Outline Evidence Based Practice Dyslexia

Transcription

Réseau canadien de recherche sur le langage et l’alphabétisation
CANADIAN LANGUAGE & LITERACY RESEARCH NETWORK
Outline
Evidence Based Practices
for the Treatment of
Speech Sound Disorders
Susan Rvachew
School of Communication Sciences and Disorders
McGill University
Partager la science. Éveiller les esprits. ● sharing the science. opening minds.
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Evidence Based Practice
Representation Based Approach
Target Selection and Ordering
Speech Perception
Articulation/Stimulability
Phonological Awareness
Dyslexia Intervention
1. Definition of evidence based practice.
2. Application of evidence based
practice.
• Would you provide or
recommend this
treatment to your
clients with dyslexia?
• (Or ADHD, or
dyspraxia of speech,
or Asperger’s
syndrome?)
VIDEO
http://www.youtube.com/watch?v=19RwE7PaX_g
http://www.badscience.net/?p=320
Application of EBP
• Integrate your own clinical expertise, the
patient’s values and preferences, and the
best research evidence to make decisions
about the care of individual patients.
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American Speech-Language-Hearing Association. (2004). Evidence-Based Practice
in Communication Disorders: An Introduction [Technical report].
Available at: http://www.asha.org/ members/deskref-journals/deskref/default
• Underlying Theory
• Basic research
• Clinical trials
• Appropriateness of context
• Professional experience
1
Early Speech Development
1. Levels of Representation.
2. Implications for the treatment of
SSD
• How does the infant
learn to produce
speech-like
vocalizations?
• How does phonology
emerge?
VIDEO
Summary
• Phonological Representations
• Sudden shifts in organization of the lexicon on the
basis of phonetic similarities among items
Animated Demonstration of
Phonological Development at
Different Levels of
Representation
• Increase in vocabulary size (neighborhood density)
• Improvements in phonetic knowledge
• Acoustic-Phonetic Representations
• Gradual increases in the specificity of acousticrepresentations
• Amount, quality, and variability of acoustic input
• Articulatory-Phonetic Representations
• Gradual increases in the precision and flexibility of
motor plans/programs
• Repeated practice achieving specific speech goals with
feedback and knowledge of results
Implications for Treatment
Levels of Representation
Input
Output
Acoustic
Phonological
Acoustic
Phonetic
Articulatory
Phonetic
σ
VL
O
C
R
V
Motor
• Intervention should address all levels of
representation
• Intervention should promote gradual
acquisition of knowledge in each domain
TT
TB
LP
GL
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to Target Selection
Target Selection
1.
2.
3.
Representation Based Approach vs Learnability
Theory
RCT Evidence: Teach complex or simpler targets first?
Additive complexity and the nonlinear approach
• Nonlinear advances in phonological organization
emerge from gradual changes in phonetic
knowledge, therefore:
• Treatment should serve to gradually increase
specificity of acoustic-phonetic representations
and precision of articulatory-phonetic
representations, therefore:
• Gradually increase complexity of treatment
targets over time
Learnability Theory Approach to
Target Selection
• The laws that unify phonological systems generally may
be used as input in treatment so as to expose a child to
the governing properties of language. This thereby
complements ontological complexity in targeting higher
order categories to induce cascading effects on
generalization learning, i.e.:
Rvachew, S. & Nowak, M. (2001).
The effect of target-selection
strategy on phonological learning.
Journal of Speech Language &
Hearing Research, 44(3), 610-623.
• Simpler input actually makes language learning more difficult
because the child is provided with only partial information about
linguistic structure.
• Treating simple targets promotes only within class learning.
• Treating complex targets is necessary to promote across class
generalization.
Treat Unstimulable First
Treat Most Stimulable First
Block 1
Block 2
Block 1
Level 4
t d
k g l v ð z
Level 4
Level 5
k g v ʤ z
ɹ
Level 5
Level 6
unstimulable
l ð θ ɹ
θ
Block 2
p d v
Level 6
unstimulable
l ʧʤ ʃ ðθ ɹ
l ʧʤ ʃ ðθ ɹ
3
Change in treated and untreated
sounds in 6 wks
Stimulable First (ME)
Gain for treated stim targets greater
than gain for untreated stim targets
Unstimulable First (LL)
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12
12
10
10
10
8
8
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4
4
4
2
2
2
2
0
0
0
A1
A2
A1
A3
A2
A3
10
4
8
3
0
A1
A2
A3
A1
Gain for untreated unstim targets
greater than gain for treated unstim
targets
Conclusion
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12
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10
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6
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4
A2
A3
• Improving articulation accuracy for
phonemes that were partially correct
facilitated learning of phonemes that were
initially absent from the phonetic
repertoire, i.e.:
• Treating simpler targets first promoted both
within-class and across-class learning.
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2
2
1
0
0
A1
A2
A3
A1
A2
A3
Target Selection Principles
Additive Complexity and the
Nonlinear Approach
• Target selection is based on a nonlinear
analysis of the child’s phonology at all levels of
the hierarchy, considering individual and
interactive elements at all levels.
• Targets are set for both word and phrasal
(prosodic) structure and features (and their
related segments) at the outset
• Strengths are used as supports for the needs,
i.e. established word structures and word
positions are used to target new features, and
vice versa.
