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Background: Children with and without speech sound disorders (SSDs) are exposed to different patterns of infant feeding (breast/bottle-feeding) and may or may not engage in non-nutritive sucking (NNS) (pacifier/digit-sucking). Sucking and speech use similar oral musculature and structures, therefore it is possible that early sucking patterns may impact early speech sound development. The objective of this review is to synthesise the current evidence on the influence of feeding and NNS on the speech sound development of healthy full-term children. Summary: Electronic databases (PubMed, NHS CRD, EMBASE, MEDLINE) were searched using terms specific to feeding, NNS and speech sound development. All methodologies were considered. Studies were assessed for inclusion and quality by 2 reviewers. Of 1,031 initial results, 751 records were screened, and 5 primary studies were assessed for eligibility, 4 of which were included in the review. Evidence from the available literature on the relationship between feeding, NNS and speech sound development was inconsistent and inconclusive. An association between NNS duration and SSDs was the most consistent finding, reported by 3 of the 4 studies. Quality appraisal was carried out using the Appraisal Tool for Cross-Sectional Studies (AXIS). The included studies were found to be of moderate quality. Key Messages: This review found there is currently limited evidence on the relationship between feeding, NNS and speech sound development. Exploring this unclear relationship is important because of the overlapping physical mechanisms for feeding, NNS and speech production, and therefore the possibility that feeding and/or sucking behaviours may have the potential to impact on speech sound development. Further high-quality research into specific types of SSD using coherent clinically relevant assessment measures is needed to clarify the nature of the association between feeding, NNS and speech sound development, in order to inform and support families and health care professionals.

Background Children with cleft palate with or without cleft lip (CP±L) are at high risk of problems with early speech sound production, and these difficulties can persist into later childhood. Early intervention could help to reduce the number of children whose problems become persistent. However, much research in the field to date has focused on older children. There is a need to determine if providing intervention during the phase of early typical speech development leads to better outcomes. Aims To review the evidence for the effectiveness of interventions targeting speech, delivered in the first 3 years of life for children with CP±L, and discuss factors such as intervention type, facilitator, dosage, outcome measures and the age of the child. Methods & procedures The systematic review was registered with PROSPERO (CRD42019121964). Eight bibliographic databases including CINAHL and MEDLINE were searched in August 2018. Studies were included if participants received speech and language interventions before 37 months and if they reported outcomes for speech. Two reviewers independently completed inclusion reviews, quality analysis and data extraction. Outcome & results The review included seven papers: one pilot randomized controlled trial, one controlled trial, four cohort studies and one case series report. Interventions largely took a naturalistic approach, namely focused stimulation and milieu teaching. The findings provide preliminary support for naturalistic interventions and suggest that these interventions can be delivered by parents with suitable training. Studies included in the review provided low-strength evidence with variation in both the type of intervention, the manner of delivery and in the risk of bias in the designs used. Conclusions & implications The papers included in this review suggest that early naturalistic interventions can have positive impacts on the speech development of children with CP±L. However, the reported methodological quality of the publications overall was weak, and the current evidence lacks clarity and specificity in terms of therapy technique, delivery and optimum age of delivery. Future research should use more robust methodological designs to determine whether early speech interventions are beneficial for children born with CP±L. What this paper adds What is already known on the subject Children with CP±L show difficulties with early speech development and often have restricted speech sound inventories. They may reach the canonical babbling stage later than children without CP±L and studies have shown that 20% of children with CP±L have speech which is considered unintelligible or barely intelligible at age 5. It has been proposed that early intervention can lessen the impact of CP±L on speech development. However, currently, the evidence for early interventions for children with CP±L is limited, with the majority of studies focusing on children aged 3 years and older. What this paper adds to existing knowledge This paper reviews the evidence for different types of early interventions for speech provided to children born with CP±L and whether these interventions are effective in supporting speech sound development. In this review, early intervention is defined as intervention provided to children in the first 3 years of life. This review describes intervention approaches and how they are delivered for this population. What are the potential or actual clinical implications of this work? In the UK, children born with CP±L and their families are supported by National Health Service (NHS) services over a 20-year period and speech and language therapy sessions may take place over many weeks and months. If providing early intervention in the first 3 years of life is effective, there is the potential for improved speech outcomes in early childhood and a reduced burden of care on children, families and services. This review considers the evidence for early speech intervention for children with CP±L in the first 3 years of life and identifies areas for future research.

Linguistic interactions between parents and their children are frequently studied to investigate how children acquire language. From observations, researchers have identified interaction strategies that foster children’s language development. In turn, interventions to support children’s early language skills employ styles of interaction derived from these observations. However, researchers have not often considered how the activity context selected forobservation may affect the language used, or whether these contexts reflect children’s diverse experiences.The aim of this scoping review was to explore the breadth of literature about language use across a range of activities. Included studies described linguistic outputs of parents and typically developing children (aged 1;0 to 5;11 years) and activity context(s). Searches were conducted in PsycInfo, Medline, CINAHL, ERIC-ProQuest and Google Scholar. From 16,718 records, 59 studies were retained. Studies were charted according to the population included, linguistic outputs recorded, activity contexts studied and the methodological design. To allow for comparison of results across activity contexts, five thematic categories were identified: play activities, book reading, naturalistic routines, media and methodological implications. Challenges for future research are discussed, including ways to ensure the ecological validity of findings by coupling naturalistic language recordings with data collected during diverse everyday activity contexts.

