American Journal of Speech-Language Pathology最新文献

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: 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: Although autism can be reliably diagnosed by 18 months of age, long wait times and limited access to qualified providers prevent families from obtaining timely diagnostic services. Trained speech-language pathologists (SLPs) are qualified to diagnose autism, ideally as part of a multidisciplinary team. SLPs working on early intervention (EI) teams are well-situated to help close this diagnostic wait time gap. The purpose of this survey study was to explore EI SLPs' experiences serving autistic children, confidence in identifying and diagnosing autism, and their perceptions of barriers or facilitators to diagnostic confidence and wait times.

Method: Two hundred eighty-seven EI SLPs from 23 states responded to survey questions about experiences, beliefs, and confidence in diagnosing autism. Descriptive and inferential statistics were conducted to determine self-reported confidence, barriers, and facilitators.

Results: An overwhelming majority of EI SLPs felt confident in their ability to identify autism in toddlers. However, reported confidence in their ability to diagnose autism was much lower. Greater awareness of diagnosis as within our scope of practice, promoting autism acceptance (reducing caregiver resistance), and access to diagnostic tool training and diagnostic experts would reportedly increase confidence and potentially facilitate more timely diagnosis.

Conclusions: Findings indicate that EI SLPs are confident in their ability to identify autism in toddlers; however, several barriers prevent them from diagnosing autism. Eliminating these barriers could help EI SLPs reduce the long diagnostic wait times experienced by families.

Supplemental material: https://doi.org/10.23641/asha.31245082.

Purpose: The aim of this study was to understand caregivers' preferences and experiences with diagnosis and treatment of childhood apraxia of speech (CAS).

Method: Caregivers of children with CAS completed a 70-item online survey that explored demographics, initial concerns, the CAS diagnostic process, speech therapy goals, and preferred and received speech therapy service delivery (session frequency, length, and context). Quantitative data were analyzed descriptively and with inferential statistics; qualitative data were analyzed using content analysis.

Results: One hundred sixty-one caregivers participated, mostly from the United States, Australia, and Canada. A total of 72% of caregivers had concerns about their child's speech by the time the child was 18 months old. Although most children had seen two or three speech-language pathologists (SLPs) by the time they were diagnosed with CAS, 23% had seen four or more SLPs. Caregivers expressed a preference for their children to receive individual, in-person sessions of 31-45 min three or more times per week, but they most commonly received individual, in-person, weekly sessions of 30 min or less. Analysis of the caregivers' open-text responses led to the construction of five themes: "roadblocks to service"; "pursuit of comprehensive and reliable information"; "SLPs: trial, error, and then trust"; "CAS-specific care"; and "family support beyond the session."

Conclusions: Results of this study highlight the need for education and communication. The challenges families experience in accessing timely and sufficient CAS-specific care indicate that greater training is needed for SLPs, pediatricians, and other health professionals to ensure that caregivers' concerns about children's speech are addressed, their desire to understand their child's diagnosis and treatment are met, and their children receive evidence-based treatment.

Supplemental material: https://doi.org/10.23641/asha.31383226.

Purpose: We examine the extent to which graduate admission policies in communication sciences and disorders (CSD) contribute to race and class-based inequities. Using Quantitative Critical Theory (QuantCrit) as an analytic framework, we critique the methodological choices in prior research and reanalyze graduate admission data to assess how traditional admission criteria reinforce whiteness as a credential for admission to CSD programs.

Method: We conducted a secondary analysis of the Communication Science and Disorders Centralized Application System Open Data Initiative data set, which included applications from four graduate admission cycles (2016-2020). Logistic regression models were used to assess the influence of undergraduate grade point average (GPA), race, socioeconomic background, and other sociodemographic factors on the likelihood of receiving at least one admission offer. We used a race- and class-conscious framework (QuantCrit) to guide the model selection and specification process. Additionally, key limitations in the data set that obscure race and class inequality were identified and critiqued.

Results: The findings indicate that applicants from historically marginalized racial and ethnic groups and those from economically disadvantaged backgrounds are significantly less likely to receive an admission offer, even after accounting for undergraduate GPA. Additionally, White applicants with comparably high academic credentials received graduate admission offers at higher rates than did applicants of color.

Conclusions: Comparing the results to prior reports revealed that a conventional approach to quantitative analyses can obscure structural inequities. Considering the current findings, we conclude that graduate admission policies in CSD that rely heavily on GPA may disadvantage applicants from historically marginalized racial and ethnic groups and economically disadvantaged backgrounds, reinforcing long-standing inequalities and representational imbalances in our professions. We advocate for holistic admission approaches that critically account for the racial and class-based biases embedded in traditional meritocratic measures.