4
Suggested Goals
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Age 2;5
More [moʌ]
Mummy [mʌmʌ]
Duck [dʌ]
Puzzle [pʌ]
Puppy [pʌ]
Me [mː]
Meow [ʌ]
House [ʌ]
Boy [bʌ]
• Prosodic Level
• Phrase
• CV + CV phrases
• Foot/word
• CVCV words
• Rime
• V → VV
• Feature
• Manner
• Introduce labial glide /w/ in CV syllables
• Stabilize labial stops and nasals → labiodental fricative
• Place
• Expand repertoire of vowels used in labial C + V syllables
6 month outcome
• Age 2;5
• More [moʌ]
• Mummy
[mʌmʌ]
• Duck [dʌ]
• Puzzle [pʌ]
• Puppy [pʌ]
• Me [mː]
• Meow [ʌ]
• House [ʌ]
• Boy [bʌ]
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Age 3;1
Shower [dauwə]
Water [wʌtə]
Bath [bæ]
No have baby [no hʌ bei]
No open bottle [no obi bɔʔo]
No cheerio [no ʧiwio]
No cowboy horse ride [no dʌboi ho
wai]
Pink [pɪn]
Cup [tʌp]
Pen [pɛn]
Where cup go? [wɛ tʌ do]
Application to Child with
Residual Errors
• “r” incorrect in all instances except:
• ‘ear’/iɝ/, ‘gear’/g iɝ/, ‘four’/foɝ/
• ‘green’/gɹin/
• Recommended goal ordering
• Expand and stabilize repertoire of Vɝ contexts in
CVC words.
• Expand and stabilize repertoire of Cɹ contexts in
CCVC and CCVCC words.
• Introduce intersyllabic /ɹ/ in CVCVC words.
• Introduce prevocalic /ɹ/ in CV and CVC words.
• Introduce unstressed /ɚ/ in CVCV words.
SAILS
Speech Perception
1. Video demonstration of SAILS
2. Speech perception skills of children
with SSD
3. Empirical evidence of treatment
efficacy
• How can you improve
children’s acousticphonetic
representations?
Video demonstration of the
Speech Assessment and
Interactive Learning System
5
Adult Produced /ɹ/ (left)
Child Produced /ɹ/ Distortion (right)
Shuster, L. I. (1998). The perception of
correctly and incorrectly produced /r/.
Journal of Speech, Language, and
Hearing Research, 41, 941-950.
F4
F4
F2 and
F3
merged.
F3
F3
F3 starts
F2 high;
rises gently
F1
F2
F1
F1 and F2
merged.
Participants
Adult Produced /ɹ/ (left)
Child Produced /ɹ/ Distortion (right)
• Group 1 (Younger) participants:
• 13 children who were just starting treatment
for /r/
• mean age 8;6
• Group 2 (Older) participants:
• 13 children who had received least 2 years of
treatment without success
• mean age 11;0
Perception Task
Right/Wrong Judgments (younger group)
50
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25 self-produced words (incorrect)
25 self-produced words (corrected)
25 other-produced words (incorrect)
25 other-produced words (corrected)
• Task
• Judge if the word was said ‘right’ or ‘wrong’
• Judge if self-produced or other-produced
Percent Correct Judgments
• Stimuli
40
30
20
10
0
self+
other+
self-
other-
6
Right/Wrong Judgments (older group)
Percent Correct Judgments
50
Rvachew, S. & Jamieson, D.G. (1989).
Perception of voiceless fricatives by
children with a functional articulation
disorder. Journal of Speech and
Hearing Disorders, 54, 193-208.
40
30
20
10
0
self+
other+
self-
other-
Perception of Fricatives
Individual Variability
16
Mean Number of "s" Responses
14
12
10
8
6
4
Adults
16
16
14
14
14
12
12
12
10
10
10
8
8
8
6
6
6
4
4
4
2
2
2
0
0
1 2 3
Typical Children
2
16
4 5 6 7
0
1 2 3
4 5 6 7
1 2 3
4 5 6 7
Misarticulating
Children
0
1
seat
2
3
4
Stimulus
5
6
7
sheet
Rvachew et al., 2004: Study Design
Rvachew, S., Nowak, M., & Cloutier, G.
(2004). Effect of phonemic perception
training on the speech production and
phonological awareness skills of
children with expressive phonological
delay. American Journal of SpeechLanguage Pathology, 13, 250-263.
EXPERIMENTAL
CONTROL
Pretreatment Assessment
Pretreatment Assessment
Speech
Therapy
Speech
Therapy
SAILS
Dialogic
Reading
Post-treatment Assessment
Follow-up Assessment
Follow-up Assessment
7
SAILS: Perception and PA
SAILS: 16 lessons
Speech Assessment and Interactive Learning System.
See www.avaaz.com for more information .
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[ɹæt]
One module per week:
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1. Phonemic
Perception
2. Letter Identification
3. Sound-Symbol
Association
4. Onset identification
[wæt]
[jæt]
Toe /t/Pea /p/Man /m/Coat /k/Lamb /l/Rope /r/Feet /f/Soap /s/Mitt -/t/
Top -/p/
Ham -/m/
Book -/k/
Nail - /l/
Door -/r/
Knife -/f/
Bus -/s/
Dialogic Reading Condition
Results: GFTA errors
control
experimental
40
Where are Grandma and
Little Critter going?