Background: A number of studies have suggested that practitioners hold speech and language therapy (SLT) practice as tacit and consequently it is difficult for the therapist to describe. The current study uses a range of knowledge elicitation (KE) approaches, a technique not used before in SLT, as a way of accessing this tacit knowledge. There is currently no agreed framework that establishes key factors underpinning practice for preschool children with speech and language disorders. This paper attempts to address that gap. Aims: The aim of this study was to develop a framework of speech and language therapists’ practice when working with preschool children with developmental speech and language disorders (DS&LD). Methods and Procedures: A mixed methods approach was adopted for this study. Data were collected iteratively, from 245 speech and language therapists with experience of working with preschool children with DS&LD across sites in England, by means of focus groups and national events. There were three stages of data collection; local sites, specific interest groups and two national events. KE techniques were used to gather data, with initial data being collected in local site focus groups. Findings from groups were taken to subsequent larger groups where a combination of concept mapping, teach-back and sorting exercises, generated a more detailed description of practice, using discussion of consensus and disagreement to stimulate further exploration and definition and provide validatory evidence. Outcomes and Results: This paper provides a high-level framework of therapy for preschool children with DS&LD that makes practice explicit in this area. The framework proposes that therapists’ aims for this group of children fall into three categories: addressing children’s areas of impairment and skills; achieving functionally meaningful skills and carryover; supporting adults to provide a supportive communication environment. The exact configuration is shaped by the child’s context and needs. Conclusions and Implications: The framework highlights themes that are well researched in the literature (e.g. speech) and others that have been little studied (e.g. adult understanding), indicating a disconnect between research evidence and practice. The research also highlights the complex nature of interventions for preschool children with DS&LD and the importance therapists attribute to tailoring therapy to individual needs. The framework provides a scaffold for speech and language therapists to focus their clinical practice and encourages us as a profession to better understand and explore the gaps between research evidence and clinical practice, for preschool children with DS&LD.

BACKGROUND: Speech development requires intact and adequately functioning oral anatomy and cognitive 'speech processing' skills. There is evidence that speech input processing skills are associated with speech output problems in children not born with a cleft. Children born with cleft palate ± lip (CP±L) are at high risk of developing disordered speech output. Less is known about their speech input processing skills and whether they are associated with cleft-related speech sound disorder (SSD). AIMS: (1) To collate and evaluate studies reporting evidence regarding the speech input processing skills of children born with cleft palate in comparison with data from typically developing children or other comparison groups; and (2) to identify any available evidence regarding relationships between speech input processing skills and speech output in children born with CP±L. METHODS & PROCEDURES: Potentially relevant studies published up to November 2019 were identified from the following databases: Medline via Ovid, Embase via Ovid, Cinahl via Ebscohost, PsycInfo via Ebscohost, BNI via ProQuest, AMED via Ovid, Cochrane Library and Scopus. Inclusion criteria were: peer-reviewed articles published in scientific journals, any design, published in English, participants born with a CP±L aged up to age 18 years who completed speech input processing assessments compared with normative data and/or a control or other comparison group. Critical Appraisal Skills Programme (CASP) checklists were used to quality appraise included studies. OUTCOMES & RESULTS: Six studies were retained in the final review. There is some evidence that children born with CP±L perform less well than non-cleft controls on some speech input processing tasks and that specific input processing skills may be related to errors in the children's speech. Heterogeneity in relation to study groups and assessments used, as well as small sample sizes, limits generalization of findings. CONCLUSION & IMPLICATIONS: There is limited evidence regarding the speech input processing skills of children born with CP±L. There are indications that children born with CP+/L may have difficulty in some aspects of speech input processing in comparison with children not born with a cleft, and that difficulties with some speech input processing tasks may be specific to errors in children's speech output. Further research is required to develop our understanding of these skills in this population and any associations with speech output. WHAT THIS PAPER ADDS: What is already known on the subject Few studies have been published that examine aspects of speech input processing in children born with CP±L. Theoretical models of speech processing, and published studies, propose that speech input processing skills are associated with SSD in children who were not born with a cleft. However, it is less clear whether there is any association between speech input processing and cleft-related SSD. What this paper adds to existing knowledge This review systematically collates and evaluates the published, peer-reviewed evidence regarding speech input processing skills in children born with CP±L. The collated evidence indicates that some speech input processing skills differ between children with and without CP±L. There is some evidence, from a single study, that speech input processing of specific cleft speech characteristics (CSCs) may be associated with the presence of these CSCs in the speech output of some children born with CP±L. What are the potential or actual clinical implications of this work? While the evidence is currently limited, increasing our knowledge of speech input processing skills in children born with CP±L contributes to our clinical understanding of the nature of cleft-related SSD. The current evidence suggests that speech and language therapists should consider speech input processing skills when assessing children with cleft-related SSD to support intervention planning. Considering these skills in relation to literacy development in these children may also be important.

