.32
MLUm 0.26 0.80 0.05
LENA voc 0.25 0.81 0.10
The EMT/PE intervention group showed significantly greater gains in ◦ Global language comprehension scores◦ Global expressive language scores◦ Number of different words used in conversation◦ Greater vocabulary size rated by parents
EMT/PE intervention group used 95.8 more words
Assesses developmentally appropriate sound production in single words◦ consonant inventory ◦ place/manner of articulation◦ syllable structure ◦ accuracy◦ error patterns
18-36 months of age Elicited with objects
40 words The words were selected based on
◦ age of acquisition (AOA) based on vocabulary words from the MacArthur Communicative Development Inventories
◦ phonetic characteristics to elicit target English consonants across all place, voice, and manner categories of production, as well as in different syllable structures and word position.
Consonant Inventory◦ Initial◦ Medial/Final
Percent Consonants Correct Error Types
◦ Substitutions◦ Omissions◦ Compensatory substitutions
Consonant inventorySpeech accuracyReduced compensatory articulation
Percent intelligibility
# Different wordsVocabulary size
Significant changes were found in both speech and vocabulary
◦ Coherence with typical acquisition
Our families who participated in the research
Our Vanderbilt and ETSU research teams Our funding agency: NIDCD
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