Speech sound disorder (SSD) is one of the most common communication disorders in children, which must be diagnosed and treated in childhood to prevent its negative psychological, occupational, and social consequences in adulthood. The use of serious games is one technology that could help treat SSD. This study aims to design and evaluate the usability of a digital game for 3-6-year-old children. This developmental study was carried out in three main stages: determining information requirements, designing and developing a digital game, and evaluating the usability of the designed game. In the first stage, the consonants, syllables, words, and sentences that should be used in the game were determined through focus group sessions and a questionnaire completed by 30 speech-language pathologists (SLPs) in two Delphi rounds. In the designing and developing stage, the game design document was first written, and then sketches and wireframes were drawn based on this document. Then, the game was developed in the second phase using Java programming language. In the third stage, the usability of the designed game was evaluated by six experts and 22 SLPs using Nielsen\'s usability heuristics and the Post-Study System Usability Questionnaire (PSSUQ), respectively. Also, the usability of the game was evaluated by ten children. To determine the information requirements, SLPs confirmed 23 consonants, 138 syllables, 564 words, and 69 sentences to teach children the game. According to Nielsen\'s usability heuristics, the designed game had 23 unique usability problems with a mean severity of 2.29. \"User control and freedom,\" with five usability problems, was the most frequently identified problem, and \"error prevention,\" with a mean severity of 3.83, was the most severe problem. The results of the SLPs\' evaluation also showed that the \"interface quality\" of the designed game obtained the highest score, with a mean score of 6.25 out of 7. Also, 100% of children stated that the game was designed beautifully, and 90% of children also liked the game. A serious game designed for children with SSDs achieved satisfactory results in usability evaluation. Therefore, this smartphone-based game can be easily used among these children to provide fun therapy sessions under the supervision of parents.

Speech training apps are being developed that provide automatic feedback concerning children\'s production of known target words, as a score on a 1-5 scale. However, this \'goodness\' scale is still poorly understood. We investigated listeners\' ratings of \'how many stars the app should provide as feedback\' on children\'s utterances, and whether listener agreement is affected by clinical experience and/or access to anchor stimuli. In addition, we explored the association between goodness ratings and clinical measures of speech accuracy; the Percentage of Consonants Correct (PCC) and the Percentage of Phonemes Correct (PPC). Twenty speech-language pathologists and 20 non-expert listeners participated; half of the listeners in each group had access to anchor stimuli. The listeners rated 120 words, collected from children with and without speech sound disorder. Concerning reliability, intra-rater agreement was generally high, whereas inter-rater agreement was moderate. Access to anchor stimuli was associated with higher agreement, but only for non-expert listeners. Concerning the association between goodness ratings and the PCC/PPC, correlations were moderate for both listener groups, under both conditions. The results indicate that the task of rating goodness is difficult, regardless of clinical experience, and that access to anchor stimuli is insufficient for achieving reliable ratings. This raises concerns regarding the 1-5 rating scale as the means of feedback in speech training apps. More specific listener instructions, particularly regarding the intended context for the app, are suggested in collection of human ratings underlying the development of speech training apps. Until then, alternative means of feedback should be preferred.