BACKGROUND NHS case note data are a potential source of practice-based evidence which could be used to investigate the effectiveness of different interventions for individuals with a range of speech, language and communication needs. Consistency in pre- and post-intervention data as well as the collection of relevant variables would need to be demonstrated as a precursor to adopting this approach in future investigations of speech and language therapy intervention. AIMS To explore whether routine clinical data collection for children with speech sound disorder (SSD) could be a potential source for examining the effectiveness of intervention(s). METHODS & PROCEDURES We examined case notes from three UK NHS services, reviewing 174 sets of case notes and 234 blocks of therapy provided for school-age children with SSD. MAIN CONTRIBUTION We found there was significant variation in pre- and post-intervention data and variables collected by the services. The assessment data available in the case notes across all sites were insufficient to be used to compare the effectiveness of different interventions. Specific issues included lack of consistent reporting of pre- and post-intervention data, and use of a variety of both formal and informal assessment tools. CONCLUSIONS & IMPLICATIONS The case notes reviewed were from three sites and may not represent wider clinical practice, nevertheless the findings suggest the sample explored indicates the need for more consistent and contemporaneous collection of data for children with SSD to facilitate the investigation of different interventions in practice. Researchers should work with the clinical community to determine a minimal dataset that includes a core outcome set and potential variables. This should be feasible to collect in clinical practice and provide a dataset for future investigations of clinically relevant research questions. This would provide an invaluable resource to the clinical academic and research communities enabling research questions to be addressed that have the potential to lead to improved outcomes and more cost-effective services. WHAT THIS PAPER ADDS What is already known on the subject While there is some evidence for the efficacy of therapy for children with SSD, studies typically focus on very specific populations who meet strict selection criteria and take place in university clinics or laboratory-style settings which do not reflect typical clinical practice in the UK and elsewhere. An alternative approach to investigating the effectiveness of interventions would be to use NHS case note data. It is not clear from the existing literature whether case note data are sufficiently robust to facilitate such an analysis. What this paper adds to existing knowledge This study found that case note data, in particular assessment data, were highly variable across services and would be insufficient to compare different interventions for this population. Agreement on what should be included in a minimal dataset for children with SSD is required to maximize the potential for NHS clinical case notes to become a resource for future research. What are the actual or potential clinical implications of this work? This study indicates that current clinical practice in SLT for children with SSD is inconsistent with regards to the reporting of pre- and post-intervention assessment data and other important variables in case notes. We make the case for agreeing a minimal dataset with a need for clinicians to work with researchers to determine core outcomes and additional relevant data, which can be feasibly collected in clinical practice.

Background Children with persistent speech disorder (PSD) are at higher risk of difficulties with literacy, with some evidence suggesting an association with poorer educational attainment. However, studies to date have either used small clinical samples, which exclude children who have not been referred to clinical services, or relied on parent–teacher report of children's speech development. There is a need for an inclusive study to investigate the impact of PSD on educational outcomes using a population‐based sample and robust measures of speech development. Aim Using a large prospective UK population‐based study—the Avon Longitudinal Study of Parents and Children (ALSPAC)—this study investigated: (1) how children identified with PSD at age 8 years perform on educational attainment tests at ages 10–11 and 13–14 years in comparison with children without PSD; and (2) whether children identified with PSD at age 8 years are more likely to receive a label of special educational needs (SEN) in secondary school. Methods & Procedures We examined the data for 263 children with PSD and 6399 controls who had speech assessed at age 8 years in a research clinic. Educational attainment was measured using data from English school standard attainment tests. Data on SEN categorization were obtained between 11 and 13 years of age. Children with PSD and controls were compared using regression analyses adjusted for biological sex, maternal age, verbal, performance and full‐scale IQ. Outcomes & Results Children with PSD at age 8 years were more likely to achieve lower attainment scores at ages 10–11 years in English and mathematics and across all three subjects of English, mathematics and science at ages 13–14 years after controlling for biological sex and maternal education; score below target levels for English at both time points after controlling for verbal IQ, and at ages 13–14 years after controlling for performance IQ; and receive a label of SEN (typically for the category of cognition and learning needs or communication and interaction needs) in secondary school. Conclusions & Implications PSD identified at age 8 years is associated with poor educational attainment at ages 10–11 and 13–14 years in the core subjects of English, mathematics and science. Children with PSD at age 8 years are more likely to be identified with SEN at ages 11–13 years, particularly cognition and learning needs, and communication and interaction needs. We need to be aware of the potential for the long‐term impact of PSD on educational attainment in providing appropriate and effective support throughout school. What this paper addsWhat is already known on the subject Speech‐sound disorder is associated with reading and spelling difficulties, with some evidence to suggest that PSD is associated with a higher risk of literacy difficulties. Limited evidence also suggests that speech‐sound disorder may be associated with poorer educational attainment. However, studies to date have used small clinical samples or parent–teacher report of speech development and there is a need to determine whether the association is observed in larger and more inclusive population‐based samples. What this paper adds to existing knowledge This prospective, longitudinal study of a large community‐based sample of English children has shown that PSD is associated with poorer educational attainment at the end of primary school and at ages 13–14 years. Children with PSD are also more likely to be identified as having SEN in secondary school, especially communication and interaction needs but also including cognition and learning needs. What are the potential or actual clinical implications of this work? Understanding the long‐term implications of PSD on educational attainment highlights the importance of ongoing monitoring and support to enable children to reach their potential throughout primary and secondary school. The identification of children with a history of PSD during transition to secondary school will enable effective support to be put in place. The intervention for children with PSD should involve close collaboration between speech and language therapists and education professionals.

