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Efficacy of an Early Speech Intervention for Children with Cleft Palate. Nancy J. Scherer A. Lynn Williams East Tennessee State University Ann Kaiser, Megan Roberts, Jennifer Frey, Kristin Mullins Vanderbilt University Carol Stoel-Gammon University of Washington.

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Efficacy of an Early Speech Intervention for Children with Cleft Palate


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efficacy of an early speech intervention for children with cleft palate

Efficacy of an Early Speech Intervention for Children with Cleft Palate

Nancy J. Scherer

A. Lynn Williams

East Tennessee State University

Ann Kaiser, Megan Roberts, Jennifer Frey, Kristin Mullins

Vanderbilt University

Carol Stoel-Gammon

University of Washington

14th ICPLA Conference

June 27-30, Cork Ireland

early speech and language development
Early Speech and Language Development
  • Delayed in onset of canonical babbling
  • Composition of babbling is less complex
  • Smaller consonant inventories
  • Poorer speech accuracy (Percent Consonants Correct)
  • Delayed onset and acquisition of words
  • Lexical selectivity
    • Produce more words beginning with the sounds they can produce (nasals, glides, vowels) & fewer beginning with high pressure consonants
    • Preference for sounds at the extremes of the vocal tract (labials, velars, and glottals)
optimal early intervention
Optimal Early Intervention
  • Targets both speech and vocabulary simultaneously
  • Is delivered in interactions that promote functional language use in meaningful contexts
  • Provides strategies to facilitate speech
  • Increases the child’s communication attempts
stages of phonological acquisition
Stages of Phonological Acquisition
  • Prelinguistic Stage (birth to 1 year)
  • First Words Stage (1 year to 18 months)
  • Early words learned as whole units (not sequence of segments)
  • Consonant production variable
  • Active selection and avoidance strategies used
  • Phonemic Development Stage (18 months to 4 years)
  • Stabilization of the Phonological System Stage (4 to 8 years)
  • Stoel-Gammon & Dunn, 1985
basis of enhanced milieu teaching phonological emphasis
Basis of Enhanced Milieu Teaching/Phonological Emphasis
  • Selecting specific language and speech targets appropriate to the child’s level
  • Arranging the environment to increase likelihood of child initiations
  • Prompting the child’s engagement through mirroring and mapping
  • Responding to the child’s initiations with prompts for elaborated language and speech accuracy
  • Functionally rewarding the child’s communicative attempts by providing access to desired events
  • Providing focused feedback regarding the form of the child’s utterance
prompts
Prompts
  • Time delay Least Support
  • Open questions
  • Choice questions
  • Model and expansions
  • Speech recastingMost Support
    • Repeating target words the child uses while emphasizing a target sound in the word
theoretical foundations of emt pe
Theoretical foundations of EMT/PE
  • Behavioral
    • Prompting strategies
    • Imitation and production practice
    • Contingencies for child’s communicative attempts
  • Developmental-Social Interactionist
    • Language learned in meaningful contexts
    • Responsiveness of the caregiver
  • Parents as speech-language facilitators
model of early speech language development in children with clefts1
Model of Early Speech/Language Development in Children with Clefts

Target Selection

EMT/PE Prompting strategies

EMT/PE Responsive interaction & Environmental arrangement

Child Outcome

purpose
Purpose
  • To assess the efficacy of an early intervention “Enhanced Milieu Teaching with Phonological Emphasis (EMT/PE)” on the speech and language development of children with CLP under 3 years of age.
    • 48 children were randomly assigned to the EMT/PE intervention or a “business as usual” control
todays presentation
Todays presentation
  • Speech and language measures pre and post intervention
    • 27 children with CLP who have completed the intervention
      • 14 children in the EMT/PE intervention
      • 13 children in the BAU
  • Compare to normative speech measures
    • 40 noncleft children at 18, 24, 30 and 36 months
participants with clp
Participants with CLP
  • 15-36 months of age
  • Non syndromic cleft lip and/or palate
  • Palate repair <13 months
  • Absence of sensorineural hearing loss
  • English is the language of the home
  • At least 5 words reported by parent
  • Able to imitate words
  • Recruited from 3 sites in middle and east Tennessee
methods
Methods
  • Pre-Post Assessment
    • Profiles of Early Expressive Phonological Skills (PEEPS)
    • Preschool Language Scale-4
    • Language sample
      • Clinician-child (Play)
      • Parent-child (Play, book, snack)
    • Communicative Development Inventory
    • LENA (Weekday, weekend)
    • Bayley Scales of Infant Development
    • Parenting Stress Inventory
    • Hearing screen
methods1
Methods
  • EMT/PE Intervention
    • Clinician implemented
    • 48 sessions
    • 5 speech targets identified from single word naming test (PEEPS) embedded in language goals
    • 5 play activities with at least 2 targets in each session
    • Criteria for exposure: At least 10 presentations of the targets in each play activity
methods2
Methods
  • BAU Control
    • Clinician implemented
    • 48 sessions
  • Characteristics of BAU Interventions
analysis
Analysis
  • Pre and post intervention assessments were compared using OLS regression models controlling for age, study group and pre intervention performance.
findings
Findings
  • The EMT/PE intervention group showed significantly greater gains in
    • Global language comprehension scores
    • Global expressive language scores
    • Number of different words used in conversation
    • Greater vocabulary size rated by parents
      • EMT/PE intervention group used 95.8 more words
profiles of early expressive phonological skills peeps williams stoel gammon
Profiles of Early Expressive Phonological Skills(PEEPS: Williams & Stoel-Gammon)
  • Assesses developmentally appropriate sound production in single words
    • consonant inventory
    • place/manner of articulation
    • syllable structure
    • accuracy
    • error patterns
  • 18-36 months of age
  • Elicited with objects
construction of peeps
Construction of PEEPS
  • 40 words
  • The words were selected based on
    • age of acquisition (AOA) based on vocabulary words from the MacArthur Communicative Development Inventories
    • phonetic characteristics to elicit target English consonants across all place, voice, and manner categories of production, as well as in different syllable structures and word position.
peeps pre post treatment data
PEEPS Pre-Post Treatment Data
  • Consonant Inventory
    • Initial
    • Medial/Final
  • Percent Consonants Correct
  • Error Types
    • Substitutions
    • Omissions
    • Compensatory substitutions
results informing the model of early speech language development
Results informing the Model of Early Speech/Language Development

Consonant inventory

Speech accuracy

Reduced compensatory articulation

# Different words

Vocabulary size

Percent intelligibility

implications
Implications
  • Significant changes were found in both speech and vocabulary
  • Coherence with typical acquisition
thanks to
Thanks to
  • Our families who participated in the research
  • Our Vanderbilt and ETSU research teams
  • Our funding agency: NIDCD