BACKGROUND: Speech and language therapists (SLTs) regularly use phonetic transcription to record and analyse typical and disordered speech. Phonetic transcription is highly demanding of auditory perceptual skills so researchers are sceptical about its accuracy and reliability. The literature describes how phonetic transcription is prone to auditory illusions and biases, such as a preference to transcribe speech sounds from the transcriber\'s own language. Few empirical research studies have calculated agreement amongst transcribers where a range of agreement scores have been reported (51%-97%). There is a consensus that agreement rates decrease as phonetic detail increases. Vowels and consonants are characterised by different perceptual features within the International Phonetic Alphabet (IPA) so they may differ in agreement rates, and thus far there is contradictory evidence as to whether vowels or consonants are more agreed upon. Transcription agreement studies to date have most commonly recruited phoneticians rather than SLTs so further research is warranted to determine transcription agreement amongst SLTs and its impact on clinical practice.
OBJECTIVE: The study\'s primary aim was to calculate agreement scores from a group of English-speaking SLTs who transcribed disordered speech samples in an ecologically valid setting. The study also sought to contribute to the pre-existing contradictory evidence base regarding whether vowels or consonants may be more agreed upon by comparing their agreement scores. The researcher aimed to comment on SLTs\' use of diacritics and non-native speech symbols (symbols not included in the English phonetic inventory) in terms of their frequency and agreement of use. By analysing transcriptions, the study aimed to discuss the impact transcription variability has on speech sound error patterns and thus its impact on clinical decision-making such as diagnosis, choice of intervention and therapy targets.
METHODS: Twelve paediatric SLTs were recruited via a convenience sample at two National Health Service trusts, two of whom were specialists in Speech Sound Disorders (SSDs). Participants transcribed 16 words from a video of a boy with disordered speech completing the Diagnostic Evaluation of Articulation and Phonology (DEAP, Dodd et al., 2006) from a telehealth appointment. The use of diacritics and non-English IPA symbols were manually analysed. A classic agreement score was calculated for each target word using a Python script, and then for vowels and consonants in isolation. Datasets were manually analysed to determine whether differences in transcription resulted in the identification of different speech sound error patterns. The researcher considered the implications this had within clinical practice.
RESULTS: The average classic agreement score was 56.3%. Consonants were more agreed upon than vowels with agreement scores of 62.8% and 48.6%, respectively. Nine participants (75%) used diacritics (most commonly length marks) and eight participants (67%) transcribed non-native IPA symbols at least once in their datasets, but generally with low frequencies and agreements amongst their use. Transcriptions captured the occurrence of typical and atypical error patterns but only three error patterns, out of the 20 identified, were present in all 12 participants\' transcriptions.
CONCLUSIONS: The agreement score of 56.3% questions the accuracy and reliability of transcription amongst SLTs which is an essential skill of the profession. The findings highlight SLTs should be more cautious of interpreting vowels than consonants given lower agreement rates. The frequency of use of non-native symbols and diacritics was relatively low which could reflect a low accuracy of their use or reduced confidence in transcribing these. The study discussed how variations in transcriptions can impact phonological and phonetic analysis, which in turn can influence clinical decision-making such as diagnosing SSDs, selecting further diagnostic assessments and choosing therapy targets and interventions. The Royal College of Speech and Language Therapists-endorsed transcription guidelines (Child Speech Disorder Research Network, 2017) could be revised to convey realistic expectations of SLTs\' transcription skills, or SLTs should be offered more training to improve transcription skills to meet current expectations. Other suggestions to improve transcription accuracy are discussed such as via instrumental methods, yet these come with their own limitations such as practicality, costs and need for specialist training.
CONCLUSIONS: What is already known on this subject Phonetic transcription is highly demanding of human perceptual skills, and researchers are sceptical about its reliability. There are few empirical research studies calculating agreement amongst transcribers, and a range of agreement scores have been reported (51%-97%) dependent on the research conditions. Research mostly involves experienced transcribers (e.g., phoneticians) rather than speech and language therapists (SLTs), a profession expected to regularly use phonetic transcription to record and analyse typical and disordered speech. What this study adds to existing knowledge A range of transcription agreement scores have been reported in previous studies, mainly comparing pairs or small groups of specialist transcribers rather than SLTs. This study provides an agreement score of 56.3% when a group of 12 SLTs transcribed a disordered speech sample in an ecologically valid setting (where speech samples were taken from a real-life speech sound assessment over a telehealth appointment using the Diagnostic Evaluation of Articulation and Phonology). The study found consonants are more agreed upon than vowels, adding to the contradictory evidence base. Unlike other studies, the researcher analysed transcriptions to identify error patterns to examine the impact that transcription variation has on clinical decision-making. What are the potential or actual clinical implications of this work? The researcher questions whether SLTs are meeting the expectations of \'accurate transcription\' as listed by the Royal College of Speech and Language Therapists (RCSLT) endorsed transcription guidelines (Child Speech Disorder Research Network, 2017) given the relatively low agreement score of 56.3%. The study also questions the reliability of the use of diacritics and non-English International Phonetic Alphabet (IPA) symbols and whether SLTs should be expected to use these due to perceptual limitations. Twenty phonological processes emerged from the datasets, only three of which were agreed upon across all 12 participants. The researcher therefore discusses how transcription variations could result in different diagnoses, therapy targets and interventions choices. The paper suggests more training is required to enhance transcription accuracy, and also considers the appropriateness of utilising instrumental methods whilst recognising its limitations such as feasibility, costs and specialist training needs.