Speech sound disorders (SSD) manifest as difficulties in phonological memory and awareness, oral motor function, language, vocabulary, reading, and spelling. Families enriched for SSD are rare, and typically display a cluster of deficits. We conducted a genome-wide association study (GWAS) in 435 children from 148 families in the Cleveland Family Speech and Reading study (CFSRS), examining 16 variables representing 6 domains. Replication was conducted using the Avon Longitudinal Study of Parents and Children (ALSPAC). We identified 18 significant loci (combined p −8) that we pursued bioinformatically. We prioritized 5 novel gene regions with likely functional repercussions on neural pathways, including those which colocalized with differentially methylated regions in our sample. Polygenic risk scores for receptive language, expressive vocabulary, phonological awareness, phonological memory, spelling, and reading decoding associated with increasing clinical severity. In summary, neural-genetic influence on SSD is primarily multigenic and acts on genomic regulatory elements, similar to other neurodevelopmental disorders.

Connected speech (CS) is an important component of child speech assessment in both clinical practice and research. There is debate in the literature regarding what size sample of CS is required to facilitate reliable measures of speech output. The aim of this study was to identify the minimum number of word tokens required to obtain a reliable measure of CS across a range of measures. Participants were 776 5-year-olds from a longitudinal community population cohort study (Avon Longitudinal Study of Parents and Children, ALSPAC). Children’s narratives from a story retell task were audio-recorded and phonetically transcribed. Automatic analysis of the transcribed speech samples was completed using an automated transcription and analysis system. Measures of speech performance extracted included: a range of profiles of percentage consonant correct; frequency of substitutions, omissions, distortions and additions (SODA); percentage of syllable and stress pattern matches; and a measure of whole word complexity (Phonological Mean Length of Utterance, pMLU). Statistical analyses compared these measures at different CS sample sizes in increments using averages and weighted moving averages, and investigated how measures performed between CS samples grouped into word tokens of at least 50, 75 and 100, and restricted to samples of 50–74, 75–99 and 100–125. Key findings showed that sample sizes of 75 word tokens and above showed minimal differences in most measures of speech output, suggesting that the minimum requirement for samples of CS is a word count of 75. The exception to this is in the case of pMLU and measures of substitutions and distortions when a word count of 100 is recommended.

BackgroundBoth active and passive cigarette smoking have previously been associated with orofacial cleft aetiology. We aimed to analyse the impact of declining active smoking prevalence and the implementation of smoke-free legislation on the incidence of children born with a cleft lip and/or palate within the United Kingdom.Methods and findingsWe conducted regression analysis using national administrative data in the United Kingdom between 2000–2018. The main outcome measure was orofacial cleft incidence, reported annually for England, Wales and Northern Ireland and separately for Scotland. First, we conducted an ecological study with longitudinal time-series analysis using smoking prevalence data for females over 16 years of age. Second, we used a natural experiment design with interrupted time-series analysis to assess the impact of smoke-free legislation. Over the study period, the annual incidence of orofacial cleft per 10,000 live births ranged from 14.2–16.2 in England, Wales and Northern Ireland and 13.4–18.8 in Scotland. The proportion of active smokers amongst females in the United Kingdom declined by 37% during the study period. Adjusted regression analysis did not show a correlation between the proportion of active smokers and orofacial cleft incidence in either dataset, although we were unable to exclude a modest effect of the magnitude seen in individual-level observational studies. The data in England, Wales and Northern Ireland suggested an 8% reduction in orofacial cleft incidence (RR 0.92, 95%CI 0.85 to 0.99; P = 0.024) following the implementation of smoke-free legislation. In Scotland, there was weak evidence for an increase in orofacial cleft incidence following smoke-free legislation (RR 1.16, 95%CI 0.94 to 1.44; P = 0.173).ConclusionsThese two ecological studies offer a novel insight into the influence of smoking in orofacial cleft aetiology, adding to the evidence base from individual-level studies. Our results suggest that smoke-free legislation may have reduced orofacial cleft incidence in England, Wales and Northern Ireland.

Children’s speech development begins in infancy. The pattern of this development has been explored in studies over a number of years using a range of research methodology and approaches to investigation. A systematic review of the existing literature was carried out to determine the collective contribution of this literature to our understanding of early vocalizations and babbling through the period 9 to 18 months. Eight bibliographic databases were searched as well as the Cochrane library. Thirteen studies were identified for inclusion, which were mostly longitudinal observational case series. The review identified progressive increases in the complexity and volume of infants’ early vocalizations through the period. It also found a broad order of phonological acquisition. Although the studies in this review demonstrated marked individual variation, the review provides indicative patterns of development which can be used as a basis to explore relationships with later speech development in future studies.