19%
resolved
30
Click the mailbox.
20
See for RCT evidence of the
effectiveness of this intervention:
van Kleeck, A., Vander Woude, J., &
Hammett, L. (2006). Fostering literal and
inferential skills in Head Start
preschoolers with language impairment
using book-sharing discussions.
American Journal of Speech-Language
Pathology, 15, 85-95.
What might happen if Little
Critter ran out on the road?
10
What do you think is
in Grandma’s basket?
50%
resolved
Pretreatment
Post-treatment
Follow-up
Results: Percent Consonants Correct
Results: PA Test Scores
control
experimental
20
15
10
5
Pretreatment
Post-treatment
Follow-up
8
Case Studies
Case Studies
Pretreatment
PA07 (SAILS)
PA08 (Control)
GFTApercentile
4
3
PCCpercent correct
66
SAILSpercent correct
PA07 (SAILS)
PA08 (Control)
GFTApercentile
17
1
51
PCCpercent correct
80
62
73
77
SAILSpercent correct
90
69
PPVTpercentile
48
40
DSSraw score
6.48
7.13
DSSraw score
4.56
3.54
PAraw score
25
13
PAraw score/34
3
5
ELAraw score
10
8
Posttreatment
Case Studies
Follow-up
PA07 (SAILS)
PA08 (Control)
GFTApercentile
44
4
PCCpercent correct
94
86
PPVTpercentile
68
87
DSSraw score
7.16
5.23
PAraw score
34
34
ELAraw score
31
19
Articulation/Stimulability
1. Perceptual Target
2. Feedback
3. Knowledge of Results
How at Articulate /ɹ/
Simple View of Motor Learning
• How does any child
learn to produce the
/ɹ/ phoneme?
• SAAS demonstration
• Motor learning requires
• practice achieving a target
• with feedback
• and knowledge of results.
9
Importance of the Target
Outcome of traditional approach with SAILS
substituted for ‘ear training’
• Rvachew, S. (1994). Speech perception training
can facilitate sound production learning. Journal
of Speech and Hearing Research, 37, 347-357.
• Rvachew, S., Rafaat, S., & Martin, M. (1999).
Stimulability, speech perception and the
treatment of phonological disorders. American
Journal of Speech-Language Pathology, 8, 3334.
• Rvachew, S. (2005). Stimulability and treatment
success. Topics in Language Disorders. Clinical
Perspectives on Speech Sound Disorders.,
25(3), 207-219.
cat vs. Pete
Did not achieve stimulability for /ʃ/ in isolation.
Achieved production of /ʃ/ in syllables.
shoe vs. moo
Achieved production of /ʃ/ in words.
shoe vs. Xshoe
1
2
3
Isolation
4
Words
5
6
7
Phrases
8
9
Sentences
Production Level Achieved in Therapy
Modification of cycles approach:
Add SAILS + stimulability training
Interaction of Perception and Stimulability
50
80.00%
Percent Change
Percentage of Targets Improved
100.00%
60.00%
40.00%
45
/ʃ/ in inventory
40
/ʃ/ not in inventory
35
30
27
27
25
20
12
15
10
5
5
0
20.00%
SAILS
Control
0.00%
Year 1
Year 2
Interaction of Perception and Stimulability
Percent Change
50
45
/ɹ/ in inventory
40
/ɹ/ not in inventory
35
30
25
25
20
15
10
6
5
5
0
0
SAILS
Control
Importance of Feedback
• Gibbon, F. E. (1999). Undifferentiated lingual
gestures in children with
articulation/phonological disorders. Journal of
Speech, Language, and Hearing Research, 42,
382-397.
• Shuster, L. I., Ruscello, D.M., & Toth, A.R.
(1995). The use of visual feedback to elicit
correct /r/. American Journal of SpeechLanguage Pathology, 4, 37-44.
• Masterson, J. J., & Rvachew, S. (1999). Use of
technology in phonology intervention. Seminars
in Speech and Language, 4, 233-250.
10
Production of /ɹ/
Undifferentiated lingual gesture
Spectrographic Feedback
Spectrogram of the clinician model
of the phrase "The writer."
From:
www.medicine.mcgill.ca/microp
The focus of treatment is the
final syllable "er". T1 marker
points to the highest value of
the third formant (F3), just
after release of the "t". The F3
falls in frequency, as
expected for "er". The drop in
frequency between the T1 and
T2 markers is 781 Hz. Notice
that the F2 is parallel to and
very close in frequency to the
F3. Both formants begin to
fall immediately after release
of the "t".
T1 = 2465 Hz
T2 = 1684 Hz
Curt, a 13 year old boy with
dyspraxia of speech, produced this
syllable with a flat F3 during the first
treatment session.
Curt gradually learned to
reduce the F3 by
progressively larger
increments. After he few
sessions, he accomplished
this 342 Hz change in F3
frequency near the end of the
syllable. Notice that the
syllable does not sound
correct, but the progress that
could be observed in the
spectrogram motivated Curt
to continue trying.
