American Journal of Speech-Language Pathology最新文献

Purpose: We examined the cognitive, emotional, and physiological experiences of adults who stutter (AWS) through a trauma lens. Specifically, we explored the cumulative effects of repeated exposures to stressful stuttering moments and the ensuing environmental reactions, hypothesizing that some AWS internalize these formative interpersonal experiences and develop complex trauma symptoms during childhood that they carry into adulthood.

Method: We conducted semistructured interviews with a purposeful sample of 20 AWS to understand their experiences from childhood into adulthood, across home, school, speech/language therapy, work, and social environments. The interviews were transcribed and analyzed via applied and reflexive thematic analyses to establish multilevel themes within a thematic network.

Results: Many AWS experienced singular and repetitive stressful moments from stuttering, which they reported as overwhelming experiences typically within close relationships. They often faced these experiences through their formative development, causing them to develop survival responses, negative self-beliefs, and meager social connections. These maladaptive responses reinforced a complex system of defenses over time to protect themselves as they came of age. A bias toward self-preservation prevented many of the AWS from building rich social lives. Over half of the participants described dissociative sensations from stuttering or others' negative reactions to it.

Conclusions: The themes align with established conceptualizations of complex trauma, lending credence to the limited evidence base that stuttering can yield trauma-related symptoms stemming from repeated overwhelming experiences within interpersonal contexts. These findings motivate future efforts to establish trauma-informed prevention and care for stutterers.

Supplemental material: https://doi.org/10.23641/asha.31173592.

Purpose: Childhood apraxia of speech (CAS), stroke-induced apraxia of speech (AOS), and progressive apraxia of speech (PAOS) cannot be diagnosed with an error-free gold standard test or measure. Reference standards are sensible approximations but are vulnerable to bias. In this scoping review, we characterize the diagnostic process for reference standards that have been used in recent diagnostic literature and evaluate the extent to which bias-reducing strategies have been implemented.

Method: We extracted data about the diagnostic process for studies of speech characteristics in CAS, AOS, and PAOS that were published between 2014 and 2024. Observational studies published in peer-reviewed journals and in English were included, whereas treatment studies, surveys, case studies, and reviews were excluded.

Results: Of 198 included studies, the most common diagnostic method was consensus or confirmation by two to three diagnosticians (38.4%), followed by checklist verification (25.3%), and simple clinical impression (19.2%). Testing or measurement techniques were used less frequently for diagnostic purposes (9.6%). The diagnostic process varied by etiology, and strategies to reduce bias were minimally implemented across the board.

Conclusions: There is a need to accept that current diagnostic reference standards are inherently imperfect and to reduce risk of bias by using converging evidence, defining syndrome features operationally, standardizing consensus formation, and estimating reliability of classification. A focus shift to how speech profiles, tests, and measures relate directly to prognosis and treatment response may expedite scientific discovery, as may strategy-sharing among those who work with children, adult stroke survivors, and adults with progressive disease.

Supplemental material: https://doi.org/10.23641/asha.31173799.

Purpose: The purpose of this study was to determine the association between the deictic gesture use of toddlers with Down syndrome (DS) and their mothers' use of labels. Relationships between child and maternal deictic gestures; maternal use of labels; and broader, traditional measures of maternal linguistic input were explored.

Method: Participants were 25 toddlers with DS (14-31 months) and their mothers. Videos of a 15-min mother-child free-play were coded for child and maternal deictic gesture use. All maternal utterances were transcribed and coded to compute the number of complete and intelligible utterances, mean length of utterance in morphemes, number of different words, use of referential nouns, and labels. Labels were operationally defined as referential nouns appearing alone, in a noun phrase (e.g., blue pants), or in a declarative sentence with the linguistic form pronoun + copula + noun phrase (e.g., that's the duck). Mothers completed the Vineland Adaptive Behavior Scales and the MacArthur-Bates Communication Development Inventory-Words and Gestures about their child.

Results: Despite the low frequency of toddlers' deictic gestures and maternal labels, all deictic gestures, all forms of pointing (touch, proximal, distal), and touch points were positively correlated with their mothers' use of labels.

Conclusions: The results of this study contribute to the body of work documenting child deictic gestures and maternal labeling in DS, as well as how deictic gestures and labels in adult input are operationally defined. Potential clinical implications are discussed.

Supplemental material: https://doi.org/10.23641/asha.31141639.

Purpose: To optimize aphasia treatment, it is critical to understand the variables contributing to outcomes. For example, treatment factors such as dosage and treatment type have received considerable attention. In this study, we examine the influence of timing, or when treatment occurs. We investigate the impact of naming training in the morning versus the evening with individuals with chronic poststroke aphasia. Prior work with other populations led to our hypothesis that training conducted in the evening would be more durable compared to training in the morning.