Background: Multiple interventions have been developed to address speech sound disorder (SSD) in children.Many of these have been evaluated but the evidence for these has not been considered within a model whichcategorizes types of intervention. The opportunity to carry out a systematic review of interventions for SSD aroseas part of a larger scale study of interventions for primary speech and language impairment in preschool children.Aims: To review systematically the evidence for interventions for SSD in preschool children and to categorize themwithin a classification of interventions for SSD.Methods & Procedures: Relevant search terms were used to identify intervention studies published up to 2012, withthe following inclusion criteria: participants were aged between 2 years and 5 years, 11 months; they exhibitedspeech, language and communication needs; and a primary outcome measure of speech was used. Studies thatmet inclusion criteria were quality appraised using the single case experimental design (SCED) or PEDro-P,depending on their methodology. Those judged to be high quality were classified according to the primary focusof intervention.Outcomes & Results: The final review included 26 studies. Case series was the most common research design.Categorization to the classification system for interventions showed that cognitive–linguistic and productionapproaches to intervention were the most frequently reported. The highest graded evidence was for three studieswithin the auditory–perceptual and integrated categories.Conclusions & Implications: The evidence for intervention for preschool children with SSD is focused on seven outof 11 subcategories of interventions. Although all the studies included in the review were good quality as definedby quality appraisal checklists, they mostly represented lower-graded evidence. Higher-graded studies are neededto understand clearly the strength of evidence for different interventions.

Background: Efforts to increase the evidence base in speech and language therapy are often limited by methodological factors which have restricted the strength of the evidence to the lower levels on the evidence hierarchy. Where higher graded studies, such as randomised controlled trials have been carried out, it has sometimes been difficult to obtain sufficient power to detect a potential effect of intervention owing to small sample sizes or heterogeneity in the participants. With certain clinical groups such as cleft lip and palate, systematic reviews of intervention studies have shown that there is no robust evidence to support the efficacy of any one intervention protocol over another. Aims: The aim of this paper is to describe the setting up of an observational clinical cohort study and to present this as an alternative design for answering research questions relating to prevalence, risk factors and outcomes from intervention. Methods: The Cleft Collective Speech and Language Study is a national cohort study of children born with cleft palate. Working in partnership with regional clinical cleft centres, a sample size of over 600 children and 600 parents is being recruited and followed up from birth to age 5. Variables being collected include demographic, psychological, surgical, hearing and speech and language data. Main Contribution: The process of setting up the study has led to the creation of a unique, largescale dataset which is available for researchers to access now and in the future. As well as exploring predictive factors, the data can be used to explore the impact of interventions in relation to individual differences. Findings from these investigations can be used to provide information on sample criteria and definitions of intervention and dosage which can be used in future trials. Conclusions. The observational cohort study is a useful alternative design to explore questions around prevalence, risk factors and intervention for clinical groups where robust research data are not yet available. Findings from such a study can be used to guide service delivery decisions and to determine power for future clinical trials.

BACKGROUND: Linguistic comprehension and narrative skills encapsulate a complex array of grammatical and semantic skills that underpin complex reading comprehension processes. However, most research in this area has focused on children with reading difficulties and not on typically developing children. Also the research has mostly focused on short-term effects of these skills on reading during the primary school years. Therefore, it remains unclear what specific role linguistic comprehension and narrative skills play in typically developing children's reading beyond the primary school years.AIMS: With this 9-year prospective longitudinal study, we sought to clarify the independent effects of linguistic comprehension and narrative skill (at 5 years of age) on children's reading ability at 10 and 14 years of age.SAMPLE: We examined the data from 716 children (MAge = 67 months, SD = 2.13 months), which were drawn from a major population cohort study, the Avon Longitudinal Study of Parents and Children.METHODS: Children's language skills were assessed at 5 and word reading and reading comprehension skills at 10 years of age. The reading achievement scores at 14 years of age were based on national curriculum test results.RESULTS: Linguistic comprehension and narrative skills at 5 years of age made unique and direct contributions to reading comprehension skills and reading achievement after accounting for general cognitive ability, memory, phonological skills, and mother's education. Moreover, listening comprehension predicted reading achievement even when prior reading skills were taken into account.CONCLUSIONS: Linguistic comprehension and narrative skills are related but distinct oral language skills that continue to influence children's reading development beyond the primary school years.

Recent studies report prevalence, phenotype, and persistence findings for a paediatric motor speech disorder in addition to childhood dysarthria and childhood apraxia of speech termed Speech Motor Delay (SMD). The aim of the present study was to determine if there is a frequent acoustic sign of SMD, with implications for theory, assessment, and treatment. We examined the frequency of 19 acoustic signs of SMD in audio recordings of continuous speech and word-imitation tasks in three groups of speakers with SMD: 50 children (mean age 5.1 years) with idiopathic Speech Delay (SD) from 6 USA cities; 87 children, adolescents, and adults with eight types of complex neurodevelopmental disorders; and 9 children (mean age 8.8 years) with persistent idiopathic SD from a population-based study of children in the South West of England. The 19 acoustic signs of imprecise or unstable speech, prosody, and voice were standardized on typical speakers of the appropriate dialect. The criterion for a frequent acoustic sign was that it occurred in at least 50% of participants with SMD in each of the three groups. Findings indicated that lengthened mid-vowels and diphthongs was the one sign that met criteria, occurring in 64.4% of the 146 participants with SMD, including 71% of the 87 participants with complex neurodevelopmental disorders. Findings are interpreted to support the potential of this acoustic sign, and possibly several others associated with temporal dimensions of speech sound development, to inform explication of the neuromotor substrates of SMD.