T1 = 2085 Hz
T2 = 2343 Hz
After approximately 6 weeks of
treatment, Curt was producing a
consistent change in F3 frequency
that corresponded to a perceptually
correct "er".
For Curt, a decline in F3
frequency of at least 800 Hz
was required for the
production of a perceptually
correct "er". However, the fall
in the F3 continued to be
delayed, resulting in an "-or"like percept. The F3 is moreor-less flat for 115 ms after
release of the "t". Subsequent
treatment focused on
reducing this time interval.
T1 = 2563 Hz
T2 = 1904 Hz
After many more weeks Curt was
producing perceptually correct ‘er’
syllables although their duration was
too long.
After Curt learned to lower his
F3 sufficiently to produce a
perceptable word final "er",
attention shifted from the
frequency characteristics to
the temporal characteristics
of F3 change. In this
production, the F3 begins to
fall 45 ms after the release of
the "t".
T1 = 2563 Hz
T2 = 1489 Hz
Future treatment will focus on
reducing the duration of this
syllable and encouraging
consistent use of word final
"er" in conversational speech.
11
Knowledge of Results
• Provide clear information about the
accuracy of the child’s response.
• Teach the child to evaluate his/her own
response.
Interventions
1. Monsters and Rimes
2. Basic Research on PA and SSD
3. Effectiveness of PA Interventions
• http://www.learningfundamentals.com/
• Articulation I
• Speech Visualization I
Monsters and Rimes
PA Skills of SSD vs NS Groups
0.5
Software Demonstration
0
Standardized Effect Size
• Does phonological
awareness
intervention prevent
reading disability?
1
2
3
4
5
6
7
8
-0.5
9
10
11
12
-1
-1.5
-2
-2.5
-3
Severity of SSD
Phonological Processing
Multiple Risk Factors
Persistence of SSDLanguage Impairment
-3.5
Summary of Basic Research
SES x PA Interaction
• Risk Factors
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Speech Sound Disorder
Language Impairment
Family History
Phonological Processing Difficulties
• Protective Factors
• Large vocabulary size
• Preschool resolution of speech/language
problems
• Appropriate inputs and home and school
12
Speech Perception, Vocabulary and
Variations in Input
Hart & Risley (1995)
100
Cluster 1 PA = 22
2500
Cluster 2 PA = 19
90
48 M
words
Cluster 3 PA = 11
Cluster 4 PA = 9
80
1500
28 M
words
1000
12 M
words
500
Speech Perception
Words per Hour
2000
70
60
50
40
0
Professional
Working
Class
Welfare
30
60
70
80
90
100
110
120
130
140
Receptive Vocabulary
National Reading Panel:
Effective Programs
SSD and Reading
Sight Word
Reading
Vocabulary
Rime
Awareness
Speech
Perception
Onset Awareness
& Onset
Segmentation
Letter
Knowledge
Nonword
Reading
• Effective programs taught one or two skills to
mastery
• Effective programs lasted between 5 and 18
hours
• Effective programs made explicit links between
PA skills and letter knowledge and/or reading
• Effective programs taught children in small groups
• Effective programs were provided early, before or
as the children were beginning to learn to read
Rvachew & Grawburg (Submitted).
Sound Foundations Trial
Byrne, B., & Fielding-Barnsley, R. (1991). Evaluation of a program to teach
phonemic awareness to young children. Journal of Educational Psychology,
83(4), 451-455.
phonemic awareness to young children: A 1-year follow-up. Journal of
Educational Psychology, 85(1), 104-111.
phonemic awareness to young children: A 2- and 3- year follow-up and a new
preschool trial. Journal of Educational Psychology, 87(3), 488-503.
Recruited 128 children from 4 preschool programs
Random assignment
Intervention
Control
n = 12 groups
n = 12 groups
Post-treatment assessment about 12 weeks later
Follow-up assessment at end of kindergarten
Byrne, B., Fielding-Barnsley, R., & Ashley, L. (2000). Effects of preschool
phoneme identity training after six years: Outcome level distinguished from
rate of response. Journal of Educational Psychology, 92(4), 659-667.
Hindson, B., Byrne, B., Fielding-Barnsley, R., Hine, D. W., & Shankweiler, D.
(2005). Assessment and early instruction of preschool children at risk for
reading disability. Journal of Educational Psychology, 97(4), 687-704.
