BACKGROUND: Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents\' role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders.
OBJECTIVE: This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention.
METHODS: A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants\' speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants).
RESULTS: The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received.
CONCLUSIONS: The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve.
UNASSIGNED: DERR1-10.2196/54426.

OBJECTIVE: Children with specific language impairment (SLI) might present with speech sound disorder (SSD) and phonological awareness (PA) deficits which put them at risk of potential reading problems. This work aimed to organize an intervention program in Arabic for phonological training and to assess the effect of PA training versus the phonological therapy (PT) for children with SLI and SSD.
METHODS: The study was carried out on 60 children with comorbid SLI and SSD, aged 5-7 years. Children were equally divided into two groups; each group received language therapy combined with (PT or PA training). Measures of language development, phonological output, and PA were taken before therapy and at 4 month post-therapy for all children.
RESULTS: The two therapy groups made nearly the same amount of progress in the development of language and phonological production, with no significant differences regarding language age and percent of consonants correct (PCC). The PA training group progressed more on the PA skills than children who received PT over the same time.
CONCLUSIONS: PA training could facilitate the development of phonological skills by targeting the child\'s awareness of phonemes and improving the production of sound patterns.

Childhood apraxia of speech (CAS) is difficult to diagnose because there is little agreement on objective clinical markers. Since studies of phonological development in French-speaking children are scarce, there are even fewer recognised markers in French as compared to English. This study aims to determine if a set of operationalised, quantitative measures derived from clinical markers of CAS in English corroborate with clinical CAS diagnosis in French-speaking children. This research contributes to improving differential diagnosis of CAS and phonological disorder cross-linguistically.
We collected data from five children diagnosed with CAS, nine children diagnosed with phonological disorder, and 75 typically-developing children aged 5.10-9.2 years old. All children were assessed on three speech production tasks: picture-naming, non-word repetition, and diadochokinesis. We extracted 20 quantitative measures corresponding to commonly accepted clinical features of CAS.
Similar to English-speaking children, French-speaking children with CAS exhibited a high number of vowel errors, consonant and cluster errors, consonant epentheses, devoicing errors, slow diadochokinesis rate, more inconsistency and increased errors with longer words. Contrary to studies on English, these children with CAS did not produce intrusive schwas or vowels.
This multiple-case study highlights the need for cross-linguistic diagnostic criteria for CAS.

The extent to which treatment of speech errors that are phonetic in nature (i.e., distortions) produces generalization to untrained sounds is not well understood. This case study reports a child referred for treatment of a velarized distortion of American English /ɹ/, who also demonstrated an inconsistent velarized distortion of /l/. Acoustic analysis revealed evidence of a covert contrast between /ɹ/ and /l/ prior to treatment. Ultrasound biofeedback treatment and perceptual training targeted /ɹ/ only, but progress was tracked for both /ɹ/ and /l/. Substantial improvements in perceptually rated accuracy and significant changes in acoustic features were observed for both sounds, indicating generalization. These results highlight that generalization from trained to untrained sounds is possible for children with residual speech errors characterized by phonetic distortions.

Purpose: To compare children\'s speech, language and early literacy outcomes, and caregivers\' empowerment and satisfaction following provision of 12 sessions of direct intervention (therapy), or face-to-face advice or a purpose-built website (device) while waiting for therapy.Method: A four-stage randomised controlled trial was undertaken involving three- to six-year-old children referred to speech-language pathology waiting lists at two Australian community health centres over eight months (n = 222). Stage 1 (screening): 149 were eligible to participate. Stage 2 (pre-assessment): 117 were assessed. Stage 3 (intervention): 110 were randomised to advice (33), device (39) or therapy (38). Stage 4 (post-assessment): 101 were re-assessed by a speech-language pathologist blinded to the intervention condition.Result: After controlling for baseline levels, children\'s speech (percentage of consonants correct) was significantly higher in the therapy group compared to the advice and device conditions. Caregivers\' satisfaction was also significantly higher in the therapy condition compared to the device condition. There were no significant differences between the three conditions for children\'s intelligibility, language and early literacy or caregivers\' empowerment.Conclusion: Therapy resulted in significantly higher speech outcomes than the advice and device conditions and was associated with significantly greater caregiver satisfaction. Provision of a website containing evidence-based material or a single session of advice may be a viable alternative while children wait for therapy targeting intelligibility, language and early literacy, and to empower caregivers.