Method: Thirteen people with chronic aphasia (at least 1 year poststroke) completed an online confrontational naming training followed by three posttests in two temporal conditions, with training occurring in both the morning and evening. The trained stimuli were unique to each participant and selected based on a screener. This resulted in a within-participant comparison of posttraining retention based on the time of training. Participants were characterized based on their results on the Boston Naming Test, the Quick Aphasia Battery, and the Morningness-Eveningness Questionnaire.

Results: There was a significant interaction between training schedule and test timing, such that words trained in the evening showed stable retention, whereas words trained in the morning showed significant decline after a 24-hr delay. We did not detect an overall difference in average naming accuracy between evening and morning conditions when collapsed across all time points.

Conclusions: These results indicate that the time of day should be considered when administering aphasia treatment. Although proximity to sleep did not result in overall larger accuracy in this sample, the interaction suggests that sleep may still play a protective role in the retention of learned items, which is consistent with findings from studies of sleep and memory in adults without aphasia.

Supplemental material: https://doi.org/10.23641/asha.31152322.

Purpose: Lexical stress errors are a reported characteristic of childhood apraxia of speech (CAS) in American English-speaking children. However, the ability to reliably identify stress errors may vary given several factors. This study examines the interrater reliability of lexical stress accuracy ratings derived from phonetic transcriptions.

Method: Fifty-six General American English-speaking participants with CAS aged 9-16 years engaged in picture-naming and multisyllabic word imitation tasks at up to four different time points. Some participants (n = 37) engaged in face-to-face data collection, and others engaged remotely via telehealth (n = 19). Among 23 transcribers, a subset of three raters per session completed narrow transcriptions of words, including lexical stress transcription. Data analysis included descriptions of the interrater reliability of the judged lexical stress accuracy of words, with comparison to the reliability of consonant transcriptions, in both face-to-face and telehealth modalities. Intrarater reliability across nine transcribers was also explored.

Results: Intraclass correlation coefficient and Fleiss' kappa were used to describe reliability across three raters per item. Results suggest that transcription of lexical stress for children with CAS is moderately reliable. Lexical stress reliability among transcribers was lower than the reliability observed for percent consonants correct from the same transcribers on the same tasks. Listeners were more reliable in transcribing productions from participants in the telehealth group than in transcribing productions from face-to-face participants.

Conclusions: Lexical stress judgments were found to have good intrarater reliability. The role of lexical stress as a moderately reliable construct in the speech profile of school-aged General American English-speaking children with CAS is discussed in regard to clinical use.

Purpose: Bilingual children of the same age may differ in narrative skills depending on their experiences in each language. This study examined the effects of Spanish and English language proficiency on the production of macrostructural elements in oral story retell tasks by Spanish-English bilingual children.

Method: Forty typically developing Spanish-English-speaking children, 5-7 years of age, participated in this study. For each language, five multiple regressions were conducted to estimate the effects of Spanish and English language proficiency on narrative macrostructure on five dependent variables: two global measures (total number of elements and number of complete episodes) and the three elements of a complete episode (initiating events, actions, and outcomes), based on Spanish and English oral narrative samples.

Results: In Spanish, language proficiency accounted for the variability in all outcome measures except initiating events and actions. In English, proficiency accounted for the variability in all outcome measures except outcomes.

Conclusion: Results suggested that Spanish and English proficiency affects children's oral narrative skills, with differential effects across outcome measures in each language.

Purpose: This randomized clinical trial investigated the short- and longer-term effects of intonation training on acoustic parameters, listener perceptions, and self-reported outcomes in transgender and gender diverse (TGD) individuals.

Method: Twenty-three TGD individuals presumed female at birth (17 nonbinary and six transmasculine) aiming for a more masculine-sounding voice were randomized into two groups. Group 1 completed 4 weeks of intonation training for developing more masculine intonation patterns. Group 2 received 4 weeks of intonation training after 4 weeks of sham training. Recordings were made pretraining, after sham training (only Group 2), after intonation training (Groups 1 and 2), and at follow-up (after 4 weeks of no intervention). Acoustic and perceptual intonation parameters, self-perception of voice, and perception of masculinity/femininity by others were examined. The outcomes were analyzed using linear mixed models.

Results: Significant and desired decreases were observed in all acoustic and perceptual intonation parameters (i.e., general and final intonation shifts, general fundamental frequency [f_o] range, and f_o variation index) across sentence types (i.e., yes/no questions, question word questions, and declarative sentences). Naive listeners perceived participants' voices as significantly more masculine after intonation training. In addition, the participants reported their voice as significantly more masculine and more aligned with their gender identity. They observed significantly more downward intonation shifts at the end of utterances, significantly less pitch variation, and significantly slower pitch changes.