Follow-up assessment at end of grade 1
Follow-up assessment at end of grade 2
Follow-up assessment in grade 5
13
Intervention vs. Control
Post-treatment Generalization
12
• Matching
• Sorting
• Identifying
• Semantic categories
• Matching
• Sorting
• Identifying
10
8
Correct Responses
• Rime and phoneme
awareness
6
4
Experimental (Initial)
Experimental (Final)
2
Control (Initial)
Control (Final)
0
Pretest
Posttest
Follow-up Assessments
Hindsen, Byrne et al. 2005
Pre-treatment Assessment
• Nonword decoding significantly better in
the experimental group through grade 5
• No significant differences for real word
reading, spelling, or reading
comprehension
• 16% of experimental group and 28% of
control group scored below 75 on one or
more reading tests in grade 5
Intervention:
Intervention:
Wait Risk:
Not At-Risk
At-Risk
At-Risk
n = 65
n = 69
n = 17
17 week intervention
Sound Foundations Phonological Awareness Intervention
Letter Knowledge
Dialogic Reading
Intervention Program
Sound Foundations
• 30 minute sessions (individual), 2 or 3 per
week, each targeting (in order)
• Phoneme identity
• Visual and tactile exposure to the letter that
represents the target phoneme
• Dialogic book reading
• Criterion test for the days target
• Targets
• Initial /s/, /m/, /p/, /l/, /t/, and /æ/
• Final /s/, /m/, /p/, /l/, and /t/
• /ʃ/, /g/, and /ɛ/ were omitted from this study but are
normally part of this program
• Procedures
•
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Worksheets for sound matching
Posters for identifying target words
Card games such as Snap
Dominoes-like game
Recorded jingles with alliteration
14
Dialogic Reading
Phoneme Identity
18
• Completion
Pre
16
• Dad and Amy drove to the _______.
Post
14
• Recall
12
• Why were they going to the dump?
10
• Open-ended prompts
• You tell me about this page.
8
• Wh-questions
6
• What are they doing?
4
• Distancing
2
• Do you remember when we went to the dump?
0
Intervention Not At Risk
Intervention At Risk
Wait List Control At Risk
Letter Knowledge
Concepts About Print
14
25
Pre
Post
20
Pre
12
Post
10
15
8
6
10
4
5
2
0
0
Receptive Vocabulary (PPVT)
Acknowledgments
115
• Canadian Language and Literacy Research Network.
Pre
Post
110
• Alberta Children’s Hospital Foundation
• Alberta Children’s Hospital
105
• Jill Newman, Michele Nowak, Patty Delaney-Bernier, Susan Rafaat
100
• Children’s Hospital of Eastern Ontario
95
• Dr. Robin Gaines
90
• McGill University
85
80
• Francoise Brosseau-Lapre, Genevieve Cloutier, Pi-Yu Chiang, Myra
Cox, Marie Desmarteau, Natalia Evans, Meghann Grawburg, Joan
Heyding, Debbie Hughes, Alyssa Ohberg, Rishanthi Sivakumaran,
Alysha Serviss, and Jessica Whitley
15
EVIDENCE BASED PRACTICES FOR THE TREATMENT OF SPEECH SOUND DISORDERS
Reference List
Section I: Evidence Based Practice
1. Definition of EBP
Ben talks about his dyslexia and DDAT (now Dore). http://www.youtube.com/watch?v=19RwE7PaX_g
Goldacre, B. Dore – The miracle cure for dyslexia. Bad Science (Nov 4, 2006) http://www.badscience.net/?p=320
American Speech-Language-Hearing Association. (2004). Evidence-Based Practice in Communication Disorders: An
Introduction [Technical report]. http://www.asha.org/ members/deskref-journals/deskref/default
2. Application of Evidence Based Practice
Faciltated communication: Siegel, B. & Zimnitzky, B. (1998). Assessing ‘alternative’ therapies for communication disorders
in children with autistic spectrum disorders: Facilitated communication and auditory integration training. Journal of SpeechLanguage Pathology and Audiology, 22(2), 61-69.
FastForWord: (a) Benasich, A. A., & Tallal, P. (2002). Infant discrimination of rapid auditory cues predicts later language
impairment. Behavioural Brain Research, 136, 31-49. (b) Nittrouer, S. (1999). Do temporal processing deficits cause
phonological processing problems? Journal of Speech, Language, and Hearing Research, 42, 925-942. (c) StuddertKennedy, M. (2002). Deficits in phoneme awareness do not arise from failures in rapid auditory processing. Reading and
Writing: An Interdisciplinary Journal, 15, 5-14. (d) Gillam, R. B., Loeb, D. F., Hoffman, L. M., Bohman, T., Champlin, C. A.,
Thibodeau, L., et al. (2008). The efficacy of Fast ForWord Language Intervention in school-age children with language
impairment: A randomized controlled trial. Journal of Speech, Language, and Hearing Research, 51, 97-119.
Learnability theory: (a) Gierut, J. (2007). Phonological complexity and language learnability. American Journal of SpeechLanguage Pathology, 16, 6-17. (b) Diedrich, W. M. (1989). A response to Gierut, Elbert, and Dinnsen, "A functional
analysis of phonological knowledge and generalization learning in misarticulating children". Journal of Speech ahd
Hearing Research, 32, 219. (c) Rvachew, S., & Nowak, M. (2001). The effect of target selection strategy on sound
production learning. Journal of Speech, Language, and Hearing Research, 44, 610-623. (d) Morrisette, M. L., & Gierut, J.
A. (2003). Unified treatment recommendations: A response to Rvachew and Nowak. Journal of Speech, Language, and
Hearing Research, 46(2), 383-385. (e) Rvachew, S., & Nowak, M. (2003). Clinical outcomes as a function of target
selection strategy: A reply to Morrisette and Gierut. Journal of Speech, Language, and Hearing Research, 46(2), 386-389.
(f) Rvachew, S. (2005). Stimulability and treatment success. Topics in Language Disorders. Clinical Perspectives on
Speech Sound Disorders., 25(3), 207-219.