The work reported in this special issue of 'Folia Phoniatrica et Logopaedica', supported by the Child Speech Committee of the International Association of Logopedics and Phoniatrics (IALP), shows how transcription has changed over the last few decades and brings readers up to date with the state of the art. Transcription is a tool which is integral to the practice of speech-language pathologists (SLPs). Being able to hear what individuals say is useful, but only by documenting this, can it be determined whether change has occurred over time or in response to intervention. It is through close observation of the transcription that you can identify patterns of ability and error and use this information to plan clinical management. After a thorough review on the history of the transcription of children's speech it has been found that the emphasis within this special topic issue lies upon cross-linguistic transcription.

Speech sound disorder is a common reason for referral to speech and language therapy services in the early years. While for some children, their difficulties are transitory and they either respond to intervention or their difficulties resolve, for others, their speech sound difficulties evolve into persistent speech disorder (PSD). The purpose of this article is to provide information on the features of PSD and how to assess children with PSD in order to identify the full range and limits of their speech sound system. Reference is made to ALSPAC, a large longitudinal population study, regarding prevalence, possible subtypes, and risk factors for PSD.

Most children develop speech and language with ease and quickly become sophisticated communicators. For some children, however, these skills are acquired with difficulty and extra support is required. A range of digital tools are available to assist with this: some of these are based on theories of speech and language acquisition, while others have been developed in response to market demands. Few empirical studies of digital tools for speech and language development have been carried out though some success has been noted when facilitated by a speech-language pathologist (SLP). Given the interactional capabilities of digital tools, it would be helpful to identify whether they could achieve similar results independent of SLP support. One such tool, Phoneme Factory Sound Sorter®, was tested in a randomised controlled trial with early childhood educators delivering the intervention. Improvement in speech production varied across both groups and significant differences were not observed. However, supplementary investigations found that parents and educators were positive towards the use of digital tools, and findings relating to the implementation of the intervention have been identified, which provide useful information for settings looking to use digital tools to promote speech and language skills in children.

Purpose The aim of this tutorial is to support speech-language pathologists (SLPs) undertaking assessments of multilingual children with suspected speech sound disorders, particularly children who speak languages that are not shared with their SLP. Method The tutorial was written by the International Expert Panel on Multilingual Children's Speech, which comprises 46 researchers (SLPs, linguists, phoneticians, and speech scientists) who have worked in 43 countries and used 27 languages in professional practice. Seventeen panel members met for a 1-day workshop to identify key points for inclusion in the tutorial, 26 panel members contributed to writing this tutorial, and 34 members contributed to revising this tutorial online (some members contributed to more than 1 task). Results This tutorial draws on international research evidence and professional expertise to provide a comprehensive overview of working with multilingual children with suspected speech sound disorders. This overview addresses referral, case history, assessment, analysis, diagnosis, and goal setting and the SLP's cultural competence and preparation for working with interpreters and multicultural support workers and dealing with organizational and government barriers to and facilitators of culturally competent practice. Conclusion The issues raised in this tutorial are applied in a hypothetical case study of an English-speaking SLP's assessment of a multilingual Cantonese- and English-speaking 4-year-old boy. Resources are listed throughout the tutorial.

Purpose The aim was to evaluate the effectiveness of computer-assisted input-based intervention for children with speech sound disorders (SSD). Method The Sound Start Study was a cluster-randomized controlled trial. Seventy-nine early childhood centers were invited to participate, 45 were recruited, and 1,205 parents and educators of 4- and 5-year-old children returned questionnaires. Children whose parents and educators had concerns about speech were assessed ( n = 275); 132 children who were identified with phonological pattern-based errors underwent additional assessment. Children with SSD and no difficulties with receptive language or hearing, typical nonverbal intelligence, and English as their primary language were eligible; 123 were randomized into two groups (intervention n = 65; control n = 58), and 3 withdrew. The intervention group involved Phoneme Factory Sound Sorter software (Wren & Roulstone, 2013) administered by educators over 9 weeks; the control group involved typical classroom practices. Participants were reassessed twice by a speech-language pathologist who was unaware of the initial assessment and intervention conditions. Results For the primary outcome variable (percentage of consonants correct), the significant mean change from pre- to postintervention for the intervention group (mean change = +6.15, p < .001) was comparable in magnitude to the significant change for the control group (mean change = +5.43, p < .001) with a small between-groups effect size for change (Cohen's d = 0.08). Similar results occurred for measures of emergent literacy, phonological processing, participation, and well-being. Conclusion Computer-assisted input-based intervention administered by educators did not result in greater improvement than typical classroom practices.

© 2017, © 2017 The Speech Pathology Association of Australia Limited. Purpose: During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents’ and educators’ concerns, (2) examine inter-rater reliability between parents’ and educators’ concerns and (3) determine the group difference between level of concern and children’s performance on clinical testing. Method: Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents’ Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n = 275), receptive vocabulary (n = 131) and language (n = 274). Result: More parents/educators were concerned about children’s speech and expressive language, than behaviour, social–emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents’ and educators’ responses were significantly correlated (except gross motor). Parents’ and educators’ level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators’ level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without. Conclusion: Children’s communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.

