Dr. Elise Baker And Dr. Sharynne McLeod - Edublogs

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Dr. Elise Baker1 and Dr. Sharynne McLeod2 1. The University of Sydney, Australia 2. Charles Sturt University, Australia ASHA Convention- San Diego, CA- November 17-19, 2011

Purpose To describe speech-language pathologists’ (SLPs) assessment, analysis, target selection and intervention practices for children with speech sound disorders (SSD) Contrast the findings with previously published research on SLPs’ methods of practice in the US, UK and Australia Consider future directions for researchers and clinicians

Learner outcomes Compare and contrast your own clinical practice in the areas of assessment, analysis, target selection, and intervention with: survey results research evidence Identify one aspect of your current clinical practice that you would like to review.

Children with speech sound disorders Form a substantial portion of speech-language pathologists’ (SLPs) caseloads USA 74.7% of preschool children (Mullen & Schooling, 2010) Australia Approximately 50% of children (McLeod & Baker, 2004)

Ideally. SLPs engage in evidencebased practice (EBP)

However. EBP “has not become a regular part of clinical practice” (Brackenbury et al., 2008, p. 78).

Participants 322 practising SLPs attended Speech Pathology Australia seminars in every state and territory of Australia. 71.5% ( 231 SLPs) completed questionnaires prior to seminars, and, consented to results being analysed

Participants 98.7% female 46.3% parents Practicing in every state and territory in Australia Professional training undertaken in Australia, UK, USA, New Zealand and South Africa 54.1% worked fulltime and 45.9% part time 47.6% practicing as an SLP for 10 years Typically worked in private practice (38.1%), schools (37.7%) or community health (29.0%) settings.

Survey Example: Please indicate the frequency with which you use the following speech assessment components Always Single word test to determine sounds in error Assessing oral motor skills using nonspeech tasks Sometimes Infrequently Never

assessment intervention analysis target selection

Assessment Results – always and sometimes used. Component ALWAYS SOMETIMES Single-word test to determine error sounds 88.9% 10.6% Stimulability testing 77.7% 17.5% Conversational speech sampling 58.3% 25.7% Estimating intelligibility 55.1% 30.9% Hearing Screening 41.3% 28.6% Assessment of phonemic awareness 25.6% 59.7% Assessment of oral motor skills using speech tasks 24.6% 47.4% Assessment of oral motor skills using non-speech tasks 21.6% 47.4% Perception / auditory discrimination 15.8% 46.3% Single-word test to determine % rank or standard score 11.2% 26.1%

Assessment Results – always used. Component Current study Skahan et al., 2007) Single-word test to determine error sounds 88.9% * Stimulability testing 77.7% 67.0% Conversational speech sampling 58.3% 36.2% Estimating intelligibility 55.1% 75.4% Hearing Screening 41.3% 70.6% Assessment of phonemic awareness 25.6% 12.9% Assessment of oral motor skills using speech tasks 24.6% 54.4% Assessment of oral motor skills using non-speech tasks 21.6% 57.6% Perception / auditory discrimination 15.8% 12.6% Single-word test to determine % rank or standard score 11.2% 74.1% * not surveyed.

Assessment results– always. Component Current study Skahan et al., (2008) Joffe & Pring (2008) 38.1% * * 21.0% always & sometimes 59.1% * * Articulation Survey (Aitken and Fisher, 1996) Informal / own test Daz Roberts Test of Articulation (Roberts) 9.4% * * Diagnostic Evaluation of Articulation and Phonology (Dodd et al., 2002) 8.6% * * Goldman-Fristoe Test of Articulation 5.5% 51.8% * Photo Articulation Test (Lippke et al., 1997) 0.6% 9.7% * South Tyneside Assessment of Phonology * * 83% (Goldman & Fristoe, 2000) (Armstrong & Ainley, 1988) * not surveyed.