Dore Achievement Centres: Bishop, D. V. M. (2007). Curing dyslexia and attention-deficit hyperactivity disorder by training
motor co-ordination: Miracle or myth? Journal of Pediatrics and Child Health, 43, 653-655.
Prelinguistic milieu therapy: (a) Yoder, P. J., & Warren, S. F. (2001). Relative treatment effects of two prelinguistic
communication interventions on language development in toddlers with developmental delays vary by maternal
characteristics. Journal of Speech, Language, and Hearing Research, 44, 224-237. (b) Yoder, P. J., & Warren, S. F.
(2002). Effects of prelinguistic milieu teaching and parent responsivity education on dyads involving children with
intellectual disabilities. Journal of Speech, Language, and Hearing Research, 45, 1158-1174.
Community SLP Services in the U.K.: Glogowska, M., Roulstone, S., Enderby, P., & Peters, T. (2000). Randomised
controlled trial of community based speech and language therapy in preschool children. BMJ, 321, 923-928.
Focused Stimulation: Fey, M. E., Cleave, P. L., Long, S. H., & Hughes, D. (1993). Two approaches to the facilitation of
grammar in children with language impairment: An experimental evaluation. Journal of Speech and Hearing Research, 36,
141-157.
Cycles Approach: (1) Pamplona, M. C., Ysunza, A., and Espinoza, J. (1999). "A comparative trial of two modalities of
speech intervention for compensatory articulation in cleft palate children: phonological approach versus articulatory
approach." International Journal of Pediatric Otorhinolaryngology, 49(21-26). (2) Almost, D., & Rosenbaum, P. (1998).
Effectiveness of speech intervention for phonological disorders: a randomized controlled trial. Developmental Medicine
and Child Neurology, 40, 319-325. (3) Hodson, B. W., & Paden, E. P. (1983). Targeting intelligible speech: A phonological
approach to remediation. Boston: College Hill.
West Virginia Speech-Language-Hearing Association Spring Convention (Friday April 18 2008)
Page 1 of 5
Reference List
Section II: Representation Based Approach
1. Levels of Representation
Infant Speech Development (video): (a) Bloom, K., Russell, A., & Wassenberg, K. (1987). Turn taking affects the quality of
infant vocalizations. Journal of Child Language, 14, 211-227. (b) Bloom, K. (1988). Quality of adult vocalizations affects
the quality of infant vocalizations. Journal of Child Language, 15, 469-480.
Phonological Development at Different Levels of Representation (animation): (a) Beckman, M. E., & Edwards, J. (2000).
The ontongeny of phonological categories and the primacy of lexical learning in linguistic development. Child
Development, 71, 240-249. (b) Callan, D. E., Kent, R. D., Guenther, F. H., & Vorperian, H. K. (2000). An auditoryfeedback-based neural network model of speech production that is robust to developmental changes in the size and
shape of the articulatory system. Journal of Speech, Language, and Hearing Research, 43, 721-738. (c) Munson, B.,
Edwards, J., & Beckman, M. E. (2005). Phonological knowledge in typical and atypical speech-sound development.
Topics in Disorders, 25(3), 190-206. (d) Pierrehumbert, J. B. (2003). Phonetic diversity, statistical learning, and acquisition
of phonology. Language and Speech, 46, 115-154. (e) Walley, A. C., Metsala, J. L., & Garlock, V. M. (2003). Spoken
vocabulary growth: Its role in the development of phoneme awareness and reading ability. Reading and Writing: An
Interdisciplinary Journal, 16, 5-20.
2. Implications for Treatment
Rvachew, S. (2005). Phonetic factors in phonology intervention. In A. G. Kamhi & K. E. Pollock (Eds.), Phonological
Disorders in Children: Assessment and Intervention (pp. 175 -188). Baltimore, Maryland.: Paul Brookes Publishers.
Rvachew, S. & Bernhardt, B. (in progress). Clinical implications of the dynamic systems approach to phonology intervention.
Section III: Target Selection
1. Representation Based Approach versus Learnability Theory
Gierut, J. (2007). Phonological complexity and language learnability. American Journal of Speech-Language Pathology, 16,
6-17.
2. RCT Evidence: Teach Complex or Simpler Targets First
Rvachew, S., & Nowak, M. (2001). The effect of target selection strategy on sound production learning. Journal of Speech,
Language, and Hearing Research, 44, 610-623.
Rvachew, S., & Nowak, M. (2003). Clinical outcomes as a function of target selection strategy: A reply to Morrisette and
Gierut. Journal of Speech, Language, and Hearing Research, 46(2), 386-389.
Rvachew, S. (2005). Stimulability and treatment success. Topics in Language Disorders. Clinical Perspectives on Speech
Sound Disorders., 25(3), 207-219.
3. Additive Complexity and the Nonlinear Approach
Bernhardt, B., & Stoel-Gammon, C. (1994). Nonlinear phonology: Introduction and clinical application. Journal of Speech
and Hearing Research, 37, 123-143.
Bernhardt, B.H., Stemberger, J. & Major, E. (2006). General and nonlinear phonological intervention perspectives for a child
with resistant phonological impairment. Advances in Speech-Language Pathology, 8, 190-206.