The purpose of this study was to investigate if multiple oppositions intervention (MOI) generated widespread change in the phonological systems of two children with cleft lip and palate (CLP) and severe speech sound disorders (SSD). We treated two children (ages 5;4 and 5;6) with CLP and severe SSD using MOI for 24 and 29 sessions. We measured the percentage consonants correct (PCC) for target consonants and untreated consonants in non-treatment single words, as well as PCC for connected speech. Data points were collected in the baseline, intervention, and maintenance phase with post-tests conducted immediately after intervention and at 1, 3, 6 and 12 months. Two speech and language therapists (SLTs) unfamiliar with the children performed phonetic transcriptions, and we calculated intra- and inter-rater agreement. We graphed the data, and used permutation tests to analyse the probability that the observed increases in PCC were due to random chance. Both children experienced considerable improvements in PCC across all measures at the first post-test, supporting the impact of MOI on their entire phonological system. The PCC continued to increase during the maintenance phase. By the final post-test, the PCC in connected speech exceeded 90% for both children, reducing their SSD classification to mild. Our findings support that a phonological, contrastive intervention approach targeting multiple consonants simultaneously can create system-wide phonological change for children with CLP and severe SSD. Further research with more participants is needed to strengthen these findings.

OBJECTIVE: Speech sound disorder (SSD) describes a \'persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication\'. There is a need to establish which care pathways are most effective and efficient for children with SSD. Comparison of care pathways requires clearly defined, evidence-based, interventions and agreement on how to measure the outcomes. At present, no definitive list of assessments, interventions or outcomes exists. The objective of this umbrella review paper is to provide a rigorous and detailed list of assessments, interventions and outcomes which target SSD in children.
METHODS: In December 2022, a systematic search of Ovid Medline, OVID Embase, CINAHL, PsycInfo and Cochrane and a number of grey literature platforms were undertaken. 18 reviews were included, and subsequently 415 primary research articles were assessed for data related to assessments, interventions or outcomes. The AMSTAR (Assessing the Methodological Quality of Systematic Reviews) framework was used to assess the quality of the retained reviews.
METHODS: Reviews were retained which took place in any setting.
METHODS: The population is children of any age with a diagnosis of SSD of unknown origin.
METHODS: Reviews reporting outcomes, assessment and interventions for children with SSD.
RESULTS: Extraction and analysis identified 37 assessments, 46 interventions and 30 outcome measures used in research reporting of SSD. Not all of the listed outcomes were linked to specific outcome measurement tools, but these were measurable through the use of one or more of the assessments extracted from the retained reviews.
CONCLUSIONS: The findings of this review will be used to develop a Core Outcome Set for children with SSD. The findings are part of a rigorous process essential for advancing healthcare research and practice in the specific area of speech and language therapy for children with SSD.
UNASSIGNED: CRD42022316284.

UNASSIGNED: Pitch variations (tone productions) have been reported as a measure to differentiate Cantonese-speaking children with and without childhood apraxia of speech (CAS). This study aims to examine fundamental frequency (F0) changes within syllables and the effects of syllable structure, lexical status, and syllable positions on F0 in Cantonese-speaking preschool children with and without CAS.
UNASSIGNED: Six children with CAS, six children with non-CAS speech sound disorder plus language disorder (S&LD), 22 children with speech sound disorder only (SSD), and 63 children with typical speech-language development (TD) performed the tone sequencing task (TST). Growth curve analysis was employed to analyze and compare the F0 values within syllables with three Cantonese tones (high level, high rising, and low falling). The analysis considered the effects of syllable structure (vowel and consonant-vowel), lexical status (word and nonword), and syllable position (initial, medial, and final) on F0, as well as comparisons within and between groups.
UNASSIGNED: Within each group, the effects of syllable structure and position on F0 values were found with different patterns. Between-group comparisons showed that the CAS group had reduced F0 contrasts. The CAS group could be differentiated from the control groups based on interactions of F0 with syllable structure and position, but not lexical status. The dissimilarity of F0 values detected between the CAS and SSD/TD groups was more prominent than that observed between the CAS and S&LD groups.
UNASSIGNED: This study demonstrated that Cantonese-speaking children with CAS had difficulty in varying F0 within syllables as compared to those without CAS, suggesting pitch variation difficulty and language-specific impairment profiles in CAS. Future investigations of objective measures for identifying Cantonese speakers with CAS and cross-linguistic investigations using growth curve analysis and the TST are suggested.

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.