Conclusion: Findings support including intonation in voice and communication training for TGD individuals seeking a more masculine-sounding voice, offering an effective intervention for gender-affirming voice modification.

Supplemental material: https://doi.org/10.23641/asha.31079494.

Purpose: Despite the inestimable importance of literacy skills for children who use augmentative and alternative communication (AAC), many AAC users do not develop even basic literacy skills. The Accessible Literacy Learning (ALL) curriculum is evidence-based; however, little research has investigated the effects of instruction using the ALL app, and no research has examined parent-implemented adapted literacy instruction.

Method: A single case study with a multiple-baseline across-participants design was used to investigate the effects of instruction using the ALL app, implemented by trained parents, on the acquisition of three phonics-based early literacy skills (i.e., sound blending, decoding, and high-frequency words), with four children who had minimal or no speech and used high-tech AAC. The ALL app was implemented by parents who were virtually trained, and progress was monitored remotely by researchers. Social validity data were also collected from parents.

Results: All four participants made intervention gains in sound blending trained words, decoding trained words, and reading high-frequency words. Three of four participants demonstrated positive gains in sound blending and decoding untrained words. All parents reported the app was easy to use, appropriate for their children, and that they would continue to use the app in the future.

Conclusions: The ALL app was an effective instructional tool to simultaneously target multiple early literacy skills for AAC users. Parents were able to provide evidence-based literacy instruction with fidelity using the app. Parent-implemented ALL app interventions have the potential to increase acquisition rates, decrease abandonment of literacy instruction, and increase instructional time, ultimately improving literacy outcomes for children who use AAC.

Supplemental material: https://doi.org/10.23641/asha.30718034.

Purpose: This study explores how speech-language pathologists (SLPs) use the American Sign Language (ASL)-English bilingual approach to support Deaf students, with a focus on how their understanding of language, collaboration, and professional roles has evolved.

Method: Using a qualitative approach, semistructured interviews were conducted with five SLPs across multiple school sites who had experience implementing the Bilingual Grammar Curriculum (BGC). Emic coding and thematic analysis were used to identify recurring concepts and shifts in thinking.

Results: This research highlights five emergent themes: collaboration, undertrained, reframing language, growth, and expectations. Findings reveal that while SLP participants lacked formal preparation in working with Deaf students, they emphasized the value of ASL as a foundational language, as well as collaboration with educators and Deaf professionals, and described the BGC as a resource that not only supported student progress but also reshaped their therapeutic approaches. They also reported increased confidence and higher expectations for students.

Conclusions: The findings showed the need for systemic change in how SLPs are prepared to work with Deaf students and point to the ASL-English bilingual programs as a meaningful resource for working with Deaf students. These insights contribute to the growing call for bilingual, culturally responsive practices in speech-language pathology and support broader efforts to align services with the linguistic and cultural needs of Deaf students.

Purpose: The aim of this study was to evaluate group- and individual-level impact of ECoLoGiC (Expanding Communication and Language Opportunities Generated in Conversation) Treatment (ECoLoGiC-Tx), an aphasia intervention aimed at improving conversational language. In addition, treatment fidelity for the speech-language pathologists (SLPs) who delivered treatment was evaluated, providing feasibility data to optimize successful future field implementation.

Method: Ten people with moderate or severe aphasia completed 10 weeks of ECoLoGiC-Tx delivered twice weekly for 1 hr. Testing occurred at pretreatment, posttreatment, and at 6 weeks maintenance. Conversation/monologue samples were collected three times per testing phase. Group results were analyzed using linear mixed models. Individual data were analyzed using effect size and minimal detectable change criteria. Treatment fidelity was analyzed using an established 23-point checklist.

Results: Robust results indicate generalization across measure types at group and individual levels. Participants improved their ability to convey meaning in conversation, the primary focus of ECoLoGiC-Tx. They demonstrated an average gain of 11.31 points on the Western Aphasia Battery-Revised (range: -1 to 21.5), and 7/10 participants shifted to a less impaired category of severity (e.g., from severe to moderate aphasia). Group-level change did not occur for reading, sentence construction in a picture task or in monologue, or Grammaticality in conversation/monologue. SLP fidelity was 97.3%.

Conclusions: Pilot study findings were replicated, with robust group and individual results. Exceptional improvements occurred for 9/10 participants. Results demonstrate generalization of skills to conversation and reduced aphasia severity for most participants. Deliverability of ECoLoGiC-Tx was evidenced by very high treatment fidelity by practicing SLPs, suggesting good potential for successful field implementation.

Supplemental material: https://doi.org/10.23641/asha.30856571.