Assessment: Always used. Children from non-English speaking backgrounds Component Current study Skahan et al., 2008) Informal procedures 70.8% 67% English-only standardized tests 45.6% 35% Standardized tests from a client’s native language 3.7%% 19% Developed local norms 10.3% 11% Query Are suitable assessments unavailable or too expensive? Is expertise in other languages unavailable? “Most participants reported using informal assessment procedures, or English-only standardized tests, when evaluating nonnative English speakers.” (Skahan, Watson, & Lof, 2007, p. 246)

assessment intervention analysis target selection

Analysis results When analysing children’s speech, which methods do you use? (tick as many as apply) Component Current study Skahan et al., 2007) Substitution, distortion, addition omission (SODA - traditional articulation analysis) 94.0% * Phonological process analysis 96.3% 51.1% Syllable-word shape analysis 20.9% 11.3% Independent and relational analysis 13.4% * Psycholinguistic analysis 7.4% * Nonlinear analysis 4.1% * Computerized analysis (e.g., PROPH) 2.3% *

Analysis results When analysing children’s speech, which methods do you use? (tick as many as apply) Component Current study Skahan et al., (2007) Substitution, distortion, addition omission (SODA - traditional articulation analysis) 94.0% * Phonological process analysis 96.3% 51.1% Syllable-word shape analysis 20.9% 11.3% Independent and relational analysis 13.4% * Psycholinguistic analysis 7.4% * Nonlinear analysis 4.1% * Computerized analysis (e.g., PROPH) 2.3% 8%

assessment intervention analysis target selection

Results: Target selection practices Factor to consider Stimulable sounds Early developing sounds Sounds in error in one position Non-stimulable sounds Later developing sounds Sounds in error across all positions Sounds in the child’s name Sounds the parent / child would like Other factors Developmental perspective Complexity perspective Social and other factors

Results: Target selection practices Factor to consider High priority McLeod & Baker (2004) 74.6% 93.7% 64.8% 86.8% 19.4% 39.3% 24.2% 8.9% 18.3% 4.8% Sounds in error across all positions Sounds in the child’s name 65.0% 59.6% 31.3% 37.0% Sounds the parent / child would like Other factors 34.8% 49.6% 32.0% * Stimulable sounds Early developing sounds Sounds in error in one position Non-stimulable sounds Later developing sounds

assessment intervention analysis target selection

Survey question: Please rate how frequently you use each of the following approaches in your therapy? List include 28 options, including: Empirically-supported approaches (e.g., Baker & McLeod 2011) Approaches previously reported to be used by SLPs (e.g., Joffe & Pring, 2008; Lof & Watson, 2008; )

Minimal pairs (minimal opposition Natural speech intelligibility training contrast) (e.g., Weiner, 1981) (NSIT) (e.g., Camarata) Multiple opposition contrast (e.g., SCIP) Phonological awareness intervention (e.g., Williams, 2000) (e.g., Gillon, 2000) Maximal oppositions contrast (e.g., Gierut, Core vocabulary (e.g., Dodd & Bradford, 2000) 1990) Cycles (e.g., Hodson, 2007) SAILS speech perception intervention (e.g., Rvachew, 1994) Psycholinguistically-based intervention (e.g., Stackhouse & Wells, 1997; 2001) Whole language intervention (e.g., Hoffman, Norris & Monjure, 1990) Metaphon (e.g., Howell & Dean, 1984) Treatment program for enhancing Metaphonological intervention stimulability (e.g., Miccio, 2005) Instrumental approaches e.g., electropalatography; ultrasound (e.g., Hesketh, Adams, Nightingale, Hall, 2000) Nonlinear phonological intervention (e.g., Bernhardt & Stemberger, 2000 Parents and children together (e.g., PACT) (e.g., Bowen & Cupples, 1999) (e.g., Hardcastle & Gibbon, 1997) Dynamic temporal and tactile cueing (Integral stimulation) (e.g., Strand & Caruso)

Non-speech oro-motor exercises (e.g., Marshalla; Rosenfeld-Johnson) Cued articulation (e.g., Passey, 1990) Nuffield Centre Dyspraxia Programme (e.g., Nuffield Hearing & Speech Centre, 2004) Auditory discrimination (e.g., Berry & Eisenson, 1956) Suck–swallow–breathe synchrony (e.g., Oetter et al., 1993) Prompts for Restructuring Oral Muscular Phonetic Targets (e.g., PROMPT) (e.g., Hayden, 2006) Traditional articulation therapy (e.g., van Riper, 1939) .has been studied experimentally: not as efficient for managing phonologically-based SSD.

