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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.

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Efficacy of an Early Speech Intervention for Children with Cleft Palate

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  1. 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

  2. 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)

  3. 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

  4. 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

  5. Model of Early Speech/Language Development in Children with Clefts

  6. 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

  7. 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

  8. 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

  9. Model of Early Speech/Language Development in Children with Clefts Target Selection EMT/PE Prompting strategies EMT/PE Responsive interaction & Environmental arrangement Child Outcome

  10. 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

  11. 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

  12. 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

  13. Description of Cleft Groups

  14. Pre/Post Treatment Descriptive Measures

  15. 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

  16. 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

  17. Methods • BAU Control • Clinician implemented • 48 sessions • Characteristics of BAU Interventions

  18. Language Measures

  19. Analysis • Pre and post intervention assessments were compared using OLS regression models controlling for age, study group and pre intervention performance.

  20. Pre-Post Language Measures

  21. 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

  22. Speech Measures

  23. 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

  24. 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.

  25. PEEPS Pre-Post Treatment Data • Consonant Inventory • Initial • Medial/Final • Percent Consonants Correct • Error Types • Substitutions • Omissions • Compensatory substitutions

  26. Speech Outcomes

  27. Pre-Post Speech Measures

  28. PCCNoncleft children

  29. Percent Consonants Correct

  30. Number of Initial Consonant Tokens

  31. Number of Medial/Final Consonant Tokens

  32. % Omissions

  33. % Substitutions

  34. Compensatory Errors

  35. Results informing the Model of Early Speech/Language Development Consonant inventory Speech accuracy Reduced compensatory articulation # Different words Vocabulary size Percent intelligibility

  36. Implications • Significant changes were found in both speech and vocabulary • Coherence with typical acquisition

  37. Thanks to • Our families who participated in the research • Our Vanderbilt and ETSU research teams • Our funding agency: NIDCD

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