Speech sound disorders are a common communication difficulty in preschool children. Teachers indicate difficulty identifying and supporting these children. The aim of this research was to describe speech and language characteristics of children identified by their parents and/or teachers as having possible communication concerns. 275 Australian 4- to 5-year-old children from 45 preschools whose parents and teachers were concerned about their talking participated in speech-language pathology assessments to examine speech, language, literacy, non-verbal intelligence, oromotor skills and hearing. The majority (71.3%) of children demonstrated lower consonant accuracy than expected for their age, 63.9% did not pass the language-screening task, 65.5% had not been assessed and 72.4% had not received intervention from a speech-language pathologist. The 132 children who were identified with speech sound disorder (phonological impairment) were more likely to be male (62.9%) who were unintelligible to unfamiliar listeners, and had poor emergent literacy and phonological processing skills, despite having typical hearing, oral structures, and intelligence. Children identified by parents and teachers with concerns may have a range of speech, language and communication needs requiring professional support.

This review investigated what is known about the impact of bilingualism on children’s phonemic awareness. Studies of bilingual children where one language was English were identified by searching electronic databases and bibliographies from the last 50 years. Thirteen studies were analysed thematically and summarized in terms of methods and key findings. Findings suggest a variable pattern of performance, with some studies showing no difference between bilingual and monolingual performance on tasks. However, there was also evidence for advanced acquisition of phonemic awareness skills in some bilingual children, mediated by characteristics of languages spoken.

Background Children who are bilingual and have speech sound disorder are likely to be under-referred, possibly due to confusion about typical speech acquisition in bilingual children. Aims To investigate what is known about the impact of bilingualism on children's acquisition of speech in English to facilitate the identification and treatment of bilingual children with speech sound disorder. Methods & Procedures A systematic review of studies from the last 50 years was conducted. Studies investigating speech acquisition in bilingual infants and children (where one language was English) were identified through searching seven electronic databases, bibliographies of relevant articles and e-mailing authors. Sixty-six studies investigating bilingual speech production met inclusion criteria, with 53 describing typically developing children and 13 describing children with speech sound disorder. The 66 studies were analysed thematically and summarized in terms of methods, key findings and underlying theories. Main Contribution There was limited evidence to suggest that bilingual children develop speech at a slower rate than their monolingual peers; however, there was evidence for qualitative differences and increased variation in speech production. Nearly all studies provide evidence for transfer between the two phonological and language structures, although the amount of transfer varied between studies. There was evidence of positive and negative transfer of features from the dominant language (L1) to the second language (L2) as well as from L2 to L1. Positive transfer became more evident with increased age and length of exposure to a second language. More recently researchers have moved away from investigating whether there are one or two phonological systems and accept that there are two systems that interact. Interest has shifted to examining how phonological systems interact and to identifying factors that influence interactions. The review revealed a number of inconsistencies in the findings of studies due to differences in methodology, languages investigated and degree of language exposure. Overall, measurement issues were addressed well but most studies provided limited sample information about language experience, schooling and socio-economic status. Conclusions & Implications There are differences in speech sound acquisition between monolingual and bilingual children in terms of rate and patterns of error, with both positive and negative transfer occurring in bilingual children.

As part of a large-scale study of children's development, 7390 children were assessed on a range of speech tasks. These were used to identify three groups of children with speech errors within the sample: persistent speech disorder (PSD); speech errors but below the threshold for classification as persistent speech disorder (non-PSD); and common clinical distortions only (CCD). These three groups were compared on demographic factors, performance on IQ, non-word repetition, and diadochokinetic tests. Findings showed that the PSD group and the non-PSD group were most similar for gender, socio-economic status, IQ, and non-word repetition. In the diadochokinetic tasks, the PSD group and the CCD groups were more similar. Implications for these findings in terms of clinical practice are discussed.

This prospective longitudinal population study observed the speech of 741 children at the ages of 2, 5 and 8 years. At the age of 8, 132 children were categorized as speech impaired. There was stro...

This paper reports on the development and evaluation of a software program aimed at assisting children with phonological impairment. An experimental approach was used whereby children's speech output was assessed pre- and post-therapy. Children were randomly assigned to a computer, a tabletop or a no therapy group. Those children receiving the computer therapy were exposed to an experimental software program that mirrored the tabletop activities using interactive computer games. The results showed no significant difference between any of the three groups with regard to change in speech output. These results may relate to the amount and frequency of therapy given and also to the heterogeneous nature of children included in the study. There was considerable variation in individual performance across all three groups and the data were therefore analysed to look for patterns that might predict performance. Stimulability and gender were identified as possible predictors. Female children and those who were able to produce a greater number of consonant speech sounds in isolation were more likely to make progress in their speech output. Future research might use a similar methodology to compare the therapy conditions but with a more homogenous group in terms of stimulability and using a greater intensity of intervention.