Purpose: This viewpoint addresses the complexity of the nomenclature of progressive speech-language disorders, which often exists at the intersection of descriptive symptoms, clinical syndromes, and underlying neuropathology. Using primary progressive apraxia of speech (PPAOS) as an example, we explore how overlapping diagnostic frameworks employed by speech-language pathologists, neurologists, and other clinicians and researchers can lead to different diagnostic labels that may evolve throughout disease progression. These discrepancies and changes can complicate patient understanding, clinical care, and affect eligibility for clinical trials. We highlight the importance of diagnostic specificity, flexibility, and multidisciplinary collaboration in improving patient counseling, prognostication, treatment planning, and clinical research alignment, particularly in the context of the growing number of clinical trials and specialized, multidisciplinary clinics.

Conclusions: This viewpoint explores how symptom-based, syndrome-based, and pathology-based diagnoses can work together to support patient care and research. Accurate and specific diagnosis of speech-language disorders has important implications for patient understanding of their condition, identity, prognostic accuracy, access to care, clinical trial enrollment, and treatment planning and efficacy. Misdiagnosis or vague labeling can result in inappropriate interventions, delayed support, and skewed research findings. We argue that multidisciplinary collaboration and flexibility in recognizing evolving symptom-based and syndrome-based labels over the disease course-and as the fields learn more-is essential to empower patients with accurate, actionable information. Embracing both the specificity and the complexity of progressive speech-language disorders can both enhance communication and facilitate research.

Purpose: The Bilingual Input-Output Survey (BIOS)-Home (Peña et al., 2018) is used to provide speech-language pathologists (SLPs) with an estimate of children's exposure to two languages. The current hour-by-hour approach of the BIOS can be time consuming to administer and calculate. The current study seeks to improve the efficiency of the BIOS-Home by replicating Calandruccio et al.'s (2021) finding that the BIOS can be shortened by time periods around children's routines and extending these findings by preliminarily exploring the relationship of the shortened BIOS with results of a bilingual screener.

Method: The current study includes 1,337 Spanish-English bilingual children from two data sets. Children's ages ranged from 49 to 71 months (M = 60.58, SD = 4.96). BIOS-Home data were collected by trained bilingual research assistants and SLPs who interviewed caregivers on their children's language input and output hour by hour. Principal components analysis (PCA) was conducted using caregiver-reported BIOS-Home data from both data sets to determine the smallest number of time chunks that could be used to measure language exposure. To explore the validity of the shortened BIOS-Home, bivariate correlation analyses were conducted to examine the relationship between children's semantics and morphosyntax scores and the original and shortened versions of the BIOS-Home.

Results: PCAs using the two data sets identified three time periods (morning, afternoon, and late afternoon/evening) for weekday receptive language and three time periods (morning, afternoon, and evening) for weekend receptive language. Language test score correlations comparing the hour-by-hour and the shortened approaches are highly similar, supporting the validity of the shortened approach.

Conclusion: Consolidating the BIOS-Home questionnaire is a viable approach that can save time and elicit valid information about children's bilingual input and output.

An aging pediatric survivor of a severe traumatic brain injury and a professor of pediatrics explore how the primary author moved beyond the trauma of a childhood brain injury and the lessons to be learned by survivors and therapists. The nature of this commentary does not allow for in-text citations; however, papers influencing the commentary's content are listed in the Additional Resources section at the end of the article.

Purpose: The present survey study measured the relationship between and degree to which perceived stress, grit, resilience, and intolerance of uncertainty (i.e., personal factors) are found in speech-language pathologists (SLPs) and sought to understand the impact of these factors on SLP job satisfaction and professional quality of life while considering stress and work setting (i.e., job factors).

Results: The results demonstrated ambivalence in SLP job satisfaction levels. Increased job satisfaction is primarily associated with reduced perceived stress. Personal factors such as grit, resilience, and intolerance of uncertainty do not appear to be additive to job satisfaction. Both professional quality-of-life compassion satisfaction and burnout (BO) are influenced by resilience. Professional quality-of-life BO is also influenced by perceived stress. Grit and perceived stress both have a positive relationship with professional quality-of-life secondary traumatic stress.

Conclusion: Findings suggest that higher resilience and lower perceived stress may contribute to greater job satisfaction and professional quality of life, informing prospective speech-language pathology students, SLP training programs, current SLPs, and SLP employers on action steps to recruit and retain personnel.