Top 5 most commonly used intervention approaches APPROACH Always Sometimes 33.5% 55.5% 31.3% 58.5% Cued articulation (Passey, 1990) 30.7% 42.4% Phonological awareness 26.0% 51.5% 23.4% 58.2% Auditory discrimination (Berry & Eisenson, 1956) Minimal opposition contrast (minimal pairs) (Weiner, 1981) (Gillon, 2000) Traditional articulation therapy (van Riper, 1939)

Use of a selection of empirically supported approaches Approach Always Sometimes Never Cycles (Hodson & Paden, 1991) 4.3% 27.6% 42.7% SAILS Speech perception intervention 0.0% 0.0% 97.7% 4.5% 16.9% 62.7% 6.0% 38.0% 30.4% 5.1% 26.0% 53.1% 2.9% 10.5% 73.8% 8.3% 56.0% 16.1% (Rvachew, 1994) Parents and children together (PACT) (Bowen & Cupples, 1999) Maximal oppositions contrast (Gierut, 1990) Multiple opposition contrast (SCIP) (Lynn Williams, 2000) Metaphonological intervention (Howell & Dean, 1984) Core vocabulary (Dodd & Bradford, 2000)

Comparison between Australia and UK APPROACH.always used AUSTRALIA UK 33.5% 87.7%% 31.3% 61.3% Cued articulation (Passey, 1990) 30.7% 30.6% Phonological awareness 26.0% 72.4% 23.4% 33.7% Auditory discrimination (Berry & Eisenson, 1956) Minimal opposition contrast (minimal pairs) (Weiner, 1981) (Gillon, 2000) Traditional articulation therapy (van Riper, 1939)

Use of non-speech oral motor exercises (NSOMEs) Australia USA Canada UK Lof & Watson Hodge, Salonka, Joffe & Pring (2008) & Kollias (2005 (2008) use 37.6% 85% 85% 71.5% never use 62.4% 15% 15% 28.5%

Diversity in clinical practice Empirically-based choices Different types of SSD appear to benefit from different approaches

For example .specific options for specific difficulties Limited phonetic & phonemic inventory Contrastive approaches such as multiple oppositions (Williams, 2000) and maximal oppositions, in addition to intervention targeting complex clusters (Gierut, 1992; 1999) Limited phonetic & syllable structure inventory Cycles targeting patterns (Hodson, 2007), PACT targeting phonological processes (Bowen, 2009) Phonological and morphosyntax difficulties Alternating phonological and morphosyntax intervention (e.g., Tyler et al., 2011) Speech perception difficulties SAILS intervention or equivalent (Rvachew, 1994)

EBP “has not become a regular part of clinical practice” (Brackenbury et al., 2008, p. 78).

Where to from here? 1. Better understanding the factors that influence clinicians’ evidence-based decision making 2. Utilize empirically-based strategies known facilitate knowledge transfer and use 3. Researchers and clinicians to work together on the process of knowledge creation, transfer and exchange.

Acknowledgments Speech Pathology Australia and members Research assistant: Madeline Hastings and Hannah Wilkin Sharynne McLeod acknowledges Australian Research Council Future Fellowship (FT0990588) Research Institute for Professional Practice, Learning and Education (RIPPLE), Charles Sturt University

Dr. Elise Baker1 and Dr. Sharynne McLeod2 1. The University of Sydney, Australia elise.baker@sydney.edu.au 2. Charles Sturt University, Australia smcleod@csu.edu.au ASHA Convention- San Diego, CA- November 17-19, 2011

Informal / own test. . Daz Roberts Test of Articulation (Roberts) 9.4% * * Diagnostic Evaluationof Articulation and Phonology (Dodd et al., 2002) . Goldman-FristoeTest of Articulation (Goldman & Fristoe, 2000) 5.5%: 51.8% * Photo Articulation Test (Lippke et al., 1997) 0.6%: 9.7% * South Tyneside Assessment of Phonology (Armstrong & Ainley .

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