This report of the Withywood Speech and Language Therapy (WiSaLT) project describes the process of setting up and evaluating a mainstream school-based and -funded speech and language therapy service. Outcomes for the child, the classroom setting, the teacher/therapist relationship and the school as a whole were monitored. Progress towards each of the outcomes was demonstrated but it was found that those children with phonological difficulties made more progress than those with language problems. The reasons for this and implications for the future of the service are discussed.

A focus group of seven speech and language therapists (SLTs) who work with children with phonological difficulties was invited to share their views on their current ways of working. Qualitative data was generated through discussion of two video-taped recordings of children with phonological difficulties and a series of brainstorming tasks. The results indicate the use of an electric approach, a mixture of theories rather than a single one. Similarities and differences between SLTs are identified. Implications for the development of clinical guidelines and the investigation of effectiveness are discussed.

A major challenge for the speech-language pathology profession in many cultures is to address the mismatch between the “linguistic homogeneity of the speech-language pathology profession and the linguistic diversity of its clientele” ( Caesar & Kohler, 2007 , p. 198). This paper outlines the development of the Multilingual Children with Speech Sound Disorders: Position Paper created to guide speech-language pathologists’ (SLPs’) facilitation of multilingual children's speech. An international expert panel was assembled comprising 57 researchers (SLPs, linguists, phoneticians, and speech scientists) with knowledge about multilingual children's speech, or children with speech sound disorders. Combined, they had worked in 33 countries and used 26 languages in professional practice. Fourteen panel members met for a one-day workshop to identify key points for inclusion in the position paper. Subsequently, 42 additional panel members participated online to contribute to drafts of the position paper. A thematic analysis was undertaken of the major areas of discussion using two data sources: (a) face-to-face workshop transcript (133 pages) and (b) online discussion artifacts (104 pages). Finally, a moderator with international expertise in working with children with speech sound disorders facilitated the incorporation of the panel's recommendations. The following themes were identified: definitions, scope, framework, evidence, challenges, practices, and consideration of a multilingual audience. The resulting position paper contains guidelines for providing services to multilingual children with speech sound disorders ( http://www.csu.edu.au/research/multilingual-speech/position-paper ). The paper is structured using the International Classification of Functioning, Disability and Health: Children and Youth Version ( World Health Organization, 2007 ) and incorporates recommendations for (a) children and families, (b) SLPs’ assessment and intervention, (c) SLPs’ professional practice, and (d) SLPs’ collaboration with other professionals. Learning outcomes: Readers will 1. recognize that multilingual children with speech sound disorders have both similar and different needs to monolingual children when working with speech-language pathologists. 2. Describe the challenges for speech-language pathologists who work with multilingual children. 3. Recall the importance of cultural competence for speech-language pathologists. 4. Identify methods for international collaboration and consultation. 5. Recognize the importance of engaging with families and people within their local communities for supporting multilingual children in context.

Speech disorder that continues into middle childhood is rarely studied compared with speech disorder in the early years. Speech production in single words, connected speech and nonword repetition was assessed for 7390 eight-year-old children within the Avon Longitudinal Study of Parents and Children (ALSPAC). The majority ( n = 6399) had typical speech and 50 of these children served as controls. The remainder were categorised as using common clinical distortions only (CCD, n = 582) or speech difficulties (SDiff, n = 409). The samples from the CCD children were not analysed further. Speech samples from the SDiff and the control children were transcribed and analysed in terms of percentage consonants correct, error type and syllable structure. Findings were compared with those from children in the Shriberg et al. (1997) lifespan database ( n = 25). The 8-year-old children from ALSPAC in the SDiff and control groups achieved similar speech accuracy scores to the 8-year-old children in the lifespan database. The SDiff group had consistently lower scores than the ALSPAC control group, with the following measures most clearly differentiating the groups: single word task (percentage of substitutions and distortions), connected speech task (percentage of vowels correct (PVC), percentage of omission of singletons and entire clusters, and stress pattern matches), nonword repetition task (PVC, percentage of entire clusters omitted, percentage of distortions, and percentage of stress pattern matches). Connected speech and nonword samples provide useful supplementary data for identifying older children with atypical speech. Learning outcomes: The reader will recognize the methods used to identify speech characteristics in a large scale population study. They will describe how measures of speech accuracy in connected speech compare with the Shriberg et al. (1997) lifespan database. The reader will also recall information on how typically and atypically developing children differ on a range of measures across different types of speech sample.

A review of software was carried out to evaluate to what extent particular titles could be used within a phonological therapy programme using a psycholinguistic approach for children aged between four and seven years. Some of the software had been developed specifically for speech and language therapists working with children's phonological impairments. Other titles were from the education market and aimed at developing children's literacy skills. This paper describes how these software programmes could be used to address phonological impairments through developing the sub-skills described within the psycholinguistic framework.

The move towards an inclusive model of education presents teachers with the difficulty of differentiating the curriculum for children with speech, language and communication impairments. This paper focuses on the ‘WiSaLT Curriculum Appendix’ - a tool which can be used by teachers and speech and language therapists to help such children access the mainstream curriculum and to promote improvement in their language and communication skills. As well as highlighting potential areas of difficulty within each attainment target for key stage one, the appendix guides users to specific strategies and activities. Thus the speech and language therapist and teacher can identify which attainment targets might prove problematic for any one child and also have access to ideas which can help.