Section IV: Speech Perception
1. SAILS Video demonstration
Speech Assessment and Interactive Learning System (see http://www.medicine.mcgill.ca/srvachew/ for updates).
Locke, J. L. (1980). The inference of speech perception in the phonologically disordered child. Some clinically novel
procedures, their use, some findings. Journal of Speech and Hearing Disorders, 45, 445-468.
Girolametto, L., Pearce, P. S., & Weitzman, E. (1997). Effects of lexical intervention on the phonology of late talkers. Journal
of Speech, Language, and Hearing Research, 40, 338-348.
Page 2 of 5
Reference List
2. Speech Perception Skills of Children with SSD
Shuster, L. I. (1998). The perception of correctly and incorrectly produced /r/. Journal of Speech, Language, and Hearing
Research, 41, 941-950.
Rvachew, S., & Jamieson, D. G. (1989). Perception of voiceless fricatives by children with a functional articulation disorder.
Journal of Speech and Hearing Disorders, 54, 193-208.
3. Empirical Evidence of Treatment Efficacy
Rvachew, S., Nowak, M., & Cloutier, G. (2004). Effect of phonemic perception training on the speech production and
phonological awareness skills of children with expressive phonological delay. American Journal of Speech-Language
Pathology, 13, 250-263.
Section V: Articulation/Stimulability
1. Perceptual Target
Kent, R.D. & Lybolt, J.T. (1982). Motor schema as a basis for motor learning. In W.H. Perkins (Ed) General Principles of
Therapy. Thieme-Stratton, Inc.: New York.
Guenther, F.H. (2003). Neural control of speech movements. In: A. Meyer and N. Schiller (eds.), Phonetics and Phonology
in Language Comprehension and Production: Differences and Similarities. Berlin: Mouton de Gruyter.
http://cnsweb.bu.edu/~guenther/Schiller_Book_Chapter.pdf
Guenther, F.H. (2006). Cortical interactions underlying the production of speech sounds. Journal of Communication
Disorders, 39, pp. 350-365. http://cns-web.bu.edu/~guenther/Guenther_J_Comm_Disorders_in_press.pdf
Rvachew, S. (1994). Speech perception training can facilitate sound production learning. Journal of Speech and Hearing
Research, 37, 347-357.
Rvachew, S., Rafaat, S., & Martin, M. (1999). Stimulability, speech perception and the treatment of phonological disorders.
American Journal of Speech-Language Pathology, 8, 33-34.
Rvachew, S. (2005). Stimulability and treatment success. Topics in Language Disorders. Clinical Perspectives on Speech
Sound Disorders., 25(3), 207-219.
2. Feedback
Gibbon, F. E. (1999). Undifferentiated lingual gestures in children with articulation/phonological disorders. Journal of
Speech, Language, and Hearing Research, 42, 382-397.
Shuster, L. I., Ruscello, D.M., & Toth, A.R. (1995). The use of visual feedback to elicit correct /r/. American Journal of
Speech-Language Pathology, 4, 37-44.
Masterson, J. J., & Rvachew, S. (1999). Use of technology in phonology intervention. Seminars in Speech and Language, 4,
233-250.
Rvachew, S. Use of Microcomputers in Phonology Intervention. http://www.medicine.mcgill.ca/microp/
3. Knowledge of Results
Locutour Articulation Software: http://www.learningfundamentals.com/
Section VI: Phonological Awareness
1. Monsters and Rimes
Grawburg, M., & Rvachew, S. (2007). Phonological awareness intervention for children with speech sound disorders.
Journal of Speech-Language Pathology and Audiology, 31, 19-26.
Monsters and Rimes: (see http://www.medicine.mcgill.ca/srvachew/ for updates on availability)
Page 3 of 5
Reference List
2. Basic Research on PA and SSD
Bird, J., Bishop, D. V. M., & Freeman, N. H. (1995). Phonological awareness and literacy development in children with
expressive phonological impairments. Journal of Speech and Hearing Research, 38, 446-462.
Hart, B. & Risley, T. (1992). American parenting of language-learning children: Persisting differences in family-child
interactions observed in natural home environments. Developmental Psychology, 28, 1096-1105
Nathan, L., Stackhouse, J., Goulandris, N., & Snowling, M. J. (2004). The development of early literacy skills among
children with speech difficulties: A test of the "critical age hypothesis". Journal of Speech, Language, and Hearing
Research, 47, 377-391.
Noble, K. G., Wolmetz, M. E., Ochs, L. G., Farah, M. J., & McCandliss, B. (2006). Brain-behavior relationships in reading
acquisition are modulated by socioeconomic factors. Developmental Science, 9, 642-654.
Noble, K. G., Farah, M. J., & McCandliss, B. (2006). Socioeconomic background modulates cognition-achievement
relationships in reading. Cognitive Development, 21, 349-368.
Raitano, N. A., Pennington, B. F., Tunick, B. F., Boada, R., & Shriberg, L. D. (2004). Pre-literacy skills of subgroups of
children with speech sound disorders. Journal of Child Psychology and Psychiatry, 45(4), 821-835.
Rvachew, S. (2007). Phonological processing and reading in children with speech sound disorders. American Journal of
Speech-Language Pathology, 16, 260-270.