BACKGROUND: Speech sound disorder (SSD) is a speech and language disorder associated with difficulties in motor production, perception, and phonological representation of sounds and speech segments. Since auditory perception has a fundamental role in forming and organizing sound representation for its recognition, studies that evaluate the cortical processing of sounds are required. Thus, the present study aimed to verify the relation between SSD severity measured by the percentage of correct consonants (PCCs) with the cortical auditory evoked potentials (CAEPs) using speech stimulus.
METHODS: Twenty-nine children with normal hearing participated in this research and were grouped into three groups by SSD level measured by the PCC index. In addition, the groups were subdivided according to the children\'s age group: between 60-71 months, 72-83 months, and 83-94 months. The CAEP with speech stimulus was carried out in all children.
RESULTS: Older children had longer P1 and N1 latencies. In P2 latency, there was an interference of age only in the severe group. The N2 latency was affected by age, where older children had longer latency.
CONCLUSIONS: The amplitude of CAEP has not suffered any interference with the age, or severity of SSD. For the latency, older children generally presented longer averages than younger ones.

UNASSIGNED: The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children\'s speech-language outcomes secondary to pandemic-related social restrictions.
UNASSIGNED: Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children\'s communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD (n = 226) Jamaican Creole-English-speaking preschoolers and those with fSSDs (n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica.
UNASSIGNED: Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate.
UNASSIGNED: Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children\'s speech-language outcomes in the context of acutely changing environmental circumstances.
UNASSIGNED: https://doi.org/10.23641/asha.25461505.

OBJECTIVE: To seek evidence of validity and reliability for the Compressed Speech Test with Figures.
METHODS: The study was subdivided into three stages: construct validation, criteria and reliability. All participants were aged between 6:00 and 8:11. For the construct, Compressed Speech with Figures and the gold standard Adapted Compressed Speech test were applied to children with typical phonological development. For criterion analysis, Compressed Speech with Figures was applied in two groups, with typical (G1) and atypical (G2) phonological development. Finally, the application protocols underwent analysis by two Speech Therapists, with experience in the area of Central Auditory Processing, seeking to obtain an inter-evaluator reliability analysis.
RESULTS: The correlation test indicated an almost perfect construct (correlation 0.843 for the right ear and 0.823 for the left ear). In the criterion analysis, it was noticed that both groups presented satisfactory results (G1 = 99.6 to 100%; G2 = 96 to 96.5%). The reliability analysis demonstrated that the protocol is easy to analyze, as both professionals presented unanimous responses.
CONCLUSIONS: It was possible to obtain evidence of validity and reliability for the Compressed Speech with Figures instrument. The construct analysis showed that the instrument measures the same variable as the gold standard test, with an almost perfect correlation. In the criterion analysis, both groups presented similar performance, demonstrating that the instrument does not seem to differentiate populations with and without mild phonological disorder. The inter-evaluator reliability analysis demonstrated that the protocol is easy to analyze and score.
OBJECTIVE: Buscar evidências de validade e fidedignidade para o Teste de Fala Comprimida com Figuras.
UNASSIGNED: O estudo foi subdividido em três etapas: validação de construto, critério e fidedignidade. Todos os participantes tinham idade entre 6:00 e 8:11. Para o construto, aplicou-se o Fala Comprimida com Figuras e o teste padrão ouro Fala Comprimida Adaptado em crianças com desenvolvimento fonológico típico. Para análise de critério, aplicou-se o Fala Comprimida com Figuras em dois grupos, com desenvolvimento fonológico típico (G1) e atípico (G2). Por fim, os protocolos de aplicação passaram pela análise de duas Fonoaudiólogas, com experiência na área do Processamento Auditivo Central, buscando obter uma análise de fidedignidade interavaliadores.
RESULTS: O teste de correlação indicou um construto quase perfeito (Rho=0,843 para orelha direita e Rho=0,823 para orelha esquerda). Na análise de critério, percebeu-se que ambos os grupos apresentaram resultados satisfatórios (G1 = 99,6 a 100%; G2 = 96 a 96,5%). Já a análise de fidedignidade demonstrou que o protocolo é de fácil análise, pois ambos os profissionais apresentaram respostas unânimes.
UNASSIGNED: Foi possível obter evidências de validade e fidedignidade para o instrumento de Fala Comprimida com Figuras. A análise de construto evidenciou que o instrumento mede a mesma variável que o teste padrão outro, com correlação quase perfeita. Na análise de critério, ambos os grupos apresentaram desempenho semelhante, demonstrando que o instrumento não parece diferenciar populações com e sem transtorno fonológico leve. A análise de fidedignidade interavaliador demonstrou que o protocolo é de fácil análise e pontuação.