Who needs intervention? A phonological screening tool for young children with cleft palate

TY - CONF

T1 - Who needs intervention?

T2 - A phonological screening tool for young children with cleft palate

AU - Jørgensen, Line Dahl

PY - 2015

Y1 - 2015

N2 - Who needs intervention? A phonological screening tool for children with cleft palate Children with cleft palate +/- cleft lip (CP) are at risk of speech and language delay. It is important to identify children with difficulties as early as possible in order to offer appropriate intervention. Conversely, it is also vital to avoid unnecessary intervention which both adds to the burden of care for the family and to socioeconomic cost. Although there is a strong relationship between early sounds and syllable shapes and later speech and language skills in children without CP (1), the picture is less clear when it comes to children with CP. However, number of oral consonants, different oral consonants, oral stops, velar consonants, and alveolar consonants have been found to predict later speech and language proficiency (2,3). Traditionally, early speech production has been evaluated by thorough phonetic transcription of a large number of utterances occurring during spontaneous interaction between child and caregiver. This is, however, a time-consuming and thus expensive procedure. Furthermore, it has been shown to overestimate the size of the child’s consonant repertoire (4). Ramsdell and her colleagues (4) found that naturalistic listening in which caregiver judgment is simulated in the laboratory is a valid way of estimating a child’s consonant repertoire when compared to both caregiver report and phonetic transcription. Lieberman and Lohmander (5) also found that a speech language pathologist’s clinical impression of a child’s consonant inventory during interaction with a caregiver correlated well with phonetic transcription. As part of a larger intervention study of young children with CP, this study aims at developing and evaluating a screening procedure for young children with CP in order to determine which children need early intervention. Naturalistic listening is used for evaluating consonant inventory, and children are assigned to +/- need for intervention based on their use of specific phonological categories known as early predictors of later speech and language difficulties in children with CP. To determine the external validity of this procedure, it is compared to experienced speech and language pathologists’(SLPs) clinical judgment of whether or not a child with CP needs early intervention. A group of 20 children with CP between 17 and 24 months of age will be video recorded for 45 minutes during natural play with a caregiver. Three SLPs trained in a naturalistic listening procedure will evaluate all video recordings, and inter and intra reliability will be calculated. Two SLPs with many years of experience working in cleft clinics will evaluate the video recordings and give their clinical opinion on each child’s need for early intervention. Cases of disagreement will be solved through consensus listening and discussion. Good agreement between the raters in the naturalistic listening procedure, and a strong correlation between the children selected for intervention with the screening procedure and the clinical opinion of experienced SLPs could indicate that the screening procedure is a valid tool for identifying children with CP who need early intervention. Poor agreement might indicate insufficient training. Weak correlation could indicate that SLPs refer children for intervention due to other parameters than the phonological categories in which case the screening procedure might need adjustment. References: 1. Olswang, L. B, Rodriguez, B. & Timler, G. (1998). Recommending intervention for toddlers with specific language learning difficulties: we may not know all the answers, but we know a lot. American Journal of Speech Language Pathology, 7(1), 23–32. 2. Chapman, K. L. & Willadsen, E. (2011). The development of speech in children with cleft palate. In Lohmander, A. Howard, S. (eds.). Cleft Palate Speech. Assessment and Intervention (pp. 23–36). Wiley-Blackwell. 3. Klintö, K., Salameh, E.-K., Olsson, M., Flynn, T., Svensson, H., & Lohmander, A. (2014). Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months: Phonology in 3-year-olds born with cleft palate. International Journal of Language & Communication Disorders, 49(2), 240–254. doi:10.1111/1460-6984.12068 4. Ramsdell, H. L., Oller, D. K., Buder, E. H., Ethington, C. A., & Chorna, L. (2012). Identification of Prelinguistic Phonological Categories. Journal of Speech Language and Hearing Research, 55(6), 1626. doi:10.1044/1092-4388(2012/11-0250) 5. Lieberman, M., & Lohmander, A. (2014). Observation is a valid way of assessing common variables in typical babbling and identifies infants who need further support. Acta Paediatrica, 103(12), 1251–1257. doi:10.1111/apa.12776