Rvachew, S. (2006). Longitudinal prediction of implicit phonological awareness skills. American Journal of SpeechLanguage Pathology., 15, 165-176.
Rvachew, S., Chiang, P., & Evans, N. (2007). Characteristics of speech errors produced by children with and without
delayed phonological awareness skills. Language, Speech, and Hearing Services in Schools, 38, 60-71.
Rvachew, S., & Grawburg, M. (2006). Correlates of phonological awareness in preschoolers with speech sound disorders.
Journal of Speech, Language, and Hearing Research, 49, 74-87.
Rvachew, S., Ohberg, A., Grawburg, M., & Heyding, J. (2003). Phonological awareness and phonemic perception in 4-yearold children with delayed expressive phonology skills. American Journal of Speech-Language Pathology, 12, 463–471.
Rvachew, S. & Grawburg, M. (in press). Reflections on Phonological Working Memory, Letter Knowledge, and Phonological
Awareness: A Reply to Hartmann. Journal of Speech, Language, and Hearing Research.
Webster, P. E., Plante, A. S., & Couvillion, M. (1997). Phonologic impairment and prereading: Update on a longitudinal
study. Journal of Learning Disabilities, 30(4), 365-376.
3. Effectiveness of Phonological Awareness Interventions
Byrne, B., & Fielding-Barnsley, R. (1991). Evaluation of a program to teach phonemic awareness to young children. Journal
of Educational Psychology, 83(4), 451-455.
Byrne, B., & Fielding-Barnsley, R. (1993). Evaluation of a program to teach phonemic awareness to young children: A 1year follow-up. Journal of Educational Psychology, 85(1), 104-111.
Byrne, B., & Fielding-Barnsley, R. (1995). Evaluation of a program to teach phonemic awareness to young children: A 2and 3- year follow-up and a new preschool trial. Journal of Educational Psychology, 87(3), 488-503.
Byrne, B., Fielding-Barnsley, R., & Ashley, L. (2000). Effects of preschool phoneme identity training after six years:
Outcome level distinguished from rate of response. Journal of Educational Psychology, 92(4), 659-667.
Ehri, L. C., Nunes, S. R., Willows, D. M., Schuster, B. V., Yaghoub-Zadeh, Z., & Shanahan, T. (2001). Phonemic awareness
instruction helps children learn to read: Evidence from the national reading panel's meta-analysis. Reading Research
Quarterly, 36(3), 250-287.
Hindson, B., Byrne, B., Fielding-Barnsley, R., Hine, D. W., & Shankweiler, D. (2005). Assessment and early instruction of
preschool children at risk for reading disability. Journal of Educational Psychology, 97(4), 687-704.
Lonigan, C. J., Driscoll, K., Phillips, B. M., Cantor, B. G., Anthony, J. L., & Goldstein, H. (2003). Evaluation of a computerassisted instruction phonological sensitivity program with preschool children at-risk for reading problems. Journal of Early
Intervention, 25(248-262).
Whitehurst, G. J., Falco, F., Lonigan, C. J., Fischel, J. E., DeBaryshe, B. D., Valdez-Menchaca, M. C., et al. (1988).
Accelerating language development through picture book reading. Developmental Psychology, 24, 552-558.
Page 4 of 5
Reference List
Effect size figure: Each effect size and corresponding confidence interval on the chart corresponds to the difference between a clinical group of and a normally
developing control group, with details as follows:
Author
Nathan et al.
Rvachew 2007
Raitano et al. 2004
Webster, Plante, &
Couvillion 1997
Nathan et al.
Raitano et al. 2004
Larrivee & Catts
Rvachew 2007
Bird, Bishop & Freeman
1995
Bird, Bishop & Freeman
1995
Raitano et al. 2004
Raitano et al. 2004
Outcome
Letter Knowledge, Sight Word, Nonword
Reading
TOWRE (Sight Word Reading, Nonword
Decoding)
BBF(Rime Match), CTOPP (Elision,
Blending, Matching)
Pseudoword segmentation
Group #
1
Effect
Size
-0.36
Upper
CL
0.28
Lower
CL
-1.01
SSD/High PP
2
-0.49
0.11
-1.08
Normalized SSD No LI
3
-0.782
-0.04
-1.2
SSD
4
-0.88
-0.13
-1.63
SSD LI
5
-1
-0.33
-1.68
Persistent SSD No LI
6
-1.018
-0.5
-1.5
SSD LI
7
-1.14
-0.58
-1.7
Experimental Group
SSD
Letter Knowledge, Sight Word, Nonword
Reading
Blending, Matching)
Woodcock Reading Mastery Test
Composite Score
TOWRE (Sight Word Reading, Nonword
Decoding)
Sight Word Reading
SSD/Low PP
8
-1.17
-0.55
-1.79
SSD
9
-1.38
-0.65
-2.1
Sight Word Reading
SSD LI
10
-1.45
-0.59
-2.32
Blending, Matching)
Blending, Matching)
Persistent SSD Normalized LI
11
-1.677
-1
-2.4
Persistent SSD Persistent LI
12
-2.301
-1.5
-3.1
Page 5 of 5

Outline Evidence Based Practice Dyslexia

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