OBJECTIVE: The objective of this study was to create a stimulability treatment program in Turkish language that targets Turkish consonants and vowels and to present the preliminary findings of the effectiveness of the program in a small group of Turkish children with speech sound disorder (SSD).
METHODS: Twenty-two children with SSD participated in the study. The Turkish Articulation and Phonology Test (SST) was used in the assessment of children. Intelligibility ratings were completed by their caregivers through the Turkish version of Intelligibility in Context Scale (ICS), and the stimulability assessments were completed. Stimulability intervention were given for a total of 12 sessions. Comparisons were made between the pre- and post-test results of children, and the preliminary data of treatment efficacy were collected.
RESULTS: The data analysis showed a significant difference in the total number of articulation errors of children between Time 1 and Time 2 (p < .0001), a statistically significant difference in auditory discrimination scores between the two measurements, (p < .05), and an increase in stimulability ratings from Time 1 to Time 2.
CONCLUSIONS: These findings provide initial data on the positive effect of the Turkish stimulability treatment program for children with SSD. This preliminary study would contribute toward designing the main trial for an evidence-based study for the Turkish stimulability treatment program, thereby leading to better practices in SSD.

This study describes the criteria that are used in ultrasound to measure the differences between the tongue contours that produce [s] and [ʃ] sounds in the speech of adults, typically developing children (TDC), and children with speech sound disorder (SSD) with the phonological process of palatal fronting. Overlapping images of the tongue contours that resulted from 35 subjects producing the [s] and [ʃ] sounds were analysed to select 11 spokes on the radial grid that were spread over the tongue contour. The difference was calculated between the mean contour of the [s] and [ʃ] sounds for each spoke. A cluster analysis produced groups with some consistency in the pattern of articulation across subjects and differentiated adults and TDC to some extent and children with SSD with a high level of success. Children with SSD were less likely to show differentiation of the tongue contours between the articulation of [s] and [ʃ].

This exploratory treatment study used phonetic transcription and speech kinematics to examine changes in segmental and articulatory variability. Nine children, ages 4 to 8 years old, served as participants, including two with childhood apraxia of speech (CAS), five with speech sound disorder (SSD) and two who were typically developing. Children practised producing agent + action phrases in an imitation task (low linguistic load) and a retrieval task (high linguistic load) over five sessions. In the imitation task in session one, both participants with CAS showed high degrees of segmental and articulatory variability. After five sessions, imitation practice resulted in increased articulatory variability for five participants. Retrieval practice resulted in decreased articulatory variability in three participants with SSD. These results suggest that short-term speech production practice in rote imitation disrupts articulatory control in children with and without CAS. In contrast, tasks that require linguistic processing may scaffold learning for children with SSD but not CAS.

Rhotics in many languages develop late and show clinically significant misarticulations. The English approximant and Spanish trill rhotics exhibit both a primary constriction along the palate and a secondary constriction in the pharynx. We speculate that the secondary constriction might be a cross-linguistic characteristic of rhotics and thus potentially a factor in delayed articulatory development/misarticulations. We describe an exploratory study analyzing rhotic tongue configurations in ultrasound videos from a small sample of native adult speakers of English, Malayalam, French, Persian and Spanish. Our findings confirm that rhotic sounds most subject to late development also involve tongue root movement towards a pharyngeal constriction, but this conclusion must remain tentative without further research. In the meantime, clinical strategies that include attention to primary and secondary constrictions should be explored for remediation of rhotic misarticulations across languages.

Blinded listener ratings are essential for valid assessment of interventions for speech disorders, but collecting these ratings can be time-intensive and costly. This study evaluated the validity of speech ratings obtained through online crowdsourcing, a potentially more efficient approach. 100 words from children with /r/ misarticulation were electronically presented for binary rating by 35 phonetically trained listeners and 205 naïve listeners recruited through the Amazon Mechanical Turk (AMT) crowdsourcing platform. Bootstrapping was used to compare different-sized samples of AMT listeners against a \"gold standard\" (mode across all trained listeners) and an \"industry standard\" (mode across bootstrapped samples of three trained listeners). There was strong overall agreement between trained and AMT listeners. The \"industry standard\" level of performance was matched by bootstrapped samples with n = 9 AMT listeners. These results support the hypothesis that valid ratings of speech data can be obtained in an efficient manner through AMT. Researchers in communication disorders could benefit from increased awareness of this method.
OBJECTIVE: Readers will be able to (a) discuss advantages and disadvantages of data collection through the crowdsourcing platform Amazon Mechanical Turk (AMT), (b) describe the results of a validity study comparing samples of AMT listeners versus phonetically trained listeners in a speech-rating task.