AB - Who needs intervention? A phonological screening tool for children with cleft palate Children with cleft palate +/- cleft lip (CP) are at risk of speech and language delay. It is important to identify children with difficulties as early as possible in order to offer appropriate intervention. Conversely, it is also vital to avoid unnecessary intervention which both adds to the burden of care for the family and to socioeconomic cost. Although there is a strong relationship between early sounds and syllable shapes and later speech and language skills in children without CP (1), the picture is less clear when it comes to children with CP. However, number of oral consonants, different oral consonants, oral stops, velar consonants, and alveolar consonants have been found to predict later speech and language proficiency (2,3). Traditionally, early speech production has been evaluated by thorough phonetic transcription of a large number of utterances occurring during spontaneous interaction between child and caregiver. This is, however, a time-consuming and thus expensive procedure. Furthermore, it has been shown to overestimate the size of the child’s consonant repertoire (4). Ramsdell and her colleagues (4) found that naturalistic listening in which caregiver judgment is simulated in the laboratory is a valid way of estimating a child’s consonant repertoire when compared to both caregiver report and phonetic transcription. Lieberman and Lohmander (5) also found that a speech language pathologist’s clinical impression of a child’s consonant inventory during interaction with a caregiver correlated well with phonetic transcription. As part of a larger intervention study of young children with CP, this study aims at developing and evaluating a screening procedure for young children with CP in order to determine which children need early intervention. Naturalistic listening is used for evaluating consonant inventory, and children are assigned to +/- need for intervention based on their use of specific phonological categories known as early predictors of later speech and language difficulties in children with CP. To determine the external validity of this procedure, it is compared to experienced speech and language pathologists’(SLPs) clinical judgment of whether or not a child with CP needs early intervention. A group of 20 children with CP between 17 and 24 months of age will be video recorded for 45 minutes during natural play with a caregiver. Three SLPs trained in a naturalistic listening procedure will evaluate all video recordings, and inter and intra reliability will be calculated. Two SLPs with many years of experience working in cleft clinics will evaluate the video recordings and give their clinical opinion on each child’s need for early intervention. Cases of disagreement will be solved through consensus listening and discussion. Good agreement between the raters in the naturalistic listening procedure, and a strong correlation between the children selected for intervention with the screening procedure and the clinical opinion of experienced SLPs could indicate that the screening procedure is a valid tool for identifying children with CP who need early intervention. Poor agreement might indicate insufficient training. Weak correlation could indicate that SLPs refer children for intervention due to other parameters than the phonological categories in which case the screening procedure might need adjustment. References: 1. Olswang, L. B, Rodriguez, B. & Timler, G. (1998). Recommending intervention for toddlers with specific language learning difficulties: we may not know all the answers, but we know a lot. American Journal of Speech Language Pathology, 7(1), 23–32. 2. Chapman, K. L. & Willadsen, E. (2011). The development of speech in children with cleft palate. In Lohmander, A. Howard, S. (eds.). Cleft Palate Speech. Assessment and Intervention (pp. 23–36). Wiley-Blackwell. 3. Klintö, K., Salameh, E.-K., Olsson, M., Flynn, T., Svensson, H., & Lohmander, A. (2014). Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months: Phonology in 3-year-olds born with cleft palate. International Journal of Language & Communication Disorders, 49(2), 240–254. doi:10.1111/1460-6984.12068 4. Ramsdell, H. L., Oller, D. K., Buder, E. H., Ethington, C. A., & Chorna, L. (2012). Identification of Prelinguistic Phonological Categories. Journal of Speech Language and Hearing Research, 55(6), 1626. doi:10.1044/1092-4388(2012/11-0250) 5. Lieberman, M., & Lohmander, A. (2014). Observation is a valid way of assessing common variables in typical babbling and identifies infants who need further support. Acta Paediatrica, 103(12), 1251–1257. doi:10.1111/apa.12776

M3 